The Texas Supreme Court on Friday rejected a lawsuit challenging the state’s abortion ban over its medical exceptions.

The court ruled against a group of women who suffered serious pregnancy complications and became the first in the country to testify in court about being denied abortion access since Roe v. Wade was overturned in 2022.

In a unanimous ruling, the court upheld the Texas law after the women filed a lawsuit in March 2023 seeking clarity on when exceptions to the abortion ban are permitted, arguing the law was confusing for doctors who might turn away patients over fears of repercussions.

The same issue was at the center of a separate lawsuit brought last year by Dallas mother Kate Cox, who sought court permission to obtain an abortion after her fetus developed a fatal condition during a pregnancy that resulted in multiple trips to an emergency room. She eventually left the state to have the procedure.

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The court said Friday that the law’s exceptions are broad enough and that doctors would be misinterpreting the law if they decided not to perform an abortion when the mother’s life is in danger.

“Texas law permits a life-saving abortion,” the court wrote in the order signed by Justice Jane Bland.

The decision closed, at least for now, another pathway for opponents who have attempted to force the state to provide more clarity about when exceptions to abortions are allowed. Last year, plaintiffs in the lawsuit testified in court how they carried babies they knew would not survive and continued with pregnancies that put their health at risk.

Plaintiff Kaitlyn Kash, whose fetus developed severe skeletal dysplasia, was told even the simplest movements could break its bones in utero. Her life was not threatened, but she still chose to leave Texas for an abortion.

“I wanted to end my child’s pain before it could begin,” Kash said. “The state just told me that as a mother, I don’t have the right to make those decisions for my child. … If you want to grow your family, if you want to have children, you should get out of Texas.”

The Texas law states that doctors who perform abortions risk life in prison, fines of up to $100,000 and could lose their state medical licenses.

“Now we know the courthouse doors are closed to them,” said Molly Duane, a staff attorney for the Center for Reproductive Rights, which represented the group of Texas women. “It seems Texans have nowhere to go but the voting booth, in terms of what comes next.”

Last year, a lower court granted a temporary injunction preventing Texas from enforcing the ban against doctors who performed an abortion using their “good faith judgment” after determining a pregnancy was unsafe due to medical complications. That ruling, however, was immediately blocked after an appeal from the Texas attorney general’s office to the state’s Supreme Court.

The lead plaintiff in the lawsuit, Amanda Zurawski, had been told that she had a condition that her baby would not survive. She said she was forced to wait until she was diagnosed with a life-threatening case of sepsis before obtaining an abortion. She spent three days in intensive care and was left with a permanently closed fallopian tube from an infection, affecting her ability to have more children.

The court ruled Friday that state law does not require that a woman’s death or serious impairment be “imminent” when she is evaluated by a doctor for a potential abortion.

“Ms. Zurawski’s agonizing wait to be ill ‘enough’ for induction, her development of sepsis, and her permanent physical injury are not the results the law commands,” the court wrote.

Zurawski said the ruling was “heartbreaking.”

“I am outraged on behalf of my fellow plaintiffs who the Court deemed not sick enough,” Zurawski said. “We all deserve bodily autonomy. Every day, people in Texas are being told that they have no options. It’s sickening and wrong.”

Republican Texas Attorney General Ken Paxton praised the ruling after his office defended the law in this case.

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“I will continue to defend the laws enacted by the Legislature and uphold the values of the people of Texas by doing everything in my power to protect mothers and babies,” Paxton posted on X, the platform formerly known as Twitter.

The lawsuit argued that exemptions under the Texas law, which allow an abortion to save a mother’s life or prevent the impairment of a major bodily function, led to confusion among doctors, who were turning away some pregnant women experiencing health complications because they feared repercussions.

The plaintiffs said the abortion ban, which allows an abortion to save a mother’s life or prevent the impairment of a major bodily function, has made doctors fear of potential liability if the state does not consider a case a medical emergency.

New guidelines proposed by the state medical board earlier this year did not provide much beyond advising doctors to meticulously document their decision-making. The Republican-led state Legislature is not expected to make any changes to the law’s language.

The Associated Press contributed to this report.