The moment Kristen Petranek knew she would stop trying to get pregnant came in May, while lying on her couch in Madison, Wisconsin. That's when she saw the news pop up on her phone about a leaked Supreme Court draft opinion overturning Roe v. Wade.

Petranek, 31, and her husband Daniel have two children – a 7-year-old son and 4-year-old daughter. Her pregnancies had been hard on her body, she says, and risky, because she is diabetic. But she and her husband still planned to have more kids – they wanted three. "I have three brothers and he has one brother – we kind of liked [a number] in the middle of that," she says.

After 10 long months of trying, Petranek got pregnant in March 2022. The whole family was thrilled. But at her first prenatal appointment, her doctor couldn't find a heartbeat. It was an early miscarriage.

Devastated, she went home to wait for the miscarriage to resolve. It was the second time she'd miscarried and she was anxious about possible complications. The days passed miserably, she says, as she suffered through nausea, extreme fatigue, abdominal pain and backaches. After a few days, she started to run a fever.

Resting under a heating pad, she tried to distract herself from the miscarriage by scrolling through Twitter, and that's when she saw the leaked Supreme Court opinion indicating that Roe v. Wade could imminently be overturned.

She knew what that would mean in Wisconsin – an old law on the books could snap back into place, making abortions illegal. Petranek had no plans to end a pregnancy – she was focused on growing her family. But she realized right away that if abortion became illegal, that could affect how doctors cared for her if anything went wrong.

Pregnant patients with diabetes, like Petranek, have elevated risks of birth defects, preterm birth, preeclampsia and more. "Even though my diabetes is well managed, it's always a risk," she says. And in places that ban abortion, care for complications can be more difficult to access if doctors and nurses are nervous about being accused of violating the law.

Petranek says she had been paying attention to how this was playing out in Texas, which had banned abortion after about six-weeks, back in 2021. That ban was already having repercussions on pregnancy care.

NPR reported on two cases in which women were refused treatment when their waters broke too early – one had to fly out of state for care, the other had to wait until she was showing more signs of infection. And a survey of health care providers by the Texas Policy Evaluation Project found that one hospital was no longer treating some ectopic pregnancies, even though they are never viable and can be life-threatening if left untreated.

On the couch on May 2, as she read the news about Roe v. Wade, and anticipated what it would mean for reproductive health care in Wisconsin, Petranek made a decision about the size of her family.

"That was the moment I knew I couldn't try again," she says. "It wasn't even a conscious decision, it was just like – I will not put myself through that again if I don't have the confidence that I will be able to come out the other side."

During her first miscarriage years ago, Petranek ended up in the E.R. Doctors gave her a dilation and curettage, or D&C, procedure to stop the bleeding – the same procedure that's used for many abortions.

This time, she'd hoped the miscarriage would resolve on its own. But a few days after that moment on the couch in May, still running a fever, she worried she could have an infection. She called her doctor and scheduled another D&C.

"That's what saved me," she says. "That's why I'm healthy. That's why I'm here."

If she got pregnant again, she says, and had another miscarriage or any serious pregnancy complication, she thinks there's a real risk her providers would be afraid to give her a D&C in case they'd be charged with violating the abortion ban.

She says the fact that her pregnancies have been physically and emotionally draining weighs into her calculus as well: "It's kind of like – I will fall apart."

So for her, the dream of a third child is gone. "It's very surprising and sad to suddenly not be able to plan the family we all wanted," she says.

The situation: A 31-year-old mother of two, Kristen Petranek decided to stop trying to have a third child because of the risks she could face during a pregnancy in Wisconsin, where abortion is banned.

The state law: Wisconsin's abortion ban was written in 1849, just one year after Wisconsin became a state. The law classifies abortion as a felony, punishable by up to 6 years in prison and a maximum fine of $10,000. The only exception is "to save the life of the mother" – there is no exception for rape or incest or to preserve a patient's health.

The law is currently being challenged in courts, with Wisconsin's Democratic attorney general Josh Kaul arguing in a lawsuit that the law shouldn't be enforced because it's superseded by more recently passed laws. But given the uncertainty and certain local prosecutors' promises to enforce the ban, doctors in the state have stopped providing abortions.

"Abortion care is incredibly difficult to get in Wisconsin – you have to leave the state," explains Elizabeth Nash, a state policy analyst at the Guttmacher Institute, a reproductive health research group that supports abortion rights.

Democratic Governor Tony Evers supports the lawsuit against the 1849 ban. But the Republican-controlled legislature has made it clear it wants it to remain in place, and rejected the governor's call to overturn it in a special session in June. Assembly Speaker Robin Vos and Senate Leaders Devin LeMahieu and Chris Kapenga – all Republicans – declined NPR's requests for an interview for this story.

Three Wisconsin doctors have joined the lawsuit challenging the law. In affidavits shared with NPR, they say the law and their fear of prosecution has already impacted their medical decision making and their "ability to provide necessary and appropriate care in Wisconsin."

What's at stake: Decisions about how many children to have, when to start trying, how close in age children should be spaced – are usually not made by individuals alone, explains Dr. Abigail Cutler, an obstetrician-gynecologist and professor at the University of Wisconsin's medical school.

Those decisions are often made with other people, "partners within the context of families, romantic relationships, extended family or chosen family, friends, faith leaders," she says. Now, after the overturning of Roe v. Wade, she says a new element must be added to that calculus: the state laws where people live, and whether they have access to comprehensive care during pregnancy.

How that calculus plays out may come down to personal risk tolerance. Cutler notes pregnancies often don't go as planned – at least one in five women have miscarriages and one in four women have abortions in their lifetimes. There are other serious risks in pregnancy too, such as hypertension, ectopic pregnancy, and depression. And the U.S. maternal mortality rate is much higher than other industrialized countries around the world.

How people process these risks, varies, Cutler explains. "A single mom [with] four kids at home – their tolerance for incurring even the smallest amount of risk that could be associated with even just a healthy pregnancy is going to be potentially lower than someone who really desperately wants to become pregnant and is really willing to do whatever it takes in order to have a child."

Meanwhile, researchers are trying to measure the many different effects of abortion restrictions – such as how many additional babies will be born, how many people will cross state lines for care, and more.

The impact of an abortion ban on someone's private plans about their family size is much quieter, and is also harder to measure, notes Cutler's colleague Jenny Higgins, a professor of Gender and Women's Studies at UW-Madison and the director of the Collaborative for Reproductive Equity.

Pregnancy intentions are nuanced, she says. "There are people who are really desperate to get pregnant, there are people who are really desperate to not be pregnant, and most people are somewhere in between," she explains, and it's a challenge to capture that nuance in data.

"I think on balance, there'll be more people who want abortions who can't get them than people who want babies and choose not to have them because of these policies," she says. "But there'll still be a group of people – like [Petranek] – who are opting out of having another baby, and that has a major impact on their own hopes and dreams about family-making."

Anti-abortion groups dispute that state abortion bans like Wisconsin's can impinge on pregnancy care. Gracie Skogman, legislative director for Wisconsin Right to Life, says "it's heartbreaking to hear of any woman who feels that she would not be able to have care for miscarriage."

She says those fears are based on what she calls "misinformation" that miscarriage treatment could be affected by Wisconsin's law. "When we're talking about an ectopic pregnancy, a miscarriage – these are in no way, shape or form an abortion," she says.

Cutler says that the concern Petranek feels about potentially not being able to get timely or appropriate care during a pregnancy complication could be very real.

Since Roe v. Wade was overturned, news reports and affidavits have shown how this is happening around the country, including NPR's story about a woman who was sent home from an Ohio ER hemorrhaging from a miscarriage.

In Missouri, hospital doctors treating a woman whose water broke at 18 weeks wrote in her chart that "current Missouri law supersedes our medical judgment" and so she could not receive an abortion procedure even though she was at risk of infection, according to a report in the Springfield News-Leader. That hospital is now under investigation for violating a federal law that requires doctors to treat and stabilize patients during a medical emergency.

In Wisconsin, Cutler says she's seeing similar problems unfold. "There are delays in care because physicians are hesitating, thinking twice, calling legal counsel, conferring to make sure – where the direction from a medical perspective seems very clear, but is it legal?"

The policy debate: It may take some time before there is clarity on the status of Wisconsin's 1849 abortion ban. Attorney General Josh Kaul recently told Wisconsin Public Radio that it would likely be months before there's a decision from the county circuit court. Eventually, the case is expected to go to the state Supreme Court.

As the case works its way through the courts, there's also the possibility that the state legislature will move to change the law. "We have a large majority in both state houses that are pro-life, that are in favor of the current law," says Skogman of Wisconsin Right to Life. "We realize that our law may need to have further discussions on strengthening the medical emergency language so that it's very clear to women and medical providers that those cases are not in violation of the law."

Assembly Speaker Robin Vos has also said he favors adding an exception for rape and incest, something Skogman's organization does not support.

Cutler calls it "outrageous" that medical care for pregnant patients in the state is governed by a law from the 19th century.

"[It] was written solely by men, at a time when neither antibiotics nor ultrasound existed, basic infection control was not practiced, C-sections – and all surgeries for that matter – were performed without anesthesia, and problems of pregnancy and labor were poorly understood," she says. "Not to mention that in the 1850s women were literally second class citizens with few to no rights."

For doctors and patients in Wisconsin trying to live with an abortion ban in legal limbo, "the level of confusion and uncertainty and – [even] chaos – that this has injected into the provision of all sorts of pregnancy-related health care, not just induced abortion, cannot be overstated," Cutler says.

The patient's perspective: Kristen Petranek and her husband have started regularly using birth control – condoms for now, but she's looking into longer-term options like a vasectomy for her husband or an IUD for herself.

Petranek is resolute about the decision, but also sad, and reminders of what she's lost are everywhere. If she hadn't miscarried, she would have had a baby over Thanksgiving this year. "It was good that I had the distraction of the holiday but I kept thinking, 'I would have been holding a newborn right now,'" she says.

She says she thinks about it every day – the loss of the pregnancy this spring, and the loss of the chance to add to her family in the future. "We wanted a baby – we wanted to have a third child," she says, through tears.

And she says, she finds herself looking at her 4-year-old daughter in a new way. "I have to reconcile with the fact that she's truly, always going to be my youngest child now, when I always pictured her as a big sister someday."

Kristen Petranek wonders if people who favor abortion restrictions understand the real impact they can have on people facing situations like hers. She explains that she was raised an evangelical Christian – she now goes to a Presbyterian church every Sunday.

"There's a huge cultural problem with people who would call themselves pro-life, not wanting to accept that these are the consequences," she says. "Women that they know, women who want to be mothers, women who go to church every week – are going to be the ones that are also suffering."

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