The state of Texas has one of the most restrictive abortion laws in the country, resulting in the needless deaths of women whom doctors were fearful of treating for pregnancy-related problems because the state could prosecute them under the law. ProPublica has been exposing these cases and reports on yet another one.

Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital’s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

This is a scandal that should outrage anyone, that pregnant women are bleeding to death when a routine procedure could save their lives.

It should be no surprise that as a result, Texas is seeing an exodus of ob-gyns, including Tony Ogburn who had started an ob-gyn department at the nearby University of Texas Rio Grande Valley in order to serve the rural community along the Mexico border. But now he is leaving.

The list of conditions that could be treated narrowed substantially. If a woman came to the hospital with a lethal fetal anomaly, she had no option but to carry the pregnancy to term. The outcome was traumatic for both the mother and her doctors. “Several people had babies die in their arms,” Ogburn said. Doctors were even reluctant to treat life-threatening complications such as ectopic pregnancies. “It’s the standard of care everywhere in the world,” Ogburn remembers telling an anesthesiologist. “And you’re telling me you can’t treat an ectopic?”

A majority of women didn’t know that the laws had changed, and many of those who did know were not in a position to seek care out of state. A somewhat simpler solution was to cross the border into Mexico and buy abortion pills over the counter. Misoprostol, which causes uterine contractions, often comes in blister packs of twenty-eight. Women would call the hospital to ask if the twenty-eight pills should all be taken at once. The answer was no—four was typically the recommended dosage. But even such vital counsel could now be construed as aiding and abetting.
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Texas is among the twenty-one states where abortion is banned or severely restricted. In Idaho, nearly a quarter of the state’s ob-gyns have left since the ban went into effect, and rural hospitals have stopped providing labor and delivery services. In Louisiana, three-quarters of rural hospitals no longer offer maternity care. Half a year after Ogburn left the Valley, another doctor submitted her resignation. The school’s Department of Obstetrics and Gynecology was folded into a new unit: the Division of Women’s and Children’s Health. By then, the department had shrunk to three doctors, one of whom plans to leave next spring.

The situation in Texas has got so bad with these deaths and the exodus of physicians that some lawmakers are seeking to loosen the restrictions under which doctors can operate.

Weeks after ProPublica reported on the deaths of two pregnant women whose miscarriages went untreated in Texas, state lawmakers have filed bills that would create new exceptions to the state’s strict abortion laws, broadening doctors’ ability to intervene when their patients face health risks.
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Texas’ abortion ban threatens up to 99 years in prison, $100,000 in fines and loss of medical license for doctors who provide abortions. The state’s health and safety code currently includes exceptions if a pregnant woman “has a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.” A separate exception exists that provides doctors with some legal protections if they perform an abortion for an ectopic pregnancy or in cases when a patient’s water breaks.

The bills, filed in the state House and Senate last week, create new health exceptions. They would allow doctors to induce or perform abortions necessary to preserve the mental or physical health of a patient, including preserving the patient’s fertility. Doctors could also provide abortions in cases where the fetus had an anomaly that would make it unable to survive outside the womb or able to survive only with “extraordinary medical interventions.”
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Molly Duane, a lawyer with the Center for Reproductive Rights who represents women who are suing the state, said the bill, if passed, could help save some lives, but cautioned that without removing the threat of criminal penalties, some doctors might still deny care.

“Exceptions don’t work in reality, no matter how clear they are,” Duane said. “We’ve seen hospitals turn away Texans facing life-threatening ectopic pregnancies, even though providing an abortion in these cases is legal under state law. As long as doctors face the threat of jail time and loss of license, they will be terrified to provide care.”

While this bill would be an improvement, it is not clear if it will become law. The state’s governor and attorney general are adamantly opposed to abortion and may well seek to kill it.