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A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments. Thirty-five-year-old Porsha Ngumezi’s case raises questions about how abortion bans are pressuring doctors to avoid standard care even in straightforward miscarriages. by Lizzie Presser and Kavitha Surana. PROPUBLICA Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital’s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.

ProPublica condensed 200 pages of medical records into a summary of the case in consultation with two maternal-fetal medicine specialists and then reviewed it with more than a dozen experts around the country, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in maternal health.

Texas doctors told ProPublica the law has changed the way their colleagues see the procedure; some no longer consider it a first-line treatment, fearing legal repercussions or dissuaded by the extra legwork required to document the miscarriage and get hospital approval to carry out a D&C. This has occurred, ProPublica found, even in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.

Misoprostol, the medicine given to Porsha, is an effective method to complete low-risk miscarriages but is not recommended when a patient is unstable. The drug is also part of a two-pill regimen for abortions, yet administering it may draw less scrutiny than a D&C because it requires a smaller medical team and because the drug is commonly used to induce labor and treat postpartum hemorrhage. Since 2022, some Texas women who were bleeding heavily while miscarrying have gone public about only receiving medication when they asked for D&Cs. One later passed out in a pool of her own blood.

“Stigma and fear are there for D&Cs in a way that they are not for misoprostol,” said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.” Hope visits his wife’s gravesite in Pearland, Texas. Credit: Danielle Villasana for ProPublica

Doctors and nurses involved in Porsha’s care did not respond to multiple requests for comment.

Several physicians who reviewed the summary of her case pointed out that Davis’ post-mortem notes did not reflect nurses’ documented concerns about Porsha’s “heavy bleeding.” After Porsha died, Davis wrote instead that the nurses and other providers described the bleeding as “minimal,” though no nurses wrote this in the records. ProPublica tried to ask Davis about this discrepancy. He did not respond to emails, texts or calls.

Houston Methodist officials declined to answer a detailed list of questions about Porsha’s treatment. They did not comment when asked whether Davis’ approach was the hospital’s “routine.” A spokesperson said that “each patient’s care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson added, “including the abortion law in place in Texas.” “We Need to See the Doctor”

Hope and his two sons outside their home in Houston Credit: Danielle Villasana for ProPublica

Hope marveled at the energy Porsha had for their two sons, ages 5 and 3. Whenever she wasn’t working, she was chasing them through the house or dancing with them in the living room. As a finance manager at a charter school system, she was in charge of the household budget. As an engineer for an airline, Hope took them on flights around the world — to Chile, Bali, Guam, Singapore, Argentina.

The two had met at Lamar University in Beaumont, Texas. “When Porsha and I began dating,” Hope said, “I already knew I was going to love her.” She was magnetic and driven, going on to earn an MBA, but she was also gentle with him, always protecting his feelings. Both were raised in big families and they wanted to build one of their own.

When he learned Porsha was pregnant again in the spring of 2023, Hope wished for a girl. Porsha found a new OB-GYN who said she could see her after 11 weeks. Ten weeks in, though, Porsha noticed she was spotting. Over the phone, the obstetrician told her to go to the emergency room if it got worse.

To celebrate the end of the school year, Porsha and Hope took their boys to a water park in Austin, and as they headed back, on June 11, Porsha told Hope that the bleeding was heavier. They decided Hope would stay with the boys at home until a relative could take over; Porsha would drive to the emergency room at Houston Methodist Sugar Land, one of seven community hospitals that are part of the Houston Methodist system.

At 6:30 p.m, three hours after Porsha arrived at the hospital, she saw huge clots in the toilet. “Significant bleeding,” the emergency physician wrote. “I’m starting to feel a lot of pain,” Porsha texted Hope. Around 7:30 p.m., she wrote: “She said I might need surgery if I don’t stop bleeding,” referring to the nurse. At 7:50 p.m., after a nurse changed her second diaper in an hour: “Come now.”

Still, the doctor didn’t mention a D&C at this point, records show. Medical experts told ProPublica that this wait-and-see approach has become more common under abortion bans. Unless there is “overt information indicating that the patient is at significant risk,” hospital administrators have told physicians to simply monitor them, said Dr. Robert Carpenter, a maternal-fetal medicine specialist who works in several hospital systems in Houston. Methodist declined to share its miscarriage protocols with ProPublica or explain how it is guiding doctors under the abortion ban.

As Porsha waited for Hope, a radiologist completed an ultrasound and noted that she had “a pregnancy of unknown location.” The scan detected a “sac-like structure” but no fetus or cardiac activity. This report, combined with her symptoms, indicated she was miscarrying.

But the ultrasound record alone was less definitive from a legal perspective, several doctors explained to ProPublica. Since Porsha had not had a prenatal visit, there was no documentation to prove she was 11 weeks along. On paper, this “pregnancy of unknown location” diagnosis could also suggest that she was only a few weeks into a normally developing pregnancy, when cardiac activity wouldn’t be detected. Texas outlaws abortion from the moment of fertilization; a record showing there is no cardiac activity isn’t enough to give physicians cover to intervene, experts said.

Dr. Gabrielle Taper, who recently worked as an OB-GYN resident in Austin, said that she regularly witnessed delays after ultrasound reports like these. “If it’s a pregnancy of unknown location, if we do something to manage it, is that considered an abortion or not?” she said, adding that this was one of the key problems she encountered. After the abortion ban went into effect, she said, “there was much more hesitation about: When can we intervene, do we have enough evidence to say this is a miscarriage, how long are we going to wait, what will we use to feel definitive?”

Washington Post editors upping their racism arms race with the NYT

From Reuters:

Diplomacy over Lebanon has focused on restoring a ceasefire based on U.N. Security Council Resolution 1701, which ended the last major war between Hezbollah and Israel in 2006.
It requires Hezbollah to pull its fighters back around 30 km (20 miles) from the Israeli border, behind the Litani River, and the regular Lebanese army to enter the frontier region.
Israel and Hezbollah have accused each other of failing to implement it in the past; Israel says a new ceasefire must allow it to strike any Hezbollah fighters or weapons that remain south of the river.

Not hard to see where this goes - ceasefire for some months, Israel continues airstrikes claiming they are not violating the terms of the ceasefire, Hezbollah retaliates, Israel invades again once Trump is president, no Hezbollah troops in the south means Israel can actually advance. Unless Hezbollah is much worse off than what I would guess, it's hard to see what they get out of this.

The Lie of Singapore

I have written a lot about Singapore and Malaysia here. Posts, here and there, that showcase aspects of their incestuous relationship.

But I never really stated explicitly, or more clearly debunk, the pernicious state narratives that both states and their comprador classes vehemently adhere to.

So I am going to rectify that right now.

Note: communal and racial are synonyms in Singapore and Malaysian politics. See here for elaboration.

General Background

The region was known as Malaya and Northern Borneo, back in the 19th and first half of the 20th century, consisting of the Malay Peninsula and their surrounding islands and the British controlled part of Borneo, but explicitly did not include the Riau Islands, were under Dutch administration or the Southern Thailand provinces, which were seceded to the Thai Monarchy in 1909, even though both regions had Malay majorities.

This region was sorted in more or less 3 distinct types of administrations, the federated and unfederated Malay Sultanates, in addition to the the protectorate of Brunei, in which over time the role of the Sultans diminished as the power of the colonial British advisers grew. The second was the Strait Settlements, British crown colonies which British laissez-faire Capitalism was allowed to flourish, especially in goods that the British were particularly good at trading (smuggling), opium. The colonies in Borneo, Sarawak and North Borneo Chartered Company (Sabah) was land “given” by the British protectorate Brunei to the British. Unlike in Malaya, Sarawak and North Borneo was also under direct control of the British, and Sarawak in particular was under the rule of the “White Rajah” (White King). Missionary influence especially was prevalent here, which resulted in more extensive use of English and Christianity being the majority in the state.

The Strait Settlements were crown colonies located in strategic positions within the Straits of Malacca, and were concentrated in the 3 main ports of Melaka, Penang (now officially called Pulau Pinang) and Singapore. These ports were fully controlled by the British and had appointed governors. The infamous one being Stamford Raffles, so-called founder of Singapore.

Nearing independence in the 1940s and 1950s. Guerrilla warfare was being waged by the Communist Party of Malaya, with membership within their mass organisations nearing 50% of the entire workforce. Furthermore there were unrest in others parts of the Malayan economy. Indian labourers in rubber plantations, Chinese miners in Tin mines, the Malay peasantry facing accumulation by dispossession and oppression by the Chinese capitalists, local Malay landlords, and the general comprador Malay Sultanates and their British advisors.

Independence was the name of the game, with waves of unrest and decolonization swept across East Asia at that time. In China, in Korea, in the Philippines, in Indonesia and in Viet Nam.

Malaya was no exception.

The Official Narrative™️

We gained independence in 1957 - under the "good graces" of the British, who simply let us free after of course, negotiations by the Malay sultans themselves. One infamous speech in which the Yang di-Pertuan Agong (the elected King) screamed the word "Merdeka!" (independence) 7 times and centuries of colonial exploitation just vanishes! At this point, this independence was only for the Malay Peninsula sultanates, and so logically lead to the official name of the federation of Malaya.

After a decades spanning communist guerilla warfare, the so-called 'insurgency', and British inability to maintain and sustain their prized colony in Southeast Asia, and fear of the so-called domino effect if communists and anti-colonial forces were to win, they came up with the Malaysia Agreement. An opaque document that mainly involved negotiations and consultations with the comprador elite and their masters. It stipulated that the British colonies of Sarawak, the North Borneo Chartered Company (Sabah), Malaya and Singapore were to merge into Malaysia.

This was to the dismay of the Malays, the British-educated elites in the United Malays National Organisation (UMNO) proclaimed, because the indigenous were a minority in their own native land. The Malays, they proclaim, do not want to include Chinese majority Singapore in the federation. Even including Sarawak was contentious, because Sarawak was majority Christian.

Singapore’s British educated Chinese elite, influenced by the British Labour Party and the Fabian society, formed the People’s Action Party. There was a more radical sect within the party that called for the creation of a unified proletarian state. The party, was in theory, on-board with unification.

The various state actors signed the agreement in 1963 to form a unified and federated Malaysia.

However, the official narratives warns us, racial tensions were simmering. The Malays were not giving equal voting representation the Chinese majority in Singapore. The Malays, were also afraid of a secret Chinese communist takeover, precipitated itself by the super-liberal People’s Action Party!

The Racialised Class Realities laid bare

Secret negotiations were taking place between the reactionary comprador elements of the PAP and UMNO, even before the signing of the 1963 Malaysia Agreement, of an eventual secession of Singapore.

The elites in Singapore publicly welcomed the idea of unification, and so the infamous clip of Lee Kuan Yew crying after Singapore being “kicked” from federation was widespread. Little did others know until decades later that it was merely a facade, when he was the head of the clique that lead the negotiations for separation.

It would be good for Singapore because they would remain in a singular currency market with the underdeveloped parts of Malaya and North Borneo, without dealing with rising labour militancy. Think the Eurozone with the European periphery. As I mentioned before, Singapore's departure would secure the politial hegemony of UMNO.

"When the Tunku (the first Prime Minister of Malaysia) first informed Keng Swee in December last year (1964) of his desire to have Singapore "hive off" from Malaya, it generated considerable excitement amongst us first because this showed their realisation that we cannot be fixed in Malaysia and the supremacy of Malay communalists assured forever. Next, it gave us an escape, if there is to be trouble in Malaya with communal clashes over language and other issues. We might in such a rearrangement insulate ourselves from communal conflict which is building up in Malaya.

"[The] greatest attraction of this rearrangement is our hope to get the benefits of all worlds - the common market, political stability with economic expansion, and autonomy in Singapore without interference from KL. The picture of a prosperous and flourishing Singapore doing better than the rest of Malaysia is most attractive."

And here is where the whole story crumbles, from the words of Singapore's infamous and first Prime Minister himself, Lee Kuan Yew.

The fake stories about our so-called independence laid bare for what it was and continues to be. Lies, regurgitated by compradors and foreign Capital.

Epilogue

This brief exposition of independence was of course simplified and did not include many of the nuances that made up the whole story. From the inclusion of North Borneo, Sarawak and Brunei, disagreements between the various Sultans, the specific amendments to accommodate Singapore's brief inclusion in the federation, the voting boycotts, racial riots and the Northern Borneo Communist uprisings, and the many grassroots shifts that had occurred by the time of independence and the couples of decades after. Many had to be foresaken for brevity.

History does not spare the sympathy to give us breaks.

In my previous characterizations of Singapore, I tried to convey this Europhilia that was/is heavily present in the elite's unsophisticated and underdeveloped minds.

Just read their own words -

Next, it gave us an escape, if there is to be trouble in Malaya with communal clashes over language and other issues

Who has not had the displeasure of interacting with a white European who has definitely exclaimed that they are not racist, while actively benefitting, supporting and instigating racism? How are these words any different?

The guardians of so-called "Asian values", while in actuality mirror their European counterparts in crystal clear clarity. This is recognised by many of the European chauvinists, who often emphasize that the Orientals can only be prosperous if they imitate the West, with Singapore being their prime example.

Singapore's role in the world economy is like that of South Korea, Rwanda, United Arab Emirates, or Panama. It is, and continues to be, a colonial outpost of US hegemony. Treat it as so.

Learn to read through the libspeak that a lot of the Singaporean and Malaysian elites like to shroud themselves in.

Social fascist has horrible take, gets even more racist

In an upcoming book Peter Hummelgaard, head of Denmark's Social Democrat-controlled ministry of justice, recounts growing up as a victim of domestic violence. He is using the account of his childhood trauma to advocate for what he himself terms "a far-reaching proposal": introducing a so-called "strict reporting requirement", making it a criminal offence not to report child abuse to authorities. A similar requirement already exists for teachers and other professionals working with children.

But there is a catch to his proposal, it should be geographically limited to "at risk areas on the parallel society list". Yes, that is an actual legal term in Denmark.

These areas, formerly officially termed "ghettos", are social housing estates officially characterised by residents being significantly poorer and significantly less white than average. The term "parallel society" is a dog whistle targeting Muslims. These areas are portrayed as dangerous, hostile and foreign in public discourse and all the social problems associated with the term are heavily racialised. Residents are treated as second-class citizens by the state with regards to everything from housing law and unemployment benefits to daycare options.

Hummelgaard has no problem being up front about his racism, he says:

Whole families are often complicit, as part of efforts to prevent girls and young women from fully integrating into Danish society—fathers, mothers, aunts, uncles, and older siblings alike.

When asked by state media DR, the Social Democrat-controlled ministry of Housing and Social Affairs had no data indicating an elevated incidence of child abuse in the targeted areas.

This does not give Hummelgaard pause. He continues his racist screed:

I believe we have been far too passive for years when it comes to addressing violence against boys and girls in specific communities.

He defends only targeting racialised housing areas by saying:

Initially, I have targeted these communities where we already know there is significantly higher crime and a prevalent culture of silence, often involving arbitration councils and imams [referring to a moral panic about mosques mediating in conflicts between community members without involving authorities]. This is why it’s a particularly far-reaching proposal.

These fucking Rosa-killers are the "progressive" option in electoral politics, you either put these ghouls in office or you get someone who's even worse.

• Source DR (state media), November 25th 2024

Significant progress made on Lebanon ceasefire - France

Michael Herzog, the Israeli ambassador in Washington, told Israel's GLZ radio an agreement was close and "it could happen within day ...We just need to close the last corners", according to a post on X by GLZ senior anchorman Efi Triger.

Hidden in the last paragraph of the article:

Hezbollah, militarily more powerful than Lebanon's regular army, has said it is defending the country from Israeli aggression.

It vows to keep fighting and said it will not lay down arms or allow Israel to achieve political gains on the back of the war.

So what does this mean? Is Israel exhausting it's stocks of missiles? Has Lebanon been beaten down to much by Israeli airstrikes to keep going?

Also if Hezbollah keep fighting, and they will, this doesn't seem likely to change much. There's also the likelihood of Israel just not honoring any kind of deal.

Smarter hexbears please chime in

Imam Khamenei Calls for Netanyahu’s Execution:
https://english.almanar.com.lb/2277596