Delayed and denied: Women pushed to death's door for abortion care in post-Roe America
DENTON, Texas, and NEW YORK -- This is Part II of a three-part special ABC News investigation looking at the impact of abortion restrictions in America after the U.S. Supreme Court overturned Roe v. Wade in June 2022. The "Impact by Nightline" broadcast, "On the Brink," with exclusive interviews by Diane Sawyer and Rachel Scott, brings you inside the raw, intimate and overlooked conversations playing out in clinics and exam rooms as the country continues to confront the realities of a post-Roe America. It premieres Dec. 14 on Hulu.
ABC News brought together 18 women from across 10 states who say their medical care was impacted by abortion bans -- bringing some of them to the brink of death. These women said they have been turned away in medical emergencies for not being sick enough, and had their health care delayed or denied due to state laws.
Blair Nelson and her husband started trying to conceive in 2018 right after they got married. When the Austin, Texas, couple was not getting pregnant as quickly as they wanted, Nelson switched to an OB-GYN that a friend had recommended.
"We found out pretty much immediately that things were going to be hard for us for a multitude of reasons, and he sent me straight to an IVF clinic," Nelson said in an interview with ABC News.
Since then, Nelson has undergone five rounds of in vitro fertilization, seven embryo transfers, multiple surgeries and also had an early miscarriage. But it was all worth it for Nelson, who got pregnant and gave birth in May 2021 to her daughter -- she was her fifth embryo transfer.
The couple still wanted to grow their family. Nelson got pregnant again, through her sixth embryo transfer, but she received devastating news 12 weeks in -- the fetus had rare, fatal anomalies making survival unlikely.
Yet, as a result of Texas' abortion restrictions -- including a 2021 ban on abortions after fetal cardiac activity is detected, which generally occurs at around six weeks, and other bans that went into effect after Roe v. Wade was overturned -- Nelson was forced to travel hundreds of miles away from home and her daughter to find care across state lines.
Far from home, Nelson also experienced a medical emergency that left doctors unsure if she would be able to get pregnant again.
Nelson's story is one echoed in those of other women who had to continue their pregnancies despite devastating, fatal diagnoses for their babies, even if their pregnancies posed a risk to their health.
In some cases, these women's medical care was left up to panels of doctors – and sometimes lawyers -- in their home states and they had to carry on their pregnancies for weeks as they waited for an appointment in another state. Since at least 16 states ceased nearly all abortion services, facilities that provide abortion care in states that border states with bans have seen an influx of tens of thousands of women crossing state lines for care, according to the Guttmacher Institute.
Some had to travel hundreds of miles -- by car or plane -- spending money they didn't have, all while coping with the pain, anxiety and grief of losing a child they desperately wanted.
And some were compelled to speak publicly and take action, in hopes that other women would not have the same experience they did.
These are their stories:
Impact X Nightline
ABC News' Diane Sawyer and Rachel Scott report on pregnant women with high-risk pregnancies in states that have enforced their own laws since the Supreme Court overturned Roe v. Wade.
'Something was wrong'
After her sixth embryo transfer, Nelson had a "very uneventful pregnancy" up until her 12-week appointment, when she went in for NIPT testing -- blood tests that screen pregnant women for certain genetic anomalies -- bloodwork and an ultrasound.
"Immediately I knew, looking at the screen, that something was wrong," Nelson said.
"I just looked at [my husband] Will and said, 'I can't handle any bad news. This journey has been so long already, we are five years into this,'" Nelson said.
Nelson was then moved into a consultation room and her doctor came in to tell her "the worst news ever," Nelson said.
According to her physician, Dr. John Thoppil, it looked like Nelson's baby had a rare anomaly called limb body wall defect -- a condition where a fetus has multiple malformations.
"This is a baby that's most of the time is gonna die in utero. Rarely, you know, at birth, is gonna survive not very long at all if you get to that point," Thoppil said.
Thoppil referred Nelson to a doctor who handles high-risk pregnancies and, fortunately, was able to get her an appointment right away. But the doctor confirmed the diagnosis.
"I felt gutted and heartbroken and immediately angry at the policy in place and what that was likely going to mean for my life and my husband's life," Nelson said.
"Every single one of my son's organs were growing outside of his body, including his heart -- everything. But the heart was still beating, outside of his body, and I couldn't even get the care," Nelson said.
Nelson remembers sitting down with her husband after their appointment and feeling like they had been so close to the end of their IVF and fertility journey, having gotten pregnant with their second child.
But that feeling was ripped away from them with this tragic diagnosis.
"Instead of being able to grieve the news that we just received, we have to plan travel to a foreign place we don't want to be in in the first place, spending money that we don't wanna spend or may not have, to go do something to take care of ourselves," Nelson said.
Texas' abortion bans do not have exceptions for fatal fetal anomalies, so Nelson would not be able to access abortion care in her home state. Her only options would be to carry the pregnancy to term, knowing that her baby would not survive, or travel to another state to get care. It can cost thousands of dollars for travel and care.
Because of that, the couple started searching for abortion clinics in New Mexico and Colorado, the two states that were the closest to their Texas home and where they could easily travel. The couple didn't know what to do in such a situation and had to do their own research to find a facility that could provide the care they needed and where Nelson would feel safe.
After reading that there were protesters at a clinic in Albuquerque, New Mexico, where she had planned to go, Nelson said she chose one in Colorado because she didn't want to be "harassed as you walk in; as if it's not bad enough."
Adding to the trauma of having to travel to receive abortion care, she experienced an emergency while accessing care in an unfamiliar place, without friends or family there to support them.
Three doctors need to approve
Meagan and her husband, Jon, were excited to find out she was pregnant -- Meagan, who has polycystic ovary syndrome which can make it difficult to conceive, said she needed medication to help her get pregnant.
The couple, who lives in Wisconsin, began preparing a nursery in their home and were excited to have a baby on the way.
Meagan asked that ABC News not use her last name to protect her privacy.
At a routine 20-week ultrasound appointment last July, Meagan's physician noticed that the fetus was unusually small, an indication that something was wrong. Further testing revealed that the fetus had skeletal dysplasia — a severe, life-limiting anomaly.
Adding risk to her pregnancy, Meagan also had some bleeding and was diagnosed with placenta previa, where her placenta covered her cervix.
"It would be unsafe to have a standard, natural delivery because the baby would go through the placenta and she would bleed out," said Dr. Jordan Crow, Meagan's doctor.
"Every day that Meagan stays pregnant with her placenta previa, especially when there is probably not a clear tangible benefit to her pregnancy, that is going to be a riskier day," Crow said.
At the time, Wisconsin had a total abortion ban in effect that only allowed exceptions to save the life of the mother, but the law required three doctors to approve the abortion.
Crow determined that the pregnancy posed a risk to Meagan's life and tried reaching out to hospitals all over the state to find her a facility that would perform the procedure.
Still, he was not able to find anyone who would agree to do it, despite other physicians agreeing that the pregnancy posed a risk to her life.
Crow and the couple spent days doing research and looking for a place where she could get abortion care out of state.
"Prior to Dobbs, she would have had it in Wisconsin, she would have had it near her support system, but instead she has to cross state lines to be able to do that," Crow said, referring to the landmark Supreme Court opinion Dobbs v. Jackson, which overturned Roe.
"If someone found out 'Yeah the way that my doctor found a good doctor for me was going through seven different degrees and texting and calling people after hours just to find me routine care,' I think that would be deeply unsettling to most people," Crow said.
'Nightmare' journey
Some women had to travel even farther away from their homes to get abortion care in another state.
Anabely Lopes, 45, who lives in Florida with her husband and is originally from Brazil, was boxed in. In the wake of Dobbs, all neighboring states had abortion bans on the books that would deny her access to care in July 2022.
Lopes' fetus had a deadly fetal anomaly called trisomy 18, which results in various severe deformities. Only 5% to 10% of babies with this anomaly survive to their first birthday, according to research published in the Orphanet Journal of Rare Diseases.
But Lopes herself also has thrombosis, a health condition with a proclivity for dangerous blood clots, which makes her pregnancy high risk.
"I was afraid about my life and about everything. It's just me and my husband here. We moved to the USA 11 years ago to live here and to have a better life here," Lopes said.
Lopes said her doctor gave her the devastating diagnosis while she was at work -- she was 15-weeks pregnant at the time -- and she was so upset she couldn't drive home.
Her doctor scheduled an appointment with a specialist in Florida for her the following week.
"I used to be a nurse in my country; I understand this part, but I felt so alone. Me and my husband didn't know what to do," Lopes said through tears.
Lopes had done her research before the appointment, and she said the specialist explained the anomaly to her. But the doctor told her there was nothing she could do for her because physicians are afraid of the consequences of violating the state's ban.
Lopes then sought care at an abortion clinic in Florida. For three days the clinic tried to see if it could legally provide Lopes with abortion care. Ultimately the doctors did not want to risk providing care under the unclear state law and the clinic called other states to find Lopes care.
The clinic was able to find her another clinic nearly 1,000 miles away.
Driving nearly 400 miles
Chelsea Stovall was 20 weeks pregnant when she found out her baby was growing without a chest cavity, her organs were wrapped around her heart and she was abnormally small. In a scan, she was measuring the size of a 2-week-old fetus, according to her husband, Thomas Stovall.
Chelsea Stovall said after the 20-week scan, they had to do research on their own to find out where they could go for abortion care. Surrounded by border states that have ceased abortion services -- Oklahoma, Louisiana, Mississippi, Tennessee, and Missouri -- the couple had to drive from their home state of Arkansas to Illinois.
"One thing people don't realize: health insurance is not going to cover it -- at all. They will not touch it; they will not even remotely listen to you. So, it has to come out of your pocketbook and for some families, that's their whole savings," Thomas Stovall said.
"It was ours," Chelsea Stovall added.
Stovall said it cost the couple over $3,000 for the procedure, travel and accommodation. Even more devastating than the financial blow was not being near loved ones.
Delays in accessing abortion care -- like needing to travel to another state -- can push women further along in their pregnancies and the cost of later term care can skyrocket.
The Stovalls had a tight window to book and travel to Illinois for care because the state only allows abortions up to 24 weeks. Once they had the appointment, they had to make the nearly 400-mile drive.
"Even though I had my husband with me and I am so grateful he was there as much as he could be -- he wasn't allowed in the building when I went in and delivered our daughter -- but the drive was still, it felt lonely because we knew we were gonna have to say goodbye to the daughter that we're really looking forward to meeting," Chelsea Stovall said.
"He was there when I delivered our other children and to not have him there was very lonely," she said. The couple has two other children.
49 days to get care
Jill Hartle, whose baby had severe heart anomalies, had to travel from South Carolina to Washington, D.C., to get abortion care. But it took her 49 days to get care she said she deserved to get in her home state.
With 16 states ceasing nearly all abortions, data shows there has been a surge in women traveling to other states for care, overwhelming facilities not used to treating so many patients and leading to significant delays in care.
Hartle has since become outspoken on the consequences of the ban in South Carolina.
"I talked to so many politicians at the State House in South Carolina this year … one House of Representatives man told me that he was an attorney and said, 'I write laws clear and concise enough and if the doctors and lawyers at [the hospital] are not competent enough to read and interpret them correctly, that's their problem,'" Hartle said.
"And I quickly responded back, 'Well it might have started out as their problem, but it turned into my problem and a lot of other women's problem because of how you wrote that law and how they interpreted it. And y'all didn't do your due diligence to go and talk to a medical attorney or any medical doctor or any fetal medicine doctor,'" Hartle said.
'We need to do this now'
Allie Phillips did extensive research on her own to find a clinic where she could receive care.
By the time Phillips -- a woman from Tennessee, a state surrounded by neighboring states with abortion bans -- got to a clinic in New York, her health was in serious jeopardy. Her baby had died inside her and doctors were not sure when the baby had died.
Phillips' last ultrasound had been one week and three days before, and the fetus had a heartbeat then.
"The doctor told me that because we don't know when my daughter passed, there is about a two-week window when you carry a deceased fetus when your body doesn't recognize it when you are at risk for blood clots, infections or going septic," Phillips said.
"He's like, 'Since it has been a week and three days you are very close to that window. We need to do this now,'" Phillips said her doctor told her.
She had her abortion within an hour. Phillips said she didn't leave her room for two weeks when she got home.
"It was a very traumatic experience," Phillips said.
She is now running for the Tennessee House of Representatives.
Scared and far from home
Like other women in their positions, finding abortion care for Meagan, Lopes and Stovall involved a long journey and, in some cases, a long wait once they got there due to surging demand in states that provided it.
Meagan had to wait three weeks before she was able to get a termination at a hospital about 100 miles away from her home.
Despite Meagan and her doctor, Jordan Crow, working hard to find care that would be covered by her insurance, the procedure itself and part of her hospital stay -- for recovery -- were denied. In total it cost her more than $3,000, but she says if she didn't have insurance coverage at all it would have cost them around $20,000.
Abortions have since resumed at two Planned Parenthood facilities in the state when a Wisconsin judge issued a ruling -- weeks later -- that an 1849 law on the books does not prohibit abortions. The case is expected to go to the state supreme court.
Lopes was able to get an appointment at a clinic in Washington, D.C., 1,000 miles away from her home state of Florida, but she feared for her life.
She was scared to tell anyone on the flight what the couple was going there to do and called her flight to D.C. a "nightmare."
"Everybody see my belly and ask me about the baby. And I couldn't tell nothing. I just cried because I was afraid for my life. I thought about suicide and I had never thought about that. My husband was crying and we didn't know what to do," Lopes said through tears.
"After the termination, I was bleeding and they touched me and said 'Wake up, you need to go,'" Lopes said.
The next day Lopes went home because she said she didn't want to stay in a hotel any longer. She said she spent 10 days in bed.
Thomas Stovall said he was neither allowed to be with his wife during the procedure at the facility due to Illinois state law nor could the couple have their baby girl's remains.
"They said that I couldn't take her remains with me, but they let me have her footprints, so I have those," Chelsea Stovall said.
"That's all we've got to remember our daughter by -- and our memories," Thomas Stovall added.
The couple said they do not feel safe getting pregnant again in Arkansas.
"I don't think that any woman should feel safe to get pregnant in the United States right now — period," Thomas Stovall said.
Chelsea Stovall told ABC News in December that she doesn't think they will have any more children.
"I just can't go through that again. It was hard enough the first time. I don't think I could come back from that a second time. So, we made the decision to keep our family exactly the way it is and we are OK with that," she said.
'Freaking out'
Like the other women, for Nelson, finding a clinic outside Texas willing to perform the procedure was not the end of her trauma.
Doctors said it was safe for her to have the two-day procedure performed in the clinic. But then Nelson began bleeding during the procedure.
At the hospital, Nelson was admitted to triage to stabilize her blood pressure. Doctors were worried she may need a blood transfusion because of how much blood she lost. They then put a Foley balloon -- a balloon catheter doctors insert inside the uterus -- to put pressure on the cervix and stop the bleeding.
Doctors now suspected Nelson had developed placenta accreta -- a deadly complication where the placenta goes through the lining of the uterus and can attach itself to other organs in the mother's body -- which could result in the need for an emergency hysterectomy or complex procedures to preserve a mother's fertility.
When she continued bleeding for several hours, doctors gave her two options: a uterine artery embolization, or UAE, surgery -- in which doctors put particles into the main blood source for the uterus in hopes that it triggers clotting and stops her bleeding -- or a hysterectomy to remove her uterus.
"My first thought is, well, I want more children and I also want to keep my body parts so let's do the UAE and see if it works," Nelson said.
Nelson was immediately taken into surgery. Despite telling her husband it would take two to three hours, it took much longer.
"So, of course he's freaking out and we're there with no family, no support system, we don't know these people, we don't know the city. It was just kind of terrifying," Nelson said.
Doctors monitored Nelson closely over the next few hours -- she was not out of the woods until she began passing blood clots, a sign that the bleeding would stop.
"I did pass like one huge clot, and then they looked [at my uterus] again and it looked to be like everything had cleared out," Nelson said.
She was in the hospital for another night and spent one more night in Colorado before the couple flew home.
Thoppil said that if her care was not delayed it is likely Nelson would not have developed an accreta.
"The policies of Texas may have kept her from ever having a kid again," Thoppil said.
"She went through something that I don't think she would have had to if she didn't have this one-month delay in care," Thoppil said.
At home, Nelson's hormones dropped and her milk came in -- which she called "heartbreaking" -- and she experienced typical postpartum emotions mixed with anger. But she didn't have the baby she had fought so hard for.
Nelson also had several months of not knowing whether she would be physically able to get pregnant again. Her doctors were concerned about potential scar tissue in her uterus or other complications that may arise.
"Before this happened, the worst thing in my mind that could have happened to us as a family is that we have an embryo transfer work and then I miscarry. Or it just doesn't work at all," Nelson said.
"I never thought like a genetically normal embryo would have something else wrong with it that they can't even test for," Nelson said.
The couple's determination to have another child remains steadfast. Nelson told ABC News in late November that they plan to have their last embryo transferred in February 2024.
"I'm trying to hold on to hope to get pregnant again, but it's going to be 10 months of severe anxiety. I don't think I'll be able to enjoy the pregnancy the way I did with my daughter. I'll just be constantly worried and anxious about every single scan," Nelson said.
Nelson has shared her fertility journey on her Instagram account for the last five years after she suffered her first miscarriage.
And she said she hopes sharing the story of her most recent pregnancy and termination will pressure lawmakers to change laws and keep this from happening to other women in Texas.
Click here to read Part III