This article is part of a special series called “One in four: How abortion access shapes America.”
As a physician, I’ve often witnessed the profound complexities and emotional turmoil that accompany pregnancy complications. Each time I encounter these situations, one universal truth emerges: No one wants to find themselves in this vulnerable and heart-wrenching position. Sadly, depending on where you live, it could also be the difference between life or death.
The state of Texas, where I’m from, is one such place. It’s also where Kaitlyn Kash lives, the Austin mother who joined other plaintiffs in a 2023 lawsuit, Zurawski v. Texas, seeking to clarify the state’s medical emergency exceptions under its strict abortion laws. In 2024, the Texas Supreme Court ruled in the case, and refused to clarify the exceptions.
The prognosis was grim: a short lifespan of three to four years and possible lifelong hospitalization.
The approaching election presents a critical opportunity to influence the future of reproductive rights in America. The outcome will determine whether women continue to have autonomy over their bodies and access to necessary medical care. It will also decide if doctors can practice medicine without fear of legal consequences for simply discussing all available options with their patients.
Kash’s story, as shared during an interview I conducted with her in late August, is a poignant reminder of the real-life implications of restrictive abortion laws across the country. Texas has enacted laws that severely restrict abortion access, notably banning abortions at all stages unless there is a life-threatening medical emergency. The lack of exceptions for rape or incest underlines the state’s stringent stance, with severe penalties imposed on providers, including life imprisonment and substantial fines. This legal environment creates significant barriers for both patients seeking care and providers who risk severe consequences for offering, or in some cases even discussing, abortion services.
Kash’s journey began with what was supposed to be a routine ultrasound at 13 weeks. As she recounts, her scan seemed normal, and she even texted her husband with relief. But she was told to wait for her doctor to immediately review her results. Her obstetrician performed a full exam, even gave her a flu shot and then casually mentioned that her baby’s limbs were measuring shorter than expected and she required further evaluation, but she shouldn’t worry. To Kaitlyn, that was a red flag. As she recalls, she got in her car, called her husband and burst into tears.
Kash’s prior experiences with pregnancy complications gave her an advantage in navigating medical complexities like this, but it also heightened her awareness of the potential severity of the diagnosis. She immediately sought an appointment with a maternal-fetal medicine specialist (one of only three in the region), knowing that severe skeletal dysplasia could lead to serious outcomes for the baby.
She was told that her unborn child was likely to develop osteogenesis imperfecta, a severe condition where bones are prone to breaking, causing lifelong pain. The specialist, with 35 years of experience, had only encountered two cases as severe as hers. He explained that bone fractures could start occurring soon, even during normal activities like picking up her child. Delivery would be traumatic and likely require a C-section, with risks of further bone fractures. The prognosis was grim: a short lifespan of three to four years and possible lifelong hospitalization. Faced with these realities, Kash assumed the conversation would lead to discussion of terminating the pregnancy that she so desperately desired.
“I just sat there thinking, okay, he’s gonna talk about abortion, right?” Kash told me. “He’s gonna say, ‘This is your option,’ right? And he didn’t, he just said we could do CVS” (chorionic villous sampling, a prenatal test that samples tissue from the placenta.) “What is that gonna do?” she recalled asking. “And he goes, ‘Well, it’ll just give us a name.’ And he said, ‘I need to set you up with palliative care’ and I think in my head, ‘I’m not delivering this baby.’”
Kash waited for her doctor to talk about options, but he didn’t. And it became clear that it was because he couldn’t.
Kash waited for her doctor to talk about options, but he didn’t. And it became clear that it was because he couldn’t.
“I said, ‘This is something you would terminate, right? Like prior, if this had been a few months ago, right?” Kash said. Senate Bill 8, Texas’ strict abortion ban, had passed weeks prior, placing doctors at risk of criminal penalties to discuss abortion. “And he said, ‘In the two cases that I’ve seen, the women ended their pregnancies and went on to have successful next pregnancies. But I can’t tell you that, right?’ And I said, ‘Okay.’ And he goes, ‘Right, that’s it.’ He couldn’t say anything.’”
The doctor did recommend Kash leave Texas promptly to get a second opinion, which she realized was the only way he could tell her that he couldn’t take care of her health properly. The same doctor later admitted to her that after Katilyn left, he broke down crying in his office. She said that emotional grip that doctors often avoid has been ubiquitous for reproductive health providers and their staff: “They all say the same thing: ‘We go home and cry.’” As Kash’s story illustrates, restrictive abortion laws like Texas’ SB8 create an environment where doctors are unable to provide clear guidance on termination options due to legal constraints. This lack of communication can add unnecessary stress and anxiety for patients facing already difficult decisions. In Kaitlyn’s case, her doctor was unable to openly discuss termination as an option because of fear of legal repercussions. And when there is already a shortage of maternal health specialists, even one doctor going to jail translates to hundreds if not thousands of patients never receiving compassionate care. Kash set out to find a clinic that would treat her, but it wasn’t easy. It required days of calls, dozens of faxes, consent forms, waiting for call-backs and every minute that went by Kaitlin was concerned that her baby’s bones were breaking and that one more day could mean unnecessary pain for the baby. Eventually she found a clinic in Kansas and had to make the trip alone, without her husband, due to security concerns for the workers at the clinic. She had to undergo the procedure with no anesthesia so that she could drive herself back home. Kash had the abortion performed and her doctor gave her instructions for post surgical care. But unlike every other surgery, she could not seek follow up care in her own home state; she would have to rely on an underground secret glossary to seek post-op care if she needed it without placing herself or her care team in legal danger. Kash eventually had the child she desired, but the grief and mental anguish is still fresh, like a stone in her shoe that is constantly there. Her experience, like those of so many others, lays bare the injustices that women and men face when seeking health care. Kash describes herself as being “in the worst club” — of mothers who wanted children and have nothing to show for it, after going through incredibly painful and grueling experiences like her Kansas abortion. The dark humor underscores a nontrivial number of women who, like Kaitlyn Kash, find themselves grieving in perpetuity.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
