Emily Waldorf was denied care. But she didn't need an abortion

At 17 weeks, Emily Waldorf's pregnancy took a tragic turn. She was suffering from cervical insufficiency and premature preterm rupture of membranes, miscarrying her child whose foot was protruding from her cervix, and, to make matters worse, doctors weren't helping her. ProPublica recently shared Waldorf's story to make the erroneous claim that the state's pro-life law didn't allow doctors to care for her. Its goal is to scare Americans, specifically women, into believing abortion must be legal throughout pregnancy for any reason or they too could be subjected to the same substandard care that Waldorf received.

But Waldorf never needed an induced abortion. The treatment she needed was not in violation of any law.

Key Takeaways:

• Emily Waldorf experienced cervical insufficiency at 17 weeks pregnant, and four days later her water broke.

• Doctors at Washington Regional Hospital tried to send her home despite her baby's foot protruding from the cervix.

• They ultimately admitted her, but failed to provide medical care, claiming the hospital's risk management team would not allow labor to be induced, even after Waldorf's water broke and her temperature began to rise.

• Rather than deliver her baby as would have been the legal standard of care, the hospital sent her by ambulance to a Kansas hospital, where labor was induced.

• Induced labor in a medical emergency is not an abortion.

The Details:

As ProPublica reported, after experiencing pressure and bleeding. Waldorf went to Washington Regional Hospital in Fayetteville, where she happened to be employed:

In a dark room, a doctor pointed to an hourglass shape glowing on the ultrasound screen: There was [Waldorf's] amniotic sac, funneling into her dilated cervix, and there was their tiny daughter’s foot, dipping out. 

“Your body is about to miscarry,” the doctor said. 

Doctors told Waldorf and her husband, Justin, that she was suffering from cervical insufficiency, a condition in which the cervix is 'weak' and begins to open too early. With her cervix open, Waldorf was at risk of an infection that could turn to sepsis, a life-threatening infection that could require a hysterectomy. They advised that the best course of action was to 'empty her womb.'

The standard of care for cervical insufficiency is to stitch the cervix closed if possible and monitor the mother for signs of infection for as long as possible with the hope and goal of reaching viability (at least 21 weeks). If signs of infection begin or her waters rupture too soon, a preterm delivery may be necessary, but would not be classified as an induced abortion.

For Waldorf, at this stage of cervical insufficiency, the standard practice of stitching the cervix closed to try to postpone delivery does not appear to have been a feasible option. The other option would still be expectant management, but, if all else failed, to deliver the baby, who was too young to survive. Board-certified OB/GYN Dr. William Lile explained to Live Action News that at this point, with a foot protruding from the cervix at 17 weeks, it would likely not have been possible to continue the pregnancy for four more weeks, and preterm induced delivery was necessary — not abortion.

Induced abortion vs induced delivery

An induced abortion is the direct and intentional killing of a preborn child. At 17 weeks, an induced abortion would be committed by using a drug to stop the baby's heart before delivery or by using a Sopher clamp to dismember the baby as doctors removed her from the uterus.

An induced preterm delivery to save the life of the mother, however, does not carry the intent to cause the child's death and therefore is not an induced abortion. The doctor would not inject a medication to stop the child's heart and would not dismember her. She would be delivered and given age-appropriate care.

ProPublica and hospital staff seem to be confused about the difference between the two, claiming that doctors couldn't 'empty her womb' because of the pro-life law (emphasis added):

The baby still had a detectable heartbeat, and stopping it would run afoul of a state abortion ban that snapped into place after the Supreme Court overturned Roe v. Wade in 2022; violations carried penalties of up to $100,000 in fines and 10 years in prison. They needed to wait until Waldorf went into labor on her own or showed signs of a dangerous infection, or until the fetal heartbeat ended.

But doctors didn't need to 'stop' the baby's heartbeat before delivering her. They needed to deliver her.

Rather than help her deliver her child, doctors told Waldorf to go home, and that "[a]t any moment, she could start bleeding heavily and go into labor." ProPublica explained what doctors allegedly advised Waldorf:

When the baby started to emerge, the doctor said, Waldorf shouldn’t pull too hard or she could rip the baby’s head off. She would need to cut the umbilical cord herself and return to the hospital for care in a diaper, her fetus wrapped in towels and the cord hanging between her legs. 

What a horrifying thing to tell a scared, grieving pregnant mother. Unsurprisingly, Waldorf begged to stay in the hospital, which is what standard of care would have called for anyway. Doctors "agreed," and Dr. Britte Smith consulted with the hospital's risk-management team. ProPublica wrote:

Smith returned about two hours later, Waldorf recalled, and told her she had two options: She could remain under observation at the hospital, or she could get into her car and drive nearly four hours to Kansas, a state with no abortion ban, where doctors could induce her. The hospital would not authorize a transfer or arrange to send her in an ambulance, and it offered no explanation for why. 

On her fourth morning in the hospital, Waldorf was using the bathroom when she "felt something heavy fall." There was a large blood clot, and her water had broken. The next day, her temperature rose to 99.3 degrees.

Still, the risk-management team would not allow induction, claiming there were no signs of maternal infection, and that her temperature had to reach 100.4.

Andrew Cozart, the hospital’s director of risk management, and Thomas Olmstead, its general counsel, allegedly claimed the doctors could not act because they "cannot rule out the possibility of an overzealous prosecutor." It appears that doctors knew what needed to be done to help Waldorf, but the hospital's risk management team refused to allow them to provide that care based on unfounded fears that a delivery before viability is an abortion. This is not true.

According to Dr. Lile, there is no reason why the hospital could not have induced labor at this point. The water had broken, the baby's foot was out of the cervix, and Waldorf's temperature had risen. Based on this limited amount of information, Dr. Lile believes labor should have been induced to protect Waldorf's life.

What the law says

Arkansas law defines abortion as:

the act of using, prescribing, administering, procuring, or selling of any instrument, medicine, drug, or any other substance, device, or means with the purpose to terminate the pregnancy of a woman, with knowledge that the termination by any of those means will with reasonable likelihood cause the death of the unborn child.

This definition alone is problematic because it implies that it would be illegal for a doctor to carry out any procedure — such as a preterm induced delivery — that would likely lead to the death of the baby. And it was clear that at 17 weeks, Waldorf's daughter was too young to survive. But the law doesn't end there.

It also states that an abortion is allowed for a medical emergency:

'Medical emergency' means a condition in which an abortion is necessary to preserve the life of a pregnant woman whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy itself.

And it goes on to say:

It is an affirmative defense to prosecution under this section if a licensed physician provides medical treatment to a pregnant woman which results in the accidental or unintentional injury or death to the unborn child.

And that's the key part of the law that allowed doctors in Arkansas to intervene for Waldorf regardless of their confusion over the difference between induced abortion and induced delivery. In fact, Waldorf and her sister pulled up that definition of medical emergency on a phone and pointed out to hospital staff that Waldorf qualified. They also contacted attorney Molly Duane, who worked with several women who were denied maternal care. She noted that "providing the standard of care is legal." That standard of care at this point was induced delivery, and even ProPublica reported that the treatment Waldorf needed was "an induction."

Waldorf's lawsuit against the state says, "Throughout this time, Ms. Waldorf continually requested labor induction, understanding the reality that this pregnancy was no longer viable, but failing to grasp why hospital staff refused."

Sending Waldorf to Kansas

ProPublica reported that Duane sent the hospital evidence that not providing care for Waldorf "would be a violation of medical standards and common understandings of the law’s exception..."

But the hospital decided that rather than treat her, it would put Waldorf in an ambulance at 10 p.m. and send her four hours away to a hospital in Kansas. When she arrived, she was given misoprostol to induce labor, and she delivered her daughter at one in the afternoon. ProPublica reported:

She and Justin held their daughter for a few precious moments as her heartbeat stilled, marveling at her perfect tiny fingers and toes and whispering private words of love. 

They named her Bee. It was noted in Waldorf's medical records that the induced labor was carried out "with the intent to preserve the life and health of the mother."

Bee wasn't aborted. She was delivered, alive but prematurely, to save her mother.

Then Waldorf began to bleed heavily. Her placenta was not detaching, and doctors reacted to save her as she lost a liter of blood. It is presumed that this complication occurred due to Waldorf's delay in care.

Doctors have 'forgotten about basic professionalism'

Dr. Jody Steinauer, an OB-GYN professor at the pro-abortion University of California, San Francisco, told ProPublica, "Hospital leaders and institutional lawyers are basically interpreting these laws so conservatively, and so worried about a criminal charge, that they have forgotten about basic professionalism values of healthcare."

Likewise, Ghazaleh Moayedi, a doctor in Texas who has continued to provide care for women suffering miscarriages, told ProPublica, "It’s been five years, and people are still like: ‘I don’t know what we can do.' That’s willful ignorance at this point.”

Zoom Out:

ProPublica brought in stories of other women who suffered medical neglect during pregnancy emergencies, including Josseli Barnica and Amber Thurman, both of whom died after a medical emergency during pregnancy and a failure on the part of doctors to provide the standard of care.

ProPublica claimed that if any of these women had gone to a hospital "from Nigeria to Mexico, that follow standards from the World Health Organization and countless medical associations," then "treatment would have been much different."

It explained that in "those hospitals, when a patient's cervix opens too soon, signaling an 'inevitable miscarriage,' or when their water breaks before the fetus can survive, known as previable preterm premature rupture of membranes (shorthanded as 'PPROM'), it's standard for doctors to offer to empty the uterus. That's true even if there is still a heartbeat, given the high risk of infection."

Dr. Allison Goulding told ProPublica that this "is basic obstetrics."

According to several medical sources, including Yale Medicine, treatment for cervical insufficiency "includes monitoring, progesterone supplement, and surgery (cervical cerclage)." UChicago Medicine states, "Placement of a cerclage is the standard treatment for cervical insufficiency." And the American Pregnancy Association says, "The treatment for an incompetent or weakened cervix is a procedure that sews the cervix closed to reinforce the weak cervix."

As for PPROM, the Cleveland Clinic writes, "Treatment depends on the gestational age of the pregnancy.... the health of the fetus and how severe your condition is." It offers two options: delivery or expectant management. Not abortion. And, according to the WHO, treatment for PPROM includes expectant management with monitoring for infection, fetal wellbeing, and active labor. As long as there is no active labor, no sign of infection, and the baby is doing well, doctors will continue expectant management. Prior to 34 weeks, they will administer steroids to help the baby's lungs, give antibiotics to try to prevent infection, and monitor both mother and child until delivery is necessary. Abortion is not listed as standard care.

The Bottom Line:

The Arkansas pro-life law — or any state pro-life law — is not causing harm to pregnant women facing medical complications. Hospital staff who haven't read the laws or don't understand the difference between induced abortion and induced delivery are failing both women and children.