Dr Tony Ogburn
Eight months after the fall of Roe v. Wade, Vanessa Garcia lay on a hospital table in Texas’s Rio Grande Valley, as a technician performed an ultrasound. Garcia had given birth to two children with no complications, but her third pregnancy seemed alarmingly different. The ultrasound revealed that her placenta was covering her cervix—a condition, known as placenta previa, that heightened her risk of hemorrhage or preterm birth.
Garcia was referred to a maternal-fetal expert at D.H.R. Health Women’s Hospital, in Edinburg, Texas, and began going in for weekly ultrasounds. She approached the visits as an opportunity to catch a glimpse of her daughter, whom she had named Vanellope. Before driving to appointments, she got in the habit of drinking half a gallon of water, hoping that it would contribute to a clearer image. During scans, she gazed at the monitor, watching raptly when Vanellope lifted her hand to her eyes, as if gently rubbing them.
At the start of her second trimester, Garcia returned to the hospital and followed a now familiar routine, uncovering her belly and resting on a table. On this visit, though, the technician kept moving the probe across her skin for an unusually long time, without ever turning the monitor to face Garcia. Then she rose and left the room, without saying a word.
Alone, Garcia couldn’t resist examining the images. The baby was curled into a ball, looking eerily still. Instinctively, Garcia snapped a photo and texted it to her husband, a manager at a supermarket chain. He was checking inventory as he opened the text and told himself, “This isn’t real.” Then a doctor walked in and informed Garcia that her daughter’s heart had stopped.
Garcia was fifteen weeks into her pregnancy, and, in cases of miscarriage in the second trimester, the safest treatment is a surgical removal or a medical induction of labor. Instead, she was “discharged to home self-care,” as her chart notes. All Garcia could do was wait until she had a natural miscarriage. The thought of it terrified her. What if she hemorrhaged in the middle of the street? Or in the car, picking up her children from school? Her doctor’s only departing instructions were: if you start bleeding or develop a fever, check into the hospital immediately. (The doctor did not respond to requests for comment.)
A mournful silence settled in Garcia’s home. Her husband busied himself, but there were only so many times he could empty the trash or mow the lawn. Garcia spent most of her days lying in bed. In a corner of their bedroom sat purchases she had made for the baby: diapers, a snuggly blanket, and now a small urn.
Garcia’s situation was not unique. Across Texas, reports were surfacing of women being sent home to manage miscarriages on their own. In 2021, the state had passed a law known as S.B.8, banning nearly all abortions after electrical activity is detected in fetal cells, which typically happens around the sixth week of gestation. The law encourages civilians to sue violators, in exchange for the possibility of a ten-thousand-dollar reward.
From a medical standpoint, the treatment for abortion and miscarriage was the same—and so, even though miscarriage care remained legal, physicians began putting it off or denying it outright. After Roe was overturned, the laws in Texas tightened further, so that abortion was banned at any phase of pregnancy, unless the woman was threatened with death or “substantial impairment of a major bodily function”. Violations could send practitioners to prison for life.
After a week of increasing pain and anxiety, Garcia noticed that her belly seemed to be flattening, and she couldn’t help wondering if Vanellope was still there. Finally, she asked her husband to drive her to the hospital. In the emergency room, a nurse advised her just to keep waiting and “let the tissue pass.” Garcia shot back, “Tissue or baby? Law-wise, it’s a baby, but now you’re telling me it’s a tissue?”
Eventually, her family doctor referred her to another physician: Tony Ogburn, the founding chairman of the ob-gyn department at the nearby University of Texas Rio Grande Valley. Ogburn, a tall man of sixty-four… had come to the Valley eight years before, with a mission to improve health care for women. When he read Garcia’s file, he was outraged. After carrying the dead fetus for weeks, she risked needing a full hysterectomy. Why had she had to wait this long?
When they met, though, Ogburn reassured Garcia that she had options: his team could induce delivery or perform a dilation and evacuation (D&E). The latter option was “emotionally better for most patients”, Ogburn told me. In his experience, it was traumatic enough for a mother to lose a child, without having to go through labor to deliver a corpse. “For a lot of people, the tipping point is, ‘You mean I can go to sleep, and when I wake up it’ll be done?’”
Garcia was torn. For weeks, she had sustained the hope of holding the baby at least once. But she couldn’t summon the resolve to go through labor and return home without her child. Ultimately, she opted for surgery, and the procedure was scheduled for the next day. “I’m sorry,” Ogburn told her. “You should never have gone through this alone at home.”
In the recovery room, when the anesthesia wore off after the surgery, Garcia’s eyes filled with tears. “My first thought was, She’s gone,” she said. But Ogburn had provided a memento: with her permission, he had recorded her daughter’s hand- and footprints on a sheet of paper. “I didn’t get to carry her, but I have that part of her,” Garcia said. Back home, she put the diapers, the blanket, and the urn in storage, and replaced them with the baby’s prints, set in a wooden frame.
Garcia felt grateful to have been referred to Ogburn, but there were few other choices: hardly any physicians in the Valley were trained to perform a D&E.
[The report continues…In New Mexico, Ogburn had conducted studies on how to improve health outcomes for women, and advocated for abortion care to be a part of every medical student’s education. He was invited to open a medical school in the Rio Grande Valley in Texas….]
In the summer of 2016, Ogburn looked on as fifty-five student physicians lifted their right hands to recite the Hippocratic oath. They were the inaugural class at the University of Texas Rio Grande Valley’s medical school….The United States averaged almost three hundred practicing doctors for every hundred thousand people; even in the most populous county of the Rio Grande Valley, the ratio was less than a third of that. Though the Valley included some of the poorest cities in the nation, there wasn’t a single public hospital. The school intended to turn things around.
The idea was to create a practice staffed by doctors who would also teach at the med school and oversee residents at the hospital. Ogburn visited medical facilities around the country, seeking talent. His pitch was meant to counteract the stereotype of the Valley as a region defined by clashes between smugglers and Border Patrol agents—what Ogburn described as “people with machine guns driving around in pickup trucks.” But what stood out most was the moral urgency of his message. “He was the only person that talked about human rights,” Zoe Kornberg, one of the residents he recruited, said. She emerged with a galvanizing idea: “It’s a radical act to make somebody feel cared for and empower them, if they’ve never had that before.”
The article describes how Ogburn set up a very successful clinic and teaching hospital, providing pregnant women with the best of care, and how that programme was destroyed by anti-abortion policies that were interpreted in such a way as to make it impossible to provide miscarriage care, or treatment to prevent haemorrhage, or in fact treat any complication of pregnancy. Every form of standard ob-gyn care was being treated as a felony, due to clinicians’ fear of being put on trial and jailed for life. It led to every ob-gyn working with Ogburn to resign, one by one, not only leaving the hospital but the state of Texas altogether. Others contemplated early retirement. Finally, Ogburn also left and both the hospital and the medical school he had started were shut down.
SOURCE: The Texas Ob-Gyn exodus, by Stephania Taladrid. New Yorker. 25 November 2024. PHOTO: Christopher Lee for the New Yorker.