Texas’ strict abortion ban means doctors can’t even discuss abortion care with their patients

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 could also be the difference between life and death.

The state of Texas, where I’m from, is such a place. It is also where Kaitlyn Kash lives, the Austin 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 in the case and declined to clarify the exceptions.

The upcoming election presents a critical 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 needed health care. It will also decide whether doctors can practice medicine without fear of legal consequences for simply discussing all available options with their patients.

Kash’s story, as shared during an interview we conducted with her in late August, is a poignant reminder of the real-life implications of restrictive abortion laws across the country. Texas enacted laws which severely restricts access to abortionspecifically banning abortions at all stages unless there is a life-threatening medical emergency. The lack of exceptions for rape or incest underscores the state’s strict stance, with severe penalties for providers, including life imprisonment and substantial fines. This legal environment creates significant barriers for both patients seeking care and providers who risk serious consequences for offering or, in some cases, even discussing abortion services.

Kash’s journey began with what was supposed to be a routine ultrasound at 13 weeks. As she recounts, 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 did a full exam, even gave her a flu shot, and then casually mentioned that her baby’s limbs measured shorter than expected and she needed further evaluation, but she shouldn’t worry . For Kaitlyn, this was a red flag. As she recalls, she got into her car, called her husband and burst into tears.

Kash’s previous experiences with pregnancy complications gave her an edge in navigating such medical complexities, but also heightened her awareness of the potential severity of the diagnosis. She immediately sought an appointment with a maternal-fetal medicine specialist (one of only three in the region), knowing that severe skeletal dysplasia could lead to dire outcomes for the baby.

She was told her unborn child could develop osteogenesis imperfecta, a serious condition where bones are prone to breaking, causing lifelong pain. The specialist, with 35 years of experience, had encountered only two cases as serious as hers. He explained that bone fractures could soon begin to occur, even during normal activities such as picking up her child. The birth would be traumatic and would likely require a C-section, with risks of additional bone fractures. The prognosis was grim: a short life expectancy of three to four years and possible lifelong hospitalization. Faced with these realities, Kash assumed the conversation would lead to discussion of the termination of the pregnancy she so desperately wanted.

“I sat there thinking, well, he’s going to talk about abortion, right?” Kash told me. “It’s going to say, ‘That’s your option,’ right? And he didn’t, he just said we can do CVS” (chorionic villus sampling, a prenatal test that takes tissue from the placenta.) “What’s that going to do?” he remembered asking. “And he says, ‘Well, he’ll just give us a name.’ And he said, “I have to put you in hospice care,” and I’m thinking in my head, “I’m not going to deliver this baby.”

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

“I said, ‘This is something you would terminate, right? Like before, if that was a few months ago, right? Kash said. Senate Bill 8Texas’ strict abortion ban passed a few weeks ago, putting doctors at risk of criminal penalties for discussing abortion. “And he said, ‘In the two cases I’ve seen, the women have completed their pregnancies and gone on to be successful in subsequent pregnancies. But I can’t tell you that, can I? And I said, “Okay.” And he says, “Okay, that’s it.” He couldn’t say anything.'”

The doctor recommended that Kash leave Texas immediately to get a second opinion, which she realized was the only way he could tell her that she couldn’t take care of her health properly. The same doctor later admitted to her that after Katilyn left, she burst into tears in his office. She said the emotional grip that doctors often avoid was pervasive for 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 where doctors can’t provide clear guidance 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 termination as an option due to fear of legal repercussions. And when there is already a shortage of maternal health specialists, even one doctor going to jail translates into hundreds, if not thousands, of patients never receiving compassionate care.

Kash set out to find a clinic to treat her, but it wasn’t easy. It took days of phone calls, dozens of faxes, consent forms, waiting for callbacks, and with every passing minute Kaitlin worried that her baby’s bones were breaking and that one more day could mean unnecessary pain for the baby. She eventually found a clinic in Kansas and had to make the trip alone without her husband due to safety concerns for the clinic workers. She had to undergo the procedure without anesthesia so she could return home.

Kash had the abortion and her doctor gave her instructions for post-op care. But unlike any other surgery, she couldn’t seek follow-up care in her own home state; she would have to rely on a secret underground glossary to seek aftercare if she needed it without putting herself or the care team in legal jeopardy.

Kash finally had the baby she wanted, but the pain and mental anguish is still fresh, like a stone in the shoe that’s always there.

Her experience, like many others, highlights the injustices women and men face when seeking medical care. Kash describes herself as being “in the worst club” — of mothers who wanted children and have nothing to show for it, after going through incredibly painful and draining experiences like her abortion in Kansas. The dark humor highlights a non-trivial number of women who, like Kaitlyn Kash, find themselves grieving in perpetuity.