Amanda Zurawski stepped up to a podium outside the Texas Capitol. Close your eyes, she began, and picture someone you hold incredibly dear. “Now imagine someone telling you you’re going to lose that person in the very near future, but they can’t tell you exactly when or how,” she said. “On top of that, there’s a very high likelihood that you’ll get extremely sick, maybe even near death, as you wait for that person you love to die.”

“It sounds like a pretty sick and twisted plot to a dystopian novel,” she continued. “But it’s not. It’s exactly what happened to me while pregnant in Texas.”

Zurawski and her husband had known each other since preschool. They married in 2019 and were excited to start a family. After months of fertility treatments, Zurawski learned she was pregnant. The couple was beyond thrilled; they decided to name their daughter Willow. Zurawski was “cruising though” her second trimester, she said, and had just finished the invite list for her upcoming baby shower when everything changed. She developed “unexpected and curious” symptoms. Her obstetrician told her to come in right away. After an examination, the couple received the “harrowing news” that Zurawski’s cervix had dilated prematurely. Later her water broke; because Zurawski’s pregnancy was still weeks from viability, there was no chance Willow would survive.

“I asked what could be done to ensure the respectful passing of our baby and … protect me from a deadly infection,” she recalled. Nothing could be done, she was told, because of Texas’s abortion bans.

Zurawski is one of five Texas women who are plaintiffs in a lawsuit that the Center for Reproductive Rights filed against the state this week. The lawsuit argues that the state’s various abortion bans, which contain only vague exceptions in cases of medical emergency and impose both civil and criminal penalties if violated, have caused confusion and sparked fear among medical professionals, putting pregnant people’s lives in danger.

“What the law is forcing physicians to do is to weigh … very real threats of criminal prosecution against the health and well-being of their patients,” Nancy Northup, CEO of the Center for Reproductive Rights, said during the Tuesday afternoon press conference. The lawsuit seeks to stop the “unnecessary pain, suffering, injury, and life-threatening complications caused by Texas’s abortion ban.”

The lawsuit asks a state district judge to clarify the scope of the medical emergency exception and affirm that physicians can provide abortion care when an emergency condition arises. It is the first lawsuit of its kind, Northup said, “in which individual women have sued a state for the harm that they endured because abortion care has been criminalized in the wake of Roe’s reversal.”

Zurawski’s doctor said her pregnancy could not be terminated until there was no longer fetal cardiac activity or her health had deteriorated enough that the ethics board at the hospital would allow an abortion. “I cannot adequately put into words the trauma and despair that comes with waiting to either lose your own life, your child’s life, or both,” she said. “For days I was locked in this bizarre and avoidable hell.” Zurawski developed life-threatening sepsis; only then did the hospital agree that she was sick enough to qualify for abortion under Texas law. “What I needed was … a standard medical procedure,” she said. “An abortion would have prevented the unnecessary harm and suffering that I endured.”

AUSTIN, TEXAS - MARCH 07: CRR President & CEO Nancy Northup at the Texas State Capitol after filing a lawsuit on behalf of Texans harmed by the state's abortion ban on March 07, 2023 in Austin, Texas. (Photo by Rick Kern/Getty Images for the Center for Reproductive Rights)

Nancy Northup, president of the Center for Reproductive Rights, speaks at the Texas Capitol on March 7, 2023, in Austin.

Photo: Rick Kern/Getty Images for the Center for Reproductive Rights

Confusion and Intimidation

By the time the U.S. Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health Organization last June — which overturned Roe v. Wade and eliminated a half-century of constitutional protection for abortion — Texas politicians had already codified two abortion bans. During their 2021 biennial legislative session, lawmakers passed Senate Bill 8 , a six-week ban that sidestepped constitutional oversight by outsourcing enforcement to vigilantes empowered to bring civil suits against health care providers or anyone else they believed might have aided a patient seeking an abortion in violation of the law. Lawmakers also passed a so-called trigger ban, a complete ban on abortion that took effect in August 2022, shortly after Roe’s demise.

Theoretically at least, each of the Texas bans has an exception for cases involving medical emergencies. But according to the new lawsuit, the laws don’t use standard medical terminology, and what exactly counts as a medical emergency is vague. “Inconsistencies in the language of these provisions, the use of non-medical terminology, and sloppy legislative drafting have resulted in understandable confusion throughout the medical profession regarding the scope of the exception,” the lawsuit reads. While the exception appears multiple times in the state’s health and safety code, conflicting language leaves “physicians uncertain whether the treatment decisions they make in good faith, based on their medical judgment, will be respected or will later be disputed.”

And that is a serious problem given the extreme penalties for violating Texas’s abortion bans. Doctors who violate the trigger law, for example, face revocation of their license, a civil penalty of at least $100,000 per violation, and, if criminally charged, up to 99 years in prison.

To date, abortion is banned in 13 states , including Texas. Medical exceptions in those states vary, and some have none at all, providing only a list of possible defenses a physician can assert if they are prosecuted. Physicians have long warned that these exceptions are vague and place patients in danger. Stories of pregnant people denied abortion care despite suffering from serious medical complications or carrying a fetus with a fatal diagnosis have made news across the country, but they have prompted few, if any, attempts to better define exceptions to the bans.

During his 2022 reelection campaign, Texas Gov. Greg Abbott told Inside Texas Politics that he’d seen some situations in which pregnant people were not getting the heath care they needed to protect their lives. “There’s been too many allegations that have been made about ways in which the lives of the mother are not being protected, and so that must be clarified.” Although the Texas Legislature convened in January, no action has been taken to remedy the problem. A spokesperson for Attorney General Ken Paxton told the Associated Press that Paxton is “committed to doing everything in his power” to defend the laws as written.

Meanwhile, anti-abortion groups have pushed back on the notion that the bans they advocated for need any clarification, suggesting that where patients like Zurawski are concerned, doctors are simply being negligent. That’s exactly what the Texas Alliance for Life did in the wake of the center’s lawsuit. “Tragically, some physicians are waiting until their patients are nearly dead before performing a life-saving medical procedure,” Amy O’Donnell, the group’s communications director, said. “We see situations when pregnant women do not promptly receive treatment for life-threatening conditions as potential medical malpractice issues.”

AUSTIN, TEXAS - MARCH 07: (L-R) Plaintiffs Anna Zargarian, Lauren Miller, Lauren Hall, and Amanda Zurawski at the Texas State Capitol after filing a lawsuit on behalf of Texans harmed by the state's abortion ban on March 07, 2023 in Austin, Texas. (Photo by Rick Kern/Getty Images for the Center for Reproductive Rights)

Plaintiffs Anna Zargarian, Lauren Miller, Lauren Hall, and Amanda Zurawski at the Texas Capitol in Austin on March 7, 2023.

Photo: Rick Kern/Getty Images

“You Need to Leave the State”

In the face of legislative inaction, the new lawsuit seeks to have a judge step in and declare that doctors have the right to exercise their best medical judgment — and that they won’t face penalties for doing so. It also argues that the Texas Constitution guarantees fundamental rights that don’t disappear simply because a person is pregnant. “Texas law cannot demand that a pregnant person sacrifice their life, their fertility, or their health for any reason, let alone in the service of ‘unborn life,’ particularly where a pregnancy will not or is unlikely to result in the birth of a living child with sustained life,” it reads.

Three additional plaintiffs in the center’s lawsuit were also on the Capitol grounds Tuesday. Like Zurawski, they shared stories of wanted pregnancies that ended in heartbreak amid a nightmare of trying to access necessary abortion care in Texas.

Lauren Hall was nervous about becoming a parent, but excited, she told reporters. Then, when she was 18 weeks pregnant, an anatomy scan revealed anencephaly; her fetus was not growing a skull and had little brain matter. Her husband held back tears when he asked the doctor what they should do. The doctor hesitated. Wait to miscarry or leave Texas for an abortion, the couple was told. The doctor warned that if they chose to leave Texas, they should not tell anyone where they were going or why, and she couldn’t refer Hall to an out-of-state provider or even transfer her medical records; under Senate Bill 8, no one knew how far Texas would go to prosecute people involved in abortion care. Hall and her husband made their way to Seattle, where she finally received the medical intervention she needed. Hall recalled protesters outside the clinic, “calling us killers and waving pictures with dead babies at us.”

Lauren Miller already had a young son when she found out she was pregnant with twins. She and her husband were excited. They started calling the twins “Los Dos,” and every night, her husband would give her two kisses on the belly, “one for each.” But Miller began suffering from debilitating nausea and vomiting. At 12 weeks, she found out that one of the fetuses had two large fluid masses developing where his brain should be. The fetus had an often-fatal genetic abnormality, and later scans revealed “one heartbreaking issue after another.” Miller’s medical providers seemed to be searching for words when trying to counsel her about her options, she said. Finally, one specialist tore off his gloves and threw them in the trash: “I can’t help you anymore,” she recalled him saying. “You need to leave the state.”

That’s what she and her husband decided to do. She wanted to just “curl up and cry and mourn,” but instead, she had to scramble to find care to give the other twin “and myself the best chance of surviving this pregnancy.” She and her husband felt lost, she said, “like we were in a dark room feeling for a door.” She noted that while she had the resources to access the care she needed out of state, others might not be as fortunate. “Layers of privilege should never determine which Texans can get access to the health care they need.”

“Where else in medicine do we do nothing and just wait to see how sick a patient becomes before acting?”

Anna Zargarian was surprised to find out she was pregnant. It was September 2021, just after S.B. 8 had gone into effect, and she remembered “naively” thinking that it was a good thing she wouldn’t need an abortion. Two months later, Zargarian’s water broke; her amniotic fluid was gone, and she was told the baby would not survive. On the Capitol lawn, Zargarian began to cry as she recalled getting the news. “My heart broke into a million pieces,” she said. “I didn’t even know a pain like that could exist until that moment.” Under the provisions of S.B. 8, she wouldn’t be able to get the care she needed in Texas until “my life was actively in danger,” she said. “I couldn’t understand what was going on.” She fled to Colorado for care. “Where else in medicine do we do nothing and just wait to see how sick a patient becomes before acting?”

A reporter at the press conference asked how the women felt now, filing this case together after going through such an isolating ordeal. To be clear, Zurawski said, none of the women wanted to be there: “We have all become involuntary members of the most horrific club on the planet.” And they were just a small representation of “countless others” in Texas and around the U.S. who have gone through similar trauma. “Being together is powerful, but it’s also traumatic knowing that there are so many people who are going through this,” she said. “And I think that’s why we’re all here.”