Madison Underwood was lying on the ultrasound table, nearly 19 weeks pregnant, when a doctor came in to say her abortion had been cancelled. Then nurses arrived who began to clean the gel from her abdomen, while the doctor leaned over to speak to her fiancé, Adam Queen.
Madison remembers being silent, motionless. Two weeks earlier she and her fiancé had been informed that the fetus had a condition that would make it impossible for him to live outside the womb. If he tried to carry the pregnancy to term, she could become critically ill or even die, the doctor had warned. Now they were saying that she couldn’t have the abortion she didn’t want but needed.
“Are they just going to let me die?” he thought.
In the midst of the confusion, she heard about a clinic in Georgia that could perform the procedure, now that the legal stakes in Tennessee were too great. She heard her fiancé curse and tell the doctor in a frustrated voice that it didn’t make sense. She heard the doctor agree.
Three days earlier the US Supreme Court had struck down the constitutional right to abortion. A law passed in Tennessee in 2020 that banned the procedure from six weeks pregnant had been stopped by a court order, but could now go into effect.
Madison hadn’t thought it would affect her. She was 22 and was thrilled with the idea of having a child with Adam, 24. They had spent days reflecting before making the decision to terminate the pregnancy. She arrived at the clinic crying and scared.
The young woman had heard about the Supreme Court overturning Roe v. Wade, but she thought that since her abortion had been scheduled before the court ruling and any state bans went into effect, the procedure would be authorized.
Abortion is legal in Tennessee if a woman’s life is in danger, but doctors were afraid to make that decision too soon and risk prosecution. The legal landscape was changing so rapidly across the country that some clinics started turning away patients before the laws officially took effect.
Measures enacted centuries ago banning abortion were reactivated, but were challenged in an equally short time. In states where the procedure was still permitted by law, waiting times at clinics increased tremendously, with a queue of women from places where the ban was in effect seeking alternatives.
Madison was sent home in the midst of this chaos, pregnant and in shock. The doctor had recommended that she go to Georgia, where abortion was allowed up to 22 weeks’ gestation—a ban would take effect shortly.
‘I want a girl’
Adam Queen realized that his fiancée was pregnant before she was: Madison had been vomiting every morning and had started ordering Chinese food, which she normally hated. One night in May, he took home a pregnancy test. He twisted and prayed.
With the positive result, Madison was left with bated breath. “I hope it’s a boy,” said the groom. Her heart began to pound.
Adam already had a daughter from a previous relationship. He and Madison had been dating for four years, and he asked her to marry him while traveling. The two faced criticism for getting pregnant before getting married, but with the ceremony scheduled for the end of June, along with the expectation of a baby, that has been forgotten.
When Madison had her first check-up at a free local clinic, she learned that she was 13 weeks pregnant and that she was due on November 23. At the next appointment, a nurse promised the couple more ultrasound pictures to take home. She asked questions, took measurements, but then fell silent. “She told us to wait. She said the head nurse was going to come and talk to us and see what we should do from there,” says Madison.
For Adam’s mother, Theresa Davis, who suffered seven miscarriages, the words set off alarm bells. “It doesn’t look good to me,” she told her future daughter-in-law.
The head nurse said there was a mild case of encephalocele, the formation of a kind of tumor on the back of the fetus’ neck because the neural tubes do not close in the first month of pregnancy. The condition occurs in 1 in 10,500 babies born in the US, according to the CDC.
She stated that the problem could be solved with surgery and that the baby could have some intellectual disability or developmental delay, in addition to possible seizures. Madison and her fiancé accepted that possibility, but she found it worrying that the baby would have to undergo surgery immediately after it was born.
They were even informed that they would have a girl. They decided to call her Olivia.
Doctors referred the family to Regional Obstetrical Consultants, a network of clinics specializing in treating high-risk pregnancies. The clinic declined to comment for this report. There, Madison and Adam received another devastating news: the fetus had not developed a skull. Even with the surgery, the baby would survive at most a few hours after delivery.
Even so, Madison hoped to be able to carry the pregnancy to term so she could meet her daughter and donate her organs if possible. But doctors told him that the fetus’ brain tissue was leaking into the umbilical pouch. This could trigger sepsis, leading to critical illness or even death. Doctors recommended terminating the pregnancy to ensure the mother’s safety.
The couple postponed their wedding and scheduled the abortion for a Monday, May 27.
Engaged in a national battle
Prior to June 24, the day the Supreme Court’s decision was announced, abortion was allowed in Tennessee up to 24 weeks’ gestation, but clinics rarely performed the procedure after 20 weeks.
That day the state’s attorney general, Herbert Slattery 3rd, filed a motion in the 6th US Court of Appeals to suspend a nearly two-year earlier injunction that had blocked an attempt to ban abortions after the sixth week of pregnancy. The injunction was lifted the day after Madison’s abortion was cancelled.
Her parents and grandparents, who are against the voluntary termination of pregnancy, interpreted this as a sign that the decision should be reconsidered. When the abortion was not performed, they were convinced that Madison should carry the pregnancy to term. “We were hoping for a miracle,” explains her mother, Jennifer Underwood.
Adam’s mother said she supported the couple’s decision; she had been raped at age 12 and given birth to a stillborn baby. “Religion has nothing to do with it. Sometimes the body plays a trick. If you have to have an abortion, don’t feel guilty about it,” she said.
With the pressures on the couple mounting, Adam quit his job to take care of Madison. His mother raised $5,250 in a virtual crowdfunding fund for travel expenses and the cost of cremation of the fetus.
‘Our baby is going to die’
One day in early July, two cars left Pikeville at 2 am to, crossing state lines and time zones, arrive in time for an 8 am appointment at an abortion clinic in Georgia. Madison, Adam and his mother were in one of the cars; Madison’s parents and one of her siblings on the other—they had decided at the last minute to accompany her, though they didn’t entirely agree with her decision.
At dawn, Madison and Adam were sitting at a corner table in the Waffle House. She would have a two-part procedure known as D&E, dilation and extraction, over the course of two days. First, she would be given medication to induce dilation and sent to a hotel room to wait. The next day, she would return to the clinic to complete the procedure.
Staff warned the family about the presence of protesters in front of the clinic. When the two cars reached the parking lot, they passed a man holding up signs depicting dead fetuses. “Is killing babies all right with you?” he yelled into a megaphone.
The man approached Madison’s parents’ car, and her mother opened the window. “We’re on the same side as you. But the doctors said our baby is going to die.” He replied, “Do you trust doctors more than God?”
Side by side, Madison and Adam walked up a steep climb to reach the clinic. She wore headphones. Six hours later, they left again. The parking lot was silent.
