Texas banned abortions - and then sepsis rates started to soar
ProPublica analyzed seven years of Texas hospitals' discharge data — from 2017 through 2023 — and found that since 2021, when the southern state's initial abortion ban went into effect, the rate of sepsis surged by more than 50 percent for women hospitalized when they experienced miscarriages in the second trimester.
Sepsis is a medical emergency that occurs when a patient's body improperly reacts to an infection. It can lead to organ failure or death if not treated quickly enough.
In September 2021, the state banned most abortions after a fetal heartbeat was detected. Then, in August 2022 following the Supreme Court's decision to overturn Roe v Wade, Texas's 'trigger law' took effect, criminalizing abortion. Doctors who perform abortions could face life in prison and fines of up to $100,000. Now, abortions are banned in all cases except if the mother's health or life is at risk — a definition that the state's supreme court has refused to clarify.
The rate of sepsis among patients experiencing second-trimester pregnancy loss remained pretty steady until the state added criminal penalties for abortion providers, the analysis shows.
In 2021, before they were introduced, 67 patients who miscarried in the second trimester were diagnosed with sepsis but after, in 2022, that figure increased to 90. That number increased again to 99 in 2023.
ProPublica believe those figures could be 'conservative.'
Treating miscarriages has also become complicated as a result of these laws. Medical professionals are constrained by either having to wait for the mother's life to be in jeopardy or having to wait for the fetus' heart to stop beating.
For example, three days after the fetal heartbeat law took effect, on September 3, 2021, Josseli Barnica went to a Houston hospital at 17 weeks pregnant to discover she was battling a deadly infection as a result of a miscarriage. But doctors were restricted in how they could treat her, since her fetus still had a heartbeat. After 40 hours in pain from the infection, Barnica delivered the fetus after there was no longer a detectable heartbeat. Three days after being treated and discharged, she died from sepsis. Medical experts who reviewed her case told ProPublica that they believed her death was 'preventable.'
Another patient cited in the study, Nevaeh Crain, died after doctor's waited for her fetus' heart to stop beating as her organs failed. Before rushing the teenager to the operating theter, they conducted another test to confirm her fetus had expired, the outlet reported.
The data also underscores the confusion around miscarriage treatment. The rate of sepsis was less severe for pregnant patients who were admitted to the hospital without a fetal heartbeat. The rate moved from 2.1 percent in 2017 to 3.1 percent in 2023 for those admitted with fetal death, and from 3.7 percent to 6.9 percent for those without fetal death.
'What this says to me is that once a fetal death is diagnosed, doctors can appropriately take care of someone to prevent sepsis, but if the fetus still has a heartbeat, then they aren't able to act and the risk for maternal sepsis goes way up,' Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at UW Medicine, told the outlet. 'This is needlessly putting a woman's life in danger.'
Other indicators suggest pregnancy in Texas has become more dangerous. Since 2021, dozens more pregnant and postpartum women have died in Texas hospitals than had before the Covid-19 pandemic — despite a drop in maternal mortality rates at a national level in the same period.
There were 79 maternal hospital deaths in 2018 and 2019 compared to 2022 and 2023 when there were 120. Despite this alarming uptick, the Texas Maternal Mortality and Morbidity Review Committee opted not to review pregnancy-related deaths in 2022 and 2023.
'The fact that Texas is not reviewing those years does a disservice to the 120 individuals you identified who died inpatient and were pregnant,' said Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University. 'And that is an underestimation of the number of people who died.'
The laws in place appear to be interfering with patient care, one doctor suggested.
'We have the ability to intervene before these patients get sick,' Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington, told the outlet. 'This is evidence that we aren't doing that.'
Even though the Texas Supreme Court rejected a lawsuit asking for clarification over who qualifies for an abortion in the state, Lt. Gov. Dan Patrick called on the state legislature to clear up the language of the law. 'I do think we need to clarify any language so that doctors are not in fear of being penalized if they think the life of the mother is at risk,' he said last month.
Gov. Greg Abbott, however, doesn't seem to be convinced that any clarification is necessary. 'There have been hundreds of abortions that have been provided under this law, so there are plenty of doctors and plenty of mothers that have been able to get an abortion that saved their lives and protect their health and safety,' he told the Houston Chronicle this week before ProPublica's report was released. 'So I know as the law as it currently exists can work if it is properly applied.'
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