UPDATE: On Tuesday, the Texas Senate approved House Bill 7, which will incentivize people to bring $100,000 lawsuits against anyone who makes, sends, or transports abortion medication in Texas, regardless of where they’re located. The bill is headed to the governor to be signed into law. This story has been updated to reflect the development.
Five years ago, when Felisa Yzaguirre became a licensed certified professional midwife in Texas, she couldn’t imagine a time when she wouldn’t deeply connect with the ceremony of birth, as she calls it.
The Xicana indigenous El Paso native felt it was her ancestral calling to step into the practice after having her own child. She was excited to support Spanish-speaking providers as a community midwife rooted in traditional indigenous practice and focused on de-colonizing midwifery. She began attending births in 2014 as part of her studies, helping pregnant patients through hours and hours of labor.
But working as a midwife for the last three years in Texas — under some of the country’s most restrictive abortion bans — has meant taking on a new invisible labor.
Every woman and femme understands the weight of invisible labor. The little unpaid tasks that live rent-free in your brain: knowing what’s in the fridge, locating that piece of paper that was on the counter for months, cleaning the forgotten place behind the toilet, making grocery lists, remembering everyone’s schedules (not just your own), watering the plants, planning the family’s birthday presents, researching doctors, building community and friends.
“Invisible labor” is a term coined to describe the countless, often unnoticed, necessary duties (primarily) women take on both at home and in the workplace. It often takes the form of unrewarded and unrecognized emotional work and project management that quietly prevents the home and office from falling apart — and it’s why so many women, particularly working moms, are run ragged.
Reproductive healthcare, including abortions, has been increasingly described as “invisible labor” to “highlight the critical work undertaken by abortion providers not only to comply with regulations, but also to minimize the burden that new laws impose on patients,” according to one study in the National Library of Medicine. “This labor provides a crucial bridge in the preservation of abortion access.”
As the writer Hannah Giorgis said in The Atlantic, Rachel Somerstein’s book “Invisible Labor: The Untold Story of the Cesarean Section” posits “that the U.S. health-care system has come to devalue the importance of human touch, relationship building, and interpersonal support.”
In Texas, that invisible labor is even heavier. In recent years, anxiety, confusion, and legal fears have left many women wondering if the risk of pregnancy is worth their own lives. And many midwives and other healthcare providers have questioned if they can keep going in Texas.
“I’ve had to take a break because of the extreme level of need and witnessing so much that people are living through has really, just like left me in a place of burnout,” Yzaguirre said. “The need is so high.”
This Labor Day, typically a day of rest for America’s workers, represents a chance to spotlight the quiet, grueling work reproductive healthcare workers — and their patients — have taken on under Texas abortion bans. It is just one of the consequences of a cruel conservative movement: The more dangerous pregnancy is for Texans, the more laborious. And the more of a professional and emotional toll caregiving takes on healthcare providers.
Coincidentally, Monday also marks four years since the state banned abortions after a fetal heartbeat is detected, usually around six weeks. The law, passed in 2021, made Texas the first state in the country with a bounty hunter abortion ban, which incentivizes citizens with a cash “bounty” if they succeed in suing anyone who has helped a person get an abortion. Last week also marked three years since Texas’ trigger ban outlawed almost all abortions in the state when Roe v Wade was overturned.
In the years since those laws were enacted, data, research, and reporting have shown that infant deaths rose considerably, as did the maternal mortality rate, cases of sepsis, and mental health distress in women and teens, not to mention the $15 billion in expected economic losses for women and businesses.
And yet, Republicans are moving to add another ban on reproductive healthcare. Last week, the Texas House passed House Bill 7, essentially replicating the bounty hunter law, this time for abortion medication like mifepristone and misoprostol. The House version, as it stands, would restrict the manufacture, prescription, and distribution of abortion-inducing drugs in Texas. It would incentivize people to bring $100,000 lawsuits against anyone who makes, sends, or transports abortion medication in Texas, regardless of where they’re located.
Late Tuesday evening, the Senate passed the bill, after which it heads to Gov. Greg Abbott’s desk.
“This bill only works if we turns Texans against each other,” said state Sen. Carol Alvarado, a Democrat, while speaking against it. “Imagine living in fear of the man standing behind you at the pharmacy… every word every conversation could be twisted into evidence. It’s surveillance in isolation. This bill will put women in impossible and life-threatening situations.”
“It’s an attempt to turn a Texas abortion ban into a nationwide abortion ban,” she added. “Women are already begging for basic care. This bill only makes it harder.”
State Sen. Molly Cook, also a Democrat said, “It is my honor to fight for the rest of my life to repeal these bills.”
State Rep. Jeff Leach, the bill’s Republican author, said it would shield licensed hospitals and licensed physicians in the state, and anyone who manufactures or distributes the drugs for “legitimate medical reasons,” the Texas Tribune reported.
But many of those working in this space don’t buy it — and doctors disagree with the use of “legitimate” in this context.
“The words that are written on the paper often don’t match exactly what’s going on. It is going to restrict the ability to have access to the medications that we need to provide good care for people who are pregnant and non pregnant,” said Houston-based gynecologic and obstetrics specialist Dr. Anitra Beasely.
What does that look like? According to Beasely, that means “people who have miscarriages, who go to the pharmacy, have to prove the fact that they are having a miscarriage and not an abortion in order to get the medications that they need.”
“That is happening right now,” she said.
For Beasely, that means spending additional — and unnecessary — time on the phone with pharmacists, rewriting prescriptions, and figuring out how patients can get the drugs that they need. A delay in this type of care is not simply an inconvenience, it could be deadly. This will undoubtedly get worse if the bill is passed into law. “Those particular laws aren’t in place right now, so I know that with SB 7, it’s going to be even worse,” Beasely said.
If Texans lose access to abortion medication like mifepristone and misoprostol, it means doctors like Beasely won’t be able to offer their patients the standard of care expected in a developed country.
Dr. Austin Dennard, a Dallas-based OB-GYN, told The Barbed Wire: “I myself (prescribe) misoprostol daily in my life at work for aid of preventing hemorrhage during a delivery, whether that is on labor and delivery, or whether that’s in management of miscarriage care.”
Restrictive abortion laws in Texas didn’t just start, it’s been a more than 20-year fight, but for Dennard and Beasely, the exacerbation feels compounded.
“If I can’t stop the bleeding, there’s not enough blood in the world to transfuse to help someone who’s continuing to bleed, and that would just be utterly devastating to have to watch someone die for something that should be treatable,” Beasely said.
Porsha Ngumezi died in 2023 at a Houston hospital because she lost too much blood and doctors delayed giving her abortion care after a miscarriage, ProPublica found. So far in Texas, there have been three documented deaths, but experts say it’s a gross undercount because the state refuses to investigate maternal mortality rates, leaving journalists or independent researchers alone in tracking any data they can get access to.
Dennard and Beasley have stayed to care for Texas patients so far, but both admit that they have thought about what it would be like to leave Texas. They’re just two examples of the 44% of doctors in the state who feel the same.
“Texas Republicans have taken a lot from me, professionally, but also personally, because of how these abortion laws have affected my own life and my own fertility journey and my own journey with my husband building a family,” Dennard said. “Feeling so judged and feeling so abandoned by a state where I have lived my entire life, where my family has been for six generations, is a type of pain that is hard to describe, and the distress and cruelty of having to navigate getting standard medical care and fleeing your state is just absolutely unacceptable.”
“If all of the doctors who felt like me, all of the providers, who felt like me left? Who would remain to take care of the patients we already know live in maternity deserts and reproductive health care deserts,” Beasley said. “If everyone left, what I mean, what would that be like?”
In another five years, Texas is expected to have 15% fewer OB-GYNs than is needed to keep up with demand. Already more than 45% of Texas counties are considered maternity care deserts, meaning there’s no doctor to see during pregnancy and nowhere to give birth, according to the Texas Tribune.
As a community midwife, Yzaguirre is part of a small solution to rural maternity care deserts. She’s seen a drastic increase in midwifery needs at the same time she’s been legally restrained in the ways she can help a growing number of clients.
“Having access to just general life saving medications that we use as home birth community midwives is harder because there’s this notion that it’s going to be used in a ‘wrong way,’” Yzaguirre said. “But the truth is, having access to those meds really helps us save people in emergency situations, which feels silly to be looking at one thing and talking about being pro-life and then totally denying this spectrum of realities that exist.”
Today, Texas women have a 155% higher risk of maternal death than those in California, according to a report from the Gender Equity Policy Institute. Maternal mortality rose 56% in Texas in the first full year of the state’s abortion ban; up 95% among white women and Black mothers, who are 3.3 times as likely to die as white mothers. For Texas Latinas, the risk is nearly tripled.
This, too — the increased risk of dying in pregnancy, and the resultant fear — is additional emotional labor.
But the cost to Texas women doesn’t stop there.
Terrifying pregnancy stories like the one about Joseli Barnica, a 28-year-old immigrant mother from Honduras who died during a miscarriage at a Houston hospital, weigh heavily on families who seek help from Yzaguirre. The extra layer of an increase in immigration enforcements have also brought a lot of fear to communities Yzaguirre works with. This past December, a Mexican mother was deported along with her two newborn baby girls because she missed an immigration appointment due to an emergency c-section at a Houston hospital.
“So many people are either choosing home birth or choosing care out of midwives, not because they maybe truly desire that, but out of fear of what would happen,” Yzaguirre said. “The policing of bodies has always been happening, but now it seems to be ramped up.”
If it seems the stakes are ramped up, that’s because they are.
In 2023, after a successful IVF journey, Kaitlyn Kash delivered a healthy baby girl but nearly died in the moments after, while her husband was holding their baby.
“What I really want women to understand is, you may think that this issue isn’t about you, but you need to understand that a D&C, misoprostol, mifepristone, all of these things are billed under abortion,” Kash said.
A placenta is typically delivered within 30 minutes of birth, but Kash had a retained placenta, a common cause of major hemorrhaging and obstetrical morbidity, according to research from Harvard Medical School. Kash had to wait nearly two hours to get a minor abortion procedure called suction dilation and curettage to remove the placenta from her uterus.
“I almost died because of a completely preventable thing,” Kash told The Barbed Wire.
“If you think (all) abortion means ending an unwanted pregnancy, you are wrong,” she said. But, with more restrictions on these medications, it’s only going to get worse. “When it does happen to you, you’re going to have even less access to care than I did.”
House Bill 7 was quickly passed through committee and through the House, but not before members of the Texas Medical Association pleaded with lawmakers to vote down the bill. “‘This bill as filed runs the risk of having a chilling effect on our physician’s ability’ to make the best health care decisions for patients,” said Dr. Zeke Silva, the chair of the association’s council on legislation, according to the Texas Tribune.
“Abortion medication should be renamed pregnancy aiding medication,” Dennard told The Barbed Wire. “The terminology is stigmatized and can be very triggering for people, because they might not realize how universally these medications are needed to keep pregnant people safe.”
It’s unknown what the far-reaching implications of yet another abortion ban will mean for the safety of Texas families and their children, but it is clear that this is yet another consequence of unscientific legislation that people with a uterus will have to bear.
And the next generation is defiantly against it.
“As scary as it is and as difficult as it is to navigate this space as a 20-year-old, it gives me a lot more freedom, and I am able to unapologetically do my work,” DakotaRei Frausto, a San Antonio-based full spectrum doula, told The Barbed Wire. She said she had to flee the state to get an abortion when she was 17. Most of her clients are teenagers with unplanned pregnancies, many of them as a result of family abuse.
Doctors point out that these laws and policies disproportionately impact people of color, minors, people in the LGBTQ community, people who live in rural areas, and people with low incomes.
“It is scary especially as an indigenous queer person. That comes with even more levels of uncertainty and even more levels of danger,” Frausto said. “I owe it to everyone before me to resist in that way.”
“My grandma wasn’t able to continue her high school education because she got pregnant and was kicked out of her house and forced to marry a man who was way too old for her and was physically, emotionally and sexually abusive to both her and her children,” Frausto added. “That went on to impact my mother, who then also got in a domestically violent relationship and was trapped in that and so for me, I feel like I owe it to break that cycle for myself, but also break that cycle for other people.”
Real Texans, like Frausto and those who come after her, will continue to pay the price of these laws.
Yzaguirre is on sabbatical from birth work, incorporating rest and joy. But she’s also working with local public health departments to discuss midwifery models of care as a public health solution to the increase in maternal mortality rates. There are only about 500 certified nurse midwives practicing in the state, though studies from the World Health Organization show that investing in more midwives could prevent about two-thirds of maternal deaths, newborn deaths, and stillbirths by 2035.
“We’re always looking for someone to save us, and it might sound harsh, but no one’s going to come to save you,” Yzaguirre said. “I’m always going to be a community advocate for birth, and I am going to continue to create systems where we can gather as people, whether that is organizing, making equity centered collaborations as part of my mission, and expanding what it means to be a midwife, because midwives don’t only attend births.”
“Beyond sustainability, I want to thrive in my life, so that if I choose to go to birth, I’m well,” she said.
We can only wish the same for all Texas women.