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The protesters outside the Seattle abortion clinic waved pictures of bloody fetuses, shouting that she was a "baby killer" and begging her to choose life.
Lauren Hall, 27, fought the urge to scream back and tell them just how badly she wished life was a choice she could have made.
She wanted to tell these strangers about the day she ran into her husband's home office, pants still around her ankles, waving that positive pregnancy test. How they'd told their families, picked out a name, built a crib and bought pink sheets.
She wanted them to experience the agony she felt when she learned that her fetus was developing without a skull or a brain, a condition her doctors told her was "incompatible with life."
Many of the protesters had traveled to Seattle all the way from Texas, just like Hall had. She wished she could make them answer for the state's near-total ban on abortions after the overturning of Roe v. Wade just a few weeks prior.
As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy.
Hall managed not to scream any of this at the protesters, instead just silently flipping them off.
Once she made her way through the clinic's stringent security, the nurses took her into a private room. Hall, raised in a conservative Christian family outside Dallas, felt like she had whiplash from the sudden and tragic events that had brought her to an abortion clinic halfway across the country.
A doctor she had never met entered the room.
"She just put her arms around me and took my hand and she was like, 'I know you don't want to be here, but you're in good hands. We're going to take care of you, and you're going to be OK,'" Hall remembers.
After holding it together all morning, Hall burst into tears.
"It was just the most tender moment," she said. "And it just occurred to me that the people I've been told my whole life are going to hell for their actions were the most kind and angelic individuals through this whole thing."
Joyful beginnings
Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with God's plan. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea.
"I would always say, 'What if it was necessary to save the life of the mother? Or in cases of rape or incest? Or what if the pregnancy wasn't viable?'" she said. "And that was always the scenario I used to explain what a ban would do, and I never met a self-proclaimed conservative that doesn't think those exceptions should be in place."
Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it.
"We both have good jobs, we've got a house and we were at a place where … if it happens, it happens," she said. "Took no time at all."
When she first saw that positive pregnancy test, she panicked — even at 27, she said, her first reaction was that of a 15-year-old, worried about telling her parents. But then an overwhelming sense of calm washed over her.
This was fine. In fact, this was good.
She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. She knew the doctors at the practice were both proud members of the American Association of Pro-Life Obstetricians and Gynecologists, but she waved it off. After all, she didn't need an abortion — she needed convenient pregnancy care.
After she got through the first trimester, Hall and her husband both heaved a sigh of relief and got to work telling their friends and family. Everyone was thrilled, buying them car seats and baby clothes.
When they learned they were having a girl, Hall and her husband even picked out a name: Amelia.
Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional protection for abortion and allowing states to set their own laws governing abortion access. In Texas, the second-largest state in the nation, legal abortion immediately ceased to be an option except to save the life of the pregnant patient.
Hall was outraged about the world that her daughter was going to be born into, but she didn't worry too much about how this would affect her pregnancy.
Almost immediately, though, Texas' conflicting and confusing laws on abortion started to cause problems for pregnancy care. All of Texas' abortion laws have exceptions to treat miscarriages and ectopic pregnancies, a potentially life-threatening condition in which a fertilized egg grows outside the uterus, as well as to save the life of the pregnant patient.
But pregnancy care isn't as clear cut as the law makes it out to be, doctors say, and fear of criminal prosecution has led medical professionals to delay or deny care they otherwise would have provided.
Researchers with the Texas Policy Evaluation Project at the University of Texas at Austin documented several cases in which doctors waited to treat pregnancy complications until a patient's health had deteriorated to the point that their life was in danger.
According to a letter from the Texas Medical Association, a physician in Central Texas was instructed not to treat an ectopic pregnancy until it ruptured, which can cause serious medical complications.
Patients experiencing miscarriage have also struggled to get prescriptions filled for misoprostol, which is used both to treat miscarriages and induce abortions.
Earlier this month, Gov. Greg Abbott said there were "some things that we need to work on" to ensure patients can get treatment for miscarriages and ectopic pregnancies.
"There has been apprehension by doctors about dealing with both of those two issues," Abbott told Fox 4 News. "I want to see legislation come out that will both do more as well as clarify the ways that we are protecting the life of the mother."
But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. Texas' abortion laws make no exception for these cases, which are not as rare as people would like to imagine, said Dr. John Thoppil, an Austin OB-GYN and president of the Texas Association of Obstetricians and Gynecologists.
"This is already incredibly difficult news that someone receives," Thoppil said. "But now we're forcing someone to continue the pregnancy and go through all the risks of a potentially term delivery and all those potential complications for a pregnancy that has no chance of surviving. It just seems cruel and unusual."
Many of these lethal fetal abnormalities come to light at an anatomy scan performed later in pregnancy. Hall was 18 weeks along when she went in for hers on a Friday afternoon.
"I was so excited for this appointment because it's so good to see her in there," she said. "But there was a vibe immediately. I'm a nurse. I knew something was wrong."
A pregnancy interrupted
Hall's fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb.
Most of these pregnancies end in miscarriage or stillbirth. Anencephalic babies born alive will likely survive only for hours or days; they will be unconscious, blind, deaf and will not voluntarily respond to touch or sound, according to the Cleveland Clinic.
Hall's maternal-fetal medicine specialist laid out the best-case scenario: If she managed to carry to term and deliver a live baby, with miracles of medicine, science and technology, they might be able to keep her alive for a few weeks, tied to machines and without hope of recovery.
Hall's entire vision of this pregnancy — giving birth, becoming a mom, watching her daughter grow up — evaporated in an instant. She was bereft, unable to even process the news. Her husband took over, asking the doctor what, if anything, they could do.
Immediately, they sensed hesitation from the doctor. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion.
"And she said, 'If you do that, don't tell anybody why you're traveling, don't tell your jobs, don't tell anyone at the airport,'" Hall remembers. "Which sounds extreme, but Roe had just been overturned. Everyone was so scared."
Hall and her husband left the specialist's office in a daze. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate.
If she wanted to stay in Texas, Hall's only choice was to continue with a pregnancy that would not yield a healthy, living baby. But that comes with the same significant risks that accompany a viable pregnancy, said Dr. CeCe Cheng, a high-risk OB-GYN in San Antonio. Cheng did not treat Hall, but has counseled patients facing similar situations.
"All the changes your body faces in pregnancy are going to be very similar, no matter if your fetus is viable or whether the baby won't survive on the outside," said Cheng, who is also a fellow at Physicians for Reproductive Health. "But it's not just the physical changes, but the emotional toll of knowing their baby is not going to survive and just waiting for something to happen so they can get the care they need."
The emotional toll was what worried Hall most of all.
"It was just a matter of time before the baby died, or maybe I'd have to go through the trauma of carrying to term knowing I wasn't bringing a baby home," she said. "I couldn't do that."
Hall has struggled with depression, and as the weekend wore on, her mental health deteriorated. One of the most painful parts was trying to reach her medical team. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence.
Her mental health spiraled to the point that she considered checking herself into the hospital. But she was too scared to tell health care providers what was going on for fear that they would know she was considering an abortion.
"I was losing my mind," Hall said. "I would consider what I experienced that weekend a medical emergency."
At the same time, she was searching for abortion clinics. She considered Colorado and New Mexico, the nearest states without a total ban, but both states are being inundated with patients from Texas and elsewhere.
Eventually, she found a clinic in Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. She and her husband booked outrageously expensive last-minute flights, got a hotel and, four days after they got the news that upended their world, flew out of Dallas/Fort Worth International Airport.
Despite the tragedy she was facing, Hall knew she was one of the lucky ones. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure.
And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments.
"They were just all shocked, like, 'Surely, there's an exception for this,'" Hall said. "It just didn't occur to them that a ban would include cases like this."
Many Texans facing this same set of circumstances won't have the means to leave the state, Thoppil said, contributing to the state's high rates of maternal morbidity and mortality, particularly among communities of color.
"The women who will be forced to carry these babies are the women with less resources," he said. "It doesn't take a huge leap to see that our rates of complications will go up because we have a selection bias on who is going to have to continue more complicated pregnancies."
Cheng, in San Antonio, said that even as she cautiously points her patients to their options out-of-state, she's well aware that many of them struggle to even make it to their appointments in-state.
"Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care," Cheng said. "Sometimes they're the primary caregiver. They have jobs and multiple children to take care of and they don't have the finances to take four or five days to go to a different state. … These are the patients that are the most affected."
Inside the clinic
As a clinic that offers second-trimester abortions, Cedar River Clinic in the Seattle area has always seen a good number of patients from states with more restrictive laws, said clinic communications director Mercedes Sanchez. But those numbers have skyrocketed since Roe v. Wade was overturned.
"Texas is the state we've seen the biggest increase from," Sanchez said. "Starting last September, when the [ban on abortions after about six weeks of pregnancy] went into effect, we started getting calling from Texas and it hasn't stopped."
To deal with the increased demand, Cedar River has reopened a previously shuttered location, enhanced its telemedicine services and worked to find ways to help patients pay for travel and procedures.
It's also had to heighten security — since Roe was overturned, Sanchez said, the clinics have seen more — and more aggressive — protesters, including people from out-of-state like those Hall faced.
After Hall made it through the protesters and the clinic's security screening, the clinic itself was an oasis, she said. She had to go two days in a row and both times the staff gave her the support, sympathy and care she'd been missing in Texas.
Cedar River offers specialty care for patients facing lethal fetal abnormalities like anencephaly. They have private waiting rooms for these patients and offer grief support, genetic counseling and even bereavement services, including ways to memorialize the lost pregnancy.
"We see patients from many different religions and cultures, and how they grieve is unique to each patient," Sanchez said. "We do what we can to honor each of those cases."
Hall declined those services. It was just too hard, as she navigated a complicated mix of relief and grief. Coming back to Texas a few days later only amplified those feelings.
"You have to suddenly leave for a medical procedure, and you don't know what's going to happen, so despite everything that made me leave, it was a relief to be back home," she said. "But I'm still so angry I had to leave."
It's been a difficult few weeks since the procedure. The pink-sheeted crib is still set up in the nursery, filled with all the baby supplies they'd bought or been gifted that they now have no use for. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. And they've had to navigate complicated politics when sharing their news. More often than not, they just say they lost the baby.
Hall and her husband would like to try again at some point. But first, she's focused on her mental health and getting through the next few months. The holidays are going to be especially hard.
She was due just a few days before Christmas.
Disclosure: Texas Medical Association and University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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This article originally appeared in The Texas Tribune at https://www.texastribune.org/2022/09/20/texas-abortion-ban-complicated-pregnancy/.
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