Author: Lizzie Presser, ProPublica

Lizzie Presser covers health, inequality and how policy is experienced at ProPublica. She was previously a contributing writer for The California Sunday Magazine, and her work has appeared in The New Yorker, The Guardian, This American Life and others. Her story “The Dispossessed,” published in partnership with The New Yorker, won the George Polk Award for Magazine Reporting and the John Bartlow Martin Award for Public Interest Magazine Journalism in 2020. She is a two-time finalist for the Livingston Award and the National Magazine Award.

After Years of Silence, Texas Medical Board Issues Training for Doctors on How to Legally Provide Abortions

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For the first time since Texas criminalized abortion, the state’s medical regulator has instructed doctors on when they can legally terminate a pregnancy to protect the life of the patient—guidance physicians long sought as women died and doctors feared imprisonment for intervening.

The new training from the Texas Medical Board was released nearly five years after the state passed its strict abortion ban in 2021, threatening doctors with severe penalties. Pregnancy became far more dangerous in the state after the law took effect: Sepsis rates spiked for women suffering a pregnancy loss, as did emergency room visits in which miscarrying patients needed a blood transfusion; at least four women in the state died after they didn’t receive timely reproductive care. More than a hundred OB-GYNs said the state’s abortion ban was to blame.

The new medical training, which ProPublica obtained under a public records request, assures doctors they can now legally provide abortions, even when a patient’s life isn’t imminently in danger, and goes over nine example scenarios, including a patient’s water breaking before term and complications from an incomplete abortion. 

But medical and legal experts who reviewed the training said the case studies represent only the most straightforward situations doctors encounter. The complications that women face in pregnancy are varied, complex and impossible to capture in a brief presentation, many cautioned. One attorney called the training “the bare minimum.”

If You’re Pregnant, Here’s What You Should Know About the Medical Procedures That Could Save Your Life

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Abortion laws are affecting how physicians treat pregnancy loss and other complications because the procedures used in these cases are also used for abortions. We spoke to women who survived terrifying experiences, and we interviewed family members of those who died without care. They all felt unprepared as they entered emergency rooms, unaware of how abortion laws were reaching into pregnancy care.

They wished they had known what to expect and how to advocate for themselves and their loved ones.

We created this guide for them and anyone who finds themselves in the same position.

Texas Banned Abortion. Then Sepsis Rates Soared.

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ProPublica’s investigation reveals that Texas’ abortion ban has led to a sharp rise in life-threatening complications, particularly sepsis, for women experiencing pregnancy loss.

Since the ban’s enactment, the rate of sepsis during second-trimester pregnancy loss has surged by over 50 percent, and maternal deaths in Texas hospitals have increased significantly, even as the national maternal mortality rate declined. Doctors cite the law’s vague emergency exception and the threat of legal consequences as key reasons for dangerous delays in care.

While some Texas lawmakers now acknowledge the need for legal clarifications, the Republican-controlled legislature remains divided, with some pushing for even stricter abortion penalties.

A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments.

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Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see his wife. Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.