Arkansas abortion – In Fayetteville, Arkansas, 17-week pregnant physical therapist Emily Waldorf was told doctors couldn’t empty her womb while her baby’s heartbeat still showed—because the state’s abortion ban took effect after Roe was overturned. Over days, she and her family w
On the morning of Sept. 16, 2024, Emily Waldorf’s preschooler found her curled on the bathroom floor. Waldorf had felt a strange pressure during a shower—like a balloon bulging into her vagina—and then she began bleeding.
She was 17 weeks pregnant.
Waldorf and her husband. Justin. dropped their daughter off at her grandparents’ and rushed to Washington Regional Hospital in Fayetteville. Arkansas. where Waldorf worked as an acute care physical therapist. In a dark room. a doctor pointed to an hourglass-shaped image on the ultrasound screen: there was her amniotic sac funneling into her dilated cervix. and there was their tiny daughter’s foot. dipping out.
“The doctor said, ‘Your body is about to miscarry.’”
Three doctors gathered and told the couple that the longer Waldorf’s cervix remained open and her uterus exposed to bacteria, the higher her risk of developing a life-threatening infection. The standard of care, they said, would be to quickly empty her womb.
But they couldn’t do that—one doctor said apologetically. sighing deeply—because the baby still had a detectable heartbeat and stopping it would run afoul of an Arkansas abortion ban that snapped into place after the Supreme Court overturned Roe v. Wade in 2022. The doctor explained that violations carried penalties of up to $100,000 in fines and 10 years in prison. The couple would need to wait until Waldorf went into labor on her own or showed signs of a dangerous infection. or until the fetal heartbeat ended.
“Our hands are tied behind our backs,” Dr. Erin Large later told her, according to a journal Waldorf began keeping on her phone and shared with ProPublica. “Tell your friends to vote differently.”
Waldorf, raised Baptist in a Republican family, struggled to understand what the doctors were saying as grief hit in waves. The law, she kept asking herself, was aimed at women who wanted to end pregnancies—so how could it also reach a woman who didn’t?
She didn’t oppose abortion, but until that week she hadn’t considered that the ban could apply to her. Her father was a doctor. This was the hospital where she had worked for six years. The OB-GYN team treating her had delivered her daughter, and some lived blocks from her parents. She was 38 years old, highly educated, and had connections to the governor.
Lying in a hospital bed, worried infection could enter her uterus at any moment, she finally grasped what the ban meant in practice: it didn’t just restrict abortions. It restricted how doctors could respond when a pregnancy was already failing.
Trapped in that medical limbo, Waldorf started writing everything down. The journal, along with her medical records and interviews, offers a rare, harrowing account of how Arkansas’ abortion ban, rather than best practices or medical training, guided her doctors’ decisions.
Her ordeal unfolded as hospitals and doctors around the country confronted the reality that bans designed to be strict and punitive can produce preventable harm—sometimes death. Yet there was no coordination between states to protect women once a crisis began. and Waldorf would learn she could be left alone in the gap.
One doctor advised her to go home and told her what to expect: at any moment, she could start bleeding heavily and go into labor. It might happen while she was using the bathroom or playing on the floor with her daughter.
When the baby started to emerge, the doctor said, Waldorf shouldn’t pull too hard or she could rip the baby’s head off. She would need to cut the umbilical cord herself and return to the hospital for care in a diaper—her fetus wrapped in towels and the cord hanging between her legs.
Waldorf didn’t want those memories in their home. So she begged to stay, and the doctors agreed. No one could predict when the ordeal would be over.
In the days that followed. her husband sat beside her on a vinyl couch. and both were reeling from the impending loss of what would have been their second daughter. Their pregnancy had reached the point where their four-year-old daughter was excited about decorating a nursery. family-of-four camping trips. and becoming a big sister.
Now those plans collapsed into the morbid ritual of waiting.
Doctors and nurses returned again and again with Doppler machines and ultrasounds—forcing them to hear the heartbeat and see movement. “Oh look,” Large said during one of the ultrasounds, “she’s opening and closing her mouth.”
“My body failed a baby,” Waldorf wrote in her journal.
Waldorf’s job had taught her to compartmentalize, to stay cool under pressure. But the days blurred into one another, and panic rose when she realized an outcome she hadn’t considered.
On her third night at the hospital, she was scrolling through social media when a headline appeared: “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.”
On the same day Waldorf was admitted to Washington Regional, ProPublica published an investigation into the death of Amber Thurman. Thurman, a 28-year-old medical assistant, died of infection after doctors delayed emptying her uterus. Thurman left behind a 6-year-old son.
Waldorf read the story and thought, “Oh my god, it isn’t just me.” When she kept going, she arrived at the thought that stayed with her: “But she died.”
Almost exactly three years earlier—before Waldorf arrived at Washington Regional—another 28-year-old woman. Josseli Barnica. came to a Houston emergency room with the same condition. Barnica was 17 weeks pregnant. Her fetus’ head pressed up against her dilated cervix, and her miscarriage was “inevitable,” according to her medical record.
Barnica’s husband later told ProPublica that the medical team had told him inducing delivery or emptying her uterus would be “a crime,” and that they had to wait until there was no heartbeat.
Texas, like Arkansas, has a criminal abortion ban. And if Barnica had been treated in facilities that follow standards from the World Health Organization and numerous medical associations—including for “inevitable miscarriage” when the cervix opens too soon—doctors would have had a different route. In those settings. it is standard to offer to empty the uterus even if there is still a heartbeat. because infection risk is high.
“This is basic obstetrics,” said Dr. Alison Goulding, a maternal-fetal-medicine specialist in Texas. “Everyone should know that you have to provide an abortion in these settings or women can die.”
For 40 hours, Barnica waited while her cervix remained exposed to bacteria. ProPublica reported in October 2024 that she died three days after she delivered, and the cause was a deadly infection. The hospital declined to comment on Barnica’s case. saying “our responsibility is to be in compliance with applicable state and federal laws and regulations. ” and that physicians exercise their independent judgment. The doctors involved did not respond to requests for comment.
Barnica’s death, and those of six other women in three states over the next three years, sharpened what bans do when emergency exceptions are vague and have rarely been tested in court: liability-conscious hospital administrators, lawyers, and doctors can place legal risk above patient care.
Texas lawmakers responded to ProPublica’s investigations by amending the exceptions in their state laws so that a life-threatening emergency did not need to be “imminent” for physicians to act. The state’s medical board specified that doctors can empty the uterus of any patient with PPROM. and it required doctors to undergo training to ensure they know that.
But Texas’ reforms stayed inside Texas. Without a single federal law governing abortion. the other 19 states with similar bans were not required or advised to follow suit. including Arkansas. Arkansas bills itself as the “most pro-life state in America.” Since its ban took effect. the article says. not one person there has been granted a medically necessary abortion. according to the state’s public data.
Arkansas’ Republican lawmakers and officials have repeatedly rejected efforts to broaden exceptions. A ballot initiative to let voters weigh in was blocked over a paperwork error and then met restrictions designed to make future initiatives harder to file.
Doctors and Democrats fighting for reform, meanwhile, have faced a practical handicap: they lacked key information that could help them build their case. Even though Texas’ changes were made across a border, news of them didn’t land quickly in neighboring Arkansas.
Three Democratic state representatives said they had not heard of the new Texas guidance until ProPublica asked about it. Ashley Hudson, who tried twice to pass broader exceptions, said, “If there are things that are working in other states, we should be looking at that.”
Back in Arkansas, everything turned sharply on timing. On Waldorf’s fourth morning, she was sitting on the toilet when she felt something heavy fall. She couldn’t see what it was because the bleeding was so severe. A nurse confirmed it was a blood clot 3 inches across.
Her water had broken.
All morning, she watched amniotic fluid drain away. With only seven weeks before the edge of viability—she was now far enough along to begin getting their four-year-old excited—there was virtually no chance the fetus’s lungs would develop in time. Infection risk, though, grew with every passing hour.
Waldorf believed this would finally mean induction. After confirming the fetus still had heart tones, the OB-GYN on duty, Dr. Britte Smith, said she couldn’t induce yet. She needed to consult the hospital’s risk-management team.
“Oh,” Waldorf thought. “I’m a liability.”
Smith returned about two hours later and told her she had two options: stay under observation at Washington Regional. or get into her car and drive nearly four hours to Kansas. where doctors could induce her. The hospital would not authorize a transfer or arrange an ambulance, and it offered no explanation.
Medical records note that the risk-management team was consulted twice over the next 31 hours. Smith wrote: “Since there is still a heartbeat and no signs of maternal infection, we can not proceed” with induction of labor.
Waldorf’s own consultation didn’t lead to permission; it led to more barriers. She called the maternal-fetal-medicine team at the University of Arkansas for Medical Science in Little Rock. the state’s only academic health center. The team told her standard guidelines recommended induction if she didn’t deliver within 12 to 24 hours due to the rising risk of infection each hour. But the team also said, “It can’t be done in Arkansas.”.
Waldorf’s sister, Elizabeth Rowe, had almost died from hemorrhaging during childbirth. For the family, a drive through rural roads without medical support wasn’t an option.
Her father, gastroenterologist Kenneth Rodgers, was baffled. “You don’t sit around and wait for somebody to become septic. You do whatever it takes to prevent them from becoming septic,” he said. “If I don’t do what’s medically indicated in a potentially life-threatening situation, then I am liable for neglect. Why isn’t this the same thing?”.
Her mother, Linda Quattlebaum, said, “It’s inhumane,” and added, “I’m pro-life, but for the mother.” Her husband, Paul Quattlebaum, fumed, “If I took my dog to a vet and it had this problem, that dog would get better treatment.”
By day five, 24 hours had passed since Waldorf’s water broke. She texted a friend from college that her temperature had risen to 99.3 degrees. Her friend, Lindsey Haire, wrote back asking if they could help now.
Waldorf replied, “I think it has to be like 100.4. They will continue to monitor my temp or my symptoms.”
In her journal, she spelled out the catch-22: “If I need a blood transfusion and it stabilizes my condition, they cannot induce. If my temp continues to spike then they can induce.”
Rowe entered the room to find Waldorf with her eyes wide and glazed over, her jaw tense. Justin slumped on the couch, defeated. “Are they going to let me die?” Waldorf asked.
Rowe said she had never seen her sister like that. Waldorf had always been calm and practical under stress. Rowe replied, “That’s crazy. We’re in a hospital. People come to the hospital for them to save your life, not to let you die.”
Some hospitals in ban states try to protect patients through coordinated policy. During Ohio’s 2022 and 2023 six-week ban, a group of hospitals in one region aligned on miscarriage care. Dr. Justin Lappen. chair of the Society for Maternal Fetal Medicine’s committee on reproductive health. described why they did it: “Everyone at the same time thought the worst thing to do would be to have different practices.”.
They interpreted Ohio’s vague law the same way across institutions—PPROM qualified as a medical emergency. Lappen said, “There’s power in numbers. If we are going to do something, we should do it together and be similar, because that also hopefully gives you legal protection.”
But he said that isn’t typical.
A 2024 Senate Finance Committee report—commissioned after Thurman’s death—found that many hospital leaders and lawyers left doctors to fend for themselves. In some cases, hospital leaders remained “conspicuously and deliberately silent” about how to provide miscarriage care under bans.
Physicians described hospital lawyers who were “refused to meet” with them for months, were “pretty much impossible” to reach during “life or death” scenarios, and provided little beyond “regurgitating” the law, according to the report.
Information about handling the legal conflicts between bans and federal law often isn’t written down and is sometimes shared only on a “need-to-know” basis.
ProPublica has also reported that hospitals in different Texas regions treated miscarriage patients in wildly different ways—and that patients were more likely to get gravely ill where hospitals weren’t offering abortions without signs of infection.
Even basic disclosure is rare. Many hospitals in ban states do not disclose their PPROM policy publicly. In Arkansas, ProPublica surveys found that of 10 hospitals with labor and delivery wards, only one responded.
The University of Arkansas Medical Sciences shared an FAQ on abortion policy stating that under Arkansas law. whether abortion can be performed when a mother’s life is at risk “depends.” Only abortions “necessary” to preserve a patient’s life are allowed. not ones that could prevent “possible” emergencies.
Dr. Jody Steinauer. a professor of OB-GYN at the University of California. San Francisco. said. “Hospital leaders and institutional lawyers are basically interpreting these laws so conservatively. and so worried about a criminal charge. that they have forgotten about basic professionalism values of healthcare.”.
In interviews with seven doctors who worked in Arkansas, all said no hospitals allowed abortions for “inevitable miscarriage” or PPROM without signs of infection.
Dr. Dina Epstein. an OB-GYN in Little Rock. said in cases like Waldorf’s patients often panic and beg for help. but they lack the resources to travel. Doctors then negotiate among themselves about what counts as sick enough. “What organ needs to fail?. What thing needs to happen that pushes us over the edge?” she said.
Experts also say doctors remain paralyzed even though no one has been prosecuted for treating a miscarriage with a procedure that would be considered an abortion. “It’s been five years. and people are still like: ‘I don’t know what we can do. ’” said Ghazaleh Moayedi. a doctor in Texas who never stopped providing abortions for women facing miscarriages. “That’s willful ignorance at this point.”.
When Waldorf’s sister couldn’t find help through private ambulance companies—Rowe says companies would not drive because they considered Waldorf unstable—the family calculated the price of medevac helicopter service. “in the tens of thousands of dollars. ” and Rowe considered putting it on a credit card.
Then she turned to the governor’s office.
Rowe called “Sarah,” by reaching an aide in Gov. Sarah Huckabee Sanders’ office at 9:27 a.m., according to Waldorf’s journal, on Waldorf’s fifth day. Rowe explained the connections she believed she shared with the governor—Ouachita Baptist University. where Waldorf attended four years ahead of Sanders and joined the same sorority. described in the account as a social club.
Rowe told the aide about those links and argued it was urgent.
“We recommend you seek legal advice,” the aide responded, according to the journal.
“This is an emergency,” Rowe countered. “We need some help now!”
The aide’s reply, as Rowe recounts it, was, “What is it you expect the governor’s office to do?”
Rowe says the family never received another call. A friend called the governor’s office twice and reached two different aides, receiving a similar answer.
ProPublica asked whether Sanders was aware of the calls and what she would tell women facing this kind of situation, but the spokesperson didn’t respond. The spokesperson said Sanders had prioritized “the wellbeing of Arkansas’ unborn children but also at-risk kids and mothers.”
Rowe and her sister pulled up the law’s exception language on a phone. The definition of medical emergency described a condition where an abortion is necessary to preserve the life of a pregnant woman whose life is endangered by a “physical condition caused by or arising from the pregnancy itself.” Waldorf’s case. they argued. fit. They asked for someone to call the hospital and the attorney general’s office.
Instead, they were left waiting.
Then the family found another advocate.
A friend reached out to Molly Duane—then a senior attorney at the Center for Reproductive Rights—representing dozens of women denied medical care under abortion bans. Duane’s work included the case of Amanda Zurawski. a Texas woman who contracted sepsis and lost a fallopian tube in 2021 after doctors refused to induce her at 18 weeks pregnant. In response, the Texas Supreme Court said PPROM should count as a medical emergency.
Duane said she was confident she could fix what she viewed as fear and misunderstanding because this was “the hospital where she works.”
Her arguments didn’t change the outcome.
In a conversation with Andrew Cozart, the hospital’s director of risk management, and Thomas Olmstead, its general counsel, Olmstead told her, “We cannot rule out the possibility of an overzealous prosecutor,” according to Duane’s account.
Duane sent evidence and asked for a different outcome, saying it would violate medical standards and a common understanding of the exception if Washington Regional didn’t induce. ProPublica reviewed the letter Duane sent and reached out to Cozart and Olmstead, who did not respond.
At 5 p.m.—about an hour after Duane’s email—Waldorf says the hospital CEO, Larry Shackelford, came to her door. Waldorf told him she needed a moment to get dressed.
The couple recalled Shackelford appearing disheveled, like he’d left work quickly. Shackelford said, “I’m so sorry you’re in this situation. We’re going to take the very best care of you.” He repeated that message but didn’t say much else.
Waldorf and Justin were left wondering whether it was a breakthrough or merely a political visit.
Large returned afterward to tell them the hospital’s decision hadn’t changed. The medical record language. according to the account. said: “With positive fetal heart rate and no evidence of maternal distress/severe illness at this time unable to augment/induce labor to expedite delivery. ” and that they should consider going home.
Soon afterward, Washington Regional officials told Duane they would agree to transfer Waldorf to a Kansas hospital where abortion at her gestational stage was legal. Duane found a team at The University of Kansas Health System about four hours away.
But before authorizing transfer, Large told Waldorf she had to say specific words. “Repeat after me,” Large said, as Rowe and the Waldorfs recall. “I no longer want to receive care here. I would like to transfer to another hospital with a higher level of care.”
Waldorf repeated the words, and they were noted in her medical record.
At 10:20 p.m., Waldorf was strapped into a five-point harness in the back of an ambulance and began the bumpy ride along rural roads. Her husband and sister followed behind, watching anxiously through the window.
Her arrival at the Kansas hospital felt different immediately. The account says women in green scrubs and hairnets lined up near the elevator. Dr. Megan Thomas spoke first.
“We are so glad you made it,” she said.
The University of Kansas Health System hasn’t always been that way. Two years earlier. its legal team at a separate facility blocked care to a woman named Mylissa Farmer for PPROM at 17 weeks. Even though the state did not have a sweeping abortion ban. the Biden administration investigated and concluded the denial violated the Emergency Medical Treatment and Labor Act. Federal investigators interpreted the law as requiring hospitals to offer abortions in emergency situations, even in states with bans.
The government learned that University of Kansas Health System officials had deemed the political climate “too hot and heated” to help Farmer. The government cited the hospital for violating the law and threatened fines if the system didn’t correct issues linked to the denial. The hospital said Farmer’s care followed hospital policy. medical standards. and the law based on facts known at the time.
After that, the account says, the Trump administration rescinded the Biden-era guidance that had pressured hospitals to offer emergency abortions and dropped the government’s related lawsuit.
Across other ban states. Republican lawmakers have not introduced legislation to punish hospitals and physicians who fail to provide care. even when they cite malpractice and confusion as explanations for deaths and injuries. State medical boards also have not disciplined physicians reported to have refused a medically necessary abortion during a miscarriage. including doctors involved in Barnica’s. Zurawski’s. and Farmer’s care.
In Arkansas, doctors told ProPublica that guidance from the medical board similar to Texas’ would help because it would address the vagueness and the provider questions.
Even Americans United for Life—the prominent anti-abortion advocacy group—told ProPublica it agreed with the Texas stance on treating previable PPROM.
ProPublica asked the Arkansas Medical Board. the governor’s office. and Republican lawmakers who sponsored the abortion ban whether they planned to issue similar guidance. The Arkansas board said the law is already clear enough. Medical boards in 18 other states with bans either said they did not plan new guidance or did not respond.
The governor’s office didn’t answer questions.
Mary Bentley. a Republican state representative and lead sponsor of the original ban. told ProPublica she believes the law allows doctors to offer abortions to women with PPROM and she said doctors do not need to wait for signs of infection. She said she is reaching out to the medical board to see if it can issue guidance like Texas’ and that she would work toward more legislation if needed. She said, “Medical decisions should not be made by lawyers. We need to just clarify it for them better. The women of our state definitely deserve it.”.
Another route for accountability is the courts. Abortion-rights groups have sued at least 13 states over their laws, sometimes forcing clarifying statements from judges, though the account says impact has been limited.
In Texas, one lawyer has started filing malpractice lawsuits. Michelle Maloney represents 10 women or their families who allege doctors did not provide medical care that should have been legal under the abortion law’s medical emergency exception. Maloney said. “I think it is the most effective way to potentially make hospital systems do what they need to do to support doctors. If we can create some risk on the other side, hopefully we can motivate people to do the right thing.”.
In Kansas, the care finally began. The account says Waldorf received misoprostol around 1 p.m. and delivered.
Waldorf and Justin held their daughter for a few moments as her heartbeat stilled. They marveled at her tiny fingers and toes and whispered private words of love. They named her Bee, for the “interconnectedness of the natural world,” and because they wanted reminders of her each spring.
Then the situation turned again. Her placenta was having trouble detaching, the account says. Blood kept gushing out and soaking the pads. A nurse weighed them.
“Is that a lot of blood?” Waldorf asked.
“It’s a lot of blood,” the nurse replied.
The monitor began beeping. Waldorf’s blood pressure was dangerously low. Justin saw his wife’s face turn white. Working in the intensive care unit, a doctor went elbow-deep into her uterus trying to loosen the placenta. The team was about to take her to the operating room when they were finally able to detach it.
Doctors said she lost a liter of blood and complications were likely worse because doctors had waited so long to deliver.
Waldorf realized that if she’d gone into labor at home or on the road, there was no way she would have made it to the hospital in time.
In her medical record, the Kansas doctors stated the induction was performed “with the intent to preserve the life and health of the mother,” and that it included four dense paragraphs citing evidence of the high risks of sepsis and hemorrhage if the medical team waited.
Back in Arkansas. Washington Regional had not provided prewritten language to physicians to remove ambiguity about why an abortion falls under an emergency exception. according to the account. Washington Regional declined to comment on its policies. None of the doctors involved agreed to discuss the case.
Waldorf continued to bleed after returning home. Her mother came to stay with her. She didn’t want to go out in public and suffered headaches for a week.
In her journal she wrote her grief and rage. “It all feels quite like the Handmaid’s tale,” she wrote on Sept. 24, 2024. “I had to seek refuge, travel by ambulance across borders.”
Explaining to their daughter when her little sister would arrive became a daily strain. Waldorf and Justin told their child the baby wasn’t coming anymore until she eventually stopped asking.
Later, after alumni weekend arrived, Waldorf canceled the bed-and-breakfast stay with the governor but decided seeing her community might help. At the opening event, the emcee announced that Sanders was in attendance and the audience rose to applaud. Waldorf stayed seated, the account says. So did her mother and stepfather, both longtime supporters of the governor.
Her stepfather tore the Sanders bumper sticker off his car afterward and made it known to local politicians what happened.
On Dec. 8—when she was scheduled to return to work—Waldorf was frantically cleaning her house and snapping at her daughter. The next morning, she could barely push herself out of the car.
When she walked into Washington Regional. memories flooded back: the ultrasound images. the “risk management” waiting game. and the moments when the CEO and the hospital staff couldn’t help her. A month later, she submitted her resignation letter. She wrote that the decision made her feel “lighter,” “Exhausted. Free.” She started her own physical therapy practice that spring, naming it Hive Therapy in honor of Bee.
She estimates the lost income, startup debt, and out-of-pocket medical costs from her ordeal at more than $147,000. Included in that tally was more than $5,000 for the ambulance ride to Kansas, which Washington Regional was unwilling to pay.
In a letter to Duane. the hospital’s general counsel Thomas Olmstead used Waldorf’s words against her—specifically the words Large had asked her to repeat. Olmstead wrote that the ambulance transfer happened because of Waldorf’s “specific request. ” and not because the attending physician believed she needed a “higher level of care.”.
“It is simply not reasonable for you to make demand that WRMC assume responsibility for the cost of a patient-directed transfer,” Olmstead wrote.
Olmstead has since been promoted to executive leadership. the account says. and he did not respond to a request for comment. Large would not speak about Waldorf’s case even though Waldorf gave permission. but she said. “I am glad that the topic at hand is being discussed. because that’s incredibly important. I’m glad her voice is being heard.”.
The Arkansas Medical Board said it is not currently investigating complaints against the doctors. Local lawyers, according to the account, have been unwilling to take on malpractice cases because Waldorf did not die or end up with permanent injuries.
A year after leaving her job. in February 2026. Waldorf joined a lawsuit led by Duane alongside an OB-GYN and five other women denied care under Arkansas’ abortion law. The lawsuit seeks to block the state’s ban on the grounds that it violates the state constitution. Named defendants include Sanders, the Arkansas attorney general, state prosecutors, and members of the state medical board. The state is trying to get the case thrown out on jurisdictional grounds. and the governor’s office told ProPublica. “Governor Sanders looks forward to defending Arkansas’ pro-life laws in court.”.
Waldorf’s personal story and deep Arkansas roots, the account says, reached people who typically don’t follow abortion policy. Former co-workers at Fayetteville’s hospital reached out. A pastor she’d known since childhood defended her on Facebook against anti-abortion attacks. Friends who identified as “pro-life” wrote long messages about how her experience sickened them and that they want the law changed.
Even as her voice has spread, she has not escaped the moments themselves. In a small town, she keeps running into former co-workers from the hospital—at the grocery store, the coffee shop, school pick-up. Each time, she says, everything pours back: the ultrasounds, the “risk management,” the blood.
But also, she says, the state line.
The relief she felt crossing it.
Arkansas abortion ban miscarriage care PPROM Emily Waldorf Washington Regional Hospital Sarah Huckabee Sanders medical emergency exception ProPublica Kansas induction maternal health law