When Genevieve Postlethwait’s water broke in her sleep one July morning, she knew something was wrong. At 17 weeks pregnant, it was too soon for this to be normal.

That afternoon at her OB-GYN’s office, Genevieve and her husband saw their daughter’s moving shape on an ultrasound screen. But she looked different — opaque, hard to see, almost “squished,” the 35-year-old recalled. The ultrasound tech was “clearly rattled and didn’t know what to say.”

Over the next several hours, Genevieve learned her daughter would not continue developing without that fluid, and now she was at serious risk of severe infection, too. Even though there was still a fetal heartbeat, her pregnancy was no longer viable.

But because of the OB-GYN’s own religious beliefs — and because of Kentucky’s restrictive abortion bans, the expectant couple later came to understand — their doctor would not surgically remove the fetus, and she could not recommend where Genevieve could go to get an abortion, even though it is widely considered the standard of care in this scenario.

“Her plan of action was to send us home and drink lots of water,” Genevieve said.

Less than a week later, at a loss for options that felt safe from the Paducah hospital where Genevieve had hoped to give birth to a healthy baby for the first time, the couple instead drove roughly 70 miles to an Illinois clinic and charged $1,100 to a credit card to end her pregnancy.

Genevieve’s situation is not unusual in Kentucky.

Five OB-GYNs and high-risk maternal fetal medicine doctors across central and southern Kentucky told the Herald-Leader that the commonwealth’s near-total abortion bans and their vaguely defined exceptions do not permit doctors to legally provide the standard of care to patients like Genevieve.

All said their ability to safely treat pregnant patients who require a medically indicated abortion has been compromised by state statute. Nearly all have referred patients out of state for these procedures, fearful of performing them in violation of the law and being charged with a felony.

Kentucky’s abortion bans have routinely prevented doctors from providing the standard of care since they were enacted in 2022, according to interviews for this story and previous Herald-Leader stories.

But lawmakers still haven’t taken steps to remediate the law’s impact in this way, either by considerably rolling back the ban, removing or lessening its criminal penalty or by adding more exceptions.

A bill to add some exceptions was filed by a Republican in the first week of the legislative session this month, but it’s unclear whether such a proposal has any more support from the Republican caucus than in years past, when similar proposals did not progress.

Meanwhile, Kentucky’s current abortion ban “is putting women’s lives at risk for the sake of fetuses that will not survive,” said Dr. Karen Playforth, a maternal-fetal medicine doctor in Lexington who treats patients with high-risk pregnancies.

She sees patients who fall within Genevieve’s category — not in the immediate throes of a medical emergency but whose pregnancy is nonviable and the doctor-recommended course of action is abortion — “a couple times a week.”

Nearly all of those patients, some of whom have fatal fetal anomalies, major complications, or who have preexisting medical conditions that put them at especially high risk just by being pregnant, have to be referred to clinics in nearby states with less restrictive abortion laws, she said.

Outlawing an evidence-based treatment option, like abortion for nonviable pregnancies, doesn’t make it any less necessary, Playforth said.

“Pregnancy termination is absolutely a normal part of health care associated with women, reproduction, and pregnancy,” she said. “It just is.”

Dr. Alecia Fields, an OB-GYN in Somerset, agreed: “Abortion is a fact of our field, and it is not rare.”

“Abortion has become a dirty word, but it truly is something we deal with every single day, from miscarriage management, to ectopic pregnancies, to abnormal pregnancies, and unwanted or unplanned pregnancies,” Fields said.

Kentucky’s ban also hasn’t stopped women from getting abortions; more than 4,000 have traveled to states with more lenient laws, according to data from the Guttmacher Institute, a national research organization that supports abortion rights policy.

Under Kentucky’s trigger law and six-week ban, also known as the fetal heartbeat law, abortion is criminalized except to prevent a “substantial risk of death,” or to “prevent the serious, permanent impairment of a life-sustaining organ of a pregnant woman.”

These exceptions also apply in the fetal heartbeat law, otherwise outlawing abortion except in a “medical emergency” once fetal cardiac activity starts, usually around six weeks of pregnancy. Both laws include wording that requires a doctor to make “reasonable medical efforts to preserve both the life of the mother and the life of the unborn human being in a manner consistent with reasonable medical practice.”

But what medical efforts are considered “reasonable,” and what constitutes a “substantial risk of death,” are not defined or clarified in either law.

Doctors interviewed for this story said Kentucky lawmakers are fundamentally mistaken in thinking the ban’s “life of the mother” exceptions, as they’re often referred to, are broad enough to care for the full gamut of complications that require a pregnancy to be ended early. Countless medical complications may doom a pregnancy but do not immediately threaten a pregnant woman’s life, like in Genevieve’s case.

This reality, the lack of wiggle room for it in the law and the threat of a felony charge hanging over a doctor’s head if the law is violated, is pressuring doctors against providing necessary care, which continues to put patients at unnecessary risk, they said.

“It leads to confusion as to who can intervene, when they can intervene and what has to be going on for them to intervene, and that just leads to delays in care, which lead to worse outcomes,” Fields said.

Dr. Blake Bradley, an OB-GYN in Lexington, said the message to physicians is inherently “contradictory.”

“Patients would benefit from more clear guidelines than just physicians using their ‘reasonable judgment,’ because it’s hard to do both,” he said. “It’s hard to both use your good judgment and feel like you’re still in compliance with the law. That’s the problem.”

‘Very unhelpful very quickly’

That Tuesday in July, less than 24 hours after her water had broken, Genevieve listened as her doctor at Mercy Health-Lourdes explained what had happened in her body.

Ideally, water breaks in a pregnancy once it reaches full term, around 40 weeks, or at least once a fetus is considered viable outside the womb, around 24 weeks, and it usually triggers delivery. Genevieve’s water broke at 17 weeks, well before either of those milestones.

Her condition is known as the previable premature rupture of membranes, or PPROM. It’s when the amniotic sac holding a fetus ruptures, draining the fluid needed to continue the normal stages of development.

Without the amniotic sac, Genevieve’s daughter was “frozen” developmentally, her doctor explained. Vital organs, including her daughter’s lungs, would remain undeveloped without that fluid, and there was no way to replace it.

Her doctor that day “acknowledged that some would recommend termination, because of where we were in the pregnancy, and I was at a really high risk of infection with the water broken.”

But because of her doctor’s religious beliefs and the limitations under Kentucky’s abortion bans, she advised them to wait, “hoping” something would change. No one at the hospital discussed other options at length, or offered helpful advice on where Genevieve could travel to get an abortion.

Genevieve’s doctor offered to refer her to Vanderbilt in Tennessee, a two-hour drive from their Paducah home, saying they would admit her for several weeks of bed rest and monitoring before eventually inducing her early, if she could make it to a date closer to viability.

In the meantime, she would need to carry her no-longer developing pregnancy on bed rest for another six weeks, at least.

“It became very unhelpful very quickly,” her husband Stephen Montgomery, 36, said. “We were looking for medical advice about our options.”

Later that night, Genevieve texted a friend: “out of left field serious question for you: Where did you get your abortion?”

“Long story short, I’m pregnant, but I’ve had complications: my water broke at 17 weeks,” she wrote. “There’s virtually no chance of it working out, so we’re looking at options.”

“How are you feeling?” her friend asked, sharing that she’d gone to Indiana.

“I’m feeling OK now, mostly scared of going into labor or miscarrying,” Genevieve texted back. “The baby’s still alive, but basically has no fluid to keep developing. And now we’re both at high risk for infection.”

Her friend suggested she cold-call Planned Parenthood clinics.

“That’s what we’re going to be doing tomorrow, calling places,” Genevieve replied. “We’re meeting with my OB in the morning and she’s supposed to give us some referrals too — she’s team Keep It Going No Matter What.

“But I don’t think that’s what’s best for us.”

The next morning at a follow-up ultrasound, her doctor explained that the hospital board had agreed to induce Genevieve into delivery early, “but that was the only thing they could offer me,” she said.

For liability and legality purposes, since abortion was criminalized in Kentucky, hospital boards routinely weigh in on — and sometimes are the final arbiters of — any decision within hospital walls to end a pregnancy.

A separate Kentucky law requires each procedure be heavily documented and submitted to the Cabinet for Health and Family Services, who may in turn audit those hospitals to ensure they’re “in compliance” with the law.

Mercy Health-Lourdes, a Catholic hospital, did not respond to emailed questions about hospital protocols for treating nonviable pregnancies.

“In tragic circumstances where a baby is nonviable, and the continuation of the pregnancy poses medical risks to the mother, Catholic teaching allows for the treatment of serious medical conditions, even if it results in the death of the unborn baby,” hospital spokesperson Lisa Dyson said in a statement.

Those options “may include the medical induction of labor for a previable fetus,” Dyson said.

To Genevieve, being induced “sounded terrible.”

“I did not want that to be my first experience giving birth.”

Their hospital declined to perform a dilation and evacuation abortion — the procedure Genevieve wanted. Rather than inducing labor to deliver a baby that has died or will die, surgically removing the fetus — a D&E, as the procedure is referred to — is often the less traumatic, safer option for patients in these scenarios, doctors told the Herald-Leader.

The options on the table were an early induction or expectant management.

“Finding a clinic that would actually do the procedure we wanted was entirely on us,” Stephen said. “Finding out the probability of even making it to viability was all research on us.”

Later that day, he called a series of clinics in Illinois and Indiana to ask about availability. Providers at the Alamo Women’s Clinic in Carbondale agreed to see them the following day, but they would need to pay $1,100 up front.

With Genevieve’s income as a trauma therapist and Stephen’s work as a musician, it wasn’t an easy lump sum to part with all at once. An abortion fund designed to financially assist women and families who live in states with abortion bans and have to travel out of state for this type of care recouped them $400 after the fact.

At their home on July 25, the night before the procedure, Genevieve wrote in her journal a letter to her daughter.

“Letting you go (for now) is the hardest decision I’ve ever had to make,” she wrote. “You are so wanted and will be always. Our first try at building you a little body, a little home, hasn’t gone like we ever hoped.

“We’re ready for you, this little body inside mine isn’t. I want to give you lungs that breathe, muscles that move, a body that’s strong enough to bring you into this world and carry you through it. Whether your soul is tethered to this little body already, or waiting in the wings nearby, I want to wrap you in my love and appreciation and hope.”

‘Somebody is going to die’

Ardent supporters of Kentucky’s abortion bans, including former Republican Attorney General Daniel Cameron, have insisted the law’s “life of the mother” exceptions — and the law’s allowance for doctors to use their “reasonable medical judgment” — protect doctors’ ability to provide the safest care to their patients.

This is far from the reality, doctors told the Herald-Leader.

The “unintended consequences” of the state’s strict abortion bans are depriving pregnant women like Genevieve of crucial, and often time-sensitive, health care, Bradley said.

“There are these unintended consequences of a total abortion ban that reach beyond discouraging abortion for birth control,” he said.

“If you take the elective pregnancy termination conversation off the table, because it is off the table, then let’s start there. That goal has been accomplished,” Bradley said. “Now what? There’s an over-correction we need to tweak, so our ability to practice medicine in the safest and most appropriate way isn’t compromised by this blanket law.”

The blanket law, he added, “has created a situation where women are being placed at unnecessary risk under a lot of other obstetrical circumstances.”

Multiple pregnant women across the country who lived in states with abortion bans similar to Kentucky’s have died or been seriously harmed because of delays in care.

Doctors for this story said it’s only a matter of time until this happens in Kentucky.

“I do not believe it was the intent of the majority of legislators to tie doctors’ hands and keep us from taking care of women who are pregnant, but this is the kind of thing where, if we don’t get this fixed, then eventually — and probably sooner rather than later — somebody is going to die,” said Dr. Jeffrey Goldberg, a gynecologic oncologist in Louisville and the legislative advocacy chair for the Kentucky Chapter of the American College of Obstetricians and Gynecologists.

“I don’t want somebody in Kentucky to have to die before our legislators wake up, realize there’s a problem, and fix it.”

KY women fleeing the state for abortions

Regardless of the reason, pregnant Kentuckians have fled in droves to get abortions in neighboring states since Roe was overturned, most often Illinois, Indiana and Ohio, according to the Guttmacher Institute.

That data shows, between January 2023 and September 2024, 1,850 pregnant people traveled from Kentucky to Illinois to terminate their pregnancies, 790 people went to Indiana and 1,780 headed to Ohio.

Kentucky’s trend is mirrored nationally in other states with abortion bans.

Last year, more than 171,000 people nationwide traveled out of their state to get abortions. In 10 of the 13 states that have enacted near-total or total abortion bans, the number of women getting abortions increased, including in Kentucky. During the first six months of 2023, the number of Kentuckians who got an abortion climbed by 13% compared with a six-month period in 2020.

Demand did not wane in 2024.

The donation-based and grant-funded Kentucky Health Justice Network, one of just a few state-based organizations that offers funding to pregnant women who hastily need to travel out of state to terminate their pregnancies — most often a cost that’s paid out of pocket — is on track for a record-spending year.

In 2024, the network spent roughly $90,000 on travel expenses alone for people in positions like Genevieve’s, said Savannah Trebuna, the Louisville-based group’s abortion support fund director. That’s well over the $59,000 the organization spent in 2023 and $27,000 in 2022.

The health justice network, through its abortion support fund hotline, offers a few hundred dollars to each person, at least, who needs financial assistance to cover the cost of their procedure, transportation and, if needed, overnight hotel stays.

Some doctors interviewed by the Herald-Leader said they try to relay this information to patients, too, recommending certain out-of-state clinics and funds like KHJN that offer financial assistance.

Others are more reluctant, worried that even this step would incur a criminal penalty under the both bans’ “abetting” provisions. Under the trigger law, “no person may knowingly . . . procure for” a pregnant person “any medicine, drug or other substance with the specific intent of causing or abetting” an abortion.

“Abortion’s not legal in Kentucky and anything that would involve helping patients could be seen as aiding and abetting,” Fields said.

This reality, and how it ties doctors’ hands, leaves her patients “scared and lost, left on their own to navigate the system alone, to figure out where to go from there, oftentimes after a heartbreaking and devastating diagnosis.”

‘Dangerous to be pregnant in this state’

Six months later, Genevieve and Stephen are still planning to build a family, more equipped and in tune, for better or worse, with the medical shortcomings of being pregnant in a state with restrictive abortion laws, should a complication arise

“The traumatic thing we experienced was compounded by the health care system we were in,” Stephen said. “Our laws are making it harder for people to get the care they need. It feels dangerous to be pregnant in this state.”

On July 29, three days after her abortion in Illinois, Genevieve emailed the clinic to thank her doctor for taking “incredible care of me” after “a traumatizing experience at my home hospital in KY.”

“It was one of the worst days of my life, but (you) made it as peaceful and painless as it could’ve possibly been,” she told the doctor, who gave Genevieve and Stephen a print of their daughter’s ink-stamped footprints as a keepsake after the procedure.

Earlier that morning around 5 a.m., restless and unable to sleep, Genevieve wrote in her journal.

“My office at home is getting too filled with altars. During our ritual last night, we talked about giving her a name, either keeping it Fiona or naming her Anne Marie. I’m not sure which feels right. But she definitely deserves a name.

“Then there’s the anger. I can’t tell if it’s misdirected grief rage that this happened, or if it’s justified. It comes so easily, and then follows a slip into sadness, anger at the law. Anger at (her OB-GYN) for what she did and didn’t say. I could have had even more traumatic experiences and physical complications on top of everything I’m already wading through.”

But the waves of anger still gave way to gratitude, she wrote.

For Stephen, for their parents, and for her doctor at the Alamo Women’s Clinic who provided the abortion, who offered consolation and empathy at a time when she needed it most, and “who shared with me that she experienced something very similar with her first pregnancy, made the same decision, and doesn’t regret it.”

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