Paige Tobik sent her husband to buy the emergency contraceptive, Plan B, from the drugstore even though the couple used condoms.
"We don't need this," he said to her.
"Yeah, but it's better to be safe than sorry," she said. They were already raising two young children: a 3-year-old and 14-month-old. Eventually, they hoped to grow their family, but not right then.
Last summer, despite her precautions, her period was late. Tobik, a scientist in the St. Louis area, took a pregnancy test. It was positive.
Tobik visited a Planned Parenthood clinic, where an ultrasound revealed tissue in her uterus, indicating she had likely had an incomplete miscarriage. The doctor gave her medication and scheduled follow-up bloodwork. Tobik bled profusely for several days, but her lab work showed that her pregnancy hormone levels were still rising.
She made an appointment with an OB-GYN at a nearby hospital, who performed another ultrasound. The tissue was still present, so the doctor scheduled a dilation and curettage procedure (often called a "D and C") to remove it. Again, her doctor assumed Tobik had experienced an incomplete miscarriage. However, the pathology results from the procedure indicated the removed tissue was nonfetal. Meanwhile, Tobik's hormone levels continued to rise.
The doctor did yet another ultrasound and discovered an embryo attached to Tobik's ovary. It had been too small to be detected in the previous ultrasounds. She was now 7 or 8 weeks into an ectopic pregnancy.
Ectopic pregnancies, in which a fertilized egg implants outside the uterus, can rupture and cause life-threatening hemorrhaging. They cannot be carried to term.
"I was absolutely devastated," Tobik said. "It went from an incomplete miscarriage to a life-threatening situation."
Her doctor prescribed a methotrexate injection, a form of medical abortion, to end the pregnancy.
Nearly a year after her ordeal, the Supreme Court overturned Roe v. Wade. Trigger laws outlawing abortion went into effect in many states, including Tobik's home state of Missouri. She said she immediately thought about what would have happened to her today.
"I could have died," she said.
Missouri's law forbids abortion except in medical emergencies and when necessary to save the life of the mother, but the criteria for those exemptions are unclear. Gov. Mike Parson has refused to call a special session to pass legislation protecting access to contraceptives and ensuring doctors remain able to treat ectopic pregnancies. Do medical providers have to wait for a patient to hemorrhage to consider a pregnancy an imminent threat to her life?
A paper published in the New England Journal of Medicine last month shared devastating results from Texas, where a similar ban has been in place for a year. Clinicians interviewed from across the state revealed how their patients' lives have been endangered and patient care compromised. A specialist reported that their hospital no longer offers treatment for ectopic pregnancies that implant in scars from cesarean sections, despite strong recommendations from the Society for Maternal-Fetal Medicine that these life-threatening pregnancies be definitively managed with surgical or medical treatment.
"People have to be on death's door to qualify for maternal exemptions to (the Texas ban)," the specialist said.
Erin Armknecht, 42, of St. Louis, found herself in a life-threatening situation when an ectopic pregnancy ruptured in her fallopian tube in 2012.
"This was the worst pain I had ever been in, like someone was shoving a hot poker into my right side," she said. She was doubled over and sobbing when they took her in for surgery. Doctors removed the ruptured tube, and the couple struggled for two years to conceive again.
When she heard the news about the Supreme Court decision overturning Roe v. Wade, her first thought was about her harrowing experience.
"I'm glad it happened when it did because I don't know what my outcome would be now," she said. Could Armknecht have died or been left infertile if doctors or hospital administrators had hesitated, worried about prosecution under the new law?
"It's so scary for me to think how this can impact people who can get pregnant and their families and loved ones," she said.
Tobik said she thinks about how an abortion ban could have left her two young daughters motherless. She never imagined that she would end up in a situation where an abortion could save her life.
"Back when I was personally pro-life, I truly believed that abortion existed for irresponsible people only," she said. "I couldn't have been more wrong."