Texas abortion amendment bill will not address fateful pregnancy

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For the first time since Texas banned almost all abortions, Republican lawmakers are considering tweaking the language of the law to protect the lives of pregnant women.

However, this substantial lauded, bipartisan effort does not provide tolerance for women responsible for the fateful pregnancy diagnosed as a fatal fetal abnormality.

At a House Committee meeting this week, Austin resident Taylor Edwards tried to share how it felt to carry pregnancy without a chance of survival. She learned in 17 weeks that her scattered pregnancy was developing as her daughter’s “brain comes out from behind the hole in her skull,” Edwards said.

For years, at any time during Texas pregnancy, abortions of “severe and irreversible abnormalities” were permitted. However, that exception was Yanking in 2021 when Texas began Texas on the road to ban all abortions except for them in order to save the lives of pregnant patients.

“Our so-called representatives prefer to instead force these women to be called babies who cannot survive outside the womb,” Edwards said.

Nearly three-quarters of Texas voters and 63% of Republicans believe abortion should be legal if there is a “highly likely chance of serious birth defects,” according to a poll by the Texas Political Project.

However, Republican lawmakers have not shown any willingness to expand abortion laws to include these cases. Even this effort to clarify existing exceptions required strict negotiations with anti-abortion groups to ensure there was no careless expansion of access.

Fort Worth Democrat Nicole Collier said at Monday’s hearing that he was sympathetic to stories like Edwards, hoping there would be exceptions to these cases.

“But the way we are constructed, the composition of our bodies, this is what we have,” she said.

Rep. Jolanda Jones, a Democrat in Houston, was easier on the possibility of expanding abortion access because of these or other cases.

“I think people in hell want cold water,” she said. “But they don’t have it.”

“Get exception”

Kaitlyn Kash’s first pregnancy was a “textbook,” she said. So when the Austin area became pregnant again in 2021, she was expecting a standard trip as well. However, on her 13-week anatomy scan, her doctors noticed that the fetal limbs were very underdeveloped.

“That’s not something you normally measure with that appointment,” she told the Texas Tribune. “It was just how tough it was and they could see it early.”

Maternal fetal medicine experts have diagnosed babies with osteogenic imperfecta or fragile bones. Kash, she said, risks breaking the baby’s developing bones every time she leaned in.

“The baby is clearly having a very rough birth, and if the baby survives, in these cases, perhaps in extreme cases, the rib cage will not develop much enough to support lung function,” she said. “After being born without extreme medical intervention, the baby will be suffocated.”

Fatal fetal abnormalities are terminology used to describe the range of diagnoses, conditions, and deformities that may be diagnosed immediately after birth, due to reasonable certainty. Congenital abnormalities affect 2-3% of pregnancies worldwide, but not all of these diagnoses are fatal.

Kash has worked in the maternal health field and knew that he could not get an abortion in Texas. But many other people in her life thought there would be a sculpture of cases like her. Her father told her to “take an exception.” And we must repeatedly explain why she was not qualified for this medical care.

One in four Texas reproductive age believes the law allows abortion in cases of fatal fetal abnormalities, a March 2024 study found. Many people don’t find the nuance of the law until they have to call it themselves.

Risking

When Lauren Hall became pregnant in 2022, she had no idea about the state’s abortion laws. However, she became accustomed very quickly after learning that the fetus was developed without a skull. Her doctor told Hall she would likely have a miscarriage and give birth to a stillbirth, or a daughter she called Amelia.

“I knew the best case scenario was that I had a miscarriage, because otherwise I would be carrying my full term just to die,” she told the Tribune. “But I was also worried about miscarriage because I saw the stories of women who started miscarriage and were left to cleanse without intervention.

Pregnancy is not a benign condition, says Dr. Leila Zahedi Span, a Colorado maternal fetal medicine expert. Pregnant women can develop pre-lamp syndrome, are at a high risk of bleeding, and often have to undergo physically intensive surgery.

These are risks that many women are willing to take to have children, but she said, “When we talk about fatal anomalies, it’s a risk of no profit.”

Some fetal abnormalities increase the risk of pregnant patients. For example, trisomy 13 increases the risk of pre-lampsia, and because the cerebroblastic fetus cannot be swallowed, there is often accumulation of fluids that can lead to placenta destruction and bleeding.

If there is an extreme threat to the life of a pregnant patient, they may be eligible for abortion under the law. However, there are no exceptions to mental distress. So when Hall felt that she was crumbling under the sadness that carried this pregnancy into the semester, she boarded a plane and traveled to Washington to have an abortion.

In late 2023, Kate Cox, the mother of two, tested the legal limits of these exceptions as they apply to fatal fetal abnormalities. After being diagnosed with complete trisomy 18, a lethal chromosome abnormality, she sued for her right to terminate her pregnancy.

Her doctors proved that abortion was necessary to protect her health and future fertility, and the judge granted it. Attorney General Ken Paxton filed a lawsuit to the Texas Supreme Court, during which he threatened three Houston-area hospitals with fines and criminal charges if they allowed abortions to take place at the facility.

The Texas Supreme Court said Cox banned abortion and “even the difficulties of pregnancy…even serious ones do not pose a high degree of risk to mothers that the exception encompasses.”

Cox traveled out of state to end his pregnancy.

Perinatal Palliative Care

Anti-abortion groups argue that these diagnoses are not necessarily death sentences, and doctors often argue that abortion is too fast to offer as an option.

“Abortions don’t get in your way and cause the death of a child,” said John Shego of Texas Life to the Life. “It’s not a treatment for a disorder. It’s not a treatment for the mother. It’s not a treatment for the mother. It’s not necessary.”

Their solution is to raise funding and awareness about perinatal palliative care. This is a program that supports families as they navigate life-limiting or fatal fetal diagnosis. Texas Right to Life has approved two bills that will provide healthcare providers with information about these programs after receiving a fatal fetal diagnosis.

These programs provide coordination of family care between healthcare teams, emotional and mental guidance, birth planning that takes into account the patient’s wishes regarding measures to expand life, and bereavement assistance.

Perinatal palliative care is a great option for families who choose to continue to get pregnant despite a fatal fetal abnormality, said Dr. Justin Rappen, an Ohio maternal fetal medicine expert who chairs the Maternal Fetal Medicine Association’s Reproductive Health Adviser Group.

However, he said it is not a replacement for abortion access for families who want to choose to terminate instead.

“Sometimes, another mechanism of caring care is to provide abortion care rather than going to a perinatal palliative care route,” he said. “For pregnant patients facing these very important diagnoses, it’s very important… making that choice should not take it away.”

For now, at least for the time being, perinatal palliative care is the only path available to Texans with a fatal fetal diagnosis that cannot leave the state. Lawmakers are very clear that there is no effort to expand access with push to clarify existing exceptions.

Rep. Charlie Guellen, a Fort Worth Republican who holds a clear bill in the House, said at the hearing he wanted to add an exception to a fatal fetal abnormality.

“But that’s not the purpose of this bill,” he said.

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