Texas resident Olivia Harvey had an ectopic pregnancy, which is the most common cause of maternal death in the first trimester. But harsh anti-abortion laws forced her to return to her home state of NC for care.
For Asheville native Olivia Harvey, the word “congratulations” was maddening.
Three months after an ectopic pregnancy—which is the most common cause of maternal death during the first trimester—Harvey was sitting on her couch in Dallas, Texas.
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She’d moved there in April 2023, and five months later she got her first positive pregnancy test. Her boyfriend was excited.
“He wanted to hope for the best,” says Olivia, “but in my heart, I knew it wasn’t viable.”
After a lifetime of reproductive health issues, Olivia knew the test likely meant she had an ectopic pregnancy.
Ectopic pregnancies cannot be carried to term because they occur when a fertilized egg grows outside of the uterus. The treatment for these pregnancies is removal through medication or surgery. If undiagnosed or untreated they rupture around 6 weeks and can cause major organ damage, internal bleeding, sepsis, and death.
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Harvey’s Asheville obstetrician and gynecologist had previously warned that if she ever took a positive pregnancy test, she would need to go to a hospital “immediately.”
After taking her test she spent the next week in and out of the hospital.
“I was angry because they kept saying ‘congratulations,’” Olivia says. “The nurses would come in and say ‘congratulations!’ [Meanwhile] I’m trying to get help. This is not a fun situation. This is not a ‘congratulations’ thing. This is an ectopic pregnancy and I felt like they weren’t taking me seriously.”
Eventually, she found out that she was almost six weeks along, and while her doctors in Texas confirmed that the pregnancy was, indeed, outside of her uterus, they couldn’t treat her.
They talked about using methotrexate, a drug commonly used to treat ectopic pregnancies, however, the Texas abortion ban classifies the drug as an abortion-inducing medication and severely restricts its use.
Texas’ ban is one of the strictest in the country. A doctor who breaks the state law faces life in prison and a minimum $100,000 fine.
NC’s 12-week abortion ban isn’t as strict as the one in Texas, but Republican lawmakers in the state legislature will likely pass harsher bans if they win their 2024 elections.
In Texas, there are vague exceptions to save the mother’s life or to prevent serious bodily harm, but the state medical board has not issued any guidance on what conditions qualify as an exception.
After a week without answers or treatment Olivia called her doctor in Asheville and boarded a last-minute plane to North Carolina.
Texas Law
Before she moved, Olivia’s mom didn’t want her to go to Dallas. Her family was concerned about the Texas abortion ban.
Olivia had suffered medical problems with her ovaries since she was 8 years old. She had a history of ovarian torsion, had undergone four surgeries involving her reproductive organs, and had a high risk of ectopic pregnancy.
But she had always wanted to live outside of North Carolina. She had a good job opportunity, and she’d never had a pregnancy scare before.
“I was really naive to Texas law,” she said, “I thought they at least had to help ectopic pregnancies.”
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Having moved only a few months prior, Olivia didn’t have health insurance or a primary care doctor when her test came back positive.
She went to an urgent care, got an ultrasound, and more than $1,200 of bloodwork. The doctor confirmed Olivia was pregnant but wouldn’t tell her much else. He said it wasn’t his specialty and recommended that she go somewhere with an OBGYN.
From there, she went to Medical City Dallas Hospital and saw multiple doctors over the next week. They had her repeat the blood work, urinalysis, and ultrasound. The doctor told her the pregnancy wasn’t viable, but it could be, and to come back in two days. They would reevaluate and see if it was a normal pregnancy.
Olivia went back two days later to the same result. The pregnancy wasn’t in her uterus and was not progressing as it should have, but the hospital once again told her to return in two days.
At that point she was six weeks along, hoping a doctor would treat her. “I had discharge papers saying there was nothing in my uterus, ” she recalls.
But the doctor told her that while the pregnancy was not viable they could not give her methotrexate.
“It was like they were tiptoeing around the subject and just waiting,” she says. “I felt bad for them as well. I know they have to follow their laws, but it’s crazy.”
On her last visit to Medical City, Olivia was six weeks along and the doctor told her the pregnancy was “a ticking time bomb,” Harvey says, but he couldn’t treat her. He warned her they had to be “really careful about next steps.”
“At that point,” Olivia says, “I called my OBGYN in Asheville. She knows my history and told me to get on a plane and come home.”
North Carolina Law
When she flew back to Asheville, North Carolina’s abortion ban was fresh on the minds of many North Carolinians.
Since Roe v. Wade was overturned by a Republican-dominated US Supreme Court in 2022, 14 states, including North Carolina, have passed abortion bans.
North Carolina’s ban, SB20, starts at 12 weeks but includes exceptions for situations where the mother’s life and internal organs are at risk or the fetus has a life-limiting fetal anomaly. Like Texas, the ban stipulates that abortions outside of those parameters are a felony, are subject to a $5,000 fine, and the doctor could lose their medical license.
The GOP’s anti-abortion laws have been criticized by medical professionals who say the bans restrict their ability to practice good medicine.
Dr. Abby Schultz, who provides full-spectrum OBGYN care in Durham, said the state’s ban instills fear into medical practitioners.
“Providers started getting really afraid that they would be targeted in some way, having their decisions that were medically necessary being picked apart and potentially them receiving legal consequences or civil consequences as a result,” Schultz told Cardinal & Pine.
The law is murky for patients with health complications, especially when pregnancy itself can result in medical conditions like high blood pressure and preeclampsia.
“It puts us in a terrible position when people who are pregnant are sick and we’re trying to figure out whether or not those people meet exception criteria for a medically indicated abortion,” says Schulz. “[The law] is really unclear what constitutes enough of a risk to provide an abortion to save someone’s life.”
Back in Texas
When Olivia called her hometown OBGYN, it was Tuesday. By Thursday, she was on a plane to Asheville.
“I had to go instantly, so I didn’t have much clothes or anything and then had to take all that time off of work.”
She stayed with her family, and on Friday morning Olivia’s doctor did an ultrasound, diagnosed the ectopic pregnancy, and treated her with methotrexate.
“She told me it could have been really bad had I not come in when I did. I would have lost my [fallopian] tube, and I only have the one left.”
She returned to Texas after a week but says she won’t stay there forever. Not after this scare.
“I’m scared to death because I don’t want to go through that again,” she says. “I don’t want to have to deal with the doctors in Texas…I feel like they are walking on eggshells.”
Despite this, she feels bad for the doctors in states where they have to choose between following the law or providing necessary healthcare for their patients.
“I don’t look at the medical field differently. I just look at the state.”
