‘Your whole life comes to a standstill’
Texas abortion laws stymie treatment for woman’s pregnancy loss, sickness
Kristina Cruickshank knew she had lost her unborn baby.
In her 15th week of pregnancy, a large fluid-filled sac surrounded the fetus, most prominently around the head and neck. Massive cysts, some filled with blood, covered her enlarged ovaries in a “spoke wheel pattern,” according to her medical records. Additional fluid had filled parts of her abdomen.
The 35-year-old Rosenberg woman was frail, vomiting and in pain when she and her husband, John, arrived at Houston Methodist Sugar Land on Friday, June 3. She needed an abortion. But according to Dr. Lauren Swords, the maternal medical director at the hospital’s childbirth center, no one at the hospital was equipped to perform the necessary procedure, known as dilation and evacuation.
It also was not clear whether Kristina was exempt from Texas abortion laws, which threaten providers with felonies and lawsuits for performing abortions except to treat a miscarriage or a loosely defined “medical emergency.” Her fetus still had a heartbeat, and she did not yet need lifesaving care.
So over the next three days, a sick and distraught Kristina was stuck in limbo, waiting in vain for a transfer to Texas Children’s Hospital, where Swords said Methodist doctors commonly transfer pregnant patients who need a higher level of treatment. Swords, the oncall doctor who cared for Kristina during the wait, believes the laws “had something to do with this
unfortunate delay of care.”
Texas Children’s Hospital declined to comment.
“There’s so much about these laws that people just do not really understand outside of health care,” Swords said. “This is a perfect example of how these laws that are in place can directly impact maternal health and care. And it’s very frustrating to be a gynecologist in Texas.”
After Kristina was admitted Friday, her medical records show that Texas Children’s initially “declined” a transfer request early Saturday and left subsequent requests “pending” while an ethics committee reviewed the case. Before abortion restrictions tightened last year, a transfer request for similar cases “would not have taken this long,” said Swords, who could not comment on the specific reason why Texas Children’s did not immediately accept the transfer.
The wait gave Kristina a sense of powerlessness. Worry consumed her and John before they could even begin grieving for the loss of their desperately wanted child.
“You have to lay there and wait and have your life in the hands of an ethics committee, or a doctor that wants to help but can’t,” Kristina said. “Not knowing what was going to happen, or how long I was going to have to be in the hospital, or if you’re going to have to travel somewhere — that was the hardest part.”
Devastating news
A month and a half earlier, John and Kristina enjoyed a blissful Easter. It was their first wedding anniversary — the perfect time to surprise their family by announcing the pregnancy. Parents and siblings shed tears of joy as they opened Easter eggs filled with confetti and tiny baby bottles.
Early ultrasounds thrilled the couple. During one appointment, Kristina saw what looked like the baby moving its arms and waving.
“I will always remember that,” she said.
Concern arose in week 12, on May 16, when heavy bleeding sent Kristina to the ER at Methodist Sugar Land. Tests revealed that the fetus had developed a large cystic hygroma, a birth defect that causes a fluid-filled sac to form, usually around the unborn baby’s head and neck.
The diagnosis increases the risk of miscarrying, but the fetus can survive. Often, cystic hygromas are associated with other genetic abnormalities, such as Trisomy 21, also known as Down syndrome, or Turner syndrome, which can cause heart defects and, for women born with it, infertility.
Kristina’s cystic hygroma was so large, however, that doctors told her the fetus was unlikely to survive. At the time, her obstetrician-gynecologist suggested she come in for weekly appointments to monitor the fetus’ heartbeat. Senate Bill 8, which went into effect last year, bans abortion at the first sign of embryonic cardiac activity, which usually starts around six weeks after the person’s last menstrual period. Only if the heart stopped could the hospital intervene and treat the miscarriage.
“Getting that news is completely devastating,” she said. “And you’re not able to go on with your life and move past it at all. You’re just waiting. You don’t know how long. Your whole life comes to a standstill, basically.”
More complications
Over the next two weeks, Kristina developed severe nausea and so much abdominal pain that she couldn’t walk on her own. The fetus’ heart continued beating. It wasn’t until her appointment on June 3 that further testing revealed a partial molar pregnancy — a rare genetic condition in which fluid-filled, grape-like cysts form in the placental tissue alongside an abnormal embryo. It is not survivable for a fetus.
MRI images showed an enlarged placenta with “variable size cysts,” according to Kristina’s records, which also note “massive cysts” around her enlarged ovaries. In addition to her abdominal pain, the partial molar also triggered hyperthyroidism, which caused her to lose about 15 pounds.
Experts say partial molars can lead to more serious complications, including sepsis, hemorrhaging, hypertension and, in few cases, a rare form of cancer. They typically require early treatment, said Dr. Lorie Harper, chief of the Division of Maternal-Fetal Medicine in the Department of Women’s Health at Dell Medical School.
“In my lifetime of training, until the last year, there would never have been a delay in care,” Harper said. “There would be: Identify the problem, diagnose it and then treat it.”
The presence of a heartbeat complicated efforts to treat Kristina sooner. Before laws banning most abortions went into effect last year, Swords said doctors could have offered a more commonly used type of abortion, known as dilation and curettage, in the first trimester. But as the heartbeat continued, and Kristina’s condition deteriorated, she needed an abortion that Swords’ colleagues — and the majority of OBGYNs in Houston — are not trained to perform. Without a transfer to a higher level of care, all doctors could do was keep her stable, Swords said.
“In the past, Kristina’s situation would have been dealt with much earlier in pregnancy with a dilation and curettage,” the doctor said. “… What we’re going to see as a result of these laws is abnormal pregnancies going much beyond what used to be the standard of care.”
Waiting
As Kristina lay in an antepartum room at Methodist, minutes felt like months.
She feared she would start hemorrhaging before she could find treatment. Meanwhile, John tried to glean what little answers he could from the medical staff. All the Cruickshanks knew was that Methodist had asked Texas Children’s Hospital to review their case.
John became increasingly confused. He and Kristina are devout Catholics and wanted to start a family. They never considered abortion as an option, but the procedure had become the only way to stop Kristina’s pain. Even so, they had to consider leaving their state for treatment.
To him, the laws did not reflect the nuance of pregnancy complications.
“It was just really hard,” he said. “They’re telling us this is not a viable pregnancy. We’re not making an ethical choice here. We’re making the only decision the doctors are telling us we can make, but because the procedure includes a heartbeat, it’s an abortion.”
For pregnancies that do not end on their own, state law allows a doctor to intervene only when the patient is “in danger of death or a serious risk of substantial impairment of a major bodily function.” When Kristina sought care, the penalties included fines and lawsuits. Three weeks later, the Supreme Court overturned Roe v. Wade, opening the door to the state’s “trigger law,” which threatens doctors with five years to life in prison.
The chilling effect has been widespread in the medical community. Just days before Kristina was first admitted with excessive bleeding, another Houston-area woman, 26-year-old Elizabeth Weller, was forced to sit at home, waiting for her condition to worsen, after being diagnosed with a dangerous pregnancy complication. At the time, Houston Methodist said Texas law prevented the hospital from immediately treating her because the fetus still had a heartbeat.
In a recent study of 28 pregnant patients at two North Texas hospitals, researchers found that state laws forcing providers to wait for life-threatening complications were associated with worse health outcomes.
Healing
By Monday morning, June 6, Methodist doctors were still waiting to hear back from the Texas Children’s Hospital ethics committee, records show.
Texas Children’s also had asked Methodist to convene its own ethics committee, but hospital officials said “it would be inappropriate” for them to approve Kristina’s treatment, noting they would not be the ones performing the procedure, records show.
Later, Methodist doctors reached out to a physician at Memorial Hermann, which accepted the case the same day. Kristina was quickly transferred. Her pregnancy was terminated two days later, on June 8, after further tests, including X-rays to check for cancerous tumor growth, she said. Memorial Hermann declined to comment.
Three months later, Kristina is still physically recovering. She battles a persistent rapid heart rate, shortness of breath and anxiety. She also attends regular follow-up appointments at Memorial Hermann to ensure her cysts are breaking down. Doctors are still looking for traces of cancer.
She continues to process the emotional weight of the loss.
“Once I’m healthy again,” she said, “I can concentrate more on that part of the healing.”