Before February, Jaci Statton wasn't particularly focused on Oklahoma's abortion bans. "I was like, 'Well, that's not going to affect me. I won't ever need one,' " she says.
She's 25 and lives in central Oklahoma with her husband, Dustin, and their three kids — two 7-year-olds and an 8-year-old. They are a blended family with two kids from Jaci's previous marriage and one from Dustin's.
"And I have two dogs — I gotta throw that in there, too," she laughs. She's a stay-at-home mom, and Dustin is an oil field technician. They also have a fishing guide business — she says she and her family go fishing every day.
6 weeks: Picking out baby names
Jaci and Dustin were using birth control but took an "if it happens, it happens" attitude towards pregnancy, she says.
Then, in mid-February, she started to feel really sick — nauseous and dizzy and weak. The first few pregnancy tests came back negative, but after several trips to the hospital, a blood test confirmed it: She was pregnant.
"We got excited — picked out baby names, bought baby stuff," she says.
8 Weeks: 'You could bleed out'
Jaci Statton was in her kitchen, weeks later on Feb. 28, when she felt like she was going to faint. "I just looked down and there is blood everywhere," she says. "My husband grabbed the kids, grabbed me, went to the emergency room."
The hospital staff did her blood work several times and told her the results were confusing. They said she was probably having a miscarriage, and that she should follow up with her doctor.
She soon learned her situation was even more complicated. At an appointment with her OB-GYN the next day, she was told she actually had a partial molar pregnancy. Jaci says her doctor told her: "It is non-viable. It is potentially cancerous."
On the ultrasound, the doctor showed Jaci how the pregnancy tissue was bean-shaped and surrounded with cysts. "One of them had ruptured, causing me to bleed, and she explained, 'If more rupture, you could bleed out,'" Jaci recalls.
Partial molar pregnancies happen when something goes wrong during fertilization — either two sperm fertilize the same egg or an egg is fertilized by one sperm that later duplicates. A nonviable embryo with too much genetic material develops, along with abnormal placental tissue. In a complete molar pregnancy, there's no embryo at all, only abnormal placental tissue. With both types, there is a risk of heavy bleeding, infection, and a life-threatening condition called preeclampsia that can lead to organ failure. There's also a risk that cancer will develop.
In Jaci's case, there was a problem. The treatment is a dilation and curettage or D&C — an abortion procedure that clears pregnancy tissue out of the uterus. Even though Jaci's pregnancy was not viable and the embryo would never develop into a full-term infant, there was cardiac activity. Jaci's doctor said she couldn't treat Jaci at the Catholic hospital where she works.
Jaci was transferred to the University of Oklahoma Medical Center. Doctors there confirmed the partial molar pregnancy diagnosis and were ready to do a D&C, but Jaci says an ultrasound tech from the emergency department objected because he detected fetal cardiac activity. The D&C didn't happen. Instead, she was transferred yet again, this time to Oklahoma Children's Hospital.
Jaci says, through all of this, sometimes it was hard for her to follow what was happening — she was so sick and weak. "At this point, I had not eaten in about three weeks," she says, due to terrible nausea she was having. With molar pregnancies, patients have extremely high levels of the pregnancy hormone hCG, which can cause debilitating nausea — Jaci's levels were at one point 400,000, much higher than the level during a normal pregnancy at that stage. "Whenever I could eat, I would eat two or three bites and pray it would stay down, and most of the time, it wouldn't."
'Wait in the parking lot.'
At Oklahoma Children's Hospital, she says the medical staff told her that her condition was serious. "You at the most will last maybe two weeks," she remembers them telling her. But still, cardiac activity was detectable, and the doctors would not provide a D&C.
"They were very sincere, they weren't trying to be mean," she says. "They said, 'The best we can tell you to do is sit in the parking lot, and if anything else happens, we will be ready to help you. But we cannot touch you unless you are crashing in front of us or your blood pressure goes so high that you are fixing to have a heart attack.'"
At the hospital, Dustin was beside himself, Jaci says. He requested a meeting with the hospital ethics board, she says, but was refused. "I've never seen him just come apart and cry — he had his head in his hands, this huge six-foot guy," she says. "He was like, 'I'm going to lose you. I'm going to lose our baby and I'm going to lose my other two kids'" — the children from Jaci's previous marriage. "He's like, 'I'll lose everything — I'll lose my family,'" she remembers him saying.
Jaci says Dustin was also trying to argue with the hospital that the family shouldn't be sent home because they live an hour away from the hospital and might not be able to make it back in time in an emergency.
OU Health, which runs both University of Oklahoma Medical Center and Oklahoma Children's Hospital, did not respond to NPR's questions about the hospitals' policies on abortions for life-threatening conditions. The institution did not confirm or deny specific questions about whether doctors told Jaci she would need to be in more danger of imminent death before intervention or if an ultrasound technician's objection changed the course of her treatment.
In a written statement, spokesperson David McCollum said:
"OU Health remains committed to providing the highest quality and compassionate care for women and children of all ages and stages of life. The health care we provide complies with state and federal laws along with health care regulatory and compliance standards. OU Health will continue to monitor state and federal legislation and ensure full alignment with the law while ensuring patients get the care they need."
9 Weeks: The long drive to Wichita
The days wore on. Jaci says, by March 8, one doctor at the hospital began to talk about the need for her to travel out of state — to Kansas, Colorado, or New Mexico. Someone connected the family to Trust Women, which runs a reproductive health clinic in Wichita, and she was able to get in for an appointment two days later, on Friday, March 10.
She drove there with her husband and mother-in-law, hoping she wouldn't bleed on the drive. "It was probably the longest three hours of my life, in that vehicle," she says.
At the clinic, after being in so many hospitals, her veins were difficult and painful to access. "There was a lady in there, and she came over there and just held my hand while they were trying to find [a vein for the] I.V. because it hurt so bad," she says. Jaci was grateful for that.
"They took me back to the procedure room," she says. "I sat in there by myself, and I think that was the first time that I had cried. Finally, all the emotions, all my thoughts, caught up with me right there, and I sat in there by myself and just cried and cried."
When the doctors and nurses came in, they sat with her, held her hand, and assured her that the D&C was her only option. "I knew that, but they made me feel comfortable," she says. "I'm really appreciative of all of them."
The physician who treated her that day was Dr. Shelly Tien. "I remember that she is a lovely, sweet patient with great sadness because this was a desired pregnancy," she says. "She was navigating the loss of a very much wanted child, the complexities of a rather rare medical diagnosis, and then also the insult of not being able to be cared for by her own physician in her own home and familiar surroundings."
Jaci was put under general anesthesia for the D&C procedure. She also had an intrauterine birth control device placed, since it's very dangerous to get pregnant in the months after a molar pregnancy.
After the staff made sure she was stable enough to leave, she went back out to the car where Dustin and her mother-in-law were waiting. As they drove past the front of the clinic, they covered Jaci's face with a blanket so she wouldn't see or hear the anti-abortion protesters. "My husband still has nightmares about it," Jaci says.
Confusion remains even after state Supreme Court rules
Most states that ban abortion have exceptions for medical emergencies or the "life of the mother." But in the months since the Supreme Court overturned Roe v. Wade, there have been many examples of cases where doctors weren't sure how to apply those exceptions.
In Oklahoma, the legal picture is especially confusing. Oklahoma Governor Kevin Stitt pledged to sign "every piece of pro-life legislation that came across my desk." He has kept that promise, and there are currently three overlapping abortion bans, each with different and sometimes contradictory definitions and exceptions. One of the bans comes with criminal penalties including felony charges and up to five years in prison for anyone who administers, prescribes, or "advises" a woman on an abortion, so the stakes for interpreting the laws correctly are high for doctors and hospitals.
Oklahoma Attorney General Gentner Drummond said he believes doctors can use abortion to protect a pregnant person's health and his office said that doctors should have "substantial leeway" as they make these decisions, The Oklahoman reported.
Additionally, at least 15 bills directly related to abortion, some that would have clarified the exceptions, did not advance ahead of Oklahoma's legislative deadlines, according to The Oklahoman.
It can be hard for physicians to keep track of it all, says Dr. Dana Stone, an OB-GYN in Oklahoma City who was not involved in Jaci Statton's care, since new laws that regulate abortion are being introduced and passed by the Oklahoma legislature all the time. Physicians in the state also have to navigate laws that allow people to bring civil charges against doctors for "aiding and abetting" abortion, which can make it hard to know what doctors can say about abortion in the exam room. "It really keeps us from giving full information to our patients," she says.
One big issue has been how to understand the exception for when someone's life is in danger. The Oklahoma Supreme Court in late March struck down a law that required a patient's life to be in danger and for there to be a medical emergency, bringing the number of abortion bans down from four bans to three. Jaci Statton's situation happened two weeks before that decision.
"The court said [in its ruling], you can't force doctors to wait until a patient is crashing or going into sepsis to provide care," explains Rabia Muqaddam, a senior attorney with the Center for Reproductive Rights, which brought the court challenge.
The problem, she says, is that the same "emergency" exception language is in two other Oklahoma abortion bans that were not struck down by the state's high court.
"While those two other bans remain in effect, the decision doesn't have a practical impact," she says, in terms of allowing doctors to intervene earlier, providing abortions when someone's life is in danger but they are not yet in crisis. "What happened to Jaci could be happening right now to other patients."
Stone thinks that strict "emergency" exception language in Oklahoma's abortion laws is probably why doctors at OU Health felt they could not provide an abortion procedure until Jaci became sicker. "Which is just a horrible thing to tell someone," she says. "We would never tell someone with a heart attack, 'It might not be that bad, come back when you're really in bad trouble.'"
An obligation to act?
Doctors are bound not only by state law, but also by federal law. That includes the Emergency Medical Treatment and Active Labor Act, or EMTALA, which requires that patients be stabilized in an emergency. On Monday, the federal Department of Health and Human Services announced investigations into two hospitals that denied an abortion to a patient who was at risk of infection after her water broke at 18-weeks pregnant. Investigators determined that a hospital in Joplin, Missouri, and another in Kansas City, Kansas violated the law, according to the Associated Press. A spokesperson for HHS told NPR the office would not comment on whether Jaci Statton's case would be investigated.
Physicians also have professional ethical obligations not to harm patients. Some bioethicists have argued that — even when state laws provide very narrow or confusing abortion exceptions — if a patient is in danger, doctors have an ethical obligation to act.
Stone says that is a hard thing to ask of physicians. "You have studied for years, you've trained through specialty training, you have an established practice, you have obligations to your family — it's hard to say, 'I'm going to put all that on the line and possibly go to jail and possibly get sued by her family for doing the right thing,'" she says.
Hospitals also don't seem to know how to navigate these laws. The Oklahoma State Board of Medical Licensure provided guidance in September for doctors in the state on how to navigate the abortion bans, but declined NPR's interview request, citing ongoing litigation.
The state legislature has considered new exceptions to the abortion ban, and more court challenges are underway. Stone says some groups are trying to organize a voter petition to change the abortion laws in Oklahoma, but she does not think significant changes to the state's abortion laws are coming soon.
"Already, the United States has the highest one of the highest maternal mortality rates in the developed world, and Oklahoma has one of the highest maternal mortality rates within the United States — all of these things that we do that further endanger pregnant women are only going to increase that," Stone observes. "We're already bad at this. We don't need anything that ties our hands and keeps us from caring for our patients."
'This needs to change'
Seven weeks after her ordeal, Jaci Statton is still recovering. She will have to keep having her hCG levels checked for weeks — maybe as long as six months — to make sure no cancer is developing. Physically, she still feels weak and tired, and mentally it's been rough, she says.
So, at the age of 25, when she has her IUD removed, she's decided to get a tubal ligation this month. "I don't think mentally I would be okay if I were to get pregnant again."
She says she is "pro-life," but she's decided to speak publicly about her experience because she doesn't want anyone else to have to go through it. "I think something needs to be done" about the state abortion laws, she says. "I don't know how else to get attention, but this needs to change."
A MARTÍNEZ, HOST:
Most states that ban abortion have an exception if a pregnancy endangers a patient's life. But how close to death must a person be in order to qualify for an abortion? NPR's Selena Simmons-Duffin has the story of one woman in Oklahoma whose doctors were forced to make that calculation. Now, it's a story that includes some disturbing details.
SELENA SIMMONS-DUFFIN, BYLINE: Before February, Jaci Statton wasn't particularly focused on Oklahoma's abortion bans.
JACI STATTON: I kind of was like, well, that's not going to affect me.
SIMMONS-DUFFIN: She's 25 and lives in central Oklahoma with her husband and their three kids - two 7-year-olds and an 8-year-old. They are a blended family with two kids from Jaci's previous marriage and one from her husband's. Her husband, Dustin Statton, is an oil field technician, and her whole family goes fishing every day.
STATTON: And I have two dogs. I got to throw that in there, too.
SIMMONS-DUFFIN: She and Dustin were using birth control, but took a if it happens, it happens, attitude towards pregnancy, she says. Then in mid-February, she started to feel sick - nauseous and dizzy and weak. After several trips to the hospital, a blood test confirmed she was pregnant.
STATTON: So we got excited, picked out baby names, bought baby stuff.
SIMMONS-DUFFIN: When she was in her kitchen a few weeks later, on February 28, she felt faint.
STATTON: I felt like I was going to pass out, and I just looked down, and there was blood everywhere. My husband, like, grabbed the kids, grabbed me, went to the emergency room.
SIMMONS-DUFFIN: The hospital staff did her bloodwork several times and said the results were confusing and that she was probably having a miscarriage. The next day, at an appointment with her OB-GYN, she learned she actually had a partial molar pregnancy, which happens when two sperm fertilize the same egg or one sperm fertilizes an egg and then duplicates. The result is an embryo with too much genetic material and a placenta that is a mass of cysts. Jaci says her doctor told her...
STATTON: It is nonviable. Like, it is potentially cancerous.
SIMMONS-DUFFIN: On the ultrasound, her doctor showed her how the embryo was surrounded by grape-like cysts.
STATTON: One of them had ruptured, causing me to bleed. And she had explained, like, if more rupture, you could bleed out.
SIMMONS-DUFFIN: The treatment for Jaci's condition is a dilation and curettage - or D&C - an abortion procedure that clears pregnancy tissue out of the uterus. Even though the embryo would never develop into a baby, there was fetal cardiac activity. Jaci's doctor said she couldn't treat her at the Catholic hospital where she works. Jaci was transferred to another hospital, then another - Oklahoma Children's Hospital. She says medical staff there told her that her condition was serious.
STATTON: You, at the most, will last maybe two weeks.
SIMMONS-DUFFIN: But still fetal cardiac activity was detectable, and the doctors would not provide a D&C. When all of this was happening, Oklahoma had four different abortion bans on the books, and several had an extremely narrow exception that said abortion is only legal if the patient's life is in danger and it's a medical emergency. Here's what Jaci remembers her doctors telling her.
STATTON: They were very sincere. They weren't trying to be mean or say this bad, but they said, the best we can tell you to do is sit in the parking lot. And if anything else happens, we will be ready to help you. But we cannot touch you unless you are crashing in front of us or your blood pressure goes so high that you are fixing to have a heart attack.
SIMMONS-DUFFIN: At the hospital, sometimes, it was hard for Jaci to follow what was happening. She was so sick and weak, but she could tell how upset her husband, Dustin, was. He requested a meeting with the hospital ethics board, she says, but was refused.
STATTON: I look over. And he is just, like, head in his hands. This huge, like, 6-foot guy. I remember him saying - he was like, I'm going to lose you. I'm going to lose our baby. And I'm going to lose my other two kids.
SIMMONS-DUFFIN: Those are the children from Jaci's previous marriage.
STATTON: He's like, I lose everything. I'll lose my family.
SIMMONS-DUFFIN: In a written statement, a spokesperson for OU Health, which runs both Oklahoma hospitals where Jaci Statton was seen, said the health system complies with all state and federal laws and regulations. By March 8, over a week since she was diagnosed...
STATTON: One of the doctors was explaining to us that we needed to either go to Colorado, Kansas, New Mexico.
SIMMONS-DUFFIN: Places where abortion is legal, and she could be treated without waiting. Someone connected the family to the Trust Women clinic in Wichita, Kan., and she was able to get in for an appointment two days later. By this point, she was nine weeks pregnant. She drove to Kansas with her husband and mother-in-law, hoping she wouldn't bleed on the drive.
STATTON: It was probably the longest three hours of my life in that vehicle.
SIMMONS-DUFFIN: When she finally got to the clinic, she found herself sitting alone in the procedure room. And for the first time, she started to cry.
STATTON: All the emotions, all my thoughts, like, caught up with me right there. And I sat in there by myself and just cried and cried. And the doctors and then the nurses come in, and they just sat with me and talked to me and, like, held my hand. Sorry. Like, I'm really appreciative of all of them.
SIMMONS-DUFFIN: After the abortion, when she was stable enough to leave, she went out to the car where Dustin and her mother-in-law were waiting. As they drove past the front of the clinic, they covered Jaci's face with a blanket so she wouldn't see or hear the anti-abortion protesters.
STATTON: My husband still has nightmares about it.
SIMMONS-DUFFIN: Jaci Statton is still recovering. She needs to have her pregnancy hormone levels checked for weeks - maybe as long as six months - to make sure no cancer is developing. Physically, she still feels weak and tired. And mentally, it's been rough, she says. She says she is pro-life, but she's decided to speak publicly about her experience because she thinks Oklahoma's abortion laws are dangerous and need to change. Selena Simmons-Duffin, NPR News. Transcript provided by NPR, Copyright NPR.