Fetal anomalies can be detected after 22 weeks, the point at which abortion is banned in Indiana.

Amber Martin was 20 weeks pregnant with her son Arlo when she discovered her pregnancy was in danger. Living in Indiana, a red state with a near-total abortion ban, Martin feared what would happen next.

“It’s like somebody just rips a part of your heart out,” Martin said. “You’re about to find out that everything’s so great, and you get to see (your child), and you get to see their little face and what they look like in their hands and their feet, and everything was in place where it should have been — except that.”

That was a case of hydranencephaly, a rare condition in which the fetus’ brain does not properly develop due to spinal fluid in the brain. Hydranencephaly typically results in the death of the fetus after delivery.

For Martin, 41, and her fiance, Michael Dowd, 41, the discovery of Arlo’s hydranencephaly at her ultrasound appointment was world-shattering. Martin learned about the condition 20 weeks and four days into her pregnancy, starting the clock ticking on her treatment options.

It wasn’t, ‘Does Amber have an abortion or not?’

In Indiana, abortion is allowed only in cases of rape, incest, fetal anomalies or if the mother’s life is in danger. Even within those exceptions, treatment options have deadlines. Abortions for cases of fetal anomalies are banned after 22 weeks of pregnancy.

After receiving Arlo’s diagnosis, Martin had about a week and a half before she would lose access to legal abortion.

Martin transferred her care from Ascension St. Vincent Hospital, a Catholic facility that does not perform abortions, to IU Health University Hospital in Indianapolis. Her St. Vincent doctors offered Martin one path: Carry Arlo to term while having regular CT scans and ultrasounds. University Hospital gave Martin a choice between terminating the pregnancy immediately or delivering through induction, which would have resulted in the same outcome.

Martin chose a dilation and evacuation procedure, a kind of abortion.

“There’s no words to give somebody when they’re having to make an impossible decision between bringing someone to this earth and their own health,” Martin said, adding that she faced risk of sepsis. “That’s what we did. That’s the choice that we had to make. It wasn’t, ‘Does Amber have an abortion or not?’ It’s, ‘How do we help Arlo to have peace and be able to save my life at the same time?’”

Indiana abortion ban puts deadline on treatment options

Martin and Dowd received Arlo’s hydranencephaly diagnosis in time to have options, but that is not the case for every pregnancy. Dr. Carrie Rouse, an Indianapolis OB-GYN, said it is entirely possible for fetal anomalies to be detected after 22 weeks, the point at which abortion is banned in Indiana.

“The diagnosis of fetal anomalies is made through imaging, primarily ultrasound,” Rouse said. “It all depends on when the ultrasound is done. Fetal anomalies are most often diagnosed at the anatomic survey ultrasound, which is done usually between 18 and 20 weeks.

“But there are many different reasons why a patient may not have an ultrasound on that time frame. They may have a late diagnosis of pregnancy. They may have issues accessing care for many different reasons. The anomaly may not be detectable initially and developed later.”

Martin and Dowd, who live in Sheridan, want their experience to be a catalyst for change. They’re urging people to think more critically and empathetically about what abortion access really means. For the couple, choosing abortion felt similar to taking a loved one off life support.

‘The true purpose is intimidation’

Before mourning, though, Martin had to sign Indiana’s Abortion Informed Consent Certification form, which includes a list of statements that must be affirmed and signed off on before the pregnancy can be terminated. One of the statements is an acknowledgment that the fetus can feel pain “at or before twenty (20) weeks of postfertilization age,” even though that actually happens around 24 or 25 weeks, according to the American College of Obstetricians and Gynecologists.

Also, for every abortion, a terminated pregnancy report must be signed and submitted to the Indiana Department of Health. TPRs include confidential information about the patient receiving the abortion.

The IDOH stopped sharing individual TPRs in December 2023. However, a recent executive order signed by Gov. Mike Braun, calls for cooperation with Attorney General Todd Rokita’s push to publish the TPRs of individual patients.

In addition to experiencing the trauma of abortion in Indiana, Hoosier patients who undergo the procedure face fears that their private medical information could become public.

“The true purpose is intimidation,” said Liane Groth Hulka, the co-founder of Our Choice Coalition, a political action committee focused on advocating for reproductive rights. “Even patients that go through really traumatic experiences where they have to seek abortion health care for their own life because they were raped, among other things, they are subject to intimidation, to discrimination, by their need for health care.”

‘Come and sit with me’

Will elected officials, especially those who say they are proponents of saving life, step up and acknowledge that abortion bans can kill? As lawmakers consider the future of abortion policy in Indiana, Martin has one request. 

“Talk to somebody who’s been through this,” she said. “Come and sit with me while I have to go through this. Come sit down next to me in this hospital bed.”

Martin and Dowd are advocating for everyone to have life-saving access to abortion and other reproductive rights.

“I’m gonna step back from that word, (abortion), for a second, because I think people take that word and they think that it means that I’m gonna go in and chop up a baby and kill them because I just want to,” Martin said. “It’s a medical term … And there’s lots of different surgical options, medications and therapies that happen underneath that word.

“And I think that’s where we get it messed up, and I think that’s where we’re lacking in education. And that’s the part that makes me extremely angry. People don’t always go and just choose this.”

Indiana’s reproductive reality is deeply concerning. Martin and Dowd hope Arlo’s death can be the cause for life-saving legislative progress and change.

Contact IndyStar opinion fellow Sadia Khatri at sadia.khatri@indystar.com.