Tennessee woman gets emergency hysterectomy after doctors deny early abortion care

(NEW YORK) — Mayron Hollis said she had just started taking contraceptives when she found out she was pregnant again a few months after giving birth in February 2022. Despite the surprise, Hollis and her husband say they were excited about the pregnancy and eager to add another child to their growing family.

Hollis, 32, had no idea the excitement would turn into a fight for her baby’s life and her own.

The Tennessee woman would end up needing a lifesaving emergency hysterectomy, ending her opportunity to give birth to more children, after she says she was denied medically necessary abortion care at a hospital in her home state for life-threatening complications earlier in her pregnancy.

“[My doctor] told me I needed to do the surgery. If I didn’t, I could die; the baby could die,” Hollis said.

Because she had delivered by cesarean section and the two pregnancies were so close together, Hollis’ OB-GYN was worried she could develop a cesarean scar pregnancy, a type of ectopic pregnancy where the fertilized egg is implanted in the cesarean scar after a previous C-section, which can cause the uterus to rupture, leading to excessive bleeding and even death, according to the National Institutes of Health.

In August, Hollis found out that she did have a cesarean scar pregnancy, with the pregnancy bulging out of her uterus, and a placenta accreta — a serious pregnancy complication in which the placenta grows too deeply into the uterine wall and part or all of the placenta then remains attached to the uterine wall during delivery. The condition can cause severe blood loss after delivery, according to the Mayo Clinic.

“I [could] hemorrhage, because that was already bulging out,” Hollis said. “It was scary.”

Hollis was eight weeks pregnant when she met with a maternal fetal medicine specialist, who confirmed that she had a cesarean scar pregnancy and sent her back to Vanderbilt University Medical Center for care.

Vanderbilt University Medical Center said it would not comment on the case.

Because she wanted the baby, Hollis said it took her and her husband time before they were able to decide that they wanted to end the pregnancy because the risk it posed to her life was too high.

Hollis said she was unaware of the changing landscape in Tennessee after the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights. A trigger ban prohibiting nearly all abortions went into effect in Tennessee on Aug. 24, 2022.

Hollis said her doctor did not explain to her that there was a narrow window in which she could receive care before the ban went into effect.

One day before the ban went into effect, medical records show that in the early weeks of her pregnancy, Hollis’ placenta accreta had progressed and was “concerning,” according to her medical records. She was 11 weeks pregnant at the time.

“It was a hard pregnancy. It was scary the whole time,” Hollis said.

“They thought they were gonna have to reconstruct my bladder. They didn’t know if it was gonna touch any other organs — if they could even stop the bleeding if I did start to hemorrhage,” Hollis said.

When the couple realized how big the risk was to Hollis’ life, they decided it was best to end the pregnancy.

Hollis had been offered abortion care since the ban had not yet gone into effect. But when she reached out to her OB-GYN to ask for the care on Aug. 24, it was too late. That was the day Tennessee’s trigger ban prohibiting all abortions went into effect.

The ban criminalizes performing an abortion, making it a felony. An exception to save the life of the mother or prevent serious and permanent bodily injury only comes into play when a physician is defending themselves in court after they have been charged with the felony. A separate so-called “heartbeat ban” that prohibited all abortions after fetal cardiac activity is detected was also in effect.

Physicians told ABC News the exception is unclear and many worry about the consequences they could face for providing essential care.

The procedure Hollis needed was complex and required a number of physicians from different specialties to perform. Not enough physicians were willing to provide the care with the ban in effect, according to Hollis.

A specialist would have needed to inject the pregnancy with something to stop the heart before physicians from other specialties could provide abortion care that would preserve Hollis’ fertility, Dr. Sarah Osmundson, a maternal fetal medicine specialist in Tennessee who treated Hollis later in her pregnancy, told ABC News.

There is a very narrow window in which pregnancies with placenta accreta can be terminated without the need for a hysterectomy, due to the excessive bleeding that the condition causes, according to Osmundson. The window generally closes at around 12 weeks of pregnancy, Osmundson said.

Few facilities would have been able provide the complex care needed to preserve her fertility, according to Osmundson.

Hollis was recommended a facility in Pittsburgh, but she said traveling for care wasn’t an option because Hollis and her husband both needed to work and couldn’t afford to take time off.

Under the ban, Hollis was told the only way doctors could intervene was if her life was in danger, so she had to continue her pregnancy.

“Because of everything that was going on, they didn’t know what was the right thing to do was. So the only way to save me was for something bad to happen to me,” Hollis said. “That’s how it felt anyways.”

“They really had no answer for me the whole time I was pregnant. It was the scariest thing I ever did. [Doctors were] telling me that my pregnancy wasn’t viable, but we can’t send you anywhere and we can’t do anything to help you. So it’s just a lot of prayers for me. Reading up and just having a lot of faith,” Hollis said.

Procedure to deliver and save her life

As her pregnancy progressed, it had gradually attached to her bladder and her accreta progressed to placenta percreta — meaning her placenta grew through the uterine wall and attached to surrounding organs, Hollis said.

At one point she had to be put on bedrest because doctors were worried her uterus could rupture, Hollis said.

Hollis was admitted to the hospital at 25 weeks pregnant after she began excessively bleeding, according to medical records. After staying in the hospital for four days, Hollis said she went home. It was almost Christmas.

One day after returning home, Hollis was taken back to the hospital after she began significantly bleeding again, according to medical records.

Before she had the hysterectomy, Hollis said she had to write a will and tell doctors whose life to prioritize if they could only save her or the baby.

She had a cesarean delivery and an emergency hysterectomy in one procedure, according to medical records.

“I didn’t want the hysterectomy. But they said that was the only way that they could stop the bleeding to help me, so I didn’t have a choice,” Hollis said.

Hollis said she lost so much blood that doctors set up IV lines in both arms, both legs and her neck, allowing for a large transfusion of blood. Medical records show she was given eight units of packed red blood cells and six units of fresh frozen plasma. Hollis probably lost at least 2 liters of blood, Osmundson said.

“She could have easily died at another institution,” Osmundson said.

By the time Hollis was 26 weeks along, there was no other option than to perform an emergency hysterectomy to be able to stop the bleeding, Osmundson said.

An amendment was recently added to the Tennessee ban allowing abortions for ectopic pregnancies, so physicians are now able to treat patients with complications similar to Hollis, but Osmundson said there are still other cases where doctors are unsure how to act.

“So much of medicine is gray areas,” Osmundson said. “Regulating these complex decisions will result in people getting hurt and will result in people dying.”

Hollis’ baby, whom she named Alayna, was delivered so premature she was in an incubator for a month, Hollis said. She slowly graduated to different beds at the hospital. The baby was delivered on Dec. 13, but she was only able to go home on Feb. 23, needing oxygen and other interventions at the hospital.

Since the newborn returned home in February, she has been taken back to the hospital five times, Hollis said. The longest she has been at home since February was for two weeks.

“I thought I lost her one time for like five minutes. She turned colors and I had to wait on the ambulance to get here, doing CPR and an off-duty cop showed up,” Hollis said. “He did CPR on the hood of his car and saved her life.”

Hollis said the baby’s lungs are not fully formed and she is not growing as fast as she could be. She had only been eating through a feeding tube through her nose, but just started taking food by mouth, according to Hollis.

“[I’ve] just been stressed out a little bit not knowing what’s going to go on with my daughter, how I’m gonna get her what she needs and what’s gonna happen next. So I’m just trying to hang in there,” Hollis said.

“I’m very adamant to make sure that I’m on top of her care,” Hollis said. “It’s been really hard to go back to work because I don’t have the means to pay for the adequate care that she needs. So I’ve been trying to get help.”