Ashley and Chris started trying to conceive during summer 2018. She went off her birth control, she says, and “we got pregnant that very first cycle.” The couple felt “super excited that it happened so quickly.” (Xpress is using pseudonyms for the couple, who live in the Asheville area, to protect their privacy.)
They began telling loved ones about her pregnancy and posed for a pregnancy photo shoot. “I was ready to put [the photos] in the mail as soon as we got home from an appointment” for a 12-week ultrasound and genetic testing, she says.
That Friday afternoon appointment changed everything. During the scan, “I noticed the ultrasound tech was just a little bit more quiet,” Ashley recalls. The couple sat in the waiting room, “looking at the pictures of the baby, just feeling excited,” Ashley says.
“Then the doctor just kind of rushes in and goes, ‘Let’s talk about these pictures,’” Ashley recounts. The physician informed them their baby had extra fluid behind its neck, and referred Ashley to a doctor who specializes in high-risk pregnancies. “I felt like I blacked out at that moment,” Ashley says. She doesn’t remember much else about that afternoon or the following weekend.
The next week, Ashley and Chris found obstetrics specialists at UNC Chapel Hill and Duke University. In Ashley’s 13th week, health care providers at Duke extracted fluid from her placenta to conduct DNA testing.
The couple had to wait another two weeks for the test results: Her baby, a girl, had a diagnosis of Turner syndrome, Ashley tells Xpress. “The baby didn’t just have extra fluid behind her neck; she also had it surrounding her heart, and surrounding her brain as well,” she says.
Turner syndrome is a chromosomal condition that primarily affects females, according to the Mayo Clinic. People born with Turner syndrome may have heart defects and abnormal kidneys; if the child reaches adolescence or adulthood, she can have slow growth, shortness, stalled sexual development and struggles with conception, among other issues.
Ashley says she was told, in her case, if her daughter were to survive throughout the pregnancy she’d likely require cardiac surgery upon birth, Ashley says. If she were to survive postnatal cardiac surgery, she would experience very high medical needs throughout her lifetime.
“I think what really did it for us was that we didn’t want the baby to have a life of suffering,” Ashley says. “We chose to suffer so that she didn’t have to.” She calls the experience the darkest time of her life.
North Carolina law requires Ashley to receive state-directed counseling and undergo a 72-hour waiting period before terminating a pregnancy. For the counseling, her nurse at Duke “had to read me a script of all my options I had instead of an abortion,” Ashley tells Xpress. “[The nurse] even apologized — she’s like, ‘I’m so sorry, I’m required by law to do this.’” The nurse informed Ashley about her options, such as raising a special needs child, and Ashley began “sobbing,” she recalls, and pulled the phone away from her ear. After the counseling, Ashley waited the required 72 hours before physicians provided an abortion at 16 weeks of pregnancy.
Her loved ones knew about the pregnancy, and Ashley says some assumed she’d miscarried. “I didn’t know who was safe to say, ‘No, I didn’t miscarriage — we had to have an abortion,’” she explains. “I do remember [voicing my fears] to my husband. He [said] ‘It’s nobody else’s business!’”
She adds, “And I [said] ‘I know it’s not their business. But it’s my truth.’”
North Carolina’s changing abortion laws
The majority of abortions take place during the first trimester of pregnancy. According to 2016 data from Guttmacher Institute, a nonprofit dedicated to research on reproductive health, 65.4% of abortions nationwide occurred during the first eight weeks of pregnancy in 2016, and 88% occurred in the first 12 weeks of pregnancy. Four percent of pregnancy terminations occurred between 16 and 20 weeks — when Ashley had her abortion — and 1.3% occurred after 21 weeks.
The reproductive landscape in America vastly changed on June 24 when the U.S. Supreme Court ruled 6-3 in Dobbs v. Jackson that abortion is not a right under the Constitution. This overturned the precedent set by Roe v. Wade in 1973 and left legislation on abortion up to individual states. North Carolina is considered to be a state where abortion is more accessible than other places in the South. The Pew Charitable Trusts even called North Carolina a “Southern abortion haven.”
Prior to Aug. 17, abortion was legal in North Carolina until fetal viability, generally considered to be around 24-26 weeks, Elizabeth Nash, principal policy associate for state issues at Guttmacher, told Xpress in previous reporting. A physician determined viability, explains Nash, and terminating a pregnancy after 24-26 weeks was legal only if the patient’s life or health was at stake. (Life endangerment also was determined on a case-by-case basis by a physician, says Nash.)
But on Aug. 17, a ban on abortions after 20 weeks was reinstated in North Carolina after Republicans in North Carolina’s General Assembly asked U.S. District Judge William Osteen to lift an injunction that had held the ban at bay since 2019. Following the Dobbs ruling in June, N.C. Attorney General Josh Stein, a Democrat, stated he would not seek to reinstate the ban, The Associated Press reports.
Abortions after 20 weeks of pregnancy are rare. Dr. Elizabeth Buys, an obstetrics and gynecology specialist at Mountain Area Health Education Center, in North Carolina, tells Xpress “when I looked it up, the number of terminations that occurred after 20 weeks was not very many — 39 in a year” in the state.
In 2020, 31,850 abortions were obtained in North Carolina, according to the Guttmacher Institute. (This figure includes people who traveled from other states.) It is unknown yet how many people in North Carolina have sought pregnancy terminations after 20 weeks following the reinstatement of the ban in August.
There are no universally accepted answers as to when life begins or the limits of bodily autonomy. Health care professionals do, however, know how a fetus develops throughout a pregnancy.
Buys, who practices at Mission Hospital, says that at 20 weeks of pregnancy, “the basic structures of fetal anatomy are in place.” The baby has arms, legs, a heart, brain and lungs. However, those organs are undeveloped for functional usage. “At 20 weeks, a fetus cannot survive outside of the womb, no matter what the support would be,” she says.
Lung development is at a critical stage around 20 weeks, Buys says. “The fetus has lung tissue, but the lung tissue needs to develop in order to be able to ultimately breathe and have oxygen exchange.” The intricacies of brain development also are occurring at this time, she explains.
The reasons for terminating a pregnancy in the second trimester are “unique” to each family, says Buys. She continues, “These are some of the hardest situations and conversations that we have to deal with.” She has counseled families who have learned about fetal abnormalities during a second trimester.
“This is definitely more complicated than most people are aware,” says Buys. She also thinks second trimester abortions are “more common than people think.”
Terminating a pregnancy in the second trimester can be done several ways. Health care providers try to determine maternal risks like hemorrhage, infection or damage to the cervix and uterus, Buys says, explaining “depending on the gestational age, we do have some clarity on what is safest for the mom.”
One surgical procedure is a dilation and curettage, also called a D&C. Another method for terminating a pregnancy in the second trimester is “a patient can decide to go through an experience that is like labor and deliver a fetus,” Buys explains. The procedure used to terminate the pregnancy will depend on safety, as well as the patient’s wishes, she says. “It is case by case — there are so many factors that go into that.”
North Carolina’s ban on abortions after 20 weeks makes an exception for urgent medical emergencies, the AP reports. But preventing a medical emergency is unpredictable, says Buys. “One thing about a medical emergency is that the definition is obvious when you’re in that emergency,” she says. “But the goal [for doctors], really is to try to prevent being in an emergency.”
Planned Parenthood’s Asheville Health Center is Western North Carolina’s lone abortion provider, and it can terminate pregnancies up to 14 weeks. Abortions in the second trimester are typically done in Chapel Hill, says Buys.
Three months after her abortion, Ashley became pregnant again. Today she is a mother to a 3-year-old and a 4-month-old — “the loves of my life,” she says. She feels gratitude for her children, but she’s dealing with the trauma of her first pregnancy. She started to see a therapist after the birth of her son.
Ashley says she and Chris have found “peace in our decision,” especially after they learned to frame ending the pregnancy as “an act of love” for their daughter. She says that abortion is so often framed in society as commingled with shame; their decision is one they stand by.
She’s heard other people say that if they were pregnant and learned through genetic testing that a baby had health issues “‘We’d love the baby no matter what!’” Ashley says,
“That always rubbed me the wrong way,” she tells Xpress. “Because we loved her too. We just showed our love in another way, and it was for her to not have to suffer.”