My wife and I are trying to start a family. That should feel like some of the best news of our lives. Instead, some nights it scares me half to death, and not for any of the reasons people usually associate with those first nervous months of trying to conceive.
I’m scared because we live in Texas. And in Texas, once we do get pregnant, if anything ever goes wrong, the thing standing between her and the emergency care that could save her life might not be a doctor’s medical judgment. It might be a lawyer’s.
That is not hyperbole. It is the plain, documented reality for anyone pregnant in Texas right now, and I am done pretending it isn’t.
The Women Texas Would Rather You Forget
Start with what happened to four women. Not hypotheticals, not slippery slope arguments. Four real women who were pregnant in Texas, who wanted their pregnancies, and who died because doctors were too afraid of the law to treat them like patients instead of legal liabilities.
Josseli Barnica was 28, an immigrant from Honduras living in Houston. In 2021 she began miscarrying at 17 weeks. Her doctors waited nearly 40 hours, until they could no longer detect a fetal heartbeat, before they treated her. She died of sepsis three days later. More than a dozen medical experts who reviewed her case for ProPublica called her death preventable, describing it in terms usually reserved for malpractice at its worst.
Nevaeh Crain was 18. Six months pregnant, she went to two different emergency rooms in rural southeast Texas complaining of vomiting and abdominal pain. Both sent her home. On her third visit, as her condition worsened, a doctor required two ultrasounds, 90 minutes apart, to confirm her fetus no longer had a heartbeat before he would operate. By the time he had that documentation, she was too unstable for surgery. She died with her fetus still inside her.
Porsha Ngumezi was bleeding heavily during an 11-week miscarriage at Houston Methodist Sugar Land Hospital. Her OB-GYN gave her medication meant for low-risk miscarriages instead of the standard procedure experts say her case actually required. She died. The Texas Medical Board has since disciplined the doctors involved in both her case and Crain’s.
And then there’s Tierra Walker. Thirty-seven, a dental assistant in San Antonio, already a mother. A previous pregnancy had ended in stillbirth because of severe preeclampsia. When she got pregnant again in 2024, she knew exactly what she was risking, and she asked, repeatedly, whether she should end the pregnancy. More than 90 doctors, including 21 OB-GYNs, treated her over the following months. One of them wrote in her chart that she was at high risk of clinical deterioration or death. Not one of them ever offered her the option to terminate. She died two days after Christmas, 20 weeks pregnant, found by her 14-year-old son on his birthday. He performed CPR on his own mother while a 911 operator talked him through it.
These are not edge cases dredged up by activists. They are documented, medical board reviewed, autopsy confirmed consequences of what it now means to be pregnant in Texas when a pregnancy stops going according to plan.
How “Reasonable Medical Judgment” Became a Prison Sentence
Here is what Texas law actually does. Under the Human Life Protection Act, performing an abortion is a felony. If the pregnancy ends and the fetus doesn’t survive, it becomes a first-degree felony: five to 99 years, or life, in prison. On top of that, the state can hit the doctor with a civil penalty of at least $100,000 per violation, and the law requires the medical board to pull their license. A separate law lets any private citizen, a stranger, an ex, a coworker, sue the doctor and anyone who “aided” the abortion for a minimum of $10,000, with the rules rigged so the doctor covers the plaintiff’s legal fees if they lose but can’t recover their own if they win.
There is, technically, an exception. A doctor can act if, in their “reasonable medical judgment,” the pregnancy puts the patient at risk of death or “substantial impairment of a major bodily function.” That sounds workable until you realize “reasonable” is a legal standard, judged after the fact by people with no medical training. Attorney General Ken Paxton has made his own aggressiveness impossible to ignore. He fought a Dallas woman’s court-approved abortion for a nonviable fetus and won, forcing her to leave the state for care. He’s currently prosecuting a Texas midwife both civilly and criminally over the same conduct and has her wearing a court-ordered ankle monitor while the case is still open. He’s suing doctors in other states who prescribe abortion medication by mail.
Put yourself in the exam room, pregnant in Texas, hoping your doctor is willing to gamble his career on you. You’re getting sicker. Your OB-GYN believes, medically, that ending the pregnancy is the right call. But “believe” isn’t good enough anymore. If a prosecutor later decides that judgment wasn’t “reasonable,” your doctor isn’t looking at a fine he can absorb. He’s looking at the rest of his career, and potentially the rest of his life, behind bars. So he waits. For the fever to spike. For the fetal heartbeat to stop on its own. For the case to become undeniable, because undeniable is the only thing that protects him.
That fear, the fear of guessing wrong, is what took Josseli Barnica and Nevaeh Crain from their families. It’s what kept ninety doctors from ever telling Tierra Walker that ending her pregnancy was an option, even after one of them wrote in her own chart that she could die.
The Numbers Texas Won’t Look At
If you want to argue this is all anecdote, fine. Let’s talk numbers.
After Texas banned abortion, the state’s maternal mortality rate rose 56 percent in the first full year of the ban, compared to just 11 percent nationally over that same stretch, according to an analysis of CDC data by the Gender Equity Policy Institute. Among white women in Texas specifically, the rate nearly doubled. By 2023, Texas mothers were dying at a rate 155 percent higher than mothers in California. More maternal deaths now happen in Texas than in any other state.
ProPublica’s own investigation, built from seven years of hospital discharge data, found that sepsis rates among women hospitalized for second-trimester pregnancy loss jumped by more than 50 percent after the ban took effect. That’s not a coincidence. That’s what happens when the standard of care, promptly emptying the uterus to prevent infection, gets treated as a legal risk instead of a medical necessity.
I want to be fair here, because this blog tries to be. Not every study agrees on the size of the effect. A 2026 analysis out of Johns Hopkins and UCLA, looking at 14 ban states with stricter national data, found no statistically significant rise in the narrowest definition of maternal mortality: deaths from obstetric causes within 42 days of pregnancy. But that same study found a real, measurable 9.2 percent rise in the broader category of pregnancy-associated deaths, and the authors were blunt that the lack of a clean signal in the narrower number should not be mistaken for the absence of harm. These deaths are rare enough, and the data messy enough, that certainty is genuinely hard to come by.
It’s also true that Texas has made that certainty harder to find, not easier. The state’s own Maternal Mortality and Morbidity Review Committee, the body whose entire job is to study these deaths and prevent the next one, has chosen not to review any cases from 2022 or 2023, the first two full years of the ban. It’s skipping straight to 2024. A Duke University OB-GYN called that decision a disservice to the people who died in those years. He’s right. You cannot claim a law is working when the people responsible for checking your work refuse to open the file.
They Tried to Fix It. It Still Isn’t Fixed.
To their credit, some Texas Republicans tried to do something about this. After ProPublica’s reporting on Barnica and Crain, more than a hundred Texas doctors signed a public letter saying current law made it impossible to do their jobs safely. In 2025, state Senator Bryan Hughes, the same legislator who wrote the original ban, authored a fix called the Life of the Mother Act. It passed the Senate unanimously and the House 134 to 4. Governor Abbott signed it.
The bill does real things. It removes the requirement that a woman’s death be “imminent” before a doctor can act. It makes clear that doctors can discuss abortion as an option with patients and colleagues without that counting as illegal “aiding and abetting.” It shifts the burden of proof onto the state instead of the doctor. It specifically names ectopic pregnancy and premature rupture of membranes as protected conditions. “We don’t want to have any reason for hesitation,” Hughes said when he introduced it.
I want to believe that helped. Here’s the problem: it hasn’t, not enough. Months after the law took effect, a Houston OB-GYN named Dr. Damla Karsan told reporters that a patient of hers with premature rupture of membranes, one of the two conditions the new law explicitly protects, had been turned away from two other Houston hospitals before Karsan finally treated her. “Tierra’s pregnancy would have ended with the same result today,” Karsan said, referring to Walker. Not eventually. Today. After the fix.
The reason is simple, and it should make you furious: the law changed the wording, but it didn’t change the sentence. A doctor can still lose their license, face up to 99 years in prison, and get hit with six figures in fines for guessing wrong about what counts as “life-threatening enough.” No hospital’s legal department is going to bet a physician’s freedom on a clarified adjective. Center for Reproductive Rights attorney Molly Duane put it plainly: “Exceptions don’t work in reality, no matter how clear they are.” Amanda Zurawski, whose own near-death from a denied abortion helped inspire the reform, called it a “very, very, very tiny step forward.” She should know. She nearly died waiting for Texas to decide her infection was severe enough to treat.
So Much for Small Government
Here’s what actually gets me, beyond the grief of these stories. I’ve spent my adult life around people who call themselves conservative, who talk about keeping government out of people’s business, off their property, out of their bank accounts. Small government. Personal responsibility. Let people make their own decisions and live with the consequences.
Then the same legislature turns around and tells a woman bleeding out in an emergency room that her doctor needs a lawyer’s blessing before treating her. It deputizes her neighbors, her coworkers, even a stranger who’s never met her, to sue anyone who helps her for a minimum of $10,000, and rigs the court rules so she and her doctor get punished financially even for winning. It puts the Attorney General of Texas in the room with her OB-GYN, second-guessing a medical judgment call in real time. That is not small government. That is the government standing at the foot of the bed.
I’m not the only one who’s noticed the contradiction, and it’s not just Democrats making this point. Even people inside the libertarian movement, who generally want government out of everything, have said it plainly. As one Libertarian Party essayist put it, “government cannot be trusted with the power necessary to police it.” You don’t have to support abortion on demand to see the problem. You just have to be honest about what small government is supposed to mean, and notice that it stops meaning that the moment the topic turns to what’s happening inside a woman’s body.
To Be Fair
I try to run this blog straight, so here’s the other side, argued as honestly as I can make it.
Supporters of the law, including groups like Texas Alliance for Life and the American Association of Pro-Life OBGYNs, argue that Texas law has always allowed doctors to act in a genuine medical emergency, and that the deaths of Barnica, Crain, and others are tragedies caused by doctors and hospitals misreading a law that was never actually unclear, not by the law itself. The Texas Supreme Court agreed with them: in a unanimous 2024 ruling against 20 women who’d sued the state, the justices found the medical exception both constitutional and clear, effectively placing responsibility on individual physicians rather than the statute. Senator Hughes has made a similar argument, saying media coverage, not the law itself, is what made doctors afraid to treat their patients. State health officials point to data showing 119 abortions performed statewide specifically to save a mother’s life as proof the exception gets used as intended.
There’s a real point buried in there. Ending an ectopic pregnancy or inducing delivery during a septic miscarriage isn’t what most people picture when they hear “abortion,” and a genuine argument can be made that hospitals and their legal departments are being more cautious than the letter of the law actually requires. If that’s true, the fix isn’t necessarily rewriting the statute again. It’s forcing hospitals and their lawyers to stop hiding behind ambiguity that, in the state’s own telling, doesn’t exist.
I don’t find that fully convincing, mostly because “the law is clear, your doctors are just too scared to read it correctly” is a strange thing to be proud of when women are dying either way. But it’s an argument being made in good faith by people who genuinely believe they’re protecting life, and I’d be lying if I pretended otherwise.
What Would Actually Fix This
If lawmakers actually want to stop the next Tierra Walker, there are real options on the table, and some of them already have Texas precedent behind them.
Take the criminal exposure off the table for good-faith medical judgment, and let the Texas Medical Board, not a felony prosecution, handle the cases where a doctor’s judgment is genuinely in question. A doctor deciding whether a patient’s blood pressure justifies early delivery shouldn’t be facing the same prison exposure as someone accused of murder.
Write actual medical criteria into the law instead of leaning on case-by-case “reasonable judgment” made under threat of prison. Other ban states have tried versions of this. Florida publishes a list of qualifying conditions. Kentucky passed a law this year listing examples like ectopic pregnancy and excessive bleeding. It’s not a perfect fix, real pregnancies don’t always fit neatly on a list, but it beats leaving every decision to be second-guessed after the fact by people with no medical training.
Add the exceptions the law still doesn’t have. A University of Houston poll found 83 percent of Texans support adding exceptions for rape, incest, and fatal fetal diagnoses. That is not a fringe position. It’s a supermajority the Legislature has simply chosen to ignore.
And take the bounty hunter lawsuits off the books. No state should let a stranger profit from suing a woman’s doctor over her own private medical decision. If that provision can’t survive the question “would you want your neighbor able to sue your wife’s doctor for treating her,” it shouldn’t be law.
None of this requires resolving the underlying moral argument about abortion, which people are never going to agree on and which isn’t really what this post is about. It requires admitting that, whatever you believe about that argument, threatening doctors with 99 years in prison for a wrong guess made during a medical emergency isn’t pro-life. It’s just dangerous.
Still Choosing Texas, For Now
I think about Tierra Walker’s son a lot. Fourteen years old, alone in that house, doing chest compressions on his mother because ninety doctors couldn’t or wouldn’t do what she’d been asking them to do for months. I think about him because someday, God willing, I’m going to be a father too, and I don’t want to raise a kid in a state where the honest answer to “will they save Mom if something goes wrong” is “it depends on how brave her doctor is feeling that day.”
My wife and I are still trying to start that family. We’re still choosing Texas, at least for now, because our jobs and our home and our life are here. But I’m not going to pretend the fear away, and I’m not going to write around it just because it’s uncomfortable. If you’re pregnant in Texas today, or about to be, you deserve better than a press release telling you the exception is “clear.” You deserve the actual, documented experience of women who trusted that exception and didn’t make it home.
Being pro-life should mean protecting the woman in the room, not just the pregnancy inside her. Until Texas actually believes that, being pregnant in Texas is going to keep being something that should scare the hell out of anyone who loves someone carrying a child.
ProPublica — Josseli Barnica Died in Texas After Waiting 40 Hours for Miscarriage
CareProPublica — In Texas, Tierra Walker Wasn’t Offered an Abortion Before a High-Risk Pregnancy Killed Her
NPR — New Texas Law Aims to Save Lives by Clarifying the State Abortion Ban. Will It Work?
Gender Equity Policy Institute — Maternal Mortality in the United States After Abortion Bans
