Opinion | I’m a Texas Abortion Provider. I Don’t Know How to Do Right by the Community I Took an Oath to Serve.

It’s not brave for me to be an abortion provider in Texas. This is my home, too. I have a lot of support from my community. I work at several types of clinics here and in Oklahoma — independent ones, mostly. I went to medical school with the express intent to provide abortions in my home state.

We were shut down in Texas before, when Covid first hit the state in March of last year and Gov. Greg Abbott issued an executive order suspending “all surgeries and procedures that are not immediately medically necessary.” At first, we weren’t sure how it was going to be interpreted. I spent that Monday calling all the patients I could, telling them to come in immediately to get an ultrasound in the event I would be able to at least give them pills the next day. We weren’t sure if the shutdown was just going to affect procedures or also the dispensing of pills. So I just rushed the whole day, trying to take care of people, only to get back to my desk and see the attorney general’s statement, which made it clear to me that the order applied to all abortion care.

I became licensed to practice medicine in Oklahoma after we were shut down. Though the suspension of abortion care in Texas lasted only a month, I continued to travel to Oklahoma periodically and intend to keep doing so.

With the passage of the new law, Senate Bill 8, there is a lot we don’t know. According to the law, anyone who aids or abets someone to get an abortion after cardiac activity is detected — the so-called heartbeat — which can be as early as the sixth week of pregnancy, or anyone who provides the abortion care is liable to be sued. For one, I don’t know if I’m even allowed to advise patients to travel outside the state. That doesn’t seem illegal, but we have started to see some mobilization from the opposition against anyone who refers patients to out-of-state abortion care. My lawyers are concerned that I would be seen as aiding and abetting by helping people get out of the state.

In other words, those restrictions leave us with questions. We don’t know: Can Texas come after people who assist someone in leaving the state? Does that mean that if you’re in Texas and you get a pregnancy diagnosis after six weeks, then it is illegal for you to ever get an abortion anywhere? It boggles the mind to think about how abortion opponents think that this law can be extended and used, but I am an obstetrician-gynecologist, and it is my ethical duty to take care of people. It is also my ethical duty to refer those patients elsewhere when I’m barred from taking care of them where they are. When I am in a place where I can take care of them, if possible, I am going to advise them to travel to me. That is also my ethical duty.

It’s not just abortion care I am worried about. All pregnancies have now become more dangerous in Texas. There are a few reasons for that. For one, we know that death from childbirth is considerably higher than with induced abortion. And childbirth is especially dangerous in a state like Texas, with our abysmal maternal mortality rates. That doesn’t mean we should fear pregnancy. But since pregnancy can be dangerous, you should have to consent to continue a pregnancy, right. And people need to do it with a full heart and understanding.

The other thing that makes pregnancy more dangerous has less to do with having or desiring an abortion: Pregnancies that face complications will now be at greater risk. Under this new law, the only abortion exception allowed is for a medical emergency. That might mean if a woman will imminently lose an organ or die without intervention. But how we judge that risk will play out individually with each hospital’s policy, in each clinic.

I can think of no other area of health care in which we would wait for someone to worsen nearly to the point of death before we offered intervention. It’s just unconscionable.

Many years ago in my practice, I cared for a pregnant person who had heart failure. Her heart function was at 20 percent or less of what it should be. But the hospital decided that it was not bad enough that we could offer her an abortion. We know that the heart is incredibly strained during pregnancy. We expand the amount of blood that we have in our bodies in preparation for the blood loss that we will have during childbirth, but that expansion of blood volume puts a huge burden on the heart and makes it work a lot more. So someone who is in the late first or early second trimester and has a heart function of 15 to 20 percent is only going to see those numbers worsen as that pregnancy advances. She then faces a serious risk of dying from a heart attack.

What worries me most is that the decision to intervene in a case like that will be solely dependent on how the individual physician on that day understands and interprets the law. And threatening physicians with financial ruin is a good way to scare them and affect their decision making.

I’m also concerned about all of the young people I take care of, especially the ones who cannot involve their parents in their abortion decision.

In Texas, minors are required to show parental consent or get a judicial bypass, which allows young people to make the decision for themselves. But court orders can take time — which, under this law, young people would likely not have.

The majority of the people who see me for abortion care are parenting already. But I also care for kids. I have seen girls as young as 11. When you are an obstetrician-gynecologist who has cared for 11-year-olds giving birth and 11-year-olds having an abortion, it really changes your perspective on what the dark corners of humanity are and how we must open our hearts to compassion. It’s difficult to really convey to people, as a mother — and I am also a mom — how hard it can be to take care of young kids who have survived sexual violence and just to know how much our society or community has failed them. Politicians are so far away from these kids in their lives. They never have to be there holding their hand.

Those cases, thankfully, are few and far between.

My practice is filled with people who look like me, many who share my lived experiences — immigrants, children of immigrants, undocumented immigrants and people of color. And that is also central to why I went into this work and why I started working in abortion care early on after college.

In Texas, we know how to take care of our folks. We have a very solid community of people working in abortion care and abortion advocacy. And I’m hopeful that after the initial media craze dies down, people will still be directed to the right places in our state that can support them in having an abortion here when possible, or traveling out of state for care. The media attention can be powerful. But don’t forget about us.

We’ve been working. We’re all exhausted. And we all need a minute to rest, recover, and then really reimagine what we need next.

Dr. Ghazaleh Moayedi is an obstetrician-gynecologist in Texas.

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