When she awoke on the couch in the early morning hours of Nov. 21, Magon Hoffman’s pajama pants were soaked in blood. What began as light bleeding the night before had turned severe. Hoffman assumed she was miscarrying.
But an ultrasound revealed it was Hoffman’s life that was in danger.
At 14 weeks, the fetus seemed healthy, but Hoffman, 31, had one of the largest blood clots her doctor had ever seen and was at risk of going into shock or organ failure if it continued to grow.
Hoffman’s doctor restricted her physical activity to little more than a temperate walk. She was unable to work, care for her toddler or decorate her Christmas tree. All Hoffman could do was wait and hope the clot resolved itself. Doctors performed weekly ultrasounds to ensure the fetus remained safe.
On Dec. 28, Hoffman went in for her 20-week check up and an anatomy scan, an ultrasound that provides a detailed view of a fetus’ bones, heart, brain, face and other features. And it’s the first chance to detect heart conditions, spinal defects, poor organ development and other abnormalities.
Hoffman’s scan revealed that her unborn daughter was missing a skull and most of her brain. There was zero chance, not even a 0.1% possibility, that the baby would survive, Hoffman remembers her doctor saying. Her daughter would die almost immediately after birth.
Hoffman could attempt to carry the fetus to term risking gestational diabetes, high blood pressure and bleeding. Assuming no other complications arose, Hoffman would spend the next four months in bed or with highly restricted movement, attempt a life-threatening delivery and watch her daughter die. Or, she could terminate the pregnancy, reducing the risks to her own life and spare her unborn daughter pain.
“Carrying her to term sounded like the most torturous thing I could do to myself, my husband and our unborn child,” Hoffman said. “I knew immediately that the right decision for myself and my family was to terminate.”
Hated and Alone
Hoffman’s decision was sure and swift. But, months earlier, Oklahoma lawmakers took that choice away from Oklahomans like Hoffman when they passed confusing abortion restrictions that led doctors to refuse the procedure as a precaution.
In June, the U.S. Supreme Court overturned the constitutional right to an abortion allowing Oklahoma to implement some of the nation’s most restrictive laws.
An Oklahoma law written in 1910 was reinstated making performing an abortion a felony except to save the life of the mother. Another state law allowed people to sue abortion providers or others who aided and abetted an abortion. Coupled with legislation that preceded the Supreme Court ruling, five overlapping laws created an unclear picture of abortion access in Oklahoma.
Hoffman’s doctor told her she could not get the procedure in Oklahoma even though her life was in jeopardy and the fetus had no chance of survival. Hoffman was prepared to leave the state for the procedure she needed and sought guidance from her doctor on how to find the safest option, what to ask potential providers and what to tell them about her condition. After a week of desperate messages to the nursing staff she had come to trust, a nurse finally called her back and explained that they had spent the week trying to decipher the law and what they could legally say to Hoffman. The nurse offered to provide a list of clinics in neighboring states, which Hoffman had already found online.
“I didn’t become a nurse to have conversations like this,” the nurse told Hoffman. “I became a nurse to help people and I’m so sorry I couldn’t.”
Hoffman’s options dwindled the longer she waited. And, now, she was on her own to find the care she needed.
“It seems a little silly now, and I was dealing with pregnancy hormones and all that, but I truly thought everyone in Oklahoma hated me,” Hoffman said. “I thought everyone was going to think I was a murderer, even the doctors and nurses, because the way politicians talk about abortion is so hateful, like we’re only using it as birth control.”
The Chilling Effect
Access to abortions was limited in Oklahoma before the Supreme Court’s ruling. There were fewer clinics than in other states and more requirements for physicians and pregnant patients that delayed or hindered care.
In 2021, Oklahoma physicians performed about 3,600 abortions, according to a State Health Department report. Most occurred before the eighth week of pregnancy, the report shows. The majority of patients had never had an abortion before and were treated with medication rather than surgery.
Asked why they were receiving an abortion, 394 patients said health complications to the fetus and 324 said their own life was at risk, according to the report. And 59 reported the procedure was necessary to prevent death.
In the summer of 2022, new laws suppressed telehealth abortion care, medication abortions and shuttered remaining clinics almost overnight, said Janet Levit, a University of Tulsa law professor and Center for Reproductive Rights board member. Fewer than 900 residents received abortions in Oklahoma last year, according to the 2022 health department report. None occurred after May.
Vague and conflicting language in the laws heightened confusion and fear. Doctors and nurses worried about lawsuits, losing their medical license or incarceration if they acted too soon, leaving pregnant patients without care.
“Because the exceptions were so unclearly drafted, hospitals were in a fair amount of paralysis in the face of a lot of life-threatening conditions to women,” said Levit.
Rep. Jim Olsen, R-Roland, who introduced a bill that made performing an abortion a criminal offense except in a medical emergency, said broad language was intended to give doctors the discretion to act as long as they gave equal weight to the life of the mother and the unborn baby. Gov. Kevin Stitt signed the bill into law in 2022.
Jaci Statton was about to pass out from blood loss and pain in March when emergency room staff told her to wait in the parking lot of Oklahoma Children’s Hospital until she was actively crashing in front of them or on the verge of a heart attack, according to a federal complaint filed Sept. 12.
Sutton’s complaint alleges that the hospital violated federal rules when it failed to provide stabilizing care. Sutton seeks an investigation by the U.S. Department of Health and Human Services into her care, which could result in changes to hospital policy and procedure, or fines, and set a precedent for statewide pregnancy care.
The complaint follows Oklahoma Supreme Court rulings this year striking down two laws and affirming a woman’s right to terminate a pregnancy to preserve her life. The decisions broadened exemptions to state abortion bans giving some autonomy back to doctors and patients. But it’s unclear how much and whether the changes will affect results for patients like Statton or Hoffman.
Olsen said he plans to reintroduce in 2024 the stricken bills that made performing an abortion a criminal and civil offense changing the exemption from medical emergency to preserving the life of the mother. Olsen said he did not consult physicians about the first bills nor upcoming legislation.
Olsen said he also is considering proposing a state question that would allow voters to decide whether personhood begins at conception.
“It’s not only the life of the mother in question,” Olsen said. “That absolutely matters, but it’s also about the life of the baby and we have to have a solution that includes both the life of the woman and the life of the baby.”
Dr. Dana Stone, a private practice obstetrician and gynecologist who has treated pregnant Oklahomans for nearly 30 years, said fear continues to stifle physicians despite the recent rulings. It’s going to require time and more clarity to undo the damage previous language caused in medical settings, she said.
Nothing will change without guidance from hospital attorneys and the state attorney general, Gentner Drummond, she said. Drummond’s spokesman said guidance is underway but did not know when it would be released.
“The power of these laws is their chilling effect,” Levit said. “They’re drafted broadly and relatively untested, and I’m guessing that fuzziness is by strategic design, which means it’s going to take some brave attorneys and doctors to test those changes.”
In the meantime, Oklahoma is forcing women to travel out of state for care, contributing to higher rates of pregnancy-related death and complications. According to a March of Dimes’ report, the farther a woman travels for maternity care, the higher her risk of complications that can lead to severe medical conditions or death of the mother and fetus.
Hoffman traveled nearly 600 miles from Oklahoma City to Albuquerque’s University Of New Mexico Health Sciences Center.
‘Oklahoma Really Kicked Me When I Was Down’
Abortion is banned in Missouri. And laws in Arkansas and Texas are similar to Oklahoma’s.
Hoffman was 21 weeks pregnant when she called providers in Kansas. They were booked for at least two weeks and Kansas does not allow abortions after 22 weeks so Hoffman turned to New Mexico.
Clinics warned that protestors had become more aggressive since the overturning of Roe v. Wade and Hoffman would have to be transferred to a hospital if the clot ruptured during her procedure or if surgery was the better option. Finding a hospital that offered abortions added time and stress to Hoffman’s search.
The university hospital wouldn’t schedule Hoffman without reviewing her medical records. Hoffman’s Oklahoma doctor was prohibited from consulting with New Mexico physicians. He couldn’t call or send medical records, staff told her. So, Hoffman explained what she could to the New Mexico team and then collected her medical records, ultrasound images, and notes from her long-time Oklahoma doctor and sent them to someone she had never met in New Mexico.
On Jan. 11, two weeks after the ultrasound that revealed her unborn child’s fate, Hoffman’s abortion was complete. That afternoon, Hoffman grieved the loss of her daughter from the passenger seat of their Ford Escape while her husband drove eight hours home.
“I felt so judged and so alone,” Hoffman said. “This was one of the hardest moments of my life and Oklahoma really kicked me when I was down.”
Olsen said it sounded like Hoffman’s doctor could have made the case to perform an abortion under the medical emergency or to preserve her life. But, he said, it’s complicated.
“The doctor’s judgment of non-viable was likely correct, but sometimes you hear that physicians give a horrible report and then it turns out expectedly better, so there’s always that risk,” Olsen said. “The doctor needs to do all he can to preserve the life of both of them.”
Hoffman lost her job and spent nearly $6,000 on the procedure, hotel stay and other travel expenses that, she said, could have been avoided had physicians been allowed to care for her at home.
“What happened to my daughter was a tragedy,” Hoffman said. “But what happened to me was the fault of the state of Oklahoma.”
Whitney Bryen is an investigative reporter at Oklahoma Watch covering vulnerable populations. Her recent investigations focus on mental health and substance abuse, criminal justice, domestic violence and nursing homes. Contact her at (405) 201-6057 or firstname.lastname@example.org. Follow her on Twitter @SoonerReporter.