In early October, Avery Davis Bell learned that she was about to lose the baby she and her husband very much wanted.
The 34-year-old geneticist had been hospitalized in Georgia after repeated episodes of bleeding, and she and her doctors all knew exactly what was needed to manage her miscarriage and prevent a life-threatening infection. They also knew why she wasn’t receiving that care immediately.
In an instant, the impacts of her state’s restrictive laws on abortion care became clear: Had Bell been bleeding from a car accident or a burst appendix, doctors could help her right away. Had she had a miscarriage in Boston, where she lived until 2020, doctors could snap into action. But because she was having a miscarriage in a hospital in Georgia, surgery had to wait.
Since the US Supreme Court’s 2022 Dobbs decision eliminated the federal right to abortion, miscarriage management has become trickier and in some cases, deadlier.
Many miscarriages take place at home without medical intervention, but cases like Bell’s can be treated with the same medicines or surgical techniques used for abortions.
Thirteen US states have total or near-total abortion bans. Several others restrict it to certain points in pregnancy, including Georgia, which limits abortion to the first six weeks of pregnancy. Bell’s pregnancy was at 18 weeks — too early for her fetus to survive outside the womb but well past Georgia’s limit.
Doctors told Bell she’d have to wait, unless her condition grew worse: Georgia makes people wait 24 hours before they can have an abortion except in medical emergencies.
Bell switched into crisis mode.
“I was breathing, I was recording everything that was happening in my mind, and I was thinking ‘I just need to get through it,’” Bell said. “I even told my wonderful husband, who obviously was very sad when we got this news, I said, ‘I love you. We’re going to be sad, but right now I have to get through this medical emergency, and I’m sorry to ask you, but I need you to pull it together until I get through to this surgery.’ ”
Bell said she does not blame her doctors at Emory University Hospital in Atlanta. Rather, she blames the law itself.
When Georgia’s six-week abortion ban went into effect in 2022, Republican Gov. Brian Kemp promised pregnant women that the state was “ready to provide the resources they need to be safe, healthy, and informed.” But Georgia, which has long had one of the worst maternal mortality rates in the country, has also had at least two deaths of pregnant women who couldn’t access timely medical care or legal abortion.
It’s not the only state facing such issues. Texas enacted an abortion ban in 2021, and the rate of maternal deaths there increased 56% from 2019 to 2022, according to the Gender Equity Policy Institutes’ analysis of data from the US Centers for Disease Control and Prevention. This year, a woman died after being told it would be a “crime” to intervene in her miscarriage at a Texas hospital, and a pregnant teenager died after trying to get care for pregnancy complications in three visits to Texas emergency rooms.
In states with abortion restrictions, the maternal death rate increased twice as fast between 2018 and 2020 than in states without such restrictions, according to a 2022 report from the Commonwealth Fund. The inequities have deepened racial and ethnic gaps in health outcomes, as women of color – particularly Black and Hispanic women – generally have higher maternal mortality rates.
A troubled pregnancy
Bell and her husband, Julian, could have stayed in Boston, where she got a doctorate in genetics and genomics from Harvard University and he got his degree from MIT. But Bell grew up in Georgia, and they wanted to move closer to family as they expanded their own.
They were thrilled to have their first child, a son, in 2021.
This July, she learned that she was pregnant again. When she was 12 weeks along, she told her son he’d soon have a sibling. He was ecstatic.
“He talked to the baby and hugged the baby every day in my tummy,” she said.
By September, Bell had begun having trouble with her pregnancy. Her condition was stable, but she was hemorrhaging. Doctors diagnosed a subchorionic hematoma, a condition that causes bleeding between the uterine wall and the amniotic sac. It often clears up on its own, but Bell said she had one of those rare cases where she continued to bleed.
Doctors eventually advised Bell to go on bed rest. She said she left the house only to vote early and to make regular trips to the doctor.
But in early October, Bell’s bleeding got worse, and she had to take three trips to the hospital in two weeks.
At first, doctors told Bell that the baby was still doing well. On her second visit, they warned that if the bleeding didn’t stop, it could be too much for the fetus and dangerous for her own health.
At one point, she passed a clot the size of a dinner plate. She scooped it out of the toilet and put it in a takeout container to show the doctors.
“It was so scary,” Bell said.
On October 17, on her third trip to Emory, the doctor who had delivered her first child was on duty. She ran tests and told Bell that her water had broken and that her pregnancy needed to end.
“She’s been with us for a lot, and we got hugs,” Bell said. “You know when you get hugs from your doctor, it’s serious.”
Waiting periods and paperwork
Bell was crushed. She knew that at 18 weeks gestation, the fetus could not live outside the womb.
Her doctor called in a complex family planning specialist to help. A procedure called dilation and evacuation would be necessary to control the bleeding and clear out Bell’s uterus and prevent infection.
But because the fetus still had a heartbeat, the procedure would be an abortion. Georgia law criminalizes abortions past six weeks except when “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.”
The doctor “was telling me ‘because we’re in Georgia, we can’t move immediately to the surgery,’ ” Bell remembered.
Georgia’s 24-hour waiting period frightened and frustrated her.
“It’s just so hard because it’s a wanted pregnancy, to feel like this was really inevitable and that waiting period that I was put into made that harder,” Bell said. “We couldn’t just move from emergency to done. We just had to sit in limbo. My fetus is dying, and I am stable this second that I’m thinking this, but in 10 minutes I may not be, and that’s just a time no one should have to extend, that limbo.”
The law also required Bell to fill out paperwork she found distressing. It spelled out medical risks of abortion, the probable age of the fetus, the presence of a human heartbeat and details about potential economic support, had she been able to give birth.
“I had to sign a consent form for an abortion, which has some sort of garbage language about heartbeat and fetal pain and stuff that’s clearly put in for legislation reasons rather than scientific reasons,” Bell said.
The hospital transferred Bell – still bleeding and in pain – to another location that was better equipped to do the surgery but where she expected to wait again for doctors to figure out when they could schedule her procedure.
Later that day, tests showed that levels of oxygen-carrying hemoglobin in her blood had reached a dangerous low, putting her life at further risk. That new signal meant that doctors could finally help her.
Bell was grateful to finally get the care she needed but angry on behalf of her doctors, who she felt had not been allowed to use their best judgment.
“My doctor had over a decade of post-college education to be able to navigate those situations, and yet the law hamstrung her,” she said. “It makes doctors jump through hoops written by elderly men who have no medical knowledge and have an ideological position inconsistent with how biology works.”
‘We’re adding insult to injury with this law’
Dr. Sarah Prager, a fellow with the American College of Obstetricians and Gynecologists, a professional organization that represents more than 26,000 physicians, says abortion laws like Georgia’s are inhumane.
“You have people who are not clinical weighing in on a medical decision, which is asinine,” said Prager, who was not involved in Bell’s care. “The whole purpose of modern medicine is to prevent illness, so to push people to the brink of death and pull them back because of some law is wrong, and if nothing else, we’re not always successful.
“It’s cruel, and it devalues the life and the health of the person,” she added.
There’s also an emotional toll that comes with prolonging the situation. It will take a while to heal physically and emotionally, said Bell, who had to get another iron infusion after the surgery and is only now starting to take walks again.
Eventually, she expects to create a scrapbook with her ultrasounds, the notes she got from friends and family, and a print of the tiny footprints that she got from the hospital. She hasn’t been able to look at those yet.
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What’s left is a mix of emotions. The entire family is sad for the loss of the pregnancy. Bell and her husband still hope to have another child. And there’s anger that Georgia’s laws prolonged her painful experience.
“Even if everything had gone perfectly, this still would be one of the worst times of my life and the hardest times for my entire family,” she said. “And then we’re adding insult to injury with this law.”
Having family around her and having a science background made it easier to advocate for her care, she said. Her doctors reassured her throughout her hospitalization that they would not let her die. They treated her like a peer, communicating clearly and pushing to help her. But not everyone has the same circumstances, and she worries about others who miscarry in Georgia.
“I have immense, great gratitude for my doctors, sadness for our expected child and anger at the ways this was made harder for me and for my care team because of laws and policy that’s not based in biological reality,” Bell said. “Nobody should have to go through this.”