From the UK to Georgia: When Heartbeats Silence Women

Decriminalisation of abortion edged forward this week, but let's not mistake this for liberation

Louise Morris

Jun 24, 2025

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Dear friends,

Today’s topic may be triggering for some, so please pass this one by if you need to. For those who do choose to read, there are distressing stories including maternal and infant loss. To attempt to do justice to such a weighty topic has taken many days of research and deliberation on a background of decades of personal thought and reflection. This essay is therefore not a quick read. I have also almost certainly got things wrong, and am always keen to learn and correct any mistakes.

I have recorded a voiceover in case you prefer to listen, though apologise in advance for the hoarseness that comes from a summer cold. Thank you for reading, or listening, with an open mind and open heart.

Image from a seven-week ultrasound in my fifth pregnancy: ‘Pudding’

The tiny flicker on the monitor was clear to see. The only sounds in the room were the clicks as the sonographer recorded measurements at this angle and that. She said no words, but her expression told me all I needed to know.

I was seventeen when I first took a pregnancy test. My period was never late, until it was. Even now, a quarter of a century later, I vividly recall the cold fear that made my stomach churn and my hands shake as I tried not to drop that little white stick in the staff toilets at the GP surgery where I worked part time as a receptionist. The practice manager had procured a test from the consulting room and kindly waited with me to check the result, recognising that I was too panicked to begin to figure out how to interpret such a thing. In those eternal three minutes, I made the decision that I would need to have an abortion. I was about to apply for medical school. I was still a child myself, and absolutely not ready to become a mother. Terrified, I scrambled for the sentences that I might utter to tell my own mother…

The test was negative. My period started the next day, likely slightly delayed by exam stress. I have never forgotten the relief.

Twenty years later, I was a pregnancy test pro. After four pregnancies and two beautiful babies, I knew those early signs - the appearance of two blue lines came as no surprise. I waited for the initial wave of ‘Fuck, can I really do this again?’ to pass and allowed myself to get tentatively excited. I was all too aware that there were no guarantees, but goodness, I couldn’t wait to hold that child in my arms.

The first sign that all was not right was an unusual pain. Low in the right side of my pelvis, I joked with colleagues that I must have ‘stump appendicitis’1 , but took advice from a friend and asked to be seen in the early pregnancy assessment unit. Only around five weeks pregnant by dates, a blood test was taken with levels suggesting I may be a little further along than I thought, and a scan was arranged for the next day.

Over the following weeks I had regular scans. The first found a gestational sac but no evidence of a heartbeat. The second found a growing embryo, but still no visible heartbeat. I began to fear the worst. With HCG levels in the thousands, there should be a heartbeat. ‘Unless it’s twins, or more…’ I clutched at straws. Waiting two weeks for the next scan, anticipating a miscarriage to begin any day, my husband decided that £79 for a private scan would be money well spent if only as an incentive for me to leave the house. We saw a heartbeat. The sonographer smiled and called the tiny flickering shadow my ‘pudding’, which became our nickname for this tiny one. But our week of hope ended at our hospital follow up.

Entering the scanning room, my own heart was racing a little as it usually did in these places. Having had two early miscarriages previously, I was realistic enough to know the odds, though for the first time in this pregnancy I had allowed myself to feel excited about seeing our baby. But as I breathed through the discomfort of the ultrasound probe, I saw the tiny heartbeat flicker on the screen, and then I saw the sonographer’s face.

After I’d dressed, we were taken to The Quiet Room. I’d sat in many such rooms before, on both sides of the tiny table bearing a fake orchid and a box of tissues. ‘I’m very sorry,’ the sonographer, accompanied by her kind-faced student who didn’t appear to know quite where to put herself, began. We always begin with that. She explained that though there was a heartbeat, it was exceptionally slow, and the embryo had stopped growing. We were told that miscarriage was now inevitable. We discussed how it might be managed - that I could choose to wait for nature to take its course, take medication to induce contractions that would empty the contents of my uterus, or have a short surgical procedure either awake2 or under anaesthetic in theatre3. The pros and cons of each considered, I was clear that I wanted to go to theatre and make this process as quick and painless as possible, physically, at least. Intimately aware of the idiosyncrasies of the emergency operating list as I was, I expected it may take a couple of days to arrange the procedure, but the gut-punch came when I was told I couldn’t be even added to the list yet, because the embryo still had a heartbeat. I would have to wait another week, submit to another uncomfortable, transvaginal scan to confirm that the heart had stopped, before any medical care for my miscarriage could be offered. ‘Otherwise, it would be an abortion…’ As her words tailed off, I realised two things. One - my horror at any implication that I might have to request an abortion - a notion that hadn’t crossed my consciousness in two decades, until now, in this much wanted pregnancy, illustrated my internal biases and the stigma that remains prevalent around what should be an uncontroversial facet of healthcare. And two - even if I could bring myself to do so, because of the complexity of referrals and the legal requirements surrounding abortion, it would likely take much longer than a week, so I may as well just wait for the heart to stop.

I realise how fortunate I was, back in 1999, to live in a country where abortion was even available as an option - for some. In Northern Ireland, the only part of the UK at the time where the Abortion Act of 19674 did not apply, around 2000 women and girls each year faced the trauma of travelling to Britain or beyond, to obtain abortions. Whether abortion care was sought for non-viable pregnancies, those resulting from rape, or for reasons of choice; those procuring, performing or facilitating abortion risked criminal prosecution, with a contemporary BMJ article5 summarising the local provision - and attitudes - in its closing statement:

Meanwhile, Northern Ireland’s main pregnancy counselling service, the Ulster Pregnancy Advisory Association, is closing its doors after staff harassment and attempts to burn its offices down.

Doug Payne, BMJ 1999

In recent years, the dedication of campaigners for women’s right to access safe and local abortion services in Northern Ireland at last began to make progress, with formal decriminalisation signed into law in 2019, the first services commissioned in 2022, and work ongoing to expand and embed access to care across the province6.

But elsewhere in the UK even today, abortion remains governed by complex laws that differentiate these procedures from medical care.

All medical treatments, surgical or otherwise, require the presence of informed consent. This is almost always the informed consent of the patient. In the case of children, those with parental responsibility may provide consent on behalf of the child. For adults who lack capacity to make a decision whether or not to consent to care, a doctor may make a determination based on what is believed to be in the patient’s best interests, having gathered as much information as the situation permits about the patient’s own values and beliefs. Occasionally, the courts are asked to make a determination on best interests decisions.

Termination of pregnancy is different. While the requirement for patient consent still applies, this specific type of medical care also requires the consent of two doctors. Each doctor must independently come to the opinion that

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
(b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
(c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or
(d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

From the Abortion Act, 1967

Once the two doctors have made their assessment, there are then specific requirements as to the location of treatment. Currently, if authorities have reason to suspect that abortion has been performed outside of these provisions, the woman and any person who facilitated the treatment is liable for criminal prosecution with a maximum penalty of life imprisonment. And this is not just theoretical.

In England in 2020, Carla Foster, a 45 year old mother of three was around 32 weeks pregnant when she took abortion pills obtained by post during the pandemic. Emergency services were called when she went into labour; the baby was born at home, not breathing. Foster voluntarily told police that she had taken the pills. She was jailed in 2022 for 28 months, later reduced on appeal to a 14 month suspended sentence. But by then she had spent 35 days in prison, time in which she was permitted no contact with her children, including her autistic son7.

Nicola Packer8 was arrested in London in November 2020. Feeling unwell, she had taken a pregnancy test and on seeing the positive result, having calculated that she was around six weeks pregnant, immediately requested a termination. After taking the pills, she found herself delivering a fetus, later estimated to be around 22-26 weeks, in the bathroom at home. In shock, and bleeding she carried the fetus and travelled to hospital, initially afraid to admit that she had taken abortion pills in case it affected how she was treated. Once she trusted her midwife enough to tell them what had happened, the midwife called the police. It took four and a half years for Packer’s case to come to trial, where she was, at last, believed and ultimately acquitted. But those years under investigation, during which every aspect of her life was invaded as her emotional health deteriorated under such intense pressure, are years she can never get back.

These stories are sadly two of many. And women in other parts of the world were, and are, worse off still. Especially those who happen to be born with skin that is not white. In the United States, since the Supreme Court overturned the historic Roe v Wade judgement in 2022, nineteen states have passed laws banning or severely limiting access to abortion. Evidence9 shows that the effects of such bans are not uniformly felt. The impact is greatest for Black and Hispanic mothers and infants who already experience structural disadvantage and disparities in access to reproductive healthcare.

In Georgia alone there have been at least two harrowing stories of Black women dying from a lack of access to abortion care. Candi Miller10, a 41 year old mother of three died in Georgia in 2022, just months after the Supreme court decision, following an incomplete abortion, too afraid to seek medical care in a state where abortion had been deemed a felony crime. Or fellow Georgian Amber Thurman11, who did seek medical attention after similar complications, but was denied the dilation & curettage procedure that would have saved her. Despite Thurman’s pregnancy having ended and indeed been partially expelled, her necessary care was delayed as the abortion ban explicitly forbids D&C outside few, very specific circumstances. One such permitted circumstance being risk to the life of the mother, Thurman was eventually taken to the operating theatre but she died on the table. The wait for her life to be deemed sufficiently at risk to protect her doctors from the risk of prosecution, was a wait that directly led to her death.

Also from Georgia, last week we heard news that a baby was born by C-section to a mother who died four months earlier. Adriana Smith12 was eight weeks pregnant when she was diagnosed brain dead in February following a catastrophic brain bleed, but due to the state’s abortion ban, her body was then kept on life support so that her pregnancy could advance to a viable gestation. The state having ruled that abortion is currently illegal after the detection of cardiac activity which occurs at around six weeks of gestation, this so-called ‘heartbeat’ law mandated a dead mother’s heart be kept beating to create an effective incubator for a (then) embryo. Reports from the family suggest that Adriana underwent surgery to deliver a premature infant last Friday and has since, finally, been taken off life support. These months of limbo have seen medical bills continue to mount for both Adriana and her - also reported to be extremely unwell - infant, who it is understood is now receiving intensive care on a neonatal unit.

Like Amber’s, and Candi’s, Adriana’s tragic story is one not only of the rights of an embryo superseding the rights of a woman, but yet another name on the relentless roll call of Black mothers who die in pregnancy and childbirth at a rate more than four times higher than that of white women like me.

While the deficiencies of women’s reproductive rights clearly extend far deeper than abortion for us all, it is a dreadful fact that those woman who happen to be born Black face a greater fight still to access safe, respectful and effective healthcare. The organisation Five X More13, founded in London by Tinuke Awe and Clotilde Rebecca Abe have been leading the campaign to change maternal health outcomes for Black women in the UK since 2019. Their latest Black maternity experiences report is due for release in July, and will be vital reading for us all if we want to be part of a fairer future.

Decriminalisation of abortion is one, vital step in the direction of acknowledgement of women’s right to reproductive autonomy, and last week here in Great Britain, this moved several inches closer. On 17th June, MPs voted to pass the Crime and Policing Bill with the addition of a new clause14, tabled by Tonia Antoniazzi MP:

New Clause 1

Removal of women from the criminal law related to abortion

“For the purposes of the law related to abortion, including sections 58 and 59 of the Offences Against the Person Act 1861 and the Infant Life (Preservation) Act 1929, no offence is committed by a woman acting in relation to her own pregnancy.”—(Tonia Antoniazzi.)

This new clause would disapply existing criminal law related to abortion from women acting in relation to her own pregnancy at any gestation, removing the threat of investigation, arrest, prosecution, or imprisonment. It would not change any law regarding the provision of abortion services within a healthcare setting, including but not limited to the time limit, telemedicine, the grounds for abortion, or the requirement for two doctors’ approval.

Though this is a major move towards reform, the bill has yet to clear hurdles in the Lords for it to become adopted into law. And even then, the particular clause in question does not entirely remove the possibility of criminal prosecution related to abortion: if a health professional or another person assists a women in terminating her pregnancy outside the current legal framework, though the woman herself is protected by this new legislation, any other person involved remains potentially liable15. Yet, other than a minor adjustment to allow abortion pills to be taken at home, introduced during the pandemic, this is the first significant amendment to an antiquated abortion law in decades.

I am fortunate to have never had to make the decision to have an abortion. Though I once contemplated the possibility, I recognise the privileges I hold in the options that have been available to me throughout the childbearing-potential phase of my life. I am grateful, too, for the maternity care that I have had access to in the five pregnancies I have experienced, but this does not negate my responsibility to acknowledge that equity in maternity care and outcomes is far from reality.

While the story I shared of my miscarriage is one shared by countless women every day - one in four of us will experience a pregnancy loss at some point in our life - Adriana’s tale is thankfully extraordinary. But hers is one that we can only hope, may just wake the world to the injustice of legislation that claims dominion of a woman’s body for a flicker of a fetal heartbeat. I do not compare our experiences here to minimise the tragedy that Adriana Smith’s family face, nor to make any judgement on what decision her family may or may not have made, had Adriana’s wishes at any point been discussed with them or their views on her best interests been taken into account. I simply ask that women’s voices are valued. Let us not be silenced by a heartbeat that is heard only by machines, listening through our bodies. That is only present at all because it resides in our bodies. That these bodies are OUR bodies. And we deserve agency over our bodies.

My embryo had a heartbeat. So I could not grieve my miscarried child and my life was put on hold.
Adriana’s embryo had a heartbeat. So her family could not grieve their child, as her death was put on hold.

Abortion is healthcare. It’s personal. It is not for men in self (or otherwise) elevated positions of authority to debate and determine what we are deserving of. So whatever our individual beliefs, whether we might make that choice for ourselves or not, it is our duty to decriminalise abortion so that women who need to, can access safe, compassionate, non-discriminatory, effective care. And if you don’t feel able to do that? Then, respectfully, this isn’t about you. So perhaps it’s time to stop talking, stand aside, and listen.

I have been fortunate to find readers who offer thoughtful commentary on everything I’ve written, and I hope that this will be no different.

From the UK to Georgia: When Heartbeats Silence Women

Decriminalisation of abortion edged forward this week, but let's not mistake this for liberation

Dear friends,

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