Abortion in Texas: What Roe v. Wade ruling, laws mean for pregnant people, birth control

Recent abortion legal actions — the U.S. Supreme Court ruling on abortion issued June 24, the 2021 Texas heartbeat law, which bans abortions once a heartbeat is detected, usually around six weeks of gestation; and the 2021 trigger law that is set to in effect 30 days after Supreme Court ruling, banning abortions in Texas — have raised questions about what these laws and rulings mean on a practical level.

Austin Regional Clinic obstetrician/gynecologist Dr. Crystal Berry-Roberts answered our questions on different scenarios. She and Austin Regional Clinic do not currently provide abortion care, but do provide follow-up care as well as connect pregnant people to resources.

If I don't want to become pregnant, what should I do?

Berry-Roberts said anyone who wants to prevent a pregnancy should see their doctor or find a doctor if they do not currently have one.

"Go to where you can get the facts," she said. "What are your options and how will (the law) affect you?"

Options could include everything from the birth control pill or an IUD, which are reversible, to permanent choices such as tubal ligation, hysterectomy or vasectomy.

What happens if I do become pregnant?

Find out as soon as possible and begin talking to your doctor as soon as possible about what options still are available.

If you do opt for abortion care in Texas or outside of Texas, don't skip follow-up care with your doctor, Berry-Roberts said, and don't forget to include it in your medical history. It's part of your overall health.

Changing legal fight: Abortion providers sue Texas to block enforcement of 1920s-era ban

Is Plan B a form of abortion and affected by the ruling?

No, Plan B is still available. Plan B, one of the brand names for over-the-counter, FDA-approved emergency contraception, can prevent a pregnancy. Plan B equals emergency contraception. It is not an abortion. "It will not work to stop a pregnancy that is already established," Berry-Roberts said.

Is Plan B a birth control option?

Plan B should not be used as a primary birth control method, Berry-Roberts said.

Plan B uses the same ingredients found in standard birth control pills, but the dosing and the timing of use makes it for emergency contraception.

It is most effective within 72 hours of unprotected sex, having another birth control method fail such as a condom breaking or a missed birth control pill, or in the case of rape.

It can mess with a person's hormonal levels and throw off their regular cycle. "It would not be ideal for birth control," Berry-Roberts said. If someone is using it as their regular birth control, she said, they should see a doctor to get much better methods.

Is regular birth control affected by the ruling?

Berry-Roberts has not received any information that it will be, she said. She is regularly prescribing birth control and talking to patients about their options. She's not having any trouble getting those prescriptions filled or covered by insurance. She does not believe that will change after the trigger law takes effect.

Understand the law: Supreme Court overturns Roe v. Wade, trigger law to completely ban abortion in Texas

What about the abortion pill? Will that still be available?

The abortion pill is typically two medications: mifepristone, which stops the pregnancy from growing, and misoprostol, which causes the uterus to empty. It's designed for a first-trimester pregnancy, and its effectiveness goes down the later in the first trimester.

Currently, it can be prescribed to a person in Texas before six weeks gestation. It's unclear what will happen if the trigger law goes into effect. It might be possible for a woman to do a telehealth appointment with someone in another state and receive the abortion pill, but a lot is still not known, Berry-Roberts said.

Abortion access: Texas women travel to New Mexico seeking abortions

She said she is concerned people might not have coordinated care if they are not able to use local care. There can be complications such as excessive bleeding or it might not work.

She also worries that a person might get access to these medications without appropriate medical care and misuse them or not have clear guidance on how to use them. Then, she said, "a friend, a boyfriend, a mother is walking into a bathroom and seeing her bleeding out because she misused a medication or used a device or she allowed someone else to do it."

How we got here: See a timeline of Texas abortion laws: From sonogram requirements to waiting periods

Are there exceptions to the current abortion law or trigger law?

Yes, the life of the mother is mentioned in both laws. Berry-Roberts said that instead of that decision being between a pregnant person and their doctor, those decisions would more likely be taken up by groups of people such as hospital ethics panels, which currently oversee matters such as when to terminate life support if there is a disagreement between doctors and next of kin or if there is no next of kin.

Berry-Roberts said it's possible cases such as that of a pregnant person who has a history of strokes or hemorrhages could go before a medical ethics board and be heard. It will be a process that will take time, which could be difficult for the pregnant person and their family, Berry-Roberts said. It will not be just a list of conditions that will qualify. The mental health of the mother could be one of the questions that goes before an ethics committee to determine if this meets the criteria of the safety of the mother.

What about in cases of rape or incest?

There are no exceptions for those in the current law or the trigger law.

What happens if the baby is not viable?

If the baby is already dead, then a doctor can perform a dilation and curettage procedure or a dilation and evacuation procedure to remove the baby from the womb and take care of the mother. That is not considered an abortion.

If the baby is still alive, but has a genetic condition that means it will not survive outside the womb or might not make it to birth, there is currently no exception in the abortion law to allow for the mother to terminate the pregnancy. The pregnant person would have to continue to carry that baby until that baby dies or until she gives birth. Pregnant people in this situation don't have an option in Texas to receive abortion care, but some are traveling to other states for care.

Real stories: Her fetus no longer viable, Texas woman describes crossing state lines to have an abortion

What happens in an emergency?

If a mother's life is at risk, doctors can still choose the mother, Berry-Roberts said. The example she gives is the mother who is at 14 or 16 weeks' gestation whose water breaks or who starts hemorrhaging. The doctor is going to take care of that mother first. The baby isn't going to survive that.

What about an ectopic pregnancy?

That is a pregnancy that occurs outside the uterus. It is life-threatening to the mother and is not viable and needs to be removed. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws.

This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info