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(单词翻译:双击或拖选)
Because of Texas' abortion2 law, her wanted pregnancy3 became a medical nightmare
New, untested abortion bans have made doctors unsure about treating some pregnancy complications, which has led to life-threatening delays and trapped families in a limbo5 of grief and helplessness.
Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law.
She and her husband began trying in late 2021. They had bought a house in Kingwood, a lakeside development in Houston. Elizabeth was in graduate school for political science, and James taught middle-school math.
The Wellers were pleasantly surprised when they got pregnant early in 2022.
In retrospect6, Elizabeth says their initial joy felt a little naive7: "If it was so easy for us to get pregnant, then to us it was almost like a sign that this pregnancy was going to be easy for us."
Things did go fairly smooth at first. Seventeen weeks into the pregnancy, they learned they were expecting a girl. They also had an anatomy8 scan, which revealed no problems. Even if it had, the Wellers were determined9 to proceed.
"We skipped over the genetic10 testing offered in the first trimester," Elizabeth says. "I was born with a physical disability. If she had any physical ailments11, I would never abort1 her for that issue."
Elizabeth thought of abortion rights in broad terms: "I have said throughout my life I believe that women should have the access to the right to an abortion. I personally would never get one."
And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: "I had not been put in a position to where I had to weigh the real nuances that went into this situation. I had not been put in the crossroads of this issue."
But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid12 new demands of Texas law.
It was May 10, 2022. Elizabeth was 18 weeks pregnant. She ate a healthy breakfast, went for a walk outside and came back home.
In the nursery upstairs, they had already stashed13 some baby clothes and new cans of paint. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge.
Elizabeth stood up to get some lunch. That's when she felt something "shift" in her uterus, down low, and then "this burst of water just falls out of my body. And I screamed because that's when I knew something wrong was happening."
Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish15." She places the blame for the ensuing medical trauma16 on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. Greg Abbott, who signed it, and on the inflamed17 political rhetoric18, which Elizabeth says only sees abortion "as one thing, a black-and-white issue, when abortion has all of these gray areas."
State abortion laws are complicating19 other types of obstetric care
Elizabeth's pregnancy crisis began — and ended — weeks before June 24, when the U.S. Supreme20 Court struck down the federal right to abortion in its Dobbs v. Jackson ruling.
But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. That's when a new state law banned all abortions21 after fetal cardiac activity is detected — usually at about six weeks of pregnancy. Since that time, thousands of women have left Texas to obtain abortions in other states.
Today, abortion is also illegal in Texas under an old 1925 law that the state's Attorney General Ken14 Paxton declared to be in effect after Roe22 was overturned. Another pending23 ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks.
The crisis the Wellers endured is emblematic24 of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. The new abortion bans — or the old laws being resurrected in a post-Roe world — are rigidly25 written and untested in the courts. Many offer no exemptions26 for rape27, incest or fetal anomolies.
But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." These terms are left vague or undefined.
The result has been disarray28 and confusion for doctors and hospitals in multiple states, and risky29 delays and complications for patients facing obstetrical conditions such as ectopic pregnancies30, incomplete miscarriages31, placental problems, and premature32 rupture33 of membanes.
"It's terrible," says Dr. Alan Peaceman, a professor of maternal34-fetal medicine at Northwestern University's Feinberg School of Medicine. "The care providers are treading on eggshells. They don't want to get sucked into a legal morass35. And so they don't even know what the rules are."
'I need you to tell me the truth'
James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. An ultrasound confirmed that she had suffered premature rupture of membranes36, which affects about 3% of pregnancies.
A doctor sat down and told her: "There's very little amniotic fluid left. That's not a good thing. All you can do now is just hope and pray that things go well."
The staff remained vague about what came next, Elizabeth recalls. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information.
"I told her 'Look, Doctor, people around me are telling me to keep hope. And they're telling me to think of the positives. But I need you to tell me the truth, because I don't think all the positive things that they're telling me are real. I need you to give me the facts.'"
The facts were grim. At 18 weeks, the watery37, protective cushion of amniotic fluid was gone. There was still a fetal heartbeat, but it could stop at any moment. Among other risks, both the fetus38 and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis.
The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth.
One option was to end the pregnancy; that's called "a termination for medical reasons." The other option is called expectant management, in which Elizabeth would stay in the hospital and try to stay pregnant until 24 weeks, which is considered the beginning of "viability39" outside the womb.
Outcomes from expectant management vary greatly depending on when the waters break. Later in pregnancy, doctors can try to delay delivery to give the fetus more time to develop, while also warding40 off infection or other maternal complications such as hemorrhage.
But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets41. One reason is that amniotic fluid plays a key role in fetal lung development. For a fetus at 18 weeks, the chance of survival in that state is almost nonexistent, according to Peaceman: "This is probably about as close to zero as you'll ever get in medicine."
Fetuses42 who do survive a premature delivery can die soon after birth, or, if they survive, may experience major problems with their lungs, or suffer strokes, blindness, cerebral43 palsy or other disabilities and illnesses.
For the women, expectant management after premature rupture of membranes comes with its own health risks. One study showed they were four times as likely to develop an infection and 2.4 times as likely to experience a postpartum hemorrhage, compared with women who terminated the pregnancy.
In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018.
A clinical battle begins behind the scenes
Although distraught and heartbroken at this news, Elizabeth forced herself to think it through.
After talking with James, they both agreed they should end the pregnancy. The risks to Elizabeth's health were simply too high.
To Elizabeth, termination also felt like the most merciful option for her fetus. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions44.
"You have to ask yourself, would I put any living thing through the pain, and the horrors, of having to try to fight for their life the minute that they're born?"
The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. Right away, she ran into obstacles because of the Texas law. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone.
"I remember hearing her, from my room, speaking loudly about how nothing is being done here."
After one conversation, the doctor returned to her bedside.
"I can tell that she's been beat down, because she has been trying to fight for me all day, advocating on my behalf," Elizabeth says. "And she starts to cry and she tells me: 'They're not going to touch you.' And that 'you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself. Or you wait till your baby's heartbeat stops.'"
It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. The law, which still remains45 in effect, does contain one exception – for a "medical emergency." But there is no definition for that term in the statute46. No one really knows what the legislature means by that, and they are afraid of overstepping.
A wait for fetal death, or her own encroaching illness
To Elizabeth, it seemed obvious that things were deteriorating47. She had cramps48, and was passing clots49 of blood. Her discharge was yellow and smelled weird50. But the hospital staff told her that those weren't the right symptoms, yet, of a growing infection in her uterus.
They told her the signs of a more severe infection would include a fever of 100.4 degrees and chills. Her discharge had to be darker. And it had to smell foul51, really bad. Enough to make her retch.
Houston Methodist Hospital declined to comment on the specifics of Elizabeth's care, except to say they follow all state laws and that there's a medical ethics52 committee that sometimes reviews complex cases.
To Dr. Peaceman at Northwestern, it sounded like the hospital's clinicians were using the most common clinical signs of chorioamnionitis as a guideline. If Elizabeth exhibited enough of them, then it would be possible to document the encroaching infection, and therefore terminate the pregnancy under the law's "medical emergency" clause, he said.
Elizabeth found this maddening.
"At first I was really enraged53 at the hospital and administration," she says. "To them my life was not in danger enough."
Their conundrum54 became painfully, distressingly55 clear: wait to get sicker, or wait until the fetal heartbeat ceased. Either way, she saw nothing ahead but fear and grief — prolonged, delayed, amplified56.
"That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. "Most women would find it extremely difficult and emotionally very challenging. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. They're not allowed to do that in Texas."
Later on, Elizabeth said she realized that her anger at Methodist was misplaced. "It wasn't that the Methodist Hospital was refusing to perform a service to me simply because they didn't want to, it was because Texas law ... put them in a position to where they were intimidated57 to not perform this procedure."
Under Texas law, doctors can be sued by almost anyone for performing an abortion.
Elizabeth chose to go home rather than wait to get sick at the hospital.
But she was barely out the door, still in the parking lot, when her phone rang. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork.
"It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. We usually have our moms register for delivery at this point. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. How are you doing, and are you excited for the delivery?'"
Elizabeth knows it was just a terrible coincidence, an awful bureaucratic59 oversight60, and yet it drove home to her how powerless she was, how alone, in that vast medical system of rules, legal regulations and revenue.
"I just cried and screamed in the parking lot," she recalls. "This poor woman had no idea what she was telling me. And I told her 'No, ma'am. I'm actually headed home right now because I have to await my dead baby's delivery.' And she goes 'I'm so sorry, I'm so sorry, I didn't know.'"
For Elizabeth, that tragic61 conversation was just "the beginning of the hell that was going to ensue" for the rest of the week.
The next day, a Thursday, she started throwing up. But when she called, they told her that nausea62 and vomiting63 weren't among the symptoms they were looking for.
On Friday, when she woke up, she was still passing blood and discharge, still feeling sick, and feeling strange things in her uterus. She felt lost and confused. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? And it's this stupid, like, distinction that you're just making in this grief. You're trying to understand exactly what's going on. Because at this point, I'm in survival mode. I'm trying to understand. I'm trying to mentally survive this."
How the law led to medical trauma
Elizabeth's experience amounts to a kind of medical trauma, which is layered on top of the grief of pregnancy loss, says Elaine Cavazos, a psychotherapist specializing in the perinatal period, and the chief clinical officer of Reproductive Psychiatry64 and Counseling in Austin.
"It's just really unimaginable to be in a position of having to think: How close to death am I before somebody is going to take action and help me?"
Losing a pregnancy is a particular kind of loss, one that tends to make other people — even health professionals — uncomfortable. All too often, Cavazos says, patients are told to get over it, move on, try again. These dismissals only increase the sense of isolation65, stigma66 and shame.
And now the Texas abortion law has created an additional bind67, Cavazos explains.
In a sudden obstetrical emergency, a termination might be the least risky option, clinically. But now "your medical provider says that it's illegal and they can't provide it. And not only can they not provide it, but they can't talk to you about it," Cavazos says.
"It might even be scary for you to reach out and seek support — even mental health support. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added.
An invisible panel weighs their case
As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. She called her doctor and begged to get in. At the office, her ob-gyn turned down the ultrasound volume so they wouldn't have to hear.
"I said 'Well, is there a heartbeat still?' And she says 'Yes. And it's strong.'"
"It was devastating68 to hear that," Elizabeth says. "Not because I wanted my baby to die, but because I needed this hell to end. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering."
Her doctor said she had been calling other hospitals, but none of them would help. She said Houston Methodist had convened69 an ethics panel of doctors, but her doctor didn't seem very optimistic.
Right there in the office, James pulled out his cell phone, and started looking for flights to states with less restrictive abortion laws. Maybe they could get the abortion in Denver or Albuquerque.
"He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" Elizabeth says. "And yet we're being pulled through this."
Back at home, the Wellers got more serious about their travel plans and started booking tickets.
Then Elizabeth felt another sudden, forceful gush70 of fluid leave her body. The color was darker and the odor was foul. Enough to make her retch.
When they called the doctor's office back, they were told to go straight to the emergency room. And quickly. They now had some of the symptoms they needed to show the infection was getting worse.
Before they drove off, Elizabeth paused to do something. She took a swipe of the new discharge, and placed the toilet paper in a Ziploc bag to carry with her.
It was like an evidence bag. She was through with being dismissed, being told to wait. There was an infection, and she did need treatment. She had the proof.
"Because I didn't want anybody to tell me they did not believe me," she says. "And if they didn't believe me, I was going to show it to them and say "Look! You open it. You smell it yourself. You're not going to tell me that what I'm experiencing isn't real, again."
She never had to use that bag. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called.
The ethics panel had reached a decision, the doctor told them. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night.
As Elizabeth recalled hearing, it was one particular doctor who had argued her case: "They found a doctor from East Texas who spoke71 up and was so patient forward, so patient advocating, that he said 'This is ridiculous.'"
James and Elizabeth cried out their thanks to the doctor. They stood up in the middle of the ER and embraced.
"We shouldn't have been celebrating," Elizabeth says. "And yet we were. Because the alternative was hell."
A mournful birth
Elizabeth was induced late Friday night, and the labor72 became painful enough that she had to get an epidural. Midnight came and went in a blur73. On Saturday, May 14, about 2 a.m., she gave birth. Their daughter, as expected, was stillborn.
"Later they laid down this beautiful baby girl in my arms. She was so tiny. And she rested on my chest ... I looked at her little hands and I just cried. And I told her 'I'm so sorry. I couldn't give you life. I'm so sorry."
When Roe v. Wade74 fell in June, Elizabeth's pain and anger surged up again.
"You know they paint this woman into being this individual that doesn't care about her life, doesn't care about the life of the children she creates or whatever. And she just recklessly and negligently75 goes out and gets abortions all willy-nilly, left and right," she says.
"Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. Or hell — honestly it shouldn't even get to the point where you're having to save a woman's life."
The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. "It's not just the fear that it could happen again, but also the added fear of what if it happens again and I can't get help?"
"Let's say I do have to go through this situation again. And how can I be so sure I'm not going to get too sick to the point where that's it ... now you can't have kids. It is a horrible gamble that we are making Texas women go through."
Elizabeth has been sharing her story, and has found that whatever the political affiliation76 of the listener, they all agree her experience was horrible.
Now she wants those sentiments translated into action.
"We live in a culture that advocates small government and yet we are allowing states, we are allowing our Texas state government to dictate77 what women do with their own bodies and to dictate what they think is best, what medical procedures they think is best for them to get."
In the medical profession, doctors will continue to grapple with the new legal restrictions78, and the resultant dilemmas79 in obstetrical care, says Dr. Peaceman.
"It's going to take a while before ... the medical community comes to some kind of consensus80 on where you draw this line, and where you say enough is enough."
"Because that doesn't really exist right now," he added. "And if you leave it up to individuals, you're going to get uncertainty81 and people unwilling82 to make decisions."
收听单词发音 |
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abort
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| v.使流产，堕胎；中止；中止(工作、计划等) | |
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abortion
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| n.流产，堕胎 | |
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pregnancy
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| n.怀孕，怀孕期 | |
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transcript
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| n.抄本，誊本，副本，肄业证书 | |
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limbo
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| n.地狱的边缘；监狱 | |
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retrospect
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| n.回顾，追溯；v.回顾，回想，追溯 | |
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naive
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| adj.幼稚的，轻信的；天真的 | |
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anatomy
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| n.解剖学，解剖；功能，结构，组织 | |
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determined
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| adj.坚定的；有决心的 | |
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genetic
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| adj.遗传的，遗传学的 | |
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ailments
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| 疾病（尤指慢性病），不适( ailment的名词复数 ) | |
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rigid
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| adj.严格的，死板的；刚硬的，僵硬的 | |
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stashed
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| v.贮藏( stash的过去式和过去分词 )；隐藏；藏匿；藏起 | |
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ken
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| n.视野，知识领域 | |
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anguish
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| n.(尤指心灵上的)极度痛苦，烦恼 | |
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trauma
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| n.外伤，精神创伤 | |
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inflamed
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| adj.发炎的，红肿的v.（使）变红，发怒，过热( inflame的过去式和过去分词 ) | |
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rhetoric
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| n.修辞学，浮夸之言语 | |
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complicating
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| 使复杂化( complicate的现在分词 ) | |
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supreme
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| adj.极度的，最重要的；至高的，最高的 | |
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abortions
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| n.小产( abortion的名词复数 )；小产胎儿；（计划）等中止或夭折；败育 | |
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roe
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| n.鱼卵；獐鹿 | |
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pending
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| prep.直到，等待…期间；adj.待定的；迫近的 | |
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emblematic
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| adj.象征的，可当标志的；象征性 | |
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rigidly
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| adv.刻板地，僵化地 | |
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exemptions
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| n.（义务等的）免除( exemption的名词复数 )；免（税）；（收入中的）免税额 | |
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rape
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| n.抢夺，掠夺，强奸；vt.掠夺，抢夺，强奸 | |
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disarray
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| n.混乱，紊乱，凌乱 | |
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risky
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| adj.有风险的，冒险的 | |
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pregnancies
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| 怀孕，妊娠( pregnancy的名词复数 ) | |
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miscarriages
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| 流产( miscarriage的名词复数 ) | |
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premature
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| adj.比预期时间早的；不成熟的，仓促的 | |
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rupture
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| n.破裂；(关系的)决裂；v.(使)破裂 | |
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maternal
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| adj.母亲的，母亲般的，母系的，母方的 | |
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morass
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| n.沼泽，困境 | |
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membranes
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| n.（动物或植物体内的）薄膜( membrane的名词复数 )；隔膜；（可起防水、防风等作用的）膜状物 | |
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watery
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| adj.有水的，水汪汪的；湿的，湿润的 | |
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fetus
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| n.胎，胎儿 | |
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viability
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| n.存活(能力) | |
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warding
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| 监护，守护（ward的现在分词形式） | |
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plummets
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| v.垂直落下，骤然跌落( plummet的第三人称单数 ) | |
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fetuses
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| n.胎，胎儿( fetus的名词复数 ) | |
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cerebral
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| adj.脑的，大脑的；有智力的，理智型的 | |
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interventions
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| n.介入，干涉，干预( intervention的名词复数 ) | |
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remains
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| n.剩余物，残留物；遗体，遗迹 | |
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statute
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| n.成文法，法令，法规；章程，规则，条例 | |
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deteriorating
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| 恶化，变坏( deteriorate的现在分词 ) | |
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cramps
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| n. 抽筋, 腹部绞痛, 铁箍 adj. 狭窄的, 难解的 v. 使...抽筋, 以铁箍扣紧, 束缚 | |
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clots
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| n.凝块( clot的名词复数 )；血块；蠢人；傻瓜v.凝固( clot的第三人称单数 ) | |
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weird
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| adj.古怪的，离奇的；怪诞的，神秘而可怕的 | |
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foul
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| adj.污秽的；邪恶的；v.弄脏；妨害；犯规；n.犯规 | |
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ethics
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| n.伦理学；伦理观，道德标准 | |
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enraged
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| 使暴怒( enrage的过去式和过去分词 )； 歜； 激愤 | |
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conundrum
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| n.谜语；难题 | |
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distressingly
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| adv. 令人苦恼地；悲惨地 | |
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amplified
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| 放大，扩大( amplify的过去式和过去分词 )； 增强； 详述 | |
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57
intimidated
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| v.恐吓；威胁adj.害怕的；受到威胁的 | |
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58
agonizing
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| adj.痛苦难忍的；使人苦恼的v.使极度痛苦；折磨(agonize的ing形式) | |
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59
bureaucratic
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| adj.官僚的，繁文缛节的 | |
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60
oversight
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| n.勘漏，失察，疏忽 | |
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61
tragic
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| adj.悲剧的，悲剧性的，悲惨的 | |
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62
nausea
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| n.作呕，恶心；极端的憎恶(或厌恶) | |
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63
vomiting
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| 吐 | |
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64
psychiatry
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| n.精神病学，精神病疗法 | |
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65
isolation
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| n.隔离，孤立，分解，分离 | |
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66
stigma
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| n.耻辱，污名；(花的)柱头 | |
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67
bind
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| vt.捆，包扎；装订；约束；使凝固；vi.变硬 | |
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68
devastating
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| adj.毁灭性的，令人震惊的，强有力的 | |
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69
convened
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| 召开( convene的过去式 )； 召集； （为正式会议而）聚集； 集合 | |
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70
gush
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| v.喷，涌；滔滔不绝(说话)；n.喷，涌流；迸发 | |
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71
spoke
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| n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说 | |
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72
labor
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| n.劳动，努力，工作，劳工；分娩；vi.劳动，努力，苦干；vt.详细分析；麻烦 | |
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73
blur
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| n.模糊不清的事物；vt.使模糊，使看不清楚 | |
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74
wade
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| v.跋涉，涉水；n.跋涉 | |
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75
negligently
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76
affiliation
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| n.联系，联合 | |
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77
dictate
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| v.口授；(使)听写；指令，指示，命令 | |
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78
restrictions
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| 约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则） | |
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79
dilemmas
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| n.左右为难( dilemma的名词复数 )；窘境，困境 | |
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80
consensus
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| n.(意见等的)一致，一致同意，共识 | |
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81
uncertainty
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| n.易变，靠不住，不确知，不确定的事物 | |
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82
unwilling
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| adj.不情愿的 | |
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