As a physician, I have often witnessed the profound complexities and emotional turmoil that accompany pregnancy complications. Every time I encounter these situations, a universal truth emerges: no one wants to find themselves in this vulnerable and heartbreaking position. Unfortunately, depending on where you live, it can also mean the difference between life or death.

The state of Texas, where I’m from, is one of those places. This is also where Kaitlyn Kash lives, Austin’s mother who joined other plaintiffs in a 2023 lawsuit, Zurawski v. Texasseeking to clarify the state’s medical emergency exceptions under its strict abortion laws. In 2024, the Texas Supreme Court ruled on the case and declined to clarify the exceptions.

The approaching elections present a crucial opportunity to influence the future of reproductive rights in America. The outcome will determine whether women continue to have autonomy over their bodies and access to necessary medical care. It will also decide whether doctors can practice medicine without fear of legal consequences if they simply discuss all available options with their patients.

Kash’s story, as told in an interview I conducted with her in late August, is a poignant reminder of the real-world implications of restrictive abortion laws across the country. Texas has enacted laws which severely restrict access to abortionincluding prohibiting abortions at all stages except in cases of life-threatening medical emergencies. The lack of exceptions for rape or incest underscores the state’s strict stance, with harsh penalties imposed on providers, including life in prison and substantial fines. This legal environment creates significant barriers both for patients seeking care and for providers who risk serious consequences if they offer, or in some cases even discuss, abortion services.

Kash’s journey began with what was supposed to be a routine ultrasound at 13 weeks. As she tells it, her scan looked normal and she even texted her husband with relief. But she was told to wait for her doctor to review her results immediately. Her obstetrician performed a full exam, even gave her a flu shot, then casually mentioned that her baby’s limbs were shorter than expected and she needed further evaluation, but she shouldn’t not to worry. For Kaitlyn, it was a wake-up call. As she remembers, she got in her car, called her husband and burst into tears.

Kash’s previous experiences with pregnancy complications gave her an advantage in dealing with medical complexities like this, but it also made her aware of the potential seriousness of the diagnosis. She immediately made an appointment with a maternal-fetal medicine specialist (one of three specialists in the area), knowing that severe skeletal dysplasia could have serious consequences for the baby.

She was told that her unborn child was at risk of developing osteogenesis imperfecta, a serious condition in which bones tend to break, causing lifelong pain. The specialist, with 35 years of experience, had only encountered two cases as serious as hers. He explained that bone fractures could start occurring soon, even during normal activities, like picking up your child. The delivery would be traumatic and would likely require a cesarean section, with risks of further bone fractures. The prognosis was grim: a short lifespan of three to four years and possible lifelong hospitalization. Faced with these realities, Kash assumed the conversation would lead to a discussion about terminating the pregnancy she so desperately wanted.

“I just sat there thinking, okay, he’s going to talk about abortion, right?” Kash told me. “He’s going to say, ‘That’s your option,’ right? And he didn’t, he just said we could do CVS” (chorionic villus sampling, a prenatal test that takes tissue from the placenta.) “What’s that going to do? she remembers asking. “And he says, ‘Well, that’ll just give us a name.’ And he said, “I need to get you started on palliative care,” and I’m thinking in my head, “I’m not having this baby.”

Kash waited for his doctor to talk to him about his options, but he didn’t. And it became clear that it was because he couldn’t.

“I said, ‘This is something you would end, right?’ Like before, if it was a few months ago, right? Kash said. Senate Bill 8Texas’ strict abortion ban had passed weeks earlier, exposing doctors to criminal penalties if they discussed abortion. “And he said, ‘In both cases I’ve seen, the women terminated their pregnancies and then had successful pregnancies.’ But I can’t tell you, can I? And I said, “Okay. » And he said, “Okay, that’s all.” “He couldn’t say anything.”

The doctor recommended Kash leave Texas quickly to get a second opinion, which she said was the only way he could tell her he couldn’t take care of his health properly. The same doctor later admitted to her that after Katilyn left, he collapsed crying in his office. She said the emotional hold that doctors often avoid is pervasive among reproductive health providers and their staff: “They all say the same thing: ‘We go home and cry.’ »

As Kash’s story illustrates, restrictive abortion laws like Texas SB8 create an environment in which doctors are unable to provide clear advice about termination options due to legal constraints. This lack of communication can add unnecessary stress and anxiety to patients facing already difficult decisions. In Kaitlyn’s case, her doctor was unable to openly discuss the possibility of termination for fear of legal repercussions. And while there is already a shortage of maternal health specialists, even one doctor sent to prison results in hundreds, if not thousands, of patients who never receive compassionate care.

Kash searched for a clinic that could treat her, but it wasn’t easy. It took days of calls, dozens of faxes, consent forms, waiting for callbacks and with every minute that passed, Kaitlin feared that her baby’s bones would break and that one more day could mean unnecessary pain for the baby. Eventually, she found a clinic in Kansas and had to make the trip alone, without her husband, due to safety concerns for clinic staff. She had to undergo the procedure without anesthesia so she could go home on her own.

Kash had an abortion and her doctor gave her instructions for post-surgical care. But unlike all other surgeries, she couldn’t seek follow-up care in her own home state; she would have to rely on a clandestine secret glossary to obtain post-operative care if she needed it without putting herself or her care team in legal jeopardy.

Kash finally had the child she wanted, but the heartbreak and mental anguish are still fresh, like a stone in her shoe that is constantly there.

Her experience, like that of so many others, highlights the injustices women and men face when seeking health care. Kash describes herself as being “in the worst club” – mothers who wanted children and had nothing to show for it, after going through incredibly painful and grueling experiences like her abortion in Kansas. Black humor highlights a significant number of women who, like Kaitlyn Kash, find themselves in perpetual mourning.