Four women suing over Idaho’s strict abortion ban told a judge Tuesday how excitement over their pregnancies turned to grief and fear after they learned their fetuses were not likely to survive to birth — and how they had to leave the state to get abortions amid fears that pregnancy complications would put their own health in danger.

“We felt like we were being made refugees, medical refugees,” said Jennifer Adkins, one of the plaintiffs in the case.

The women, represented by the Center for Reproductive Rights, aren’t asking for the state’s abortion ban to be overturned. Instead, they want the judge to clarify and expand the exceptions to the strict ban so that people facing serious pregnancy complications can receive abortions before they are at death’s door.

Currently, the state’s near-total ban makes performing an abortion a felony at any stage of pregnancy unless it is “necessary to prevent the death of the pregnant woman.”

Adkins’ fetus had a severe medical condition that meant the fetus would not survive the pregnancy. The illness also put Adkins at risk of developing “mirror syndrome,” a dangerous syndrome that can cause fatally high blood pressure and other issues, she said.

Adkins and her husband, John, decided to seek an abortion, and learned, after another ultrasound showed the fetus still had a heartbeat, that they would have to go out of state to get one.

Idaho law prohibits a woman from getting an abortion when a fetal heartbeat is detected, with the exception of cases of rape, incest or a “medical emergency,” defined by the law as “a condition that, in reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.” 

“No parent wants to wish that when they look at an ultrasound they don’t see their baby’s heartbeat, yet here I was hoping that I wouldn’t,” Adkins said. “I wanted the decision to be made for us, and I wanted to end her suffering, so it was really hard to see that and know that we had the challenges ahead of us that we did.”

“I was not willing to watch my son suffer”

Kayla Smith cried as she told the judge how she found out she was pregnant for a second time on Mother’s Day of 2022, and how she and her husband chose the name “Brooks” for their son. She was around 18 or 20 weeks along in her pregnancy when the sonographer grew quiet during a routine anatomy scan, Smith said.

Brooks’ heart had fatal anomalies, and the young family could not find a pediatric cardiologist willing to attempt an operation. The veins supplying Brooks’ lungs were also abnormal, Smith said, and he would not survive birth.

Smith had developed dangerously high blood pressure during a previous pregnancy, and she was at risk of developing the condition called preeclampsia again.

“If I were to continue pregnancy not only would I risk my life with preeclampsia, I was not willing to watch my son suffer and potentially gasp for air,” Smith said, crying.

Idaho’s abortion ban went into effect two days before Brooks’ diagnosis, she said, making it impossible for her to get an abortion in her home state.

“We wanted to meet our son — that was really important to us — so we needed to do it in a hospital,” she said. 

They took out a loan to cover the estimated $16,000 to $20,000 out-of-network cost for the procedure and drove more than eight hours to a hospital where doctors induced labor.

“All four of these women were overjoyed to be pregnant with their second child and all four of them received the worst news a mother can imagine,” attorney Gail Deady, with the Center for Reproductive Rights, told 4th District Judge Jason D. Scott during opening arguments. All of them sought abortions “to protect their health, to spare their babies from pain and suffering, and to remain alive and healthy to protect their young children.”

James Craig, a division chief with the Idaho Attorney General’s office, said the women and their attorneys are relying on hypotheticals rather than concrete facts to make their case. Under their proposal, a pregnant woman could receive her abortion for something as minor as stepping on a rusty nail — even though the risk of infection in that scenario could be easily treated by receiving a tetanus booster shot, Craig said.

“Unborn children have a fundamental right to life, and protecting the lives of children is a legitimate and fundamental government interest,” Craig said.

The state also has the same interest in protecting the lives of women, Craig said — and the abortion ban laws do both, he contended.

In the “rare circumstances where abortion is necessary” to prevent the death of the mother, Idaho law allows that to occur, Craig said. The women suing are trying to “usurp the role of the Legislature” by asking the judge to rewrite the law, he said, and that is not the proper role of the court.

Dr. Emily Corrigan, an ob-gyn who works in emergency medicine at Saint Alphonsus Regional Medical Center who is also a plaintiff in the case, told the judge how Idaho’s multiple abortion bans have created confusion for physicians and made it difficult to treat pregnant patients who need emergency care.

Doctors have had to “basically guess which pregnancy conditions would fall under the state medical exception,” Corrigan said.

“I have had other hospital staff refuse to participate in the care of my patients because of the lack of understanding of the laws, and this has caused patient care delays,” she said. “I have personally cared for several patients who have been denied stabilizing abortion care at other hospitals in Idaho. By the time they arrive at my institution, their conditions have deteriorated and have lead to increased complications that I need to manage.”

Several conditions can put the health of pregnant people at risk, she said. Some are caused by pregnancy like preeclampsia, and others — including some chronic illnesses and cancers — can be made worse by pregnancy, she said. In those cases, delaying an abortion might not cause immediate death but can cause a shortened life span or have dramatic effects on a person’s health, Corrigan said.

“We are not trained to wait until things become urgent or emergent. We are trained to prevent harm to our patients,” she said.