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An OB-GYN in Texas weighs in on medical exceptions to the abortion ban


A deeply personal and painful story has been at the center of a legal and political battle in recent days. A 31-year-old mom was denied a medical exception to the Texas abortion ban. Kate Cox has sued for abortion access after her fetus was diagnosed with a genetic condition that's almost always fatal. Before the Texas Supreme Court ruled, Cox left to obtain an abortion out of state. To understand the medical implications of a case like this, we reached out to Dr. Andrea Palmer, an OB-GYN in Fort Worth, Texas.

ANDREA PALMER: When I have a patient who is in the same or similar situation, you know, we talk about the risks of pregnancy termination versus the risks of carrying a pregnancy to term. And when you compare the two, the benefit for mom's health almost always is going to lie on the side of terminating the pregnancy.

RASCOE: And why is that? - for people who may not understand or...


RASCOE: ...Who may not be familiar, which is a lot of people.

PALMER: Sure. And I think that's, you know, part of the problem when we talk about abortion and pregnancy termination. I think the one thing that people really need to remember is that pregnancy itself is not a health-neutral situation. Women die in childbirth and after childbirth. You know, in the United States, we don't boast a particularly healthy maternal mortality rate. And so we have risks of things like hemorrhage, catastrophic events like amniotic fluid embolism, hypertensive disorders like preeclampsia and eclampsia that can lead to seizures, strokes and death.

So when we talk specifically about patients like Ms. Cox, who have a history of prior C-sections - a repeat cesarean section comes with a certain amount of required blood loss and risk to mom. And then, when we talk about repeat C-sections - number four for her if she were to go on and have another pregnancy. Number four, as far as our C-section goes, statistically is where the risk really starts to increase for mom with each pregnancy that she might have a placental abnormality, something that we would call a placenta accreta, where the placenta kind of is - invades into the muscle or beyond of the uterus instead of just attaching to the lining. And that can be a very dangerous situation. And that risk increases with every cesarean section. So asking a woman to carry a fetus to term that is not going to live to survive much after the C-section she's going to be required to have to deliver it is just putting her at risk for every pregnancy thereafter.

RASCOE: Well, as an OB-GYN in Texas, are you and the colleagues you speak with clear on what constitutes a medical emergency under the Texas abortion ban?

PALMER: Yeah, a medical emergency is a pretty nebulous designation. I can tell you when somebody is actively dying right in front of my face. We - you know, we see that happen. But everything is a risk, right? So it's really hard to draw the line. You know, I think the problem with trying to legislate medical care is that there are so many nuances. There are so many situations that - you can't write a law for every scenario that might happen. That's why taking the decisions out of the hands of the patient and the physician is just really dangerous and scary.

RASCOE: Are you afraid to make these sorts of decisions? Like, does the fear of prosecution factor into some of the choices that you make?

PALMER: You know, when SB 8 first passed in Texas, I think a lot of us got scared to almost even have conversations with our patients because the way that law was originally written and presented and passed is that we could be sued personally for even - for aiding and abetting - so even having a conversation to talk with the patient about how they could access an abortion outside of the state of Texas or within the state of Texas. And so I definitely know that some of my colleagues wouldn't talk to patients about terminating pregnancy.

I personally didn't change my counseling, but I also have a - you know, a deep, trusting relationship with my patients that - I was just betting on the fact that they trusted that I was giving them accurate and honest medical advice.

RASCOE: Have you considered not practicing in Texas?

PALMER: Oh, I think. Yeah. No, absolutely. I think that, you know, being able to offer full-spectrum obstetric care has definitely - has absolutely driven some people out of the state. I think, more than anything, it's a big barrier for physicians coming into our state, for physicians coming in to train in our state. You know, for somebody who's starting their OB-GYN residency, to go to a place where they're not going to get any education on family planning and abortion care is really a deterrent. The population that is going to be around to care for our women in the next 10 to 15 years is going to look very different than it would have had these laws not changed.

RASCOE: That's Dr. Andrea Palmer. She is an OB-GYN in Fort Worth, Texas. Thank you so much for joining us.

PALMER: You're most welcome. Thank you for shining light on our struggle down here. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.

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