Marin Wolf | The Dallas Morning News (TNS)
DALLAS — The woman knew there would be blood, but she hadn’t expected this much or for it to be bright red.
It had been nearly a day since the Surepoint Emergency Center outside of Fort Worth told her that she was miscarrying at nearly 13 weeks and sent her home with a prescription and a set of instructions.
Administer the misoprostol, a drug that helps empty the uterus, and wait, the instructions said. If it doesn’t work, take another dose. There will be a lot of blood, the doctor said, but you only need to worry if it’s scarlet instead of a rusty brown. The woman, who asked not to be named out of concern for her safety, wanted a surgical procedure to clear her uterus, but the doctor told her it wasn’t an option at the facility.
Worried by the amount of blood, the woman and her husband, Ryan Hamilton, returned to Surepoint, their 9-month-old daughter in tow. The trip was the beginning of a 24-hour race to get the woman additional abortion care while she bled until she lost consciousness on her bathroom floor.
“She started to lose a lot of blood and a lot of body fluid, to the point where it’s scary,” Hamilton said. “She’s a very strong Texas woman. She’s determined to do it. I’m not surprised she stayed in there longer than she probably should have before she passed out.”
The woman’s story, which her first husband shared on social media and with The News, is yet another example of a Texan stuck in the gray space of the state’s abortion laws that ban the procedure in all cases except to preserve the life of the mother. Her miscarriage occurred two weeks before the Texas Supreme Court ruled against several other women who sued the state because they struggled to get medical assistance for complications including conditions that lead to miscarriage, they said.
Two medical centers allegedly denied the woman a surgical abortion because her case was not considered emergent enough, Hamilton said, despite the fact that her fetus’ heartbeat had stopped.
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The Dallas Morning News reviewed the woman’s medical records shared by Hamilton to confirm the timeline of the family’s experience. The News also consulted an outside physician who specializes in obstetrics and gynecology on the case and contacted the Surepoint Emergency Center and Lake Granbury Medical Center, the two hospitals where the woman was prescribed misoprostol.
A legal representative for Surepoint Emergency Center said that, because of patient confidentiality, the medical center is unable to comment on specific cases. Lake Granbury Medical Center, another hospital the couple visited, did not immediately respond to requests by email and phone for comment on Monday.
The News is not naming individual doctors associated with the case as there were clinicians providing the woman care across multiple hospitals working within the rules and guidance of their medical institutions. Hamilton and his wife are not pursuing legal action against any of the physicians they saw regarding the miscarriage, they said.
Miscarriage, also known as a spontaneous abortion, can be devastating and isolating. Hamilton said his wife’s experience trying to access the treatment that was safest and best for her made it even more traumatic.
Dr. Todd Ivey, a Houston-based OB-GYN who was not involved in the woman’s case, said that, though it depends on the specifics of each patient, it’s common for doctors to give the choice between medication or surgical miscarriage treatment, or even managing the pregnancy until it passes on its own.
“I find that the majority of my patients opt for a surgical treatment because, once they find out their pregnancy is not viable, they prefer to get it over with. Once they resolve all of it and they grieve and they say, ‘I want to move on,’” Ivey said. “Neither option is wrong.”
‘Get this dead baby out of me’
When the couple found out they were pregnant with their second child, Hamilton said he and his wife never discussed what they would do if something went wrong. They talked about names and landed on Dre or Drake, depending on the baby’s gender.
“We were excited. There was no, ‘What can we do?’ Because we had such a successful pregnancy the first time,” Hamilton said. “You don’t think this is ever gonna happen.”
On Thursday, May 16, a doctor confirmed their worst fears: The woman was miscarrying. Records from the visit shared with The Dallas Morning News confirm the practitioners couldn’t find fetal heart tones. The fetus measured at just over seven weeks, meaning the fetus had stopped growing and that they had likely lost their heartbeat days or weeks earlier.
That day, a doctor prescribed three tablets of misoprostol with one refill in case the first dose didn’t work. Hamilton said the doctor told them they would have to go to another hospital to get a dilatation and curettage, or a surgical abortion, to remove the fetus.
Dr. Ivey, speaking generally about medication abortions, said it can take up to a week for someone to pass a pregnancy using misoprostol.
The woman began the medication the next morning. After hours, it became clear that she hadn’t passed the pregnancy, so the couple picked up the second dose from the pharmacy.
“We try it again and there’s bright red blood,” Hamilton said. “It’s not working. It’s not gonna work.”
The woman labored through the night and returned to the same medical center the next morning, with Hamilton listening to the appointment by phone in the family’s truck with their daughter. The doctor told the woman they wouldn’t prescribe her another dose.
“She told the doctor ‘Get this dead baby out of me,’” Hamilton said, choking up. “And they asked her to leave.”
The family drove nearly an hour to Lake Granbury Medical Center, the hospital where the woman gave birth to their 9-month-old daughter, to get a second opinion. They waited for hours before doctors at the hospital said they didn’t find her case emergent enough to do a surgical abortion, but that they could schedule it for a week or two later.
Doctors repeatedly asked the woman the same questions. Hamilton said it felt like they were stalling.
The medical center did not immediately respond to The News’ request for comment by email and phone on Monday.
The doctors eventually agreed to prescribe one final, stronger dose of misoprostol, Hamilton said. Medical records from the visit The DMN reviewed again confirmed that the fetus did not have a heartbeat.
“They didn’t explain why they were hesitant. They framed it like, ‘Look, we’re going to give you this prescription, but this is it. You’re not going to be able to get another one if this doesn’t work,’” Hamilton said. “It was like we were being reprimanded.”
Hamilton and his wife were frightened but relieved that they at least had another opportunity to help complete the miscarriage.
The dose was eight pills inserted vaginally over 24 hours. The bleeding intensified and the woman became increasingly weak and pale. She started vomiting and having diarrhea before passing softball-sized blood clots. After days of waiting, Hamilton said, it felt like progress.
At 10 a.m. on Sunday, May 19 — two days after beginning her first dose of misoprostol — Hamilton found his wife unconscious in their bathroom, covered in her own blood and feces.
“She needed help as soon as possible or she was going to die,” said Hamilton. “I knew if I picked her up and got her in the truck, I could get to the hospital faster. That may be reckless, but in that moment I did not care. All I wanted to do was save my wife’s life.”
He rushed her to a third hospital, where doctors gave her fluids. Medical records confirm she had passed the pregnancy at that point.
Texas’ abortion landscape
Making decisions that could impact a person’s life, pregnancy or future fertility is a difficult task. Medical experts say it’s become even more challenging in the last two years.
Doctors in Texas must now operate under three overlapping bans. The Texas Heartbeat Act, also known as SB8, allows private individuals to bring civil suits against anyone who performs or aids an abortion after the detection of fetal cardiac activity. A “trigger ban” went into effect when the U.S. Supreme Court overturned Roe v. Wade, ending federal abortion protections. Then, there’s the pre-Roe ban, which is still possibly in effect, that criminalizes performing or providing the means for an abortion.
Certain situations are exempt from the bans, including miscarriages, ectopic pregnancies and instances where the mother is at risk of death or serious bodily harm.
Doctors and patients across the country and in Texas have called the bans confusing, saying the legal language leaves providers unsure whether their actions could lead to fines or worse.
The Texas Medical Board is currently determining what rules to issue about how doctors should practice under the bans, a move that medical experts have been requesting for months. But during a five-hour hearing last week, doctors, lawyers and patients testified that the proposed guidance offers little clarification and could make working under the laws even harder.
Last week, the Texas Supreme Court ruled against more than 20 Texas women, including multiple OB-GYNs, who sued the state over abortions they said were delayed or denied during medical emergencies. Amanda Zurawski, the lead plaintiff in the case, said she suffered permanent damage to her reproductive system as a result of her treatment.
The lawsuit argued that any woman with a medically complicated pregnancy, including a fatal fetal diagnosis, should be exempt from the state’s bans. The Supreme Court said an injunction allowing such exemptions granted in a lower court “departed from the law as written without constitutional justification.”
It’s impossible to say whether the woman’s miscarriage care was influenced by the abortion bans, even though her case should fall outside the laws’ bounds.
Still, Hamilton felt compelled to share his family’s story so people know experiences like this are happening across the state.
“I love Texas. I love the people of Texas. My wife loves Texas,” Hamilton said. “But this is something that needs to be addressed and fixed.”
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