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 situation. Unfortunately, depending on where you live, this could also be the difference between life and death.

The state of Texas where I come from is such a place. Also where Kaitlyn Kash Austin mother who joined other plaintiffs in a 2023 lawsuit is alive, Zurawski v. Texasseeks to clarify medical emergency exceptions under the state’s strict abortion laws. In 2024, the Texas Supreme Court ruled in the case and refused 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 have autonomy over their own bodies and access to necessary medical care. It will also determine whether doctors can practice medicine without fear of legal consequences by discussing all available options with their patients.

Kash’s story, which I shared with her in an interview in late August, is a reminder of the real-life consequences of restrictive abortion laws across the country. Texas passes law severely restricting access to abortionProhibiting abortion at all stages unless there is a particularly life-threatening medical emergency. The lack of exceptions for rape or incest underscores the state’s harsh stance; Heavy penalties are imposed on providers, including life imprisonment and large fines. This legal environment creates significant barriers for both patients seeking care and providers, who face the risk of serious consequences for providing abortion services, or even discussing abortion services in some cases.

Kash’s journey started with what was supposed to be a routine ultrasound at 13 weeks. According to her, her scan looked normal and she even texted her husband for relief. But he was told to wait for his doctor to review his results immediately. The obstetrician did a full exam, even gave her a flu shot, and then casually mentioned that her baby’s limbs were shorter than expected and needed further evaluation, but not to worry. To Kaitlyn, this was a red flag. As she recalls, she got in her car, called her husband and burst into tears.

Kash’s previous experiences with pregnancy complications gave her an advantage in dealing with such medical complexities, but also increased her awareness of the potential severity of the diagnosis. Knowing that severe skeletal dysplasia could have serious consequences for the baby, she immediately sought an appointment with a maternal-fetal medicine specialist (one of three in the area).

She was told her unborn child was likely to suffer from osteogenesis imperfecta, a serious condition that makes bones prone to fracture and causes lifelong pain. With 35 years of experience, the specialist had encountered only two cases as serious as his. He explained that bone fractures can soon occur even during normal activities, such as holding your child. Birth can be traumatic and will likely require a caesarean section with the risk of further bone fractures. The prognosis was dire: a short life expectancy of three to four years and possibly lifelong hospitalization. Faced with these facts, Kash assumed the conversation would lead to discussion about terminating the pregnancy she so desperately desired.

“I sat there thinking, okay, he’s going to talk about abortion, right?” Kash told me. “He’ll say, ‘This is your option,’ right? But he didn’t, he just said we could do CVS” (chorionic villus sampling, a prenatal test that samples tissue from the placenta.) “What will this do?” he remembered asking. “And he says, ‘This will just give us a name.’ “He said, ‘I need to get you palliative care,’ and in my head I thought, ‘I’m not going to have this baby.'”

Kash waited for her doctor to talk about options, but he didn’t. And it turns out it was because he couldn’t do it.

“I said, ‘This is something you’re going to end, right? Like before, if this had happened a few months ago, right?” Kash said. Senate Bill 8Texas’ strict abortion ban had passed weeks ago, leaving doctors at risk of criminal penalties for discussing abortion. “And he said, ‘In two cases I’ve seen, women terminated their pregnancies and went on to successfully carry on with their next pregnancy. But I can’t tell you that, can I?’ And I said, ‘Okay.’ And he says, ‘Right, that’s it.’ “He couldn’t say anything.”

The doctor recommended that Kash leave Texas immediately to get a second opinion; Kash realized that this was the only way Kash could tell him that he couldn’t properly care for her health. The same doctor later admitted that he cried in his office after Katilyn left. The emotional stress that doctors often avoid, she said, is ubiquitous for reproductive health providers and their staff: “They all say the same thing: ‘We’re going home and crying.’”

As Kash’s story shows, restrictive abortion laws like Texas’ SB8 create an environment where doctors are unable to provide clear guidance on abortion options due to legal restrictions. This lack of communication can increase unnecessary stress and anxiety for patients who are already facing difficult decisions. In Kaitlyn’s case, her doctor was unable to openly discuss the option of termination due to fear of legal repercussions. While there is already a shortage of maternal health specialists, even one doctor going to prison means hundreds, if not thousands, of patients are denied compassionate care.

Kash set out to find a clinic that would treat him, but it wasn’t easy. It took days of calls, dozens of faxes, consent forms, waiting for a call back, and every minute Kaitlin spent worried that her baby’s bones were broken and that another day could mean unnecessary pain for the baby. She eventually found a clinic in Kansas and had to make the journey alone, without her husband, because of safety concerns for workers at the clinic. He had to undergo this surgery without anesthesia so he could go to his own home.

Kash had an abortion and her doctor gave her post-operative care instructions. However, unlike all other surgeries, he could not receive follow-up care in his own home; He would have to rely on a secret underground dictionary to consult post-operative care if he needed it, without putting himself or his care team in legal jeopardy.

Kash finally had the child he desired, but the pain and mental anguish is still fresh like a stone in his shoe that is always there.

Her experience, like that of many others, highlights the injustices women and men face when seeking health care. After going through incredibly painful and grueling experiences like an abortion in Kansas, Kash describes it as the “worst club” of mothers who want children and have nothing to show for it. The dark humor highlights the small number of women who find themselves in constant pain, like Kaitlyn Kash.