New Texas Abortion Guidance Aims to Clarify the Law, but Uncertainty Remains for Doctors, Patients

By Samantha Rubin and Erika Gonzalez

Reporting Texas

By the time patients arrive at the Women’s Reproductive Clinic of New Mexico, many have already spent hours on the road from Texas, sometimes traveling overnight after arranging child care and scraping together money for the trip to access care that is no longer available in their state.

Some walk in quietly, others with questions, but most carry the same burden: the time that passed before they were able to seek care, said Gabriela Theard, a staff member at the Women’s Reproductive Clinic in Santa Teresa, New Mexico, a dozen miles west of El Paso.

Theard, who works directly with patients, said cost and distance aren’t the only obstacles to care for pregnant women in Texas. So is everything that happens before the trip.

“It’s absurd that someone has to drive nine hours,” she said, especially when the appointment may take less than an hour.

Many patients delay seeking care, she said, unsure of their options or hesitant to act under Texas’ restrictive abortion laws.

Both patients and doctors in Texas have been navigating uncertainty since the Texas Legislature in 2022 made it a felony for doctors to perform abortions except when pregnant women are facing life-threatening medical emergencies.

Now, for the first time since Texas banned abortions, the Texas Medical Board has issued formal training intended to clarify when physicians can legally provide abortion care under the medical emergency exception. The guidance follows legislative changes in 2025 that required the board to create educational materials for physicians about the law.

The stakes behind that guidance are significant. Under Texas law, doctors can face penalties of up to 99 years in prison, $100,000 fines and the loss of their medical licenses if they violate the abortion ban. Many have chosen not to provide care, fearing running afoul of the law.

Growing evidence suggests that the legal ambiguity has had measurable health consequences. A ProPublica analysis found that sepsis rates increased by more than 50% among women hospitalized for second-trimester pregnancy loss after the ban, while blood transfusions related to miscarriage complications rose sharply. Researchers at the University of Texas Health Science Center in Houston reported similar trends, with sepsis rates tripling in some cases.

The new training emphasizes that physicians can intervene when a patient’s life or physical health is at risk and that legal risk is “extremely low” if care is evidence-based and properly documented. The training also highlights a shift in legal standards: Prosecutors must now prove that “no reasonable physician” would have provided the abortion.

But research by Physicians for Human Rights found that 44% of OB-GYNs reported changing their clinical practices due to abortion laws, while other studies document delays in care driven by legal uncertainty, raising questions about whether this clarification will meaningfully change how doctors make decisions in practice.

Legal Uncertainty Shapes Medical Decisions

The training follows years of confusion among physicians about how to interpret Texas’ abortion ban, which allows the procedure only in limited medical emergencies.

“It’s black and white in the law, but it’s very vague when you’re in the moment,” said Dr. Tony Ogburn, an OB-GYN in San Antonio.

When a fetus still has cardiac activity, he said, physicians cannot simply follow standard evidence-based care. They must also consider whether a prosecutor could later argue that the patient was not sick enough to qualify for the exception.

“The criminalization of medical decision-making makes the stakes different than it has ever been,” he said.

Blake Rocap, a reproductive rights attorney, said the new guidance is intended to help physicians better understand those limits but does not eliminate the tension between medical judgment and legal risk.

“Doctors can no longer just rely on their medical training,” Rocap said. “They have to understand the new limitations that the law puts on their practice of medicine.”

What may sound clear in a courtroom may not substantially change how doctors behave in clinical settings. Physicians, he said, are unlikely to rely on legal defenses when making decisions and instead might prioritize caution to avoid any risk.

That caution has shaped care across Texas. Physicians have reported uncertainty about whether treatments for miscarriage complications or pregnancy loss could be interpreted as illegal, leading some to delay intervention until a patient’s condition worsens.

Even with the new training, Ogburn said, the gap between legal guidance and real-life medical scenarios remains difficult to bridge.

“They’re taking years and years of medical training and experience on how to manage these cases and summarizing it in 43 slides,” he said.

Supporters Say Guidance Reinforces Existing Law

Supporters of Texas’ abortion law say the new medical training does not change the law itself but clarifies what physicians have always been allowed to do.

“While the law was clear on several things laid out in this medical training, it was apparent that not all physicians understood the law,” said Amy O’Donnell, executive director of Texas Alliance for Life.

O’Donnell said Texas law has consistently allowed doctors to intervene in serious medical situations, including miscarriages and ectopic pregnancies, and to perform abortions when necessary to protect a patient’s life or health.

“This medical training is empowering physicians to do what they’ve been trained to do,” she said. “Exercise their reasonable medical judgment to save a woman’s life or health when necessary.”

At the same time, she acknowledged that some patients may not have received appropriate care in the years since the law took effect.

“We know that there were cases where women did not receive the standard of care allowable under Texas law, which is very unfortunate,” O’Donnell said.

Doctors and advocates say the law has already reshaped medical care in Texas, not just in operating rooms, but through delays, uncertainty and fear that patients experience long before they receive treatment.

“It’s not just the procedure,” Theard said. “It’s everything that happens before they get here.”