CHATTANOOGA - Madison Underwood was lying on the ultrasound table, nearly 19 weeks pregnant, when the doctor came in to say her abortion had been canceled.
Nurses followed and started wiping away lukewarm sonogram gel from her exposed belly as the doctor leaned over her shoulder to speak to her fiance, Adam Queen.
She recalled that she went quiet, her body went still. What did they mean, they couldn't do the abortion? Just two weeks earlier, she and her fiance had learned her fetus had a condition that would not allow it to survive outside the womb. If she tried to carry to term, she could become critically ill, or even die, her doctor had said. Now, she was being told she couldn't have an abortion she didn't even want, but needed.
"They're just going to let me die?" she remembers wondering.
In the blur around her, she heard the doctor and nurses talking about a clinic in Georgia that could do the procedure now that the legal risks of performing it in Tennessee were too high.
She heard her fiance curse, and with frustration in his voice, tell the doctor this was stupid. She heard the doctor agree.
Just three days earlier, the U.S. Supreme Court had overturned the constitutional right to abortion. A Tennessee law passed in 2020 that banned abortions at around six weeks of pregnancy had been blocked by a court order but could go into effect.
Underwood never thought any of this would affect her. She was 22 and excited to start a family with Queen, who was 24.
She and Queen had gone back and forth for days before deciding to terminate the pregnancy. She was dreading the abortion. She had cried in the car pulling up to the clinic. She had heard about the Supreme Court undoing Roe v. Wade but thought that since she had scheduled her abortion before the decision, and before any state ban took effect, the procedure would be allowed.
Tennessee allows abortion if a woman's life is in danger, but doctors feared making those decisions too soon and facing prosecution. Across the country, the legal landscape was shifting so quickly, some abortion clinics turned patients away before the laws officially took effect or while legal battles played out in state courts.
Century-old bans hanging around on the books were activated, but then just as quickly were under dispute. In states where abortion was still legal, wait times at clinics spiked as women from states with bans searched for alternatives.
It was into this chaos that Underwood was sent home, still pregnant, and reeling. What would happen now? The doctor said she should go to Georgia, where abortions were still legal up to 22 weeks, though that state had a ban that would soon take effect.
How would her fiance get the time off work to make the trip? How would they come up with hotel and gas money? How long did she have until she herself became ill? A new, more terrifying question hit her: What if she felt a kick?
'I want a girl'
Queen said he realized his fiancee was pregnant before she did.
She had thrown up almost every morning for an entire week and had started asking for Chinese takeout, which she normally hated. One night in May, after his shift as manager at a Dollar General store, he brought home a pregnancy test for her. He hoped and prayed it would come back positive.
"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, in a family farmhouse in Pikeville, a town tucked into a green valley about an hour outside Chattanooga.
Underwood crept into the upstairs bathroom. It was her first ever pregnancy test, and she didn't want to mess it up. She spent 15 long minutes staring at her bedroom television, waiting.
Her phone alarm went off and she glanced at the test, picking it up and shaking it. A line shot across it in the positive column. For a couple of seconds, she stopped breathing.
"I hope it's a boy," her fiance said.
Her heartbeat sped up. She was smiling.
"I know you want a boy! You already have a girl," she said, laughing. "But you know I want a girl."
Queen had a child with a previous girlfriend, and some of his income went to child support. He and Underwood had dated for the past four years; he proposed on a trip to Virginia Beach early this year.
On Mother's Day, the couple revealed the pregnancy to both sets of their parents through cleverly wrapped "Best Nana Ever" gift baskets. At first, they dealt with some blowback for getting pregnant before being married, but with their wedding date set for late June, and the thrill of a new baby, everyone got over it.
At her first checkup at a free local clinic, they learned she was 13 weeks pregnant and due Nov. 23. The couple left the appointment happy.
Queen worked full time, but his fiancee had no health insurance. They waited to be approved for Medicaid so she could schedule an appointment with a licensed obstetrician. Underwood went about her routines, taking care of her three cats, fish and other pets, and feeding the neighbor's goats.
Queen's mother, Theresa Davis, hung up the ultrasound photos 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 Underwood's next appointment, a nurse promised more ultrasound pictures for the family to take home. The nurse asked questions, took measurements and confirmed her due date. But then she got "real quiet," Underwood said.
"She said it'll be a few minutes, and the nurse practitioner is going to be in and she's going to talk to you and 'see what we're going to do from here,'" she said.
For Davis, who accompanied Underwood to the appointment, and had experienced seven miscarriages, the words "set off alarm bells" in her head. "It doesn't sound good," she told her future daughter-in-law.
At first, the nurse practitioner said there was a mild case of encephalocele, or a growth along the back of the fetus' neck because of neural tubes failing to close during the first month of pregnancy. Encephalocele occurs in about 1 in every 10,500 babies born in the United States, according to the Centers for Disease Control and Prevention.
The nurse practitioner told the family it would be able to be fixed through surgery, and that there might be an intellectual disability or developmental delay, possibly seizures. Underwood and her fiance were "OK with that," she said. But she was concerned the baby would have to have surgery just after birth. "I was just so scared," she said.
They also learned they were having a girl. They decided to name her Olivia, after Underwood's grandfather, Oliver.
The doctors referred the family to Regional Obstetrical Consultants, a chain of clinics that specializes in high-risk pregnancy treatments. The practice declined to comment for this article.
There, the family said they learned more devastating news: The fetus had not formed a skull. Even with surgery, doctors said, there would be nothing to protect the brain, so she would survive at most a few hours, if not minutes, after birth.
Even then, Underwood hoped to carry the pregnancy to term so at the very least, she could meet her baby and donate the organs if possible.
"It just felt like the only option," she said. "Everything happens for a reason."
But doctors told her the fetus' brain matter was leaking into the umbilical sac, which could cause sepsis and lead to critical illness or even death. Doctors recommended she terminate the pregnancy for her own safety.
"We were debating on it because I thought, maybe I can beat the odds," she said. "But then I got scared." She added that, "I wanted to make sure that I wasn't going to regret it. Because me and Adam, we're going to have to be the ones dealing with it our whole life."
They postponed their wedding and scheduled the abortion at the Chattanooga location of Regional Obstetrical Consultants for Monday, June 27.
Caught in a nationwide battle
Before June 24, the day of the Supreme Court ruling, Tennessee allowed abortion up until 24 weeks into pregnancy, but clinics rarely performed any after the 20-week mark, said a spokeswoman for the Knoxville Center for Reproductive Health, one of the largest abortion clinics in Tennessee.
Outside of abortion-specific clinics, only a few medical centers in the state provided the procedure. The Knoxville Center said it stopped providing abortions the Friday that Roe was overturned in anticipation of Tennessee law changing.
That day, Herbert Slatery III, the state attorney general, filed a motion for the 6th U.S. Circuit Court of Appeals to lift a nearly two-year-old injunction that had blocked an attempt to ban abortions after about the sixth week of pregnancy. The injunction was lifted one day after Underwood's abortion was canceled.
Her parents and grandparents, who oppose abortion, took it as a sign to reconsider. They had prayed for God to stop the abortion if it wasn't supposed to happen, and when it didn't, they were convinced she should try to carry the pregnancy to term.
"We were just hoping for a miracle," said her mother, Jennifer Underwood.
They said she should give birth so she could see Olivia, say goodbye and bury her.
She told them no. "I'm doing what I think I can handle," Underwood would say later, sobbing in between words.
Queen's mother said she supported the couple's decision from the start. At age 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 stress on the couple mounted, Queen quit his job to take care of Underwood. His mother raised $5,250 to help with travel costs from the crowd funding website GoFundMe. The cash would also help pay for the fetus' cremation.
'Our baby is going to die'
Two cars left Pikeville at 2 a.m. in early July for a four-hour drive across state lines and time zones to make the 8 a.m. appointment at an abortion clinic in Georgia. Underwood, Queen and his mother were in one car; Underwood's parents and one of her brothers followed.
When they stopped at the third Circle K of the night, she squeezed her own mother tight and cried. Her parents had made a last-minute decision to accompany her, even if they didn't fully agree.
At sunrise, the couple sat in a corner booth at a Waffle House, his hand massaging her back.
She would have a two step-procedure known as a D&E, a dilation and evacuation, over two days. First, she would be given medication to induce dilation, and sent to her hotel room to wait. The next day, she would return to the clinic to finish the procedure. The Georgia clinic's staff warned the family about protesters outside. As they pulled into the parking lot, they drove by a man with signs showing dead fetuses.
"Are all of you OK with killing babies?" he shouted into a megaphone.
He approached Underwood's parents' car, and her mother rolled down the window.
"We're on the same side of this as you," her mother said. "We don't support abortion, but the doctors said our baby is going to die."
"You trust doctors more than God?" he replied.
The couple walked side-by-side up a steep hill to the clinic entrance. She wore headphones to drown out the protesters.
Six hours later, they came back out. The parking lot was quiet.
This article originally appeared in The New York Times.