Doctors say strict abortion laws in Texas put pregnant women and their physicians at serious risk
After the Supreme Court overturned Roe v. Wade in 2022, 20 states banned or severely restricted abortion. Six states voted to protect access to it. And on Tuesday, voters in 10 states will decide on measures that would add abortion rights to their state constitutions.
To understand the impact of the changing legal landscape and its complexities, we went to the first state to change its abortion laws: Texas.
Tonight, you will hear from doctors who say, in Texas, the laws designed to stop abortions are creating unintended consequences – hurting women with desired pregnancies and the people who care for them.
Dr. Dani Mathisen: My mom is a doctor. And she is probably the coolest person I've ever met. And I grew up, you know, with her coming home in her white coat. And I honestly just wanted to be my mom.
In 2021, Dani Mathisen was following in her mother's footsteps. on her way to becoming an OB-GYN. She was 25 years old, in her final year of medical school in Texas, married to her high school sweetheart and ready to start a family.
Dr. Dani Mathisen: We planned it out perfectly. I was gonna get pregnant at this time and it was gonna be great.
Sharyn Alfonsi: You had it planned.
Dr. Dani Mathisen: I had it planned down to, like, the week.
Mathisen was thrilled when she learned she was pregnant. Early scans and testing showed a healthy baby girl. But a routine fetal anatomy scan at 20 weeks did not go according to plan.
Sharyn Alfonsi: What did they tell you was wrong?
Dr. Dani Mathisen: Her brain was not formed correctly. She only had one kidney. Her spine was so bent that it put pressure on her heart. It was honestly a blur. I either said, "Is it bad? Or is it lethal?" Her answer was, "It's lethal," meaning my daughter that I planned out to a tee, and we had already started to get little outfits and bath toys, was going to die.
Sharyn Alfonsi: What did you do?
Dr. Dani Mathisen: Screamed, cried, got a second opinion, got a third opinion. And it wasn't a question as to what we were going to do. It was a question of how we were going to do it without getting arrested.
That's because just two weeks earlier, a new Texas law went into effect, known as SB-8. Senate bill 8.
The law banned abortion at six weeks with no provisions for victims of rape, incest or severe fetal abnormalities… like Dani's case.
The law also included a novel enforcement method – deputizing citizens to sue people for aiding or abetting an abortion and rewarding successful lawsuits with a $10,000 bounty.
The bill included an exception for medical emergencies but didn't define what those were. Mathisen says her doctors seemed scared and confused.
Dr. Dani Mathisen: It wasn't clear what counted as aiding and abetting somebody getting an abortion. So they couldn't even counsel me and say like, "Yes, we recommend you have an abortion or at least look into it, even if you go to another state."
So, Mathisen and her husband turned to her mother, the physician, for help. Several calls later her mom secured an appointment for her to end her pregnancy at a clinic in neighboring New Mexico – a non-ban state.
Dr. Dani Mathisen:. She put her license on the line for that. Because I'm her baby and that's what I needed. She booked our plane ticket. She booked our hotel and gave us an envelope of cash.
Sharyn Alfonsi: You were afraid to use a credit card or have your name attached to anything.
Dr. Dani Mathisen: Yeah, we paid for the abortion in cash so that there wasn't a paper trail of our Texas credit cards paying for an abortion.
A year after SB-8 went into effect and Roe was overturned, Texas enacted another, more restrictive law – banning all abortion from conception except when the mother's life was in immediate danger.
In 2023, Dani Mathisen joined 19 women with similar stories in a lawsuit against the Texas government for denial of care.
The lawsuit did not seek to overturn the bans. rather, to clarify which exceptions were allowed under the law.
The Texas Supreme Court ultimately rejected their case.
But after the women filed their lawsuit, Texas legislators quietly passed a new law to include two exceptions to the ban – one for ectopic pregnancies – when a pregnancy occurs outside the uterus. the other, when a woman's water breaks prematurely.
But according to the Cleveland Clinic those instances only make up 5% of all pregnancies.
Dr. Emily Briggs: The inconsistencies, the misunderstanding, the confusion. This is why women will lose their lives because of these rules.
Dr. Emily Briggs practices family medicine in central Texas. Her office is papered with the photos of some of the babies she's delivered over the last 15 years. She's overseen hundreds of complicated pregnancies.
Dr. Emily Briggs: Five years ago I could counsel a patient on all the various treatment options available in these medically complex situations. And now it is a dangerous situation for me to have that comprehensive conversation with my patients.
Sharyn Alfonsi: "Dangerous" because?
Dr. Emily Briggs: Because I personally, as a family physician, could face losing my license, I could face life in prison, I could face huge fines, just for having a conversation with my patient about evidence-based care.
So far, that hasn't happened. No physician has been prosecuted for violating the ban – which is a felony in Texas.
But Dr. Briggs says the threat of prosecution has created such fear that today, it's not unusual for hospitals to require physicians to consult with staff attorneys when treating complicated pregnancies. Even, miscarriages.
Dr. Emily Briggs: This is not the medical care that those of us in medicine signed-up for. This is not what our plan was, or is, when talking to a patient about their care. It should be between me and the patient. There's so much guilt when you lose a pregnancy, So add to that the slap-in-the-face of having the Risk Department of the hospital come in and be involved in that conversation between you and your physician. And it's because of the legal ramifications from our legislature.
Sharyn Alfonsi: When there's a sense of urgency-- like, "We need to deal with this right now," how do you proceed in this moment?
Dr. Emily Briggs: With great caution. In these situations, time is of the essence. She could lose her uterus, she could lose her life because of these situations. And when we-- have our hands tied, and can't act appropriately at the medically appropriate time, we can have worsened outcomes.
Texas has only released maternal death data through 2021.
But according to CDC numbers, after Texas restricted abortion maternal deaths rose 61% from 2019, compared to 8% nationwide.
Dr. Emily Briggs says physicians can no longer offer comprehensive maternity care to women in Texas.
Sharyn Alfonsi: Have you heard from colleagues who say, "I don't want to practice medicine in Texas anymore"?
Dr. Emily Briggs: Yes. Definitely. Obstetricians, family physicians: yes.
Last year, the number of OB-GYN resident applicants in Texas dropped 16%.
Sharyn Alfonsi: What does that say to you?
Dr. Emily Briggs: That says to me that future obstetricians are acknowledging the complexity of the rules in Texas. So-- not only do they not want to train here, but that also means that they won't want to practice here.
Dr. Adrianne Smith: So we have a patient ready--
Adrianne Smith – who was a resident in Texas – transferred to the University of New Mexico hospital this year.
She told us one of her last cases in Texas still haunts her: a young woman who became extremely ill after she tried to end her own pregnancy with an unknown medication she bought in Mexico. Smith spoke to a supervising physician about the case.
Dr. Adrianne Smith: I remember being like, "I wish that there was something more I could do for her." And he looked at me and said, "The attorney general is looking to make an example outta somebody. And you don't wanna be that case." And that was when I realized that there are people that are looking to criminalize me for that and send me to jail.
Dr. Eve Espey is the chair of the OB-GYN department at the University of New Mexico.
Sharyn Alfonsi: What is it that a resident can learn here in New Mexico that they can't learn in Texas?
Dr. Eve Espey: I mean, so many things. They lack an opportunity to learn trauma informed care, diagnosing pregnancy complications in the first trimester and in the second trimester. They miss learning miscarriage care, ectopic pregnancy care, pregnancy of unknown location. I mean, the list goes on and on--
Sharyn Alfonsi: I mean, those sound like--
Dr. Eve Espey: They miss so much--
Sharyn Alfonsi: --important things to know how to do.
Dr. Eve Espey: Really important things.
Those things are part of the training required to become a certified OB-GYN anywhere in the U.S. but here's the problem.
In Texas some training is no longer offered because of the new laws. That means OB-GYN residents now have to leave the state for two to four week rotations to get the required training.
Sharyn Alfonsi: Is that long enough to really learn the lessons of all of these various things you've just described?
Dr. Eve Espey: No, it's not enough time. I mean, our residents have a dedicated rotation in the first year, in the fourth year. But they are working alongside of us throughout their four years of residency.
And Dr. Espey says her hospital isn't just absorbing more residents. Data shows more than 34,000 Texas women traveled out of state for care last year.
Dr. Eve Espey: We've seen an enormous increase in our out-of-state-- patient volume. Just in calendar year 2023 compared to 2019, we saw an over 300% increase.
Sharyn Alfonsi: 300%.
Dr. Eve Espey: Over a 300% increase. And we-- you know, on any given day-- in 2023, 70% -71% of our patients were from Texas.
Today, women making that journey face even more risks.
Six Texas counties have imposed "travel bans," which threaten legal action against anyone helping to transport women out of state for abortion services. Texas Attorney General Ken Paxton has filed a lawsuit demanding access to the medical records of women leaving the state for that care.
We reached out to Paxton's office multiple times over the last two months to ask about the issue and got no response.
Dr. Eve Espey: So many of the patients who come to us that we diagnose with a miscarriage, they're like, "I'm done with Texas. I want my care here. I can't trust my own doctor to take care of me for a miscarriage or a pregnancy complication."
Dani Mathisen was one of them. After the loss of her baby in Texas, she and her husband moved to Hawaii to begin her OB-GYN residency and start a family.
Dr. Dani Mathisen: I did not wanna be pregnant in Texas. Absolutely not. I think I know too much about what can go wrong in a pregnancy to feel comfortable being pregnant in Texas.
Earlier this year, the Mathisens welcomed Emerson, a healthy baby girl. Dr. Emily Briggs is urging Texas lawmakers to work with doctors.
Dr. Emily Briggs: We are not looking at this from a partisan standpoint, we're not saying, "We're enemies." What we need to look at this as is: We can all come together to make this safer for women in Texas.- just by making some changes to these rules.
Sharyn Alfonsi: If nothing changes, then what?
Dr. Emily Briggs: We lose physicians in Texas, we lose healthy mothers, we lose families in general. It's already scary to decide to become pregnant. Throw on top of that that if something medically complex happened, you could lose your life and not have the care that you deserve. Why would anybody stay for that?
Produced by Ashley Velie. Associate producer, Eliza Costas. Broadcast associate, Erin DuCharme. Edited by Michael Mongulla.