Tina wanted another baby. She also needed an abortion. Texas made both harder.

Tina fixated on the tiny cross. She hated that she kept thinking about it. Months later, she’d hate that it made such an impression on her at all.

But she couldn’t really blame herself. Tina, 35 at the time, was expecting her second child in five weeks. It had been more than four years of trying to complete her family: years marked by miscarriage, fertility treatment, another miscarriage, more fertility treatment and an ectopic pregnancy. She’d injected her body with hormones and undergone surgery to harvest her eggs for in vitro fertilization, hoping for an embryo to stick in her uterus. 

There had been a diagnosis, something called Asherman’s syndrome, in which repeated uterine scarring can make it difficult — in her case, maybe even impossible — to stay pregnant. Tina, whom The 19th is referring to by a pseudonym to discuss her reproductive health history in detail, had enrolled in a clinical trial in Austin. She’d hoped fruitlessly for a drug that might help her stay pregnant long enough to have another child. 

Through all this, her doctor had been there. She prescribed medication and performed surgery to help Tina’s body expel the fetal tissue of her lost pregnancies. 

And she was there — offering support even if not literally present — when, after months of heartbreak, Tina’s sister-in-law offered a gift she still couldn’t quite comprehend: to carry a baby for Tina and her husband. 

He was a boy, the pregnancy now 34 weeks along and perfectly healthy. They bought a secondhand Snoo, the robotic bassinet supposed to help with baby sleep. They booked changeable tickets to California, where her sister-in-law would soon give birth. The couple never went too far from home. They wanted to be prepared in case the baby came early, in case they had to jump onto the four-and-a-half-hour flight it would take to be there when their son was born.

But now, weeks away from her son’s arrival, she’d discovered she was pregnant. She had asked her doctor so many questions. But now she had a new one: Could she get an abortion? Desperate and resolute, she needed to decide whom she could trust — which was how she found herself fixated on the tiny pendant hanging from her longtime OBGYN’s neck.

Tina had taken the test almost on an impulse, unearthing an old one on a Sunday night in early March when her period was two days late. She waited one minute. Then another. She took a second test.

She and her husband never considered having three children. Staying pregnant now would mean two newborns eight months apart. It would mean another crib, maybe a bigger car. In 18 years, another stack of college tuition bills. Another pregnancy, she worried, would keep her from being there for her other two children: the daughter she had and the boy she’d been counting down the days to meet. 

Still, Tina — who had spent years trying to get pregnant again — hadn’t thought of herself before as the kind of person who would get an abortion. She had peed on so many sticks, hoping for a positive test. 

Now that it was here, the thing she’d been wanting for so long, it was wrong. Tina mentally went through the scenarios: Would she miscarry again? Or was this another ectopic pregnancy? Was she even capable of carrying a pregnancy at this point?

Her husband’s reaction captured it:

“Shit.”

The question wasn’t what they would do. The question was how, how could they do it when they lived in the capital of the largest state to have banned abortion — a law that had by now been in effect for almost four years.

In some ways, Texas’ abortion ban feels like old news. Since taking effect in summer 2022, it has been subject to lawsuit after lawsuit, cases filed by Texans seeking emergency reproductive health care. Texans have gone without abortions, carrying unwanted pregnancies to term. Others have found workarounds: traveling out of state or ordering pills online, often keeping their activities secret. Conservative lawmakers’ attempts to block those efforts have, so far, largely failed. Year after year, the number of abortions in Texas and around the country continues to climb. 

Still, the law has had sprawling consequences. Patients have reported difficulty receiving miscarriage care and delays in treatment for ectopic pregnancies, a life-threatening condition in which a tiny embryo implants outside the uterus, often inside the fallopian tube. Anti-abortion activists and lawmakers are now pushing for a new frontier, where the state might limit or even outlaw other forms of reproductive health care, including in vitro fertilization, the most effective treatment when people experience infertility, and now surrogacy, which might be advised if someone cannot safely become pregnant.

And yet, even with Texas home to one of the nation’s most expensive and closely watched Senate races — with a Republican candidate known for his strident anti-abortion record — the politics of abortion and reproductive health have become an afterthought for most, the ban receding from headlines.

But in March, as Tina sat with her husband in her Austin home, what happened four years ago — and what had happened every day since — was urgent, an existential concern as she pondered for the first time what it would take to get the abortion that she knew her family needed. 

“It feels like a dystopian universe,” she said months later, driving with her baby in the backseat. 

When Texas banned abortion, the day Roe v. Wade was overturned, Tina was horrified. But it felt, in some ways at least, like a problem removed from her. She didn’t imagine she would ever need one.

Her first miscarriage came in October 2022. Tina’s doctor prescribed misoprostol, an ulcer medication that would functionally induce labor, allowing her to expel the fetal tissue in her uterus. She sat home for hours, waiting to hear back from the pharmacy about when her medication would be ready. When, baffled at the delay, she finally called, the technician told her they actually needed more information: proof that she had miscarried, that she wasn’t trying to end her pregnancy. 

What did they need? she would wonder later. A photo of an empty gestational sac?

She left a message with her OBGYN’s office, hoping someone could fix it. The next day, she called the pharmacy back. This time, there was no trouble: her medication was ready for pickup. 

At the time, incidents like Tina’s were reported across the country, a byproduct of the chaos, confusion and fear that resulted from the rapid implementation of strict abortion bans. For Tina, it was the first time she really asked herself what it might mean to be pregnant in Texas — her home since she moved there for college, the state where she’d met and married her husband, where she planned to raise her daughter. 

Tina and her husband had been trying for a second child since the beginning of 2022. Testing that summer suggested there may be issues with the size and shape of her husband’s sperm, factors that could make it harder to conceive. On the advice of her doctor, they started looking into fertility treatment — starting treatment with a clinic for in vitro fertilization in January 2023.

They were hopeful at the onset, updating both of their families at each step and asking for their prayers. Tina even confided in her parents despite her sense that the two of them, Catholic immigrants, were a bit more skeptical about the whole process. To them, she said, IVF seemed a bit strange, “kind of a White person thing to do.” 

When doctors noticed widespread scarring on her uterus, which can prevent an embryo from implanting, Tina had a hysteroscopy. When the scar tissue grew back, she had another. Then another and another. She would have eight such surgeries over two years. 

In the summer of 2023, her fertility team planned to transfer an embryo into her uterus, immediately on the heels of her egg retrieval. But her uterine lining didn’t grow thick enough — she’d have to wait another menstrual cycle at least. The couple had to share with their parents another dreaded update: They still weren’t pregnant. 

They kept trying to set up an embryo transfer. Each time, her medical team canceled it. Her lining was never thick enough; the transfer would probably fail. 

That Thanksgiving, Tina and her husband were sitting after dinner with her husband’s brother and his wife. Over post-dinner cocktails, she told them her doctor was starting to worry that if this didn’t work, she may have to consider a surrogate. 

Her sister-in-law stepped in. She’d talked to her husband about this; if they needed someone, she’d be open to carrying a pregnancy for them.

Tina was floored, even if she didn’t know how to answer. The two women liked each other, and they enjoyed seeing each other at family gatherings. But they weren’t best friends, she said, the kind of sisters-in-law who texted each other daily. 

While pondering the offer, Tina texted with an old friend from college, Sarah, whose last name The 19th is withholding to protect Tina’s privacy. At the time, Sarah couldn’t understand her hesitation; after all, Tina wanted a baby. Couldn’t this solve her problem?

“She kind of explained to me, ‘I don’t know if I can separate and be like, yes I just want a baby earthside, or I also want to be pregnant and go through the process and have a baby,’” Sarah said. 

And, Tina told Sarah, there was the size of a gift. How could she ever repay someone — even family, even someone who had offered — for a thing like that?

For the time being, Tina kept the offer on hold. She had another transfer scheduled after the holiday. And this time, she got pregnant. That Christmas, they stayed home in Austin, and Santa Claus brought her daughter a bicycle. They stayed home, the three of them in their comfy clothes. It was a cozy day, she said, the way Christmas was supposed to be. 

The next day, she learned she’d miscarried again. 

For days after, she kept thinking about the life they’d put on hold, hoping in vain for a pregnancy: all the doctors visits and ultrasounds and blood draws, the months they’d kept themselves from traveling too far from the clinic, in case her uterine lining was finally thick enough this cycle to accept an embryo. 

They needed a break. She planned a family vacation that summer to Banff National Park, in Canada. It was the vacation that they hadn’t let themselves take. But from the mountains, she kept thinking about how she was supposed to be pregnant. 

When you desperately want to be pregnant — and when it seems like life just won’t let you be — it’s easy to obsess over the details: what hormone levels suggest a healthy pregnancy versus one that won’t last, message board posts from people battling the same thing as you, nuances of medical studies suggesting this one time someone did have a baby, even with the same ominous lab results or painful track record as yours. Tina’s husband said he never expected to know quite so much about how pregnancies happen; it felt almost as if he could get a degree in human reproduction.

“You spend so long of your life trying not to get pregnant,” he said. “When you’re going through fertility treatment, it’s so crazy how much you have to do to try and get pregnant.”

By this point, Tina’s fertility specialist had warned her that they couldn’t continue these IVF efforts indefinitely, certainly not without putting herself at risk. Still, she wanted to try again, this transfer after their summer vacation and another hysteroscopy, this one in August.

“Just got the call! Still pregnant!” she texted Sarah at the end of September, following up with two joyful emojis. The next weekend, the two went together to Austin City Limits, a longtime tradition. 

The first day of the festival, she started bleeding again. It must be another miscarriage. 

“Confirmed no heartbeat. Miscarriage already started and let it finish its course,” she updated her friend later.

But it wasn’t technically a miscarriage. Weeks later, she developed a sharp pain in her lower abdomen. It was excruciating, she said, akin to giving birth. At a doctor’s visit days before Halloween, her OBGYN confirmed the pregnancy was ectopic. Emergency room doctors injected her with methotrexate, a drug that stops ectopic pregnancies from growing. It was just around her husband’s birthday.

At this point, Tina and her husband finally made their decision: Maybe her body wasn’t meant to carry this pregnancy after all. She could perhaps still become a mom again. But she had to reconsider what that might mean.

“I mostly am disappointed in my body,” she wrote to Sarah one day in November. For so long she had connected having a baby with carrying the child in her uterus. Now? 

“Giving up that piece is hard but I also am trying to accept my body’s limit.” 

At Christmas, with her husband’s family, Tina brought up surrogacy again with her sister-in-law. Did the offer still stand? When she said yes, Tina almost couldn’t believe it. 

“I was like wow — an able-bodied person to carry our baby for us,” she said. 

The whole time, Tina would keep a wary eye on the news. Months before her October loss, in early 2024, an Alabama state court had temporarily banned in vitro fertilization, the regimen that doctors told her represented her best if not only chance at this point to get pregnant. Could Texas do something similar? Lawmakers who opposed abortion said they were pro-family. What was more pro-family than helping a couple have a child? 

She tried to cut off the worrying, telling herself things wouldn’t go that far. In therapy, she talked about ceding control, about understanding what was in her power, and about letting go of what wasn’t.

At the start of 2025, the families met with lawyers and drew up contracts to move forward with surrogacy. They went through medical testing to make sure Tina’s sister-in-law would be able to carry the pregnancy safely. It seemed, Sarah recalled, like Tina was waiting for a proverbial shoe to drop — for something else to go wrong. Yet for once, nothing did. 

The two couples planned to time the pregnancy so that Tina’s sister-in-law, a high school English teacher, would give birth toward the end of the academic year. They would try a transfer only once; whatever happened would happen. With that in mind, they scheduled a procedure over the summer, in California. 

Afterward, the two couples FaceTimed. When Tina and her husband learned the good news — they would welcome a baby boy in April — he started crying on the phone. 

The morning after her positive test — a misty Monday in early March — Tina reached out to an online abortion service based in Massachusetts, one that mailed abortion pills to people living in states with bans. She got a prompt response: The standard medication abortion regimen doesn’t work for people with ectopic pregnancies. Because of her medical history, she would need an ultrasound confirming that medication was safe for her to take.

For the time being, Tina decided against calling her doctor. Instead, she scheduled an afternoon visit two days later at the Planned Parenthood near her office. There, she received a transvaginal ultrasound. They couldn’t tell if she had an ectopic pregnancy; they told her she should go to the hospital to see if they might be able to figure it out. She and her husband drove to the emergency room that night. They said the same thing: It was too soon to know.

So the next day, she decided to call her doctor, scheduling an appointment for that Friday, the 13th.

Tina avoided mentioning abortion. She’d had a positive pregnancy test, and she was trying to confirm it wasn’t ectopic. Her doctor ran some bloodwork, testing her hormone levels, but she said the same thing every other medical professional had — it wasn’t quite clear where the embryo had implanted. From her perspective, it looked like Tina was OK. But if they did some follow-up in a few days, she could rule out an ectopic pregnancy.

Things like this, her doctor joked, always seemed to happen on a Friday.

“It makes me sick and just so sad at how cruel this curveball is,” Tina texted Sarah.

Weeks prior, Tina and her friends had planned a dinner for that same night: a girls night at an upscale Asian restaurant they loved, right off the river. They’d been looking forward to it, said Miranda, another college friend, herself just starting her third trimester of pregnancy at the time. All of them had reached the age where it felt harder to get together without two months’ notice.

At the restaurant, Tina broke the news to them. She was pregnant, she didn’t know what to do, and so far, it seemed no one could help her. As she spoke, Miranda said, the other women could see her anger and frustration. Their eyes turned wet as they listened.

“The idea that she was just like, ‘I’m pregnant now, how can I handle this with a newborn.’ The timing was just so cruel,” Miranda said.

That night and for months to come, whenever Miranda thought about Tina — whom she called her “sister” in fertility treatment, her support system through the loss of her own son, who died days after complications in his birth — she’d remember just how different things would be if they lived somewhere else, in a place whose laws, she said, better supported people trying to become parents. 

When Tina went back the following Monday, she and her doctor looked at the latest results together, bloodwork and an ultrasound. The embryo was in her uterus. It looked, so far, like the beginning of a healthy pregnancy.

This was the moment, then, when Tina would ask for an abortion.

She took a deep breath. She felt incredibly vulnerable, describing it “like the moment before you dive into a pool.”

Her doctor’s answer was kind. She couldn’t tell her how to find an abortion. But, she said, if Tina looked online, she should find resources that could help her. She was sorry she couldn’t do anything.

“She didn’t judge me for it and didn’t turn me away from it,” Tina recalled. “I could tell in her tone that she felt bad.”

She was drained at this point — “emotionally hungover and exhausted,” as she described it that day to Sarah. But she had to keep going. That same day, Tina placed an online order for the pills. With expedited shipping, it cost her about $250.

She started to worry again. Would people get in trouble if they knew what she was doing? If they gave her advice or if they comforted her?

As much as she could, she stopped putting things in writing. She and Sarah, who had texted constantly over the years about each positive pregnancy test and each subsequent loss, got in the habit of sending each other messages and then immediately deleting them. 

Other than her sister, she told no one in her family about the pregnancy: not her mother, who she worried might oppose abortion, not her sister-in-law, who was weeks away from giving birth to their child. As Tina’s husband put it, what if sharing this news somehow tainted what felt still like the most generous thing another person could do for them? What if it made it seem as if they didn’t actually care about what their sister-in-law had given them?

“To even tarnish that a little bit is so awful because it’s such a beautiful, amazing once-in-a-lifetime gift — and then to have anything tarnish it is just so dispiriting,” he said.

“I remember thinking about the irony of it all,” Tina said. “I remember being — it sounds silly, but almost like I felt duplicitous to myself and others because I was the person that always wanted to have another child and worked so hard and did everything within my means. I did everything I possibly could to try to have another child, and here I am pregnant and about to have an abortion.”

The pills came two days after Tina had ordered them, arriving in a small, unmarked package. The drugs were familiar: one of them, misoprostol, she remembered from miscarrying. 

But this time, they felt different. She wasn’t taking them because she had already lost a pregnancy. This time, there was a power in choosing to take pills — a sense of finality, even, she said. She was doing this herself.

There was still the question of timing. Months before, Tina and her husband had planned a spring camping trip with some friends, other parents from their daughter’s school. This weekend, the soonest chance she’d have to take the pills, she was going to be staying in a cabin with her family. But the weekend still was the only time that made practical sense; if she waited any longer, she’d have to take off work to try to recover.

Tina took the mifepristone on Saturday night, swallowing the pill before going to make stovetop brownies with her daughter. The misoprostol came the next day, when the three of them were back home. That night, they ordered pho for delivery — her daughter’s favorite, something comforting for everyone. 

At one point, Tina felt the bleeding pick up; looking down, she saw crimson spots on the white dining chair. She ran to the bathroom, yelling to her husband to spray stain remover on the fabric. 

When her daughter followed, asking why her mommy was bleeding so much, Tina reassured her. They would do their best to shield their daughter from knowing what was happening. By the time she was old enough, Tina’s husband hoped, maybe things would look different in Texas.

After dinner, Tina nursed her cramps in bed while the other two watched TV. Within a few days, the bleeding began to taper off. The cramps went away. And the abortion worked. 

No longer pregnant, Tina could finally focus on her son, now only weeks from arriving. She started pulling baby clothes out of the attic — some she had been holding onto for years. 

They flew to California a few days before he was born. That Thursday morning, when the couple woke up, they kept saying to each other: Today was the day. At the hospital, Tina was the one to cut the umbilical cord. 

Her husband cried again when his son was born. By Tina’s count, it was the third time in their relationship she’d ever seen him do so. 

They flew home that weekend, a family of four.

Now, things are getting back to normal. In late July, the family took their annual trip to New England, wandering the beach, infant in tow. When Tina drives to Costco, she straps two kids into the car. Only a handful of people know about the abortion. Her husband is back at work, parental leave finished.

Sometimes, it seems as if she made it just in time. In Washington, D.C., abortion opponents are pressing Todd Blanche, the newly confirmed attorney general, to enact national restrictions on telehealth abortion — the type of service Tina relied on for her abortion. Blanche, for his part, has expressed openness to doing so, telling religious conservatives in a private phone call that the Trump administration would be “putting practices and policies in place” to block the mailing of abortion medication. Heidi Overton, nominated to run the Food and Drug Administration, has written about her openness to similar policies.

And in Texas, the politics of abortion are shifting to target fertility treatment as well. 

This summer, Texas Republicans voted at their party convention to adopt a platform that would outlaw IVF and restrict surrogacy, deriding both as “destructive practices.” The Texas Public Policy Foundation, an influential Austin-based conservative think tank, has come out against both compensated surrogacy — in which families pay someone to carry a pregnancy for them — and the so-called “altruistic” arrangements that people like Tina have used. Lawmakers are likely to consider some kind of surrogacy ban next year.

Tina won’t have to worry about those things herself. Soon after their son’s birth, her husband had a vasectomy. Their family is complete. 

But then there is her daughter: 6 years old now, and unlike her parents, Texas born and raised. Tina wants better for her. 

“With my daughter, I feel worried about what it looks like if things get worse, if that’s even possible,” she said. “I don’t want her to think there’s no option for her and she can’t choose what’s right for her own body. As the mom of a daughter, I feel concerned for — and I feel concerned for any woman.”