ATLANTA — “Lie back and just relax,” Gloria Nesmith says, standing above a patient at the Feminist Women’s Health Center, a local abortion clinic. She pulls the woman’s shirt up to her bra line and squirts a dollop of electric-blue gel into her open palms. “Just a warning,” she says before gliding her hands across the woman’s belly: “The jelly can sometimes be a little cool.”
When patients enter the sonogram room, they’re usually nervous, says Nesmith, who has been performing ultrasounds at the clinic for 26 years. Wearing gray spandex pants and a T-shirt that reads “Feminist Forever,” Nesmith dims the overhead lights and plays soft jazz from her iPod, trying to make her patient as comfortable as possible before telling her what she has come to hear: the number of weeks since conception. The hardest part of her job, Nesmith says, is when she has to tell a patient that she is no longer legally eligible for treatment.
“I have someone’s fate in what I see on the screen."
In Georgia, abortion is currently illegal after 20 weeks of pregnancy. Earlier this month, as part of a growing movement to restrict abortion rights across the country, the state passed a “fetal heartbeat bill,” outlawing abortion after a heartbeat can be detected on a sonogram, approximately six weeks after conception. (The bill will not go into effect until January and is likely to be challenged in court.)
As with many other states passing similar legislation — last week, Alabama passed a law outlawing all abortions, unless the pregnancy poses a serious risk to the woman’s health — Georgia’s latest restrictions are part of a more long-term movement to limit abortion access: In the past seven years, Georgia lawmakers have banned abortion after 22 weeks since conception, then after 20.
Every time the laws change, Nesmith says, her role as an ultrasound technician becomes progressively more difficult. On one hand, she is under increased pressure from the state to accurately determine the gestational age of the fetus. On the other, she is responsible for telling more women that they are too far along.
But while the work has changed since Nesmith started at the Feminist Women’s Health Center (FWHC), she says, the heartbeat bill would leave her with a completely different job. Only a tiny fraction of women who come to the FWHC are less than six weeks pregnant. Most patients are low-income women of color. Even if they know they’re pregnant before the six-week mark, she says, it will often take weeks for them to make the decision, talk things over with the father and raise the money, anywhere from $400 to $1,800. Under the heartbeat bill, Nesmith’s job would consist almost entirely of turning women away.
Nesmith — known around the clinic by her nickname, Glow — started working at the FWHC in 1991, when she was 21. She’d had an abortion during her senior year of high school in a small town in Indiana, at a clinic she remembers as “physically cold” and “lonely.” She felt judged by the receptionist on her way out and was certain that parents and her grandfather — the local Baptist preacher — would be hearing about her visit. She applied to work at the FWHC because she wanted to help give other women a better experience.
Nesmith has always felt personally responsible for the women who come into the clinic, where she works six days a week, seeing up to 20 patients a day. Before clinic administrators issued a formal rule against it, she would sometimes invite out-of-state patients to stay overnight at her house — or, if they were young and traveling alone, offer to stay the night with them in a hotel. Nesmith has given ultrasounds to patients as young as 12. She remembers one, in particular, who sat down in the waiting room with a coloring book.
In her early days at the FWHC, Nesmith had to physically shield abortion patients from protesters. Right around the time of Planned Parenthood v. Casey, the landmark 1992 Supreme Court case that upheld Roe v. Wade, dozens of advocates from Operation Rescue, a major antiabortion organization, would bumrush the front doors, lie down on the floor in the waiting room and form a human chain. Nesmith and the other clinic staff would usher the patients deeper inside the building. “We would bring the women back and lock ourselves in,” she says. They would wait there until the police came.
A few years after Nesmith arrived at the FWHC, the clinic trained a group of staff members on the ultrasound machine. Everyone else did a short stint in the sonography room, then moved on. But Nesmith immediately felt tied to the role. Women, she says, expose everything to an ultrasound technician, allowing that person to literally peer inside their pregnant body. The women can leave the sonogram room feeling shaken and vulnerable or newly empowered, after connecting with someone they feel they can trust.
“I consider it my life’s work,” says Nesmith.
“She is never going to give this up,” says Barbara Graves, Nesmith’s mother-in-law, who works at the FWHC, answering phones. “She’ll work this job till she can’t scan no more.”
When Nesmith first heard that Georgia’s bill was going to pass, she says, she felt physically sick. “It was like grief for me," she says. Nesmith hasn’t told many people that, if the bill goes into effect, she plans to stop administering ultrasounds. That’s not an easy thing for her to say, she tells me. But she doesn’t know how she could continue.
The legal risks are daunting. To determine the gestational age of a fetus, an ultrasound technician will typically measure the size of the fetus — from the crown of the head to the sacrum during the first trimester, across the skull during the second — and ask the patient for the date of her last period. But fetuses don’t all grow at exactly the same rate. All the time, Nesmith says, she sees women who claim they conceived 18 or 19 weeks ago. It is physically impossible, they’ll say, that they are over the 20-week limit. It’s up to Nesmith to analyze all the information she’s given and decide whether an abortion is legal.
Nesmith has one of the most difficult jobs at the clinic, says Kwajelyn Jackson, the executive director of the FWHC. “It’s very hard to know the date of conception, exactly to the day,” Jackson says. “So we just do the best with the science that we have.”
Approximately once a year, government-appointed auditors arrive at the clinic unannounced. They tour the facility, making sure all equipment is clean and up-to-date. Then they close themselves up inside one of the waiting rooms and sift through a year’s worth of patient records, including every sonogram. They stay in there for as long as four days, according to multiple staff members.
This process always makes Nesmith uncomfortable. Even though she knows she has more experience than almost any other ultrasound technician in the state, she wonders whether the investigators might be on the hunt for any little mistake: a patient they deem to have been 21 weeks along, say, that she marked down as 20. (Nesmith technically measures the pregnancy since the woman’s last menstrual period, or “LMP,” the standard medical determination used in the industry. A pregnancy that is 20 weeks along since conception is 21.6 weeks LMP.)
If the heartbeat bill was to go into effect, Nesmith suspects the clinic would be even more closely surveilled. Under the current version of the bill, doctors who perform abortions could be prosecuted. It’s not clear whether that could include the ultrasound technicians who determine the age of the fetus.
“If they’re going to criminalize this in the way that they’re talking about, I don’t know if I want to take that risk,” says Nesmith. “I don’t want to be the one making those calls.”
Even without the legal concerns, Nesmith doesn’t think she could keep doing sonograms. She would essentially become a referral service, she says, sending women to other clinics in other states, knowing that most patients who come to the FWHC don’t have the money to go.
“It would just be too heartbreaking."
In the weeks after the heartbeat bill passed in the Georgia House and Senate, Nesmith began noticing a change in her patients, she says as she looks around her sonogram room. “Because they’re calling it the ‘heartbeat bill,’ the heartbeat has been real present in this space,” Nesmith says. Many more women have been asking her: ‘Does it have a heartbeat? Can you hear anything?’ They want to know whether they would be able to have the procedure if the bill had already taken effect, she says.
Nesmith points to a painting of a field of sunflowers that she’s had hanging on her wall for years. Her co-workers surprised her with it just before her husband went into a major surgery. When a clinic consultant had thrown it away to make the space more “streamlined,” one of her colleagues pulled it out of the trash. Nesmith’s patients often look at the sunflowers — away from the image of the fetus on the sonogram screen — as they wait for her to tell them whether they can have an abortion.
“I cannot imagine what it would be like,” she says, “to be in the business of always saying ‘no.’”
Correction: A previous version of this article incorrectly stated that Georgia changed the number of weeks after which abortion is banned three times in the last seven years. The law changed twice.