One woman had already decorated the nursery. Another had picked out a name, something with family history. A third woman was sifting through her oldest child’s clothes to see what might fit the next addition to the family. Their hopes had risen over the months; plans were taking form. Then the appointment happened.
For those who must terminate their pregnancy for medical reasons, or undergo a TFMR, as the procedure is known, the need typically becomes apparent during an appointment that takes place later in the second trimester, after week 16 or 17, an important phase for fetal development—and a period that has become highly politicized and regulated in post-Dobbs America.
Conservatives have made a talking point of abortions taking place “up to the moment of birth,” despite the fact that in 2020, 93 percent of abortions occurred at or before 13 weeks. According to the Centers for Disease Control and Prevention, only 1 percent of abortions that year were performed at 21 weeks or later. To date, 13 states have outright banned nearly all abortion (with many others trying to do the same in court). Multiple others have chosen deadlines that are prohibitive for TFMR procedures. In total, half of the states in the United States have banned abortions at or before 22 weeks, enforcing regulations hostile toward those who choose to terminate after these appointments.
Those deadlines come during a stage when pregnant people get a great deal of interesting information during check-in appointments: The ultrasound shows the fetus’s sex, size, and organ health, and practitioners check for genetic or structural conditions, some rare and some not, that will either drastically affect the fetus’s future or prove incompatible with life post-birth.
These diagnoses often exist in a gray area of incomplete statistics and “miracle” stories that force women to make difficult decisions about whether to terminate their pregnancy—a process that, because of growing hostility to abortion access, now has a ticking clock. Since the viability standard, usually understood as 24 weeks, was thrown out with Roe last year, states have been able to come up with their own rules. While legal battles still rage on, several states currently have cut off access to abortion before this appointment even takes place.
Data show that some abortions at this stage of pregnancy took place because even though women wanted to have them earlier, they were unable to, due in part to access. The span of time between choosing to have an abortion and being able to get the procedure is longest for Black women. A multiyear study found that the reasons people terminate at or after 21 weeks are because they didn’t know they were pregnant, were under- or uninsured, had a lack of understanding of access, were considered high-risk for life-threatening conditions, or found fetal anomalies.
The TFMR community, as members of this group often call themselves, represents an often misunderstood collection of people who have abortions, namely those who wanted the pregnancy and child and are devastated when health complications interfere. Arguments that divide women into stark categories of those who choose to be childless versus those who are fulfilling their purpose as mothers miss the diverse, nuanced reasons all kinds of people, with all kinds of needs and desires at different stages of pregnancy, have abortions (not to mention the fact that most people who have an abortion are already parents).
Since Dobbs, these women face additional traumas that start immediately after hearing a diagnosis. Robbed of time to process the news, they are thrown into action in order to meet state-imposed deadlines. In a week-based legal system, each day matters. Some women have mere hours to take in a medical diagnosis before they must call hospitals, acquire childcare, and book flights, let alone find the cash to pay for the procedure. What’s more, pregnancy at this stage is more publicly visible, increasing the likelihood that other people might ask what happened. In some states, those questions could lead to arrests.
I spoke with these women about their experiences having abortions in a Dobbs world. They told me about nurseries, maternity jeans, ultrasounds. They told me about hiding and mourning and choosing. This collection of as-told-to stories illustrates what happens when the context around choice is missed, flattened into a political question that often ignores the real people who face the real, and deeply difficult, decision of whether to seek an abortion.
The following conversations have been edited for length and clarity. Some names have been changed to protect the safety of sources.
Kammie | 31 | Dayton, Ohio
Both of the lines came up bold—the test was so positive. “There’s no going back at this point,” I thought.
I have two daughters, ages 4 and 2, and I’ve been with my husband since sophomore year of high school. I always knew I wanted kids, and now I only wanted three. I was excited. I thought, “This is the last time I have to go through all the sickness, the last time I have to go through all the pain, the C-section delivery.” I was letting myself enjoy every moment because it was the last one.
You’re always a smidge nervous at appointments because you just never know. As the weeks progressed, I remember feeling more and more nervous because it was finally a grandson, finally a boy. What if something goes wrong? It’s all on me. It’s gonna be my fault. I had gotten Covid, so I had to push my regular 20-week ultrasound back to 21 and a half weeks.
In the appointment, I’m trying to crack jokes to calm myself down. The technician told me to go see the doctor, and I had just this sense of dread. It wasn’t fully a pit in my stomach until I walked in and saw the red card sitting on the table. Red is not a good sign.
My OB said he couldn’t identify kidneys or a bladder, and that his condition is not compatible with life. I broke down—this is my little boy, and they’re telling me that he’s not going live. The doctor explained that there’s nothing they could do there, but we could go down to the University of Cincinnati. Only minutes later, he said, “Unfortunately, with Roe v. Wade being overturned, we can’t help you here, if you decide to terminate.”
My brain started spinning.
What does he mean when he says he can point me in the right direction? What direction? He tells me there’s a website, that he can send my paperwork, that he supports me. But he also tells me that he can’t inform me of where to go and that they need to speak to the legal team to avoid any trouble. At that point, Ohio’s Heartbeat Law was in full effect. I only had until six weeks, and I was almost at 22. He tells me some surrounding states go to 24 weeks, so I would need to move fast. And if I waited, my only option would be Colorado. Well, I have two little ones at home; I can’t just drop everything and go to a different state.
The hospital fast-tracked my trip to Cincinnati for an MRI and echocardiogram.
I guess I was in denial, trying to maintain some form of hope that we can come out of this. In the MRI, they cocooned me and my stomach. It’s a children’s hospital, so I got cool glasses to watch Harry Potter. After a while, we were told that he had cysts on both of his kidneys, four different heart defects, and that he would need immediate surgery after birth (if he even qualified). He couldn’t poop. The cone of his spine had a malformation. The bumps on his brain were too closely spaced together, and they had no idea what that meant.
I asked for odds; she couldn’t give me any. I know it’s not gambling, but I feel like that’s what we were doing.
This doctor also told us she couldn’t provide a termination because of Roe being overturned. I told her I understood and that I felt lost. She said she had a colleague that knew of places but explained that it would not be a direct referral. “I’m personally telling you,” she said. There would be no documentation of it.
That night my original doctor called me, after hours. He said he was sorry and that he too personally had reached out to a clinic in Chicago, and gave me the information. He asked me to come in the next morning before they opened, and the first thing he did was give me a hug. He handed me printed information on a piece of paper, very unofficial. The doctor who had done this whole pregnancy with me was saying how he wishes they could handle it differently. I said I wish it wasn’t so hard.
I came to the decision that I needed labor and delivery, because I still wanted to hold him. If I had those memories, it would make it feel less like an abortion. That was my thought process. It doesn’t make it less of one, but it was a way for me to cope. I’d always been against abortion, but for myself not for others. What you do doesn’t affect me; it’s not my job to tell you what to do. But I thought I would never do that. Now, here I am making a completely different decision—there are 100 reasons why somebody could get an abortion, and we just happen to be one.
The woman from the clinic called and said they had to get me in by Wednesday, the day before 24 weeks. I was worried that if I reached 24 weeks while in the hospital bed, still giving birth, they would have to stop. Once I was going into labor, she told me, they could legally continue.
Only the people closest to me knew exactly what was happening. Everybody else just knew that something was wrong. In the world we live in, you don’t know who is pro and who is against, and I can’t have my work relationships impacted. My 2-year-old was too young, but we decided to tell our oldest. She loves to watch Ryan’s World, and they taught about the heart and lungs; plus we knew from a previous conversation that she was aware of how parts of our body help us live. We told her, “Baby brother’s organs aren’t working.” We didn’t explain the nitty-gritty, but we shared that he wasn’t going to make it. “Mommy and Daddy are going to have baby brother,” I said, “but he’s not coming home.” It hurt me to tell her; she was hugging my belly every day.
After I delivered him, still in the hospital, I had to call funeral homes. Since we had to travel out of state, we had to figure out where to send him in Illinois, and then how to get him home to Ohio. It would cost thousands of dollars. I will always remember seeing him in his little basket, and having to say my last goodbye before they wheeled me down to hop in a car for another five-hour drive (not including the stops to bleed in gas station bathrooms).
Some anti-abortion people will say our situation was different. It’s not. Because he had so many issues, they try to say mine was different, somehow less of an abortion, and it’s not. And I want my daughter to know that. We haven’t told her quite yet that we are the reason he is not here. She’s not there yet. But when she’s a little older, we’ve made the decision that we’re going to tell her. I want her to know that if for any reason she needs an abortion, it’s OK. She can come to me and tell me, and I’m not going to judge her. I just want her to know that I’ve been there, that I can be her lifeline.
Ashley | 30 | Detroit
Both of my pregnancies were unplanned.
I had a pregnancy about two years ago—when I was in a really bad time in my life—and I ended up having an abortion. While I don’t regret my decision, it kind of changed my view a little bit. I now knew that I wanted kids someday. After that happened, I really, really wanted to have that positive experience in my life at some point.
This past spring, I started to get the feeling I was pregnant again. I stopped at Walmart one morning before work and tested in the bathroom—positive. Even though I hadn’t planned for this, I did want to have the baby. I embraced that, and I was excited about it. I told my partner, and we started planning. We weren’t living together at the time, so we decided to get a house while I was still pregnant.
My pregnancy was honestly pretty easy. Nothing ever came up until our 20-week scan. It was actually my thirtieth birthday; I had taken the day off already, so I just decided to do it then. It had been a while since my last scan, so I was looking forward to it—to seeing her. After our scan, they told me to wait; someone would be in to talk to me.
The doctor told me that my baby had a pleural effusion, or a fluid in the lining of the lungs. And, honestly, they kind of downplayed it, telling me that they didn’t want me to stress. We didn’t know, I was told, whether or not there was a reason to be concerned. A different scan at another hospital could give me some answers. I think I really believed that there wasn’t going to be anything serious happening.
That next week we went to this massive hospital for the testing. The practitioner scanned me forever. The whole process was just super uncomfortable—you’re over 20 weeks pregnant, lying on your back with all that pressure. It made me feel light-headed and like I couldn’t breathe. Afterwards, I had to meet with a reproductive specialist. She greeted me by saying, “I’m sorry that there’s a reason for you to be seeing us.” That’s when I knew; there was now cause for concern.
She started flipping through binders of photos, each showing different genetic conditions. She told me all of the testing we needed to do and how long each result would take. Luckily I’m on Medicaid, so I was able to get all of the tests done that I could have, which I wouldn’t have been able to do otherwise.
It was three weeks later that we got a test back that said something was positive. I was 24 weeks—officially past the point of being able to get abortion care in Michigan. The screening results showed Noonan syndrome, which, my doctor explained, can range from being super mild to extremely life threatening. I started crying in my cubicle at work. Even in the best case scenario, they’d always need to be monitored heavily. I didn’t know what we were going to do. I found all of this out on Friday, and I had a baby shower on Sunday.
We didn’t tell anybody.
My sister and aunt spent all this time and money planning the shower, and it was beautiful. But in the back of my head, I just kept thinking about how something was going on that nobody knows. I had a couple of people ask if I was OK. I told them, “I’m just anxious.” I don’t like being the center of attention anyway.
We spent a couple of weeks researching the condition and trying to learn what we could about it. This is considered a gray diagnosis. In other words, not fatal. I was incredibly torn, and I felt like my head and heart were in two different places. My heart wanted to have a baby—I just spent months planning, imagining having the baby, having a baby shower, building the registry, and decorating a nursery. But, logically, I just couldn’t get on board with it.
What if the baby ends up having a lot of problems, suffering, and dying early? What if it is a life of nothing but surgeries? If our baby has a lot of medical issues, or even intellectual problems, I would have to leave my job. We can’t afford that.
I wanted to have a baby, but it wasn’t about what I wanted. It was about the baby, it was about what their life might have been like. I didn’t feel like taking that risk was worth it. I would have felt selfish to go through with the pregnancy.
I was already at the point where I was gonna have to travel out of state, and I found that it would take two weeks to get into these abortion centers. I knew the procedure was going to be thousands of dollars, but to actually find out that it’s going to be over $12,000 was crazy to hear. The people at the clinics are wonderful, they’re as helpful as they can be, and they told me not to worry about the cost. It was just a lot.
The Boulder, Colorado, clinic was able to get me an appointment in two weeks.
They booked me without a deposit, referring me to foundations to ask for financial support. We ended up getting help from four different organizations and raised half of the $12,500 needed for the abortion. The clinic told us that if we got halfway, they might be able to just take me in for that amount. And they did. This was in addition to the cost of the hotel and, of course, getting there. In total, everything would have been nearly $15,000 out of pocket.
We traveled to Colorado on a Monday. I was 30 weeks by the time I got out there. It was a four-day procedure. I already kind of knew what to expect, because of the first abortion I had at 20 weeks. I knew that on the first day, they would give me an injection to stop the heartbeat. Before that appointment, I broke down in the bathroom of our hotel—I didn’t think I could do it. At the clinic, they had a counseling session before, which was so helpful. I don’t know what I would have done if I hadn’t had that talk with them.
On the fourth day, I was put on Pitocin and was contracting for hours. I was so drugged out I barely remember anything. I know I was in labor and that I was able to see my baby—it felt like I already knew her. I flew back home to a nursery full of baby shower presents. Sorting through cards, clothes, and toys was just really hard. Then, my body started to change. I chose to pump when my milk came in. I’ve been pumping to donate to a milk bank in Michigan as part of my healing process. And I’m going to keep decorating the nursery.
I was pregnant when the Dobbs decision leaked, and still pregnant when Roe was overturned. I cried when I found out I was having a girl, knowing I would bring a daughter into a world where they’re not gonna have rights. I really wanted to take part in marches, but I was afraid for my own safety. I saw that police had been tear-gassing the protests, with pregnant women in the crowd.
I was so angry that we were fighting to just keep the abortion laws that we had in place, when I don’t even feel like they’re good enough. I wasn’t in a state that had a radical abortion ban, but I still had to be faced with the situation of having to travel halfway across the country.
I don’t owe anybody my story, but I also don’t owe anybody the quiet politeness of my silence, the comfort of my quietness. I felt, and feel, a lot of anger. I feel like we’re fighting for the bare minimum, and it’s just not enough.
Amanda | 35 | Cleveland
I felt him kick for the first time on my birthday, at the end of July.
I remember thinking, “That’s early.” That day we went to the beach—yeah, there’s a beach in Ohio, it’s off the lake—and my husband, Peter, was playing in the water with our son, Micah. I’m sitting back, rubbing my belly, thinking, “My life is complete.” I was 16 weeks pregnant. I feel stupid now, but then, I was thinking, “We’re going to have two boys. I have the most amazing husband and father for my kids.”
Less than a month later we were getting the news at his ultrasound. I remember the technician focusing a lot on his head. I looked at it and thought something didn’t look right, but I don’t know anything about fetal anatomy. She went to get someone else to see if they could get some better pictures of the heart. But when the next person came in, she also went to the brain. When the doctor finally came in and said, “We found something,” I replied, “I knew it.”
The next moments are a little bit of a blur. They found something called “ventriculomegaly.” He could just need a shunt, I thought. That’s manageable. That’s something that we could figure out. The doctor said, “It’s not that easy. There could be many other things associated with this.” She’s throwing all these statistics at me that I couldn’t even process. She asks, “Would you terminate?” I was in shock, then came the confusion. “Where? We’re in Ohio.” She continued, “Well, you know, you can go out of state.”
This was August, right after Dobbs; everything was still so fresh. Ohio had implemented a six-week ban. When she asked me if I would terminate, I hadn’t even considered that. I was still thinking that we can fix this, that it will be simple, not ideal, but we can improve his quality of life enough. We did the amniocentesis right away—it was very, very painful—and she said, “I’m so sorry. I really don’t like to tell people this information. It’s not favorable to be in this position. I’m so sorry.” That’s when it started to sink in that he wouldn’t just need a shunt.
I remember standing in the stairwell to the garage, just bawling my eyes out. Then I realized I had to keep moving. I gotta do this, we have to make decisions because it depends on the state where we can actually get care. We were 19 weeks, six days when we had our ultrasound, and then we had our next MRI at 20 weeks, two days.
I cried that entire MRI. I was so scared. When we went into the doctor’s office afterward, I remember him grabbing the Kleenex and putting it right in front of me, and I was like, “Fuck, it’s confirmed.” He had severe ventriculomegaly. Based on what we see, the doctor said, our son would likely have moderate or severe cognitive delay. He would have been a preschooler or infant-like his whole life.
People say, “God hands me whatever I can handle.” But it’s not what I could handle, but if a baby could handle this life. Why would you put a child through this pain? He wouldn’t be able to see, he wouldn’t be able to hear, he would have seizures his whole life, he wouldn’t be able to eat, he probably would not be able to breathe on his own. What kind of life is that to put a child through?
We have perspective going into this; as a physician assistant, I see these kids in the emergency room at work, some of the sickest children with many, many developmental needs, that are nonverbal; they are completely dependent on another person. And we have family members that have similar needs.
I chose induction and delivery. I needed to deliver my child; I needed to hold him. A friend connected with a provider on Instagram and got me into Penn State Hershey Medical Center. They called me that night to say they could get me in the following Tuesday. It felt like a train had hit me. “Oh my God, that’s so quick,” I thought. Then it was practical things: I confirmed with my insurance that they would cover it because it’s a gray area—not many people want induction and delivery, but I needed that. They had said it was covered. (It still says “Denied” on my claims; I will probably need to fight that tooth and nail.)
Even though I was terminating for a medical reason, we had to have a phone conversation to fulfill the 24-hour waiting-period requirement, in order to make sure that’s really what I wanted to do. You’re making women feel like criminals when they’re trying to do what’s best for them and their families.
It was a bleak weekend as we waited for our five-plus-hour drive. During those days I asked him to stop moving, and he did. I woke up crying, I fell asleep crying. We left at six in the morning. It felt like we were living in this dystopian world. We have one of the best hospitals in the entire world 10 miles from our house, and we needed to go six hours away for medical care.
When we got to Hershey, I had to take a pill to just get the process started, and was told to come back. We just had to wait. We were just trying to burn time—we had dinner, then we went shopping. We bought some things that now every time I see them, I think of him. I found this soap dispenser that said, “You are my sunshine.” That’s what I sing to Micah. I would have probably sung it to him too.
I was induced that evening, but my epidural didn’t work. It was really painful. He was born the next morning at 8:53 a.m. He was born sleeping. I had hoped—who hopes that their baby dies?—I was hoping that he was dead. I was hoping that I didn’t have to make the decision anymore, that it was taken away from me, that it was a miscarriage. But they did get a heartbeat, and gave us a recording. I can’t listen to it right now; it’s still too hard. We spent eight hours with him. We each got to take turns reading a book to him; they had a photographer, so we have some beautiful photos of the three of us, of him.
I never thought I could have an abortion. I had thought, “I will love my baby no matter what.” And I still love my baby no matter what. But this way, all he will have ever known is my love.
I wish people understood this heartbreak, this gray area. This country makes it so black and white: either killing babies or being OK with killing babies. But there’s a lot of heartache associated with it. It’s painted as a malicious, horrible, wretched woman who ends a pregnancy, when really there’s so much involved in this decision. I just hope that you know how much we loved our son, and all my baby will have ever felt is love, not a pain-filled attempt to try to make his life go longer.