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To safeguard healthy twin in utero, she had to 'escape' Texas for abortion procedure

Lauren Miller at her home in Dallas, Texas, in January 2023. When she was 15 weeks pregnant, she traveled to Colorado to have a "selective reduction" abortion, after one of her twins was diagnosed with a fatal condition.
Nitashia Johnson for NPR
Lauren Miller at her home in Dallas, Texas, in January 2023. When she was 15 weeks pregnant, she traveled to Colorado to have a "selective reduction" abortion, after one of her twins was diagnosed with a fatal condition.

Lauren Miller sensed right away that her second pregnancy was different than her first. She felt horrible.

On Aug. 20, 2022, she wrote in her journal: "I started throwing up at five yesterday morning and it won't stop. It is now the afternoon, over a full day later. I can't even keep down crackers, water, tea."

She was worried about dehydration, so she went to an E.R. near her home in Dallas. She received a bag of IV fluid and medication for the nausea and was told she had hyperemesis gravidarum – severe morning sickness. The E.R. doctor also did an ultrasound. "That's when we found out about the twins," she says.

8 weeks: "Two-for-one special"

"I was just completely shocked because we have no history of twins on either side of our family," she says. Miller, 35, and her husband, Jason, already have a 1-year-old son. But it explained her intense morning sickness; that's a typical side effect in twin pregnancies.

At first, she felt overwhelmed, thinking through all they would need to do to get ready for twins: a bigger car, another crib, more baby gear. "But within a few days we were getting excited – I always wanted three [kids] so it's kind of like I got a two-for-one special," she laughs.

About a month later, though, everything took a turn.

13 weeks: "She can't say much"

"Today is September 23rd and it's not a good day," she wrote in her journal. That day was her 13-week prenatal appointment, and the fetus that her doctors referred to as "Baby B" because it was farther away from her cervix measured much smaller than the other twin. Two fluid-filled masses – called cystic hygromas – were in its head.

She had a blood test that screens for several common genetic conditions, and then she and Jason waited anxiously for the results.

The email hit her inbox on Monday, September 26 at around 9 in the morning. "It's so much worse than I imagined," she wrote in her journal. "It's trisomy 18. It's Edwards Syndrome." Online, she read that about 90% of fetuses with trisomy 18 die before birth, and those that do survive usually only live for a few days. "I just want to throw up. I can't even come up with words to describe how devastating this is," she wrote.

A few hours later, a genetic counselor called her. "It just gets worse," she wrote after that conversation. "Basically, every day that Baby B continues to develop, he puts myself and his twin at greater risk for complications, preterm birth, etc. But she can't say much – she was careful about what she even said."

All that the genetic counselor told her was that, when she practiced in New York, doctors would do a "single fetal reduction," Miller recalls, though she didn't explain what that procedure was, only that "you can't do that in Texas now."

Miller felt like she knew why the genetic counselor was being so cryptic. Selective reduction is an abortion procedure for pregnancies with multiple fetuses. Doctors can selectively terminate one fetus, while another or multiple other fetuses continue to develop. Multiple pregnancies are inherently risky, and selective reduction can increase the chance of a live birth or births.

But now, almost all abortions are illegal in Texas.

In fact, there are three laws banning abortion in the state. One predated Roe v. Wade, dating back as far as 1857. Another was triggered when Roe was overturned and comes with a maximum penalty of life in prison for performing an abortion in the state. Then there's SB-8, that allows people to bring civil charges for "aiding or abetting" a Texas abortion.

Miller says she felt the laws were preventing her doctor and the genetic counselor from telling her all her options in a straightforward way. "Nowadays, with the way we got this bounty hunter system in Texas, doctors are going to err on the side of caution," she says.

She wrote in her journal: "So now we have to scramble – I don't even know what we're doing, but we have to make plans. And I just feel blind and confused and scared and I hate all of this."

14 weeks: "You can't do anything in Texas"

The following day, Miller was able to get in to see another OB-GYN who specializes in high risk pregnancies for a test to confirm the trisomy 18 diagnosis.

There, she had another ultrasound. Baby A looked fine, but the scan of Baby B was "heartbreaking," she says. There were more concerning signs: an incomplete abdominal wall, indications of heart abnormalities, and the cystic hygromas had grown larger. The doctor had trouble getting the tissue sample for the diagnostic test. After multiple attempts, Miller recalls, he threw his gloves in the trash.

"He was very blunt, which was kind of refreshing, [saying], 'Look, this baby is not going to make it to birth,'" Miller says.

Then, she remembers him saying: "You can't do anything in Texas, and I can't tell you anything further in Texas, but you need to get out of state."

Lauren Miller bought a "little brother" onesie to let the grandparents know she's expecting a boy.
/ Nitashia Johnson for NPR
/
Nitashia Johnson for NPR
Lauren Miller bought a "little brother" onesie to let the grandparents know she's expecting a boy.

She decided that's exactly what she was going to do: leave Texas to get an abortion. "We knew Baby B was not viable, and so we needed to look at what to do to protect his twin and myself," Miller says. "And we knew we needed to act fast just because of how sick I was."

Plans came together quickly. A friend connected her with a doctor in Colorado. She made an appointment for the following week, in early October. She and Jason arranged to have their son stay with family, booked a flight and a hotel, and got ready.

"It was so weird packing, kind of like this secret mission," she says. "Which was so surreal. I'm from Texas – I'm an 8th generation Texan – and to be feeling like I need to escape the state was just a bizarre sensation."

15 weeks: "One last photo of the twins together"

Lauren and Jason Miller flew to Colorado the night before their appointment. It was on Tuesday, Oct. 4, one week after the doctor in Texas had told her to leave the state. She was 15 weeks pregnant.

"They did the ultrasound – we saw him one last time, took one last photo of the twins together so that we would have that," Miller remembers. "It was a single needle. They injected it directly [into Baby B] and then they were done.

That was it – the whole thing took a few minutes. There's no removal process in a case like hers, where one twin is healthy – both fetuses stay in her uterus for the rest of her pregnancy. One grows, and one doesn't.

"As soon as they left, I was sobbing," she says. "It was just so many emotions. This was very much a wanted pregnancy. That was, I think, the first time that we were really confronted fully with the loss."

The next day, she and Jason were back in Texas. She felt physically better right away – no more morning sickness – and relieved that she had acted to safeguard her pregnancy with the healthy twin and there were no more decisions to be made.

16 weeks: "Talking in code"

After she returned home, Miller says, her fear of about the abortion laws in Texas lingered. At her next prenatal appointment, as she got her ultrasound and it was clear that Baby B's heart had stopped, she wondered — could the ultrasound tech report her?

Jason and Lauren Miller are expecting their second child in late March.
/ Nitashia Johnson for NPR
/
Nitashia Johnson for NPR
Jason and Lauren Miller are expecting their second child in late March.

"You don't know where anybody stands, so it feels like we're all kind of talking in code," Miller says. "I'm pretty sure they knew we'd gone out of state for an abortion. We knew we'd gone out of state for an abortion – nobody's saying that. Everybody's dancing around it: 'Well, it appears that Baby B has passed.'"

35 weeks: "I'm still pregnant"

It's been nearly five months since Lauren Miller traveled from Texas to Colorado for her abortion. She's been processing all of it at home in Dallas, in between taking care of her one-year-old and getting ready for the new baby.

"Honestly, overall, I've been so overwhelmed by just anger at how much additional stress we've had to go through," she says. There were also additional costs. She estimates it cost more than $3,000 for her to travel to Colorado for the abortion – she's acutely aware that most people can't drop that much money on short notice.

Miller says offsetting her anger is relief she was able to get the abortion, that she is healthy, and that she only lost one of her twins. "I'm still pregnant – I'm still coming out of this with a baby."

Diane Webber edited the audio and digital versions of this story. Meredith Rizzo was the visual designer and developer. Elena Burnett was the audio producer.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Selena Simmons-Duffin reports on health policy for NPR.