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."

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?

"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.

Transcript

ARI SHAPIRO, HOST:

Texas has some of the most aggressive abortion laws in the country. It's the only state where the maximum penalty for providing an abortion is life in prison. Our next story is about a woman in Texas whose doctors were so afraid of these laws, some wouldn't say the word abortion out loud. NPR's Selena Simmons-Duffin reports for our series Days & Weeks.

SELENA SIMMONS-DUFFIN, BYLINE: Lauren Miller is 35. She lives in Dallas with her husband, Jason, and they have a 1-year-old, who she says is not a big eater.

UNIDENTIFIED CHILD: (Inaudible).

LAUREN MILLER: Breakfast is 90% throwing yogurt, sometimes eating cantaloupe, sometimes just giving it straight to the dogs (laughter).

(SOUNDBITE OF DISHES CLATTERING)

SIMMONS-DUFFIN: She and Jason were thrilled to find out she was pregnant again in late July, but it was making her feel way worse than her first pregnancy. At eight weeks, she started throwing up and couldn't stop.

MILLER: Not even tea, not water, not Sprite, nothing was staying down.

SIMMONS-DUFFIN: She was worried. So she went to an ER. for nausea medication and IV fluids. They did an ultrasound.

MILLER: And that's when we found out about the twins.

SIMMONS-DUFFIN: That explained why she felt so awful. Twin pregnancies can cause severe morning sickness. At first, she felt overwhelmed.

MILLER: But within a few days, we were getting excited. I always wanted three. So it's kind of like, hey; I'm going to, you know, knock this out. I got a two-for-one special.

SIMMONS-DUFFIN: About a month later, Miller was at a 13-week prenatal appointment, when it seemed to her that something was off. Miller's OB-GYN was willing to speak with NPR anonymously because she was not authorized by her employer to speak with the media. Here she is.

UNIDENTIFIED DOCTOR: We were starting to see signs in one of the twins that was consistent with what we see a lot of times with some abnormal genetic results.

SIMMONS-DUFFIN: The first concerning sign...

UNIDENTIFIED DOCTOR: One twin was significantly smaller than the other.

SIMMONS-DUFFIN: Her doctor called the smaller twin Baby B. The other twin was called Baby A. Miller says Baby B wasn't just smaller.

MILLER: They also saw what is called a cystic hygroma. And that's where there was just, like, a lot of fluid where the brain should be developing.

SIMMONS-DUFFIN: To find out what was going on genetically, Miller needed the results from a blood test.

MILLER: Monday morning, the screening results hit my inbox.

SIMMONS-DUFFIN: The results were worse than she'd expected. Baby B had trisomy 18, or Edwards Syndrome. About 90% of fetuses don't survive until birth. Of those that do, half die within the first week. Miller was devastated. A few hours later, a genetic counselor called her and told her this.

MILLER: Every day that Baby B continued to develop, it put Baby A and myself at greater risk, just 'cause there's the higher risk inherent to a twin pregnancy.

SIMMONS-DUFFIN: The risks to her include high blood pressure, diabetes and bleeding at delivery. The risks to the other twin is that Miller could go into labor too early. Depending on how early, Baby A might not survive or might have health problems. So Miller asked the genetic counselor, what can I do?

MILLER: She was trying to answer, but it was just, like, so difficult for her. She was like, well, you know, when I was practicing in New York, they would do a single fetal reduction. But, you know, you can't do that in Texas now.

SIMMONS-DUFFIN: That's because it's an abortion procedure to turn her twin pregnancy into a single pregnancy that she'd be more likely to carry to term. There are no less than three laws outlawing abortion in Texas. There's a pre-Roe ban, a trigger law that outlaws abortion from conception and SB-8, which outlaws aiding and abetting abortions.

MILLER: Nowadays, with the way we've got this little bounty-hunter system in Texas, doctors are going to err on the side of caution.

SIMMONS-DUFFIN: The day after Miller and her husband got the screening results, they went to a different OB-GYN who specializes in high-risk pregnancies. She had another ultrasound. Baby A looked fine, but she says the scan of Baby B was heartbreaking.

MILLER: An incomplete abdominal wall. The cystic hygromas had gotten larger. There was already abnormalities he was seeing with the heart as well.

SIMMONS-DUFFIN: The doctor had trouble getting the tissue sample he needed to confirm the diagnosis. After several attempts, she remembers he threw his gloves in the trash and turned to her. He said, this baby is not going to make it to birth. To her, his directness was refreshing. Then he said this.

MILLER: 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.

SIMMONS-DUFFIN: She decided that's exactly what she was going to do - leave Texas to abort Baby B so that Baby A would have a better chance.

MILLER: And we knew we needed to act fast just because of how sick I was.

SIMMONS-DUFFIN: Plans came together quickly. A friend connected her with a doctor in Colorado. She made an appointment for the following week. She remembers what it felt like to get ready for that trip.

MILLER: It kind of, like, felt like this secret mission - like, we've-got-to-escape kind of feeling. I'm from Texas. I'm an eighth-generation Texan. Like - and to be feeling like I need to escape the state was just a bizarre sensation.

SIMMONS-DUFFIN: Lauren and Jason Miller flew to Colorado the night before their appointment. It was on Tuesday, Oct. 4.

MILLER: They did the ultrasound. We saw him one last time, took one last photo of the twins together so that we would have that. And then they, you know, kind of turn the screen away, like, OK, like, are you ready? We'll begin. It was a single needle. They injected it, and then they were done.

SIMMONS-DUFFIN: 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. Baby B stops growing, and Baby A continues to grow. The whole thing just took a few minutes.

MILLER: Then they were like, you know, we'll give you the room. As soon as they left, I was just, like, sobbing. But it really was just sad. Like, this was very much a wanted pregnancy. And so that was, I think, the first time that we were really confronted fully with the loss.

SIMMONS-DUFFIN: The next day, she was back in Texas. She felt physically better right away - no more nausea and relief that she had acted to safeguard her pregnancy with Baby A. But her fear about Texas' abortion laws lingered. At her next prenatal appointment she wondered, could the ultrasound technician report her?

MILLER: You don't know where anybody stands on stuff, so it feels like we're all kind of talking in code. Like, I'm pretty sure, like, 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.

SIMMONS-DUFFIN: It has been nearly five months. Lauren Miller has been processing her experience.

MILLER: Honestly, overall, I've been so overwhelmed by just anger at how much additional stress we've had to go through.

SIMMONS-DUFFIN: And additional costs. She estimates it cost about $3,000 for her to travel to Colorado for the abortion. She knows most people can't drop that much money on short notice. Miller's doctor says her pregnancy is still progressing well and that she admires her.

UNIDENTIFIED DOCTOR: She's an extremely resilient, you know, just phenomenal, strong woman. And it was not easy. You know, we have gone through all the feelings together - sadness, anger. You know, it just - you go through the stages of grief.

SIMMONS-DUFFIN: Miller is grateful she was able to get the care she needed and that she only lost one of her twins. She's due in late March. She says, I'm still coming out of all of this with a baby. Selena Simmons-Duffin, NPR News.

SHAPIRO: And tomorrow on Morning Edition, Selena takes a deeper look at whether it is really illegal for doctors to talk to their patients about abortion in Texas.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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