On the morning of Sept. 16, 2024, Emily Waldorf’s preschooler found her curled on the bathroom floor. Waldorf had felt a strange pressure during a shower, like a balloon bulging into her vagina, and was now bleeding. “I can be your pillow, mommy,” her daughter said, nuzzling into her neck.

Waldorf was 17 weeks pregnant. She and her husband, Justin, dropped their daughter off at her grandparents’ and rushed to Washington Regional Hospital in Fayetteville, Arkansas, where Waldorf worked as an acute care physical therapist.

In a dark room, a doctor pointed to an hourglass shape glowing on the ultrasound screen: There was her amniotic sac, funneling into her dilated cervix, and there was their tiny daughter’s foot, dipping out.

“Your body is about to miscarry,” the doctor said.

Three doctors gathered and told the couple that the longer Waldorf’s cervix remained open and her uterus exposed to bacteria, the higher her risk of developing a life-threatening infection. The standard of care, they explained, would be to quickly empty her womb.

But they couldn’t do that, one doctor said apologetically, sighing deeply. The baby still had a detectable heartbeat, and stopping it would run afoul of a state abortion ban that snapped into place after the Supreme Court overturned Roe v. Wade in 2022; violations carried penalties of up to $100,000 in fines and 10 years in prison. They needed to wait until Waldorf went into labor on her own or showed signs of a dangerous infection, or until the fetal heartbeat ended.

“Our hands are tied behind our backs,” Dr. Erin Large later told her, according to a journal Waldorf began keeping on her phone and shared with ProPublica. “Tell your friends to vote differently.”

Raised Baptist in a Republican family, Waldorf struggled to understand what the doctors were saying as waves of grief hit her. How could an abortion ban aimed at women who wanted to end their pregnancies keep doctors from helping a woman who didn’t?

Waldorf didn’t oppose abortion, but she had never considered that the law could apply to her. Her father was a doctor. This was the hospital where she had worked for the past six years. The OB-GYN team treating her had delivered her daughter, and some of them lived blocks from her parents. She was a highly educated 38-year-old woman with connections to the governor. As she lay in a hospital bed, worried that infection could enter her uterus at any moment, she finally understood the ban now applied to anyone losing a baby.

Trapped in a medical limbo, she took a nurse friend’s advice and began writing everything down. That journal, along with her medical records and interviews, offer a rare, harrowing account of how Arkansas’ abortion ban, not best practices or medical training, guided her doctors’ choices.

She was miscarrying as hospitals, physicians, lawmakers and medical boards around the country were being confronted with the reality that the bans, designed to be as strict and punitive as possible, were causing preventable harm and even deaths. Yet even as more of these cases stacked up, there was no coordination between states to protect women. Each state, each woman seemed to operate in a vacuum. And Waldorf would find she was in it alone.

One of the doctors advised Waldorf to go home and told her what to expect: At any moment, she could start bleeding heavily and go into labor. It might happen while she was going to the bathroom or playing on the floor with her daughter.

When the baby started to emerge, the doctor said, Waldorf shouldn’t pull too hard or she could rip the baby’s head off. She would need to cut the umbilical cord herself and return to the hospital for care in a diaper, her fetus wrapped in towels and the cord hanging between her legs.

Waldorf didn’t want her daughter, or herself, to have those memories inside their home. So she begged to stay, and the doctors agreed. No one could predict when the ordeal would be over.

Waldorf settled into a small hospital room, her husband glued to the vinyl couch beside her, both reeling from the impending loss of what would have been their second daughter.

The pregnancy had been far enough along to start getting their 4-year-old daughter excited about decorating a nursery, family-of-four camping trips and what it would mean to become a big sister.

Now they had to engage in the morbid ritual of waiting for that dream to die. Doctors and nurses with Doppler machines and ultrasounds kept showing up, forcing them to hear the heartbeat and see the movement of a tiny body. “Oh look,” Large said during one of the ultrasounds, “she’s opening and closing her mouth.”

“My body failed a baby,” Waldorf wrote in her journal.

Waldorf’s job, treating critical patients in the intensive care unit, had taught her to compartmentalize, to stay cool under pressure. But as the days bled together, her resolve turned to panic when she discovered one outcome she had not considered.

Scrolling through social media on her third night, a headline caught her eye: “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.”

On the day Waldorf was admitted to the hospital, ProPublica had published an investigation on the death of Amber Thurman, a 28-year-old medical assistant who died of infection after doctors delayed emptying her uterus. Thurman left behind a 6-year-old son.

“Oh my god, it isn’t just me,”Waldorf thought.“But she died.”

Almost exactly three years before Waldorf showed up at Washington Regional in urgent need of care, a 28-year-old woman named Josseli Barnica arrived at a Houston emergency room with the same condition. She, too, was 17 weeks pregnant. The fetus’ head was pressed up against her dilated cervix, and a miscarriage was, according to her medical record, “inevitable.”

When her husband rushed from work to her side, she relayed what she said the medical team had told her: Inducing delivery or emptying her uterus would be “a crime,” he later told ProPublica. “They had to wait until there was no heartbeat.”

Texas, like Arkansas, has a criminal abortion ban. Had Barnica landed in one of the hospitals across the world, from Nigeria to Mexico, that follow standards from the World Health Organization and countless medical associations, her treatment would have been much different.

In those hospitals, when a patient’s cervix opens too soon, signaling an “inevitable miscarriage,” or when their water breaks before the fetus can survive, known as previable preterm premature rupture of membranes (shorthanded as “PPROM”), it’s standard for doctors to offer to empty the uterus. That’s true even if there is still a heartbeat, given the high risk of infection.

“This is basic obstetrics,” said Dr. Alison Goulding, a maternal-fetal-medicine specialist in Texas. “Everyone should know that you have to provide an abortion in these settings or women can die.”

For 40 hours, Barnica waited in the hospital for the heartbeat to stop, with her cervix exposed to bacteria. She died three days after she delivered, ProPublica reported in October 2024; the cause was a deadly infection. The hospital declined to comment on Barnica’s case but said “our responsibility is to be in compliance with applicable state and federal laws and regulations” and physicians exercise their independent judgment. The doctors involved did not respond to requests for comment.

Her death and those of six other women in three states over the next three years brought into sharp focus the consequences of the bans. Because the laws’ exceptions for medical emergencies are vague and have rarely been tested in courts, liability-conscious hospital administrators, lawyers and doctors have sometimes put legal concerns above their patients’ well-being, ProPublica’s reporting has found.

Texas lawmakers responded to ProPublica’s investigations by amending the exceptions in their state laws to make clear that a life-threatening emergency did not need to be “imminent” for physicians to act. The state’s medical board specified that doctors can empty the uterus of any patient with PPROM, and it requires doctors to undergo training to ensure they know that.

But Texas’ reforms stopped at its borders. Without a single federal law governing abortion, each of the 19 other states with similar bans were not required or advised to follow suit. That includes Arkansas, which touts its designation as the “most pro-life state in America.”

Since its ban took effect, not one person there has been granted a medically necessary abortion, according to the state’s public data.

The state’s Republican lawmakers and officials have repeatedly shot down attempts to........

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