The third week of July 2023 was like every other for Theresa Lee. It was a Tuesday, time for her weekly ultrasound appointment. She and her 2-year-old daughter, Millie, had gone out to lunch, run some errands and enjoyed their day in Fort Smith before heading to the doctor’s office. Lee, 28, had faced a complication to her pregnancy, but after a fun day out with her daughter, she held a positive outlook going into her appointment.
As Lee and her daughter entered the exam room, Millie grew frightened. The nurses tried to calm her, but she was inconsolable. Millie couldn’t shake the memory of this room, where she had witnessed her mom’s uncontrollable tears before.
As soon as Lee sat on the observation table, she felt that something was wrong.
The nurse conducted the ultrasound, and as it went over Lee’s stomach — over Cielle — the nurse went quiet. “There was no sound, it was silent.”
“She’s gone isn’t she?” Lee asked.
Danger grows
Lee had been carrying her baby girl, Cielle, for around seven months. These appointments had been a part of her weekly routine ever since her OB-GYN found that Cielle was lacking amniotic fluid, caused by Lee’s placenta overtaking her cervix. The amniotic fluid surrounds a developing fetus, and without it, the baby has little chance of surviving.
Lee’s doctor made this discovery early in the pregnancy and confirmed that Cielle had an extremely low chance of making it to full term. Not only was Cielle’s life in great danger, but Lee herself was at risk. Giving birth to Cielle proved a serious medical threat, as Lee had a high chance of bleeding out during birth. “The longer I went having Cielle, the more risk I was at losing my life,” Lee said.
Despite Cielle’s predetermined fate, Lee had no choice but to carry on with the pregnancy. Under Arkansas’s near-total abortion ban, no exceptions are allowed, even when death or grave suffering for the fetus is assured. Each week, Lee had to show up to her ultrasound appointments, only to observe her slowly dying child. “I was grieving her while she was still alive,” Lee said. “I just wanted that closure.”
She kept asking herself, “Is she going to be alive this week?”
In most cases like Lee’s, where a baby is very unlikely to make it to birth and is harming the carrier, doctors might perform an abortion for the physical and emotional sake of the mother. In Arkansas, however, this was not legally an option.
“My OB couldn’t do anything,” Lee said. “He didn’t want to risk his license.”
Worried that she might lose her life during birth, Lee and her husband had to have serious conversations about what to do and how to carry on if Lee were not to make it. Lee became emotional thinking about Millie’s future without her. “We didn’t know what was going to happen,” Lee said. “I’m thinking I’m going to die.”
Lee had grown up with seven sisters, and always wanted Millie to have a sibling. Before they had known about Cielle’s critical condition, Lee and her husband, Markell, were so excited to welcome another baby girl. The couple were preparing for their baby shower and buying clothes for their new daughter.
Millie was ecstatic to have a sister. “We had been teaching Millie that she has a sister, we told her that there’s a baby in my belly,” Lee said.
Millie would often come and rub her mother’s stomach and yell, “Baby!” She would continue this ritual even after Cielle died on July 18, 2023.
Pulling the trigger
Arkansas outlawed almost all abortions in 2022, right after the U.S. Supreme Court overturned Roe v. Wade, the monumental 1973 case that opened up abortion access around the country.
The state Legislature had prepared for the ruling by passing a so-called “trigger law” that would kick in if Roe were to fall. The trigger enacted a near-total ban on abortion, allowing no exceptions for incest, rape, fatal fetal anomaly, the health of the mother, or the inability to raise a child. The only current justification for abortions in Arkansas is if the mother is dying. This exception is very broad, however, and does not define how “at risk” the mother must be before abortion becomes a legal option.
“How close to death do you have to be?” asked Gennie Diaz, a board member of the group Arkansans for Limited Government. “As someone who may need to get emergency care, I would want to know that I don’t have to be at the precipice of death before someone intervenes to save my life.”
Arkansans for Limited Government is a ballot question committee advocating for an amendment to be included on this year’s ballot. The amendment would permit abortions in the state up to 18 weeks post-fertilization. It would also prevent the state from enacting additional restrictive laws against abortion.
Diaz explained that up until 18 weeks post-fertilization, people would be able to receive an abortion in the state “no questions asked.” After 18 weeks, abortions would still be permitted, but only for certain circumstances like incest, rape, fatal fetal anomaly, or to preserve the life or health of the mother.
“It’s really going to make a big difference in the lives of people who need health care in the state,” Diaz said.
Dina Epstein, an OB-GYN in Little Rock, said Arkansas abortion laws regarding the health status of the mother aren’t clear. “When is it an emergency? Who gets to determine that? Do we have to wait until the patient is knocking on death’s door before we are able to provide care for her?” Epstein asked.
Epstein has been practicing medicine for more than four years and is a member of the Healthcare Alliance for Reproductive Care, a group of health care professionals who advocate for the restoration of abortion rights in Arkansas.
The trigger law is a health care issue, not a political issue, she said. And the no-exception abortion rule interferes with the relationship between the doctor and the patient, as both parties are hesitant about the legal repercussions. “It has disrupted the trust that exists between patients and doctors,” Epstein said.
Epstein resents having to watch her patients suffer and endure serious health risks, all because they are being forced to carry unhealthy pregnancies. Epstein said she essentially has to wait for a mother to become sick enough before she can take action.
How sick is sick enough? Even many doctors are unsure when a mother is in sufficient peril to justify an abortion. But performing or attempting to perform an illegal abortion in Arkansas can put doctors in jail for 10 years, or draw a $100,000 fine.
Epstein has had many doctors tell her that they refuse to work in states with strict abortion laws due to the potential incrimination and restriction on their practice. Epstein said open positions for OB-GYNs in Little Rock are not being filled despite the city’s low cost of living, and she wonders if the state’s trigger laws may cause doctor shortages in the future.
OB-GYN positions also go unfilled in other trigger law states, like Idaho, Texas and Tennessee. These shortages worsen threats of maternity care deserts in red states, which also happen to have some of the highest rates of maternal mortality.
When the Arkansas trigger law first went into effect in 2022, Epstein noticed more patients seeking permanent sterilization. She said even women who might have been considering a family down the line were desiring permanent birth control because “the risk was too great.”
Before the Supreme Court’s decision overruling of Roe v. Wade, women in Arkansas had access to abortion despite decades of legislative attacks. In 2020, for example, 3,250 abortions were performed in the state, according to the pro-choice Guttmacher Institute.
As of April 2024, there are 674,000 women of reproductive age in Arkansas. Many of them are teenagers, and Arkansas has the highest rate of teen pregnancy in the nation.
Weighing the consequences
The doctors in Fort Smith grappled with what to do in light of the ultrasound results, Lee said. Her OB-GYN, Dr. Brock Wilson, told her he’d met with his colleagues at Fort Smith’s Mercy Hospital and posed a question: If Lee required an emergency birth at 3 a.m. and he was unavailable, would anyone be willing to perform the delivery?
All of them said no. An emergency birth could conceivably be considered an abortion under Arkansas’s ambiguous new abortion law, which does not clearly define whether the removal of a dead fetus qualifies as an illegal abortion. The lack of clarity is leading to hesitation among Arkansas doctors who face severe potential punishments. No one wanted to determine when Lee’s life was sufficiently “at risk” to legally justify performing the procedure, Lee said.
This hesitation from the Fort Smith doctors, and the fact that the two hospitals in Fort Smith did not have a large enough blood bank for Lee if she happened to bleed out during birth, resulted in her being sent to UAMS in Little Rock.
The day after the ultrasound, Lee and her husband left their home at 5 a.m. to give birth to their dead daughter.
In the hospital, it was hard for Lee and her husband to be away from their home and Millie. “I’m at a hospital that I’m not familiar with, doctors I’m not familiar with, and away from everyone,” Lee said.
Markell picked up Rally’s for Lee’s dinner. As Lee was sitting in the hospital bed, eating her french fries, she felt something wet down below. The nurse told Lee that blood clots were expected and that she should just push them out.
After passing a few, Lee felt an abnormal one approaching. Worried that she might start bleeding out, she told Markell to look under the blanket. The first thing he saw were hands.
“It was her. I pushed it out and it was Cielle.”
Lee researched before the birth to see what a premature stillborn would look like. Her doctor told her stillborns may look translucent or “alien-like,” so Lee was shocked when Cielle came out looking like a normal, healthy baby. Cielle had fingernails, and a head full of hair. Lee said “she looked just like her sister.”
Lee held her daughter for the rest of the night. She knew her time with Cielle was limited, being that her body was slowly decomposing. Although the nurses told Lee that she could spend as much time with Cielle as she wanted, she knew that their time together was coming to an end. “I could tell that she was breaking down,” Lee said.
After hours of paperwork, Lee and her husband were able to transport Cielle back to Fort Smith themselves. On the way back, the couple talked to Cielle and sang her their favorite songs the entire car ride home. The hardest part for Lee was dropping Cielle off at the funeral home. “You go there with a baby and you leave with a box,” Lee said. “I really have nothing from her.”
Lee’s pregnancy and birth with Cielle were beyond traumatic. Days were filled with antidepressants as well as uncontrollable and constant sobbing. Lee also experienced severe cases of postpartum depression and postpartum anxiety.
Lee protested in Fort Smith when Roe v. Wade was overturned. She recalled the immense feeling of solidarity and togetherness she and her husband experienced as they added their voices to a chorus of Arkansans. At the time, Lee had no idea that she would personally confront the ramifications of these laws nearly a year later.
Restoring access
Arkansas is one of the 26 states that allows citizen-led initiatives and referendums, but it’s a harder process than it used to be.
House Bill 1419 of 2023 requires signature collections from registered voters in at least 50 of Arkansas’s 75 counties. Previously, the requirement was 15 counties. More than 91,000 Arkansas voters will have to sign a petition by July 5 to get the abortion measure on the November ballot.
While she will have to work much harder because of the new law, Diaz sees this as an opportunity to reach out to even more Arkansans and educate them on the importance of abortion access.
Lee shares her story all over social media, wanting to spread the word about Arkansas’s strict abortion laws and how they affected her family. Many Arkansans, she noted, remain uninformed about trigger laws. “So many people told me, ‘Oh my god I can’t believe that you went through that and that was allowed,’” Lee said.
Lee said she knows multiple people who were previously “pro-life,” advocating for anti-abortion laws, who completely changed their perspectives after hearing her experience. “That’s why I am so open about our story,” she said.
Concerned about her young daughter, Lee is terrified of what the future might hold for women’s access to abortion, as she does not want her child to go through an experience similar to her mother’s. “When you become a parent, your priority is not yourself anymore, it’s about your child,” Lee said. “You want to make the world a better place so that your children can have a safe, loving place to grow up in.”
Lee isn’t alone in her concerns about the future; many Arkansans are voicing their anxieties about living in a trigger-law state. For now, Lee continues to amplify her story online, and volunteers persist in their efforts to gather signatures, all with the hope of restoring abortion access for women in the state.
Stella Hufhines is a journalism major with an English minor at the University of Arkansas at Fayetteville.