In late April, Elizabeth and James Weller stuck the week 17 ultrasound photo to their fridge, inside the four-bedroom Kingwood home they planned to fill. The young couple had already bought Houston Astros onesies and dark blue paint for the space-themed nursery, eagerly awaiting Theodora Rosario Weller’s due date in October.
But on May 10, at 18 weeks pregnant, the 26-year-old Elizabeth returned from a jog and saw blood leaking out of her vagina. Then her water broke.
Later, in the Houston Methodist The Woodlands Hospital emergency room, she learned she had lost a dangerous amount of amniotic fluid, which is essential for fetal development. She faced an increased risk of infection and other life-threatening complications. Doctors presented her with two devastating options: Wait until Theodora becomes viable around 24 weeks and deliver her, only to watch her die or live with a severe disability, or induce labor now and effectively terminate the pregnancy.
“In my mind, the only rational thing to do, on top of the only emotionally merciful thing to do, would be to choose (termination), to save her from going through this type of suffering,” said Elizabeth, a political science graduate student at the University of Houston. “I couldn’t justify putting her through that.”
Elizabeth agonized over her choice. Then she realized she didn’t have one. The hospital did not approve her for immediate induction, a Houston Methodist spokesperson said, because she did not meet the standards set forth in the state’s highly restrictive abortion laws, which create civil penalties for terminating a pregnancy when there is a detectable fetal heartbeat.
The newly amended Texas Health and Safety Code only allows a termination when the pregnant woman is in “danger of death or a serious risk of substantial impairment of a major bodily function” — vague terminology that is open to a range of interpretations. A violation opens providers up to lawsuits, fines and, if Roe v. Wade is overturned, a felony charge.
Elizabeth’s story illustrates the collision between medical ethics and legal ramifications that healthcare professionals and institutions face when termination is a medically appropriate option. Now dealing with a high-risk pregnancy, she and James processed their tragedy in a state of limbo, from which their only escape was a flight out of Texas or signs of an infection.
“There’s never been a hell … worse than hoping my wife gets sick, for the sake of our grief and for us to move on,” said James Weller, an 8th grade math teacher. “It’s just terrible.”
A grim outlook
At first, Elizabeth questioned whether termination would be the right choice if the baby had a chance to survive. She has Erb’s palsy — weakness in one arm — and would not end her pregnancy based on disability alone.
At the hospital, Elizabeth was officially diagnosed with PPROM, or preterm premature rupture of membranes, which affects about 1 percent of women before the fetus reaches viability. Her prognosis was grim, and solutions were complicated.
She could try to wait about six weeks to deliver the child, but she risked developing a severe infection or heavy bleeding. Both scenarios would force doctors to induce labor to save her life.
Even if she made it to a live birth, only about 26 percent of babies like Theodora survive the hospital, according to the Society of Maternal Fetal Medicine.Surviving babies can develop clubbed feet and other severe limb deformities. But more commonly, the baby dies from extreme prematurity or pulmonary hypoplasia, in which underdeveloped lungs impede heart function and overall development.
When they considered this reality, James cried over Elizabeth’s belly as they began to say goodbye to Theodora.
Elizabeth stayed at Methodist overnight and told her OBGYN, Dr. Erica Chapman, about her decision the following day. Chapman strongly advocated for her induction, Elizabeth said, but the hospital “had their hands tied behind their backs.” Elizabeth wasn’t yet experiencing severe symptoms or showing any signs of an infection, and her baby’s heartbeat was strong.
Chapman, who is affiliated with Houston Methodist The Woodlands and Kelsey-Seybold, declined an interview for this story.
Doctors put Elizabeth on a management plan to monitor her symptoms. Chapman advised her that “the best thing for me was to get discharged, otherwise I would be running up a bill,” she said.
Waiting
Back home in Kingwood, temperature checks became an obsession for Elizabeth and James.
They hoped to see a number at or above 100.4 on the thermometer dial, or for yellow and foul-smelling vaginal discharge that signaled a worsening condition. Elizabeth had seen only a faint yellow discharge without a strong smell.
While she waited for her body to break down, she became depressed. She woke up on Thursday, May 12, with the song “You Are My Sunshine” stuck in her head. She felt the urge to look up the full lyrics and sobbed at the first verse.
The other night dear, as I lay sleeping
I dreamed I held you in my arms
But when I awoke, dear, I was mistaken
So I hung my head and I cried
“All I wanted was for (Theodora) — and I’m so ashamed to say this — but all I wanted was for her to just leave because it was so nightmarish for me,” she said.
It was Friday, May 13, when the couple visited Kelsey-Seybold to check the baby’s heart. It was still beating, and Elizabeth asked not to hear it.
Chapman told the couple she tried calling other Texas Medical Center hospitals, looking for a doctor who could induce her, but no one took up her plea.
Elizabeth and James began discussing flights to Colorado, where abortion is legal in all stages of pregnancy. When they returned home later that day, Elizabeth’s vaginal discharge had turned to a vibrant yellow color. She retched at the smell and asked herself, is this the sign she needed?
Ethical challenges
As they hoped for a conclusion, James and Elizabeth also felt angry at politicians who created laws that compounded their grief.
“You expect a greater understanding of what's going on inside of a woman's body,” Elizabeth said.
The ambiguity of both Senate Bill 8 and Senate Bill 4 — the two pieces of legislation that frame the state’s abortion laws — creates an ethical dilemma for providers that could lead to devastating consequences for others in Elizabeth’s position, said Dr. Bryn Esplin, a bioethicist and assistant professor of medical education at the University of North Texas Health Science Center in Fort Worth.
There are notable examples of women who died from pregnancy complications after initially being denied an abortion on legal grounds.
“You would hope the law would be such that it supports a provider making an assessment in the patient’s best interest, versus putting them at risk for liability,” Esplin said.
Texas Right to Life Legislative Director John Seago pushed back on the assertion that the law is ambiguous. For him, the language is clear: any elective abortion is an “injustice.”
“When we look at fetal abnormalities and these kinds of tragic situations, it is still unethical to go and to cause the death of the child,” he said. “There are other positive life-affirming responses … to give the child the best perinatal outcomes.”
Relief
There was no positive outlook for James and Elizabeth.
On Friday, she wiped her yellow discharge with toilet paper, placed it in a Ziploc bag and again set out for the Houston Methodist The Woodlands Hospital emergency room, hoping the evidence was enough to encourage the hospital to act.
When she and James arrived, she reported worsening abdominal pain, in addition to her discharge. The couple also learned that an ethics committee had taken up her case, and on Friday night, Chapman called to tell them the good news:
The ethics committee had approved her for induction.
“It was a moment of just sheer happiness,” Elizabeth said. “But in retrospect, it's horrible. At no point did I want this to happen for my baby… But to have some definitive answer that there was a clear path ahead of me was comfort in its own right.”
She delivered Theodora in the early-morning hours of Saturday and let the lifeless, bright red baby — barely bigger than her hand — lie on her chest as long as she could bear.
The whole event remains fresh for the couple. It’s hard to look at the baby clothes, the nursery, the ultrasound photos. But they talk openly about their trauma, hoping that their experience will spark conversation among lawmakers and create positive changes for other parents in their situation.
“That's really all a parent can want for their kid, right? That they do something great. They create a change” Elizabeth said through tears. “And I know some people might think, you know, ‘You're not a mom.’ But she did everything for me to make me feel like one.”
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