When pregnancy turned to miscarriage, woman says Georgia's abortion laws delayed the care she needed

Avery Davis Bell was 18 weeks pregnant with a little boy.

The 34-year-old woman, who lives in Atlanta, Georgia, is already the mother of a 3-year-old who could not stop watching the "Daniel Tiger" special on becoming a big brother.

Bell and her husband, Julian, had dreamed about the family they would build since they got together at 19 and 20 years old.

On Oct. 17, Bell found herself lying in a hospital bed as blood hemorrhaged from her body in dinner plate-sized clots. Amniotic fluid began to leak as she approached her 20th hour of waiting for life-saving medical care.

Bell was suffering a second-trimester miscarriage as she said her medical team at Emory Decatur delayed treatment, navigating her care around Georgia's strict abortion laws.

"Your baby is dead or dying inside you, you're just waiting to crash," Bell told USA TODAY, days after she received a life-saving D&E, or dilation and evacuation. "And I wanted to live, of course, for myself and for my existing child, and the baby wasn't going to live no matter what."

'We always wanted two children'

Bell, who holds a doctorate in Genetics and Genomics from Harvard Medical School, and her husband, an MIT graduate, lived in Boston for seven years. But moving back to her hometown of Atlanta in 2020 was part of their family planning process. They wanted to be close to relatives, which trumped fears she already had about the state's possible "heartbeat bill," which was already on the table as early as 2019 before the 2022 Dobbs decision overturned the federal right to an abortion.

In November 2022, however, Georgia did pass a strict six-week ban, called the "LIFE Act," which criminalized most abortions after six weeks of gestation minus some exceptions, including medically futile pregnancies, in emergencies to save the life of the mother and in cases of rape and incest, though only if officially reported to and documented by police.

After the Dobbs, states have enacted a range of laws from near-total abortion bans to shield laws protecting patients from other states who travel to get the procedure. Doctors and families have left states like Georgia and Idaho in the wake of the decision, but Bell and her husband chose to stay.

After settling into a home in the Atlanta suburb of Decatur, the couple welcomed their first child, a son, in the summer of 2021.

"My older child ... my only child," she corrected after a heavy pause, "is a complete joy. And my husband and I always wanted kids. We both are people who wanted to be parents since childhood," she said. "And we always wanted two children."

Bell and her husband carefully planned the timing of their second pregnancy, waiting until the summer before their son turned 3 years old to begin trying for the next.

In July, she found out she was expecting again, but the pregnancy wouldn't be routine.

At around seven weeks gestation, ultrasounds revealed that Bell had a subchorionic hemorrhage or subchorionic hematoma. This occurs when blood forms between the wall of the uterus and the chorionic membrane, or the outermost layer separating the amniotic sac from the wall of the uterus during pregnancy, according to the Cleveland Clinic. The bleeding is a result of the chorion membrane detaching from the wall of the uterus.

Subchorionic hematomas are the most common cause of vaginal bleeding in patients between 10 to 20 weeks gestation, making up about 11% of cases, according to the National Library of Medicine. However, the majority of these occurrences resolve on their own without causing any further complications or requiring intervention.

When reviewed on imaging, Bell's bleed presented as significantly larger than is usually expected with subchorionic hematomas, which tend to be small and produce light vaginal bleeding, if any at all.

She continued to return to the doctor for testing every two weeks, and the hemorrhage was looking stable. By the time she reached her second trimester, Bell said things were looking good. She was beginning to show and tell friends and family more broadly about the pregnancy. They also told their 3-year-old he was going to have a sibling.

"He was so excited about the baby," she said. "Every time he would see me, he'd give me a big hug. He'd say, 'Hug mama, hug baby.' He totally got it. And he would pat my stomach and he'd say, 'Touch baby.'"

The ticking of a mandated 24-hour clock

By 16 weeks, she was again experiencing bleeding so heavy that doctors became concerned about her low hemoglobin levels, which were continuing to trend downward.

She was in and out of the hospital and ultimately put on bed rest.

She only broke that bed rest, she said, the same day she later ended up in the hospital for the final time. She did so to cast her early vote in the presidential election in person. In November, abortion measures will be on the ballots in 10 states.

The final time she was admitted, doctors became increasingly concerned about the heavy bleeding.

"One of the main concerns for my health and safety was that I would go into a blood crisis or a hemolytic crisis, and at that point, they would basically need to terminate the pregnancy to save my life," she said. "This was also when they brought up that in Georgia, they could not consider that until it was a case of life and death for me. And basically they said, 'We have to talk about this because we're in Georgia.'"

"So already we're having conversations about the health care I can and can't get because of the state I live in," she said. "I lost so much blood."

Tests that Thursday night in October indicated she had become anemic. It was while she was in the hospital for this bleeding that her water prematurely broke, putting her at a very high risk for infection.

Bell and her doctors determined that a D&E, or dilation and evacuation procedure, was the best course of action. A D&E is a procedure used for abortion past the first trimester or after a miscarriage to remove remaining tissue. It involves the dilation of the cervix and surgical evacuation of tissue from the uterus and is typically performed using aspiration and surgical tools.

Bell said her doctors felt the procedure was the best medical decision "because they could control the bleeding and keep me alive."

"At this point, we were not going to get to meet my baby," she said, fighting back tears.

According to Bell, her baby still had "cardiac activity," but described it as a "slow end to the pregnancy" that had "definitely ended."

Despite the heavy bleeding, Bell said she still had to be consented for an abortion and that medical staff said her condition was not considered emergent enough to forgo a 24-hour waiting period mandated in Georgia.

When asked about abortion care at its hospitals, Emory Healthcare gave USA TODAY the following statement:

"Emory Healthcare uses consensus from clinical experts, medical literature, and legal guidance to support our providers as they make individualized treatment recommendations in compliance with Georgia’s abortion laws. Our top priorities continue to be the safety and well-being of the patients we serve."

Bell described a situation in which her medical team was confused about how to care for her without getting into legal trouble.

"They were trying to get that paperwork signed so they could start the clock," she said. "If my life is definitely at risk, they could do it. But where that line is is a little hard and my doctors, rightly, they don't really want to wait until you're definitely dying to save you. And this isn't a choice they should have to have."

Bell said doctors grappled with when they could start the process of the procedure. It would take time for her cervix to dilate, but it was unclear to the medical team if beginning the dilation itself would be considered advancing an abortion before the necessary time was up.

"All of this is stuff that I shouldn't have to think about and they shouldn't have had to think about. They should have said whatever is the safest thing, let's start it now. And they couldn't do that."

She said she was transferred to another hospital better equipped to handle her case, Emory Midtown, via an ambulance.

She and her husband spent that Friday "waiting on doctors" who were "trying to figure out when I could have my surgery." After another set of tests was run, it was discovered that Bell's hemoglobin had dropped so low that it was hovering just about the level where an automatic transfusion would be necessary. Because of that, they were able to move up the surgery and not wait until the following day, though this still had to be approved by a committee the hospital designed specifically to review procedures to ensure they do not step afoul of the state's new abortion laws.

A spokesperson for Emory declined to provide further clarity or answer additional questions about the committee or its process.

Bell required a blood transfusion during surgery and has had two iron infusions since. She is still seeing a hematologist and will likely need more infusions to help her fully recover from the lasting anemia. Doctors told her it could take six months for her body to get back to baseline.

'We are putting doctors in impossible positions'

While Bell voiced appreciation to the doctors and modern medicine for eventually saving her life, she said she was "furious that it was harder than it needed to be for me."

"There's a very good chance I would've died without modern medical care if I lived 200 years ago," she said. But she also noted how in 2024, the varying abortion laws across the country are impacting care.

"If I were in Massachusetts in the hospital, very little chance I would die. If I were in Idaho, where they don't have any OBs right now because the laws are so restrictive, (or) were I in Texas where they're getting sued all the time, I might've died," she said.

"We are putting doctors in impossible positions."

"This is who your mom is"

Today, Bell is not only recovering physically, but emotionally, from the loss of her second child. The hardest part, she said, was telling her son he would no longer be a big brother.

"It's pure sadness," she said, "to hear your child go, 'I guess maybe I'm not a big brother anymore because the baby's gone?'"

Bell said she and her husband would still like to try to grow their family again when they feel ready. For now, they have decided to stay in Georgia, but the thought of leaving because of the strict abortion laws has crossed their minds.

She said she was compelled to share her story so that others could "go make their voices heard," but also to honor her unborn baby.

"This is who your mom is," she said.

What are the abortion laws in Georgia?

In Georgia, abortion is banned after six weeks with some exceptions. Georgia passed the six-week ban in November 2022, and it was upheld by the state supreme court in 2023.

The state's "heartbeat law," known as the LIFE Act, has been the subject of back-and-forth in state courts, having initially been blocked by Fulton County Superior Court Judge Robert McBurney who previously ruled the ban "unequivocally unconstitutional" on the grounds it was introduced in 2019 before the overturning of Roe v. Wade.

The higher court, however, determined in October of last year that the new precedent set by the reversal is now the standard by which to judge abortion-related matters in a 6-1 decision.

Late last month, the ban was again repealed and deemed unconstitutional by McBurney but was reinstated a week later after Georgia Attorney General Chris Carr filed an emergency motion requesting that the state supreme court reinstate the LIFE Act while the justices considered the case. An injunction was granted, temporarily preventing the lower court’s ruling from taking effect.

The ban has exceptions for medical emergencies, a pregnancy determined to be medically futile, or a pregnancy that results from rape or incest, but only if reported to police and performed at 20 weeks or less.

Exceptions also exist for "removing a dead unborn child caused by spontaneous abortion (miscarriage) or removing an ectopic pregnancy."

Unlike bans in other states, the LIFE bill does not explicitly state that a pregnant woman will not be prosecuted for an unlawful abortion. For medical professionals, a criminal abortion is punishable by up to 10 years of imprisonment, fines and medical license sanctions.

To obtain an abortion in Georgia, patients are also subjected to a mandatory 24-hour waiting period and must receive a consultation at least 24 hours before the procedure, during which time they receive information about the risks of abortions, carrying to term, information on the fetus' gestation and assistance available related to childbirth. Patients must then provide written consent to confirm the receipt of this consult, except in cases of emergency.

According to the Georgia Department of Health, an "emergency" is defined as, "any condition which, in reasonable medical judgment, so complicates the medical condition of a pregnant female as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial or irreversible impairment of a major bodily function of the pregnant woman or death of the unborn child."

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This article originally appeared on USA TODAY: Georgia abortion laws delayed lifesaving miscarriage care, woman says