Texas OB-GYN Grapples With Providing Care in a Challenging Legal Landscape

In states where abortion is banned, some patients must travel hours across state lines to receive care in the aftermath of the Supreme Court’s decision to overturn Roe v. Wade. However, travel is often not a feasible option for many of the patients that Dr. Andrea Palmer sees; these patients are instead forced to carry their pregnancies to full term or wait until their complications turn life-threatening to receive care. While many states have enacted laws to bolster protections for people seeking care out of state, Andrea notes that much of the battle is having the resources and support to get there.

Andrea Palmer is pictured in January 2023. (Photo credit: Peter Robbins Fine Art and Photography)

Andrea Palmer, a board-certified general OB-GYN and robotics surgeon in Fort Worth, Texas, provides services to patients from a wide range of backgrounds. Andrea recalls how, prior to the reversal of Roe, Texas’ S.B. 8—a bill that allows for civil action against any individuals who provide abortion care or support such care via provision of funds or transportation by effectively deputizing residents—was already beginning to limit patient care. Providers in her community found themselves nervous to speak freely to their patients about the complete and comprehensive pregnancy and abortion care they might need. Andrea said she worried a vigilante posing as a new patient would attempt to bait her into talking about abortion and attempt to sue her, and she sometimes skirts the topic of abortion when speaking with patients about their health care options.

But Andrea said the most heart-breaking change to her practice has been her approach when working with patients who have premature rupture of membranes (PROM)—a pregnancy complication in which the fluid sac protecting a fetus is broken too early—or whose fetuses are not compatible with life. Before the passage of S.B. 8 and the Dobbs v. Jackson Women’s Health Organization decision, these patients would have been able to safely terminate their pregnancies in Texas; now, patients grieving a wanted pregnancy must travel across multiple states to access lifesaving care. Some patients have the resources to make that journey, while others have no choice but to risk their health and carry a fetus to full term. Under Texas law, providers like Andrea must wait until these patients develop a severe infection to induce labor—even though this threatens the patient’s life and increases the risk that the patient will lose the ability to have children in the future.

With increasing legal challenges to Andrea’s ability to practice safely in Texas, she said she’s considering moving to a state where she can fully use her education and training.

Stories like Andrea’s illuminate the stark and disparate realities of the impact of abortion bans on patients. States legislators must seize opportunities to bolster, expand, and protect access to abortion for people traveling out of state from areas that are hostile to abortion access and rights.