CHATTANOOGA, Tenn. – Madison Underwood was lying on the ultrasound table, nearly 19 weeks pregnant, when the doctor came in and said her abortion was canceled.
The nurses followed and began to wipe the cool sonogram gel from her exposed abdomen as the doctor leaned over her shoulder to speak to her fiancé, Adam Quinn.
She remembered going quiet, her body still. What did they mean they couldn’t have an abortion? Just two weeks earlier, she and her fiancé had learned that her fetus had a disease that prevented it from surviving outside the womb. If she tried to carry it to term, she could become critically ill or even die, her doctor said. Now she’s been told she can’t have an abortion she doesn’t even want but needs.
“They’re just going to let me die?” she remembers wondering.
In the haze around her, she heard the doctor and nurses talking about a clinic in Georgia that could perform the procedure now that the legal risks of doing it in Tennessee were too high.
She heard her fiance cursing and with disappointment in her voice she told the doctor that it was stupid. She heard the doctor agree.
Just three days earlier, the US Supreme Court had struck down the constitutional right to abortion. A Tennessee law passed in 2020 that would ban abortions around six weeks into pregnancy has been blocked by a court order but could go into effect.
Mrs. Underwood never thought any of this would affect her. She was 22 and excited to start a family with Mr. Quinn, who was 24.
She and Mr. Queen had gone back and forth for days before deciding to terminate the pregnancy. She was afraid of abortion. She had cried in the car pulling up to the clinic. She had heard that the Supreme Court had overturned Roe v. Wade, but she thought that because she had planned her abortion before the ruling and before a state ban went into effect, the procedure would be allowed.
Tennessee allowed abortion if the woman’s life was in danger, but doctors feared making those decisions too early and facing prosecution. Across the country, the legal landscape was changing so rapidly that some abortion clinics were turning away patients before the laws officially took effect or while legal battles were being fought in state courts.
Centuries-old bans hanging on the books were activated, but then challenged just as quickly. In states where abortion is still legal, clinic wait times have jumped as women from states with bans seek alternatives.
It was in this chaos that Mrs. Underwood was sent home, still pregnant and shaken. What would happen now? The doctor said she should go to Georgia, where abortions are still legal up to 22 weeks, even though that state has a ban that will soon go into effect.
Read more about abortion issues in America
How will her fiancé get time off work to make the trip? How will they come up with money for hotels and gas? How long did it take for her to get sick herself? A new, more terrifying question struck her: What if she felt a kick?
“I want a girl”
Mr Queen said he found out his fiancee was pregnant before she did.
She had thrown up almost every morning for a week and had started asking for Chinese takeout, which she usually hated. One night in May, after his shift as a manager at a Dollar General store, he brought home a pregnancy test for her. He hoped and prayed for a positive return.
“I was ready to start our little family together and get the ball rolling,” he said.
To save money, they lived with his mother, Theresa Davis, and his stepfather, Christopher Davis, on a family farm in Pikeville, a town nestled in a green valley about an hour outside of Chattanooga.
Mrs. Underwood slipped into the upstairs bathroom. It was her first pregnancy test and she didn’t want to mess it up. She spent 15 long minutes staring at the TV in her bedroom, waiting.
Her phone alarm went off and she looked at the test, picked it up and shook it. A line shot through it in the positive column. For a few seconds she stopped breathing.
“I hope it’s a boy,” her fiance said.
Her heart raced. She was smiling.
“I know you want a boy! You already have a girl,” she said, laughing. “But you know I want a girl.”
Mr Queen had a child with a previous girlfriend and part of his income went towards child support. He and Mrs. Underwood had been dating for the past four years; he suggested a trip to Virginia Beach earlier this year.
On Mother’s Day, the couple revealed the pregnancy to both their parents through cleverly wrapped “Best Grandma Ever” gift baskets. At first, they were dealing with some backlash for getting pregnant before they tied the knot, but with their wedding date set for late June and the thrill of a new baby, they all got over it.
At her first checkup at a free local clinic, they learned she was 13 weeks pregnant and due on November 23rd. The couple left the meeting happy.
Mr. Queen worked full-time, but his fiancée did not have health insurance. They were waiting to be approved for Medicaid so she could schedule an appointment with a licensed obstetrician. Mrs. Underwood went about her routine, tending to her three cats, fish and other pets, and feeding the neighbors’ goats.
The Queen Mother, Mrs Davies, hung the ultrasound pictures in her bedroom. She was staring at them when she noticed something.
“I called Madison and said, ‘Is your baby a cat?'” she said. “Because the head looked like it had ears.”
Olivia
At Ms. Underwood’s next appointment, a nurse promised more ultrasound images for the family to take home. The nurse asked questions, took measurements and confirmed the appointment. But after that she became “really quiet”, Ms Underwood said.
“She said it would take a few minutes and that the nurse would come and talk to you and ‘let’s see what we do from here,'” she said.
For Ms Davies, who accompanied Ms Underwood to the meeting and had experienced seven miscarriages, the words “set off alarms” in her head. “It doesn’t sound good,” she told her future daughter-in-law.
Initially, the nurse practitioner said she had a mild case of encephalocele, or growth on the back of the fetus’s neck due to neural tube failure in the first month of pregnancy. Encephalocele occurs in about 1 in 10,500 babies born in the United States, according to the Centers for Disease Control and Prevention.
The nurse practitioner told the family that it would be fixable with surgery and that there could be an intellectual disability or developmental delay, possibly seizures. Ms Underwood and her fiance were “fine with it”, she said. But she was worried that the baby would need surgery right after birth. “I was so scared,” she said.
They also learned they were having a girl. They decide to name her Olivia, after Mrs. Underwood’s grandfather, Oliver.
Doctors refer the family to Regional Obstetrical Consultants, a chain of clinics that specializes in treating high-risk pregnancies. The practice declined to comment for this article.
There, the family said they learned even more devastating news: the fetus had not formed a skull. Even with surgery, the doctors said, there would be nothing to protect the brain, so she would only survive a few hours, if not minutes, after birth.
Even then, Ms. Underwood hoped to carry the pregnancy to term so that she could at least meet her baby and donate the organs if possible.
“It felt like the only option,” she said. “Everything happens for a reason.”
But doctors told her that fetal brain matter was leaking into the umbilical sac, which could cause sepsis and lead to critical illness or even death. Doctors advised her to terminate the pregnancy for her own safety.
“We discussed it because I thought maybe I could beat the odds,” she said. “But then I got scared.” She added that “I wanted to make sure I wouldn’t regret it. Because me and Adam are going to have to be the ones dealing with this for the rest of our lives.
They postponed their wedding and scheduled an abortion at Chattanooga Regional Obstetric Consultants for Monday, June 27.
Caught in a national battle
Before June 24, the day of the Supreme Court decision, Tennessee allowed abortions up to the 24th week of pregnancy, but clinics rarely performed abortions after the 20th week, said a spokesman for the Knoxville Center for Reproductive Health, one of the largest abortion clinics in Tennessee.
Outside of abortion clinics, only a few medical centers in the state provide the procedure. The Knoxville center said it stopped performing abortions Friday when Roe was overturned pending a change in Tennessee law.
Today, Herbert Slatery III, the state’s attorney general, filed a petition with the U.S. Court of Appeals for the Sixth Circuit to overturn a nearly two-year-old ban that blocked an attempt to ban abortions after about the sixth week of pregnancy. The ban was lifted a day after Ms Underwood’s abortion was overturned.
Her parents and grandparents, who oppose abortion, took it as a sign to reconsider. They prayed that God would stop the abortion if it wasn’t meant to happen, and when it didn’t, they were convinced that she should try to carry the pregnancy to term.
“We were just hoping for a miracle,” said her mother, Jennifer Underwood.
She was told she had to give birth to see Olivia, say goodbye and bury her.
She told them no. “I do what I think I can do,” Mrs. Underwood would say later, sobbing between words.
The Queen Mother said she supported the couple’s decision from the start. At 12, she was raped and ended up giving birth to a stillborn baby.
“Religion has nothing to do with it. Sometimes your body just does things to you, and if you have to have an abortion, don’t feel guilty about it,” she said.
As the couple’s stress grew, Mr. Queen quit his job to care for…
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