Fighting for their lives: Women and the impact of abortion restrictions in post-Roe America

DENTON, Texas and New York -- This is Part I of a three-part 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 companion broadcast, "Impact by Nightline: On the Brink," with exclusive interviews by Diane Sawyer and Rachel Scott, brings you inside the hidden health care crisis playing out in clinics and exam rooms across the country. So many families posing the question: Is this what lawmakers intended? "On the Brink" premieres Dec. 14 on Hulu.

Anya Cook had reason to celebrate. After 17 miscarriages, she was pregnant again, in her second trimester, and she and her husband, Derick, were ready to share the good news with family and friends.

After the joyous announcement in December 2022, Anya and Derick attended the Coral Springs holiday parade in their Florida neighborhood, then went to dinner at a local restaurant. It was a good end to a good day.

Then joy turned to misery.

Cook was in the restaurant parking lot when she says she thought she got soaked by someone throwing water at her.

"I literally reached down and put my hand between my legs, and I saw that it was drenched with clear fluid. Never in my wildest dreams did I even think that that was my amniotic fluid that was leaking out of me. I still was convinced that someone threw something on me, up until Derick turned me around and said 'Babe, there is no one here,'" Cook told ABC News in an interview.

"I messaged one of my friends who is a labor and delivery nurse all the way across the country, and she's like 'you need to get to labor and delivery right now.' And I literally looked at Derick and said, 'Something is wrong. This shouldn't be happening,'" Cook said.

The couple immediately drove to a hospital, where Cook says her amniotic fluid was dripping onto the floor as she waited to be seen by a doctor.

What happened to Cook's pregnancy is not an uncommon complication; the doctor diagnosed her with PPROM -- preterm premature rupture of membranes -- when a pregnant woman's water breaks before the pregnancy is viable. At her stage of pregnancy, doctors said there was nothing they could do to save the fetus. Left without care, doctors say the mother's health could be in danger as well.

However, Cook's medical care now hinged on Florida's 15-week abortion ban, which went into effect in July 2022 after Roe v. Wade was overturned. Cook was already more than 15 weeks pregnant.

Had she lived in a state without restrictions on abortion care, she would have been admitted, counseled and offered an induction of labor to protect her from infection -- which in this case would be considered abortion care.

But Cook said she was discharged from the emergency room because she was not yet sick enough to qualify for the emergency medical exception in Florida's law, despite her risk for infection and hemorrhage.

Cook, who would later find herself on the brink of death, is not alone in her harrowing experience as similar stories emerge from women around the country, ABC News has found.

The Dobbs decision and cascading bans

At least 16 states have ceased nearly all abortion services in the wake of the Supreme Court decision in Dobbs v. Jackson in June 2022, which overturned Roe v. Wade -- ending federal protections for abortion rights. The landmark ruling left it up to each state to regulate the procedure. This has led to an increase in dangerous life-threatening situations like Cook's, according to doctors and patients, and sparked a round of lawsuits in states like Florida and Texas challenging the bans.

According to new data from the Guttmacher Institute, 92,100 patients traveled across state lines for abortion care in the first six months of 2023. But Guttmacher researchers told ABC News this doesn't take into account patients who were unable to travel for care. Many barriers can stand in the way of women needing to access abortion care; it can cost thousands of dollars to get care out of state, especially further along in pregnancy.

In a months-long project, ABC News brought together 18 women from across 10 states who say their medical care was impacted by abortion bans -- bringing several of them to the brink of death. All these women had wanted their pregnancies and none of them had initially sought abortion care. These women said they have been turned away in medical emergencies for not being sick enough, had their health care delayed or denied due to state laws and been told they have to continue their pregnancies despite devastating, fatal diagnoses for their babies -- even if their pregnancies put their own lives at risk.

The women detailed how they were left to grapple with medical emergencies and devastating fetal anomalies, while physicians were unsure what care -- or even medical advice -- they could legally provide. Their stories paint a picture of women being caught in the middle of the political battle over the issue of abortion, putting their lives at risk due to -- what physicians say -- are unclear laws.

Each woman has a different story to tell, shedding light on the reality of reproductive health care in the post-Roe era and the consequences women are facing due to abortion bans. ABC News also highlights the challenges doctors are facing as they and the facilities where they work struggle to provide care for the patients without running afoul with their states' abortion laws. The penalties for performing an illegal abortion vary depending upon the state, but can include loss of medical license, life in prison and up to $100,000 in fines.

Even in states with bans that have exceptions for medical emergencies, or to save the life of the mother, the language in the laws continue to confuse doctors and their patients, according to the nearly 100 doctors from states with restrictions ABC News interviewed over the last several months. Doctors said they are at legal risk for practicing the standard of care they were trained to do, and the laws leave it unclear how sick a patient needs to be before doctors can intervene.

'Nothing' you can do?

Two years into their marriage, Kristen Anaya and her husband, Stephen, went to a fertility specialist hoping to get pregnant. After undergoing medical procedures and two rounds of egg retrievals for in vitro fertilization, the couple was told they had one embryo.

Days after the embryo was implanted in January 2023, the Texas couple was elated to find out Anaya was pregnant.

During the first four months of her pregnancy, Anaya said she didn't have any issues -- until her water broke in April.

Anaya said she lost a significant amount of fluid in the next hour. An ultrasound showed that Anaya had lost nearly all her amniotic fluid.

"I felt like it was a dumb question, but I also wanted to ask it: There's no synthetic fluid that can be put in the womb and stitched back up?" Anaya told ABC News in an interview.

"I wanted to understand, from a science perspective, there's literally nothing they can do once you've lost your fluid? And [my doctor] confirmed 'no, there's nothing,'" Anaya said.

She had PPROM, like Cook, and her medical care was delayed and put on hold due to Texas laws which prohibit nearly all abortion care.

While the Texas ban has an exception to save the life of the mother, physicians and lawyers say that the exception is unclear and has in practice resulted in care only being provided in severe cases.

Anaya and her husband were in a gut-wrenching position -- the fetus' heart was still beating, but couldn't be saved. The couple said they didn't have time to mourn their daughter, who they named Tylee, who they had fought so hard to conceive. Anaya's doctor told her that their hands were tied until Anaya was much sicker -- sick enough for them to intervene.

Excitement turns to heartbreak

Elizabeth Weller, 27, and her husband were excited when she got pregnant in the beginning of 2022. They also live in Texas and had just started trying for a baby.

When her water broke at 19 weeks of pregnancy, she rushed to the emergency room where she was also diagnosed with PPROM.

When Weller felt she was not getting enough information about her health, she called her OB-GYN who explained that the baby was not viable at 19 weeks and had no chance of survival, like Cook and Anaya's babies. Weller's health was also now at risk.

Weller's physician requested an abortion from the hospital's medical board but she was denied because Weller wasn't sick enough yet. She had been started on antibiotics and her vitals were stable. And her fetus still had a heartbeat.

A nurse told Weller she had to wait until she was showing signs of a worsening infection before she could be approved for the termination of her pregnancy, telling her the symptoms of a serious infection would include vaginal discharge that released a strong odor.

"It has to be so strong that you can smell it in a room and wretch, that's what they said; that's what they were looking for," Weller said.

"When I took that sample, I smelled it and almost threw up and went, 'Oh there it is, that's the key to me saving my life,'" Weller said.

Cook, Anaya and Weller all faced the serious, deadly risk of developing sepsis if left untreated, but still they had to wait until they got sicker before doctors could intervene due to their states' restrictions on abortion.

"We are medical refugees -- in the United States," Weller said.

In pain and 'becoming increasingly very sick'

Kristina Cruickshank was getting sicker by the day.

Cruickshank learned at 15 weeks that her pregnancy was not a formed fetus. She had a partial molar pregnancy -- when one egg is fertilized by two sperm. Her pregnancy would never develop into a child.

But Cruickshank, who also lives in Texas, was not initially admitted to a hospital.

"My baby was not viable from the moment it was conceived. I was becoming increasingly very sick -- I was throwing up numerous times every day, I developed hyperthyroidism, I could barely walk because my abdominal pain was so severe and I learned I had enlarged ovaries and cysts around both ovaries," Cruickshank said.

"At my next appointment, a different doctor realized just how sick I was and admitted me to the hospital right then," Cruickshank said.

Left untreated, partial molar pregnancies can cause cancer. The treatment is immediate termination.

"It can develop into cancer if all of the molar tissue doesn't get removed from inside. You would have to do chemotherapy or a hysterectomy," Cruickshank said.

At the hospital and in pain, Cruickshank said she waited. She said there were no physicians at that hospital trained to do a dilation and evacuation procedure, which doctors say is the standard of care to terminate a partial molar pregnancy.

"They didn't know what to do with me, frankly," Cruickshank said.

"It was the weekend, and they were trying to convene the ethics committee, but they didn't want to convene and it was just going around in circles," Cruickshank said.

In any other state, Cruickshank would have been given an immediate termination, but in Texas her physician spent three days trying to find a hospital to take her case.

In response to the changing legal landscape for abortion, hospitals throughout states with abortion bans have created termination boards that need to approve any abortion care before it is provided to patients. This sometimes leaves women waiting for many hours or days to get care they need. Many of the women interviewed by ABC News needed approvals from the boards, usually made up of physicians and lawyers, despite being in medical emergencies.

'What about my life?'

For women interviewed by ABC News, getting medical care -- that would have been available to them under Roe -- turned into harrowing journeys of confusion, loss and grief.

After three days of waiting in the hospital in pain, Cruickshank's OB-GYN found a different hospital that agreed to treat her.

She now has regular follow-up appointments to check for evidence of cancer.

Anaya, who went to the hospital after talking to her doctor, had to wait for nearly 24 hours before she was given lifesaving care, with her doctors knowing that her daughter had "no way of living" after her water broke.

"In what world does that make any sense -- to prevent health care for me. What about my life?" Anaya said.

According to medical records, Anaya's doctor initiated contact with the hospital's termination committee when she was admitted -- her doctors would need to be able to prove to the hospital's ethics board and medical board that her life was in danger. Over the next 22 hours the physician would regularly conduct blood tests and exams that they would send to the committees to document her health declining.

"They were going to be monitoring me, doing bloodwork every three hours, monitoring my vitals and 'building a case' to prove that my life was in great danger and they needed to induce labor," she said.

During that time Anaya developed sepsis, suffering a high fever, uncontrollable shaking and vomiting at least eight times.

"Our doctor, our nurses were crying at my bedside -- wishing they could do something with blank stares on their faces because they literally couldn't do anything until the bloodwork showed that I was dying," Anaya said.

Anaya told ABC News that she suffered body aches for a week after she was discharged because of how much she was shaking. Anaya recently joined an ongoing lawsuit filed by women against the state of Texas -- saying its bans put their lives in danger -- that is awaiting a ruling from the state Supreme Court.

Anaya and her husband are still going through fertility treatment and exploring all their options. Since losing Tylee, the couple have had one unsuccessful egg retrieval -- Anaya had 28 eggs but none of them developed into an embryo.

They have a surrogate medically cleared and are waiting to have an embryo.

Weller kept looking for signs of an infection for three days -- all while vomiting constantly and experiencing pain. She continued to leak amniotic fluid.

She went back for another ultrasound, but her fetus still had a heartbeat, although it would not survive.

On her way out of her doctor's office, Weller experienced another gush of liquid that was yellow and had a strong odor. She took a sample of her discharge.

She was admitted to the hospital that night -- where she showed the sample -- and was diagnosed with chorioamnionitis, an infection of the amniotic fluid and tissue surrounding the fetus. A medical board approved her abortion.

A dream becomes a nightmare

As Anya Cook sat in the hospital waiting room, she could feel her dream of becoming a mother slipping away.

"I could not believe that this was happening to me," Cook said.

"I fought hard for this pregnancy. No one chooses the route of IVF and thinks that it is going to be an exciting, happy time. It is hard, it is strenuous, it's tedious, it takes a real toll on your body and your mental health. So, I couldn't even think of the fact that I was losing my daughter," Cook said.

Despite her PPROM diagnosis, Cook says the doctor told her that he was at risk himself -- of losing his medical license or even getting arrested -- and the hospital in trouble if he admitted her for abortion care because of Florida's laws. At that point, Cook's baby still had a heartbeat and was moving around inside her.

But Cook said the doctors gave her antibiotics, and discharged her from the emergency room, telling her to return immediately if her symptoms worsened. When she realized that the hospital would not provide further care at that point and that she faced increased risk of harm, Cook said she was convinced she was not going to survive.

Cook said she kept a hair appointment she had scheduled for the next day because she didn't want her mother to worry about getting her hair done after she died. At the salon, Cook went to the restroom, where she proceeded to deliver her baby over a toilet bowl.

"I heard my daughter hit the toilet," Cook said.

She called her husband and told him to come look because she couldn't do it.

A nurse, who was in the hair salon by coincidence, told Cook she was losing a lot of blood. At the hospital, the couple was told Cook would need a dilation and curettage procedure -- commonly known as a D&C -- the surgical removal of the lining of the uterus. But there were complications, it took longer than expected and a special team was brought in to perform the surgery.

Cook lost a life-threatening amount of blood. She had hemorrhaged to the point that she was put on a ventilator that was breathing for her at 100%.

Cook was later told that her placenta had likely embedded itself into the wall of her uterus, a condition called placenta previa, which had caused excessive bleeding when she tried to deliver the placenta in the bathroom of the hair salon.

"Had that happened at the hospital the first night, they would have taken care of it that night. It would have been a physician delivering the placenta and not my husband having to play doctor," Cook said.

Read Part II in the series here.