WICHITA, Kan. — The moment is burned forever in her mind: The small exam room, her husband's ashen face, her sobs as the doctor guided a needle into her womb to kill her son.

It's been 4 1/2 years, and still Marie Becker can feel Daniel kicking inside her, kicking and kicking as she choked back hysteria — kicking until the drug stopped his heart and she felt only stillness.

 

She prayed Daniel would forgive her.

She prayed for forgiveness from God as well. Becker had been taught that abortion was a sin; she wanted so to believe it might also be a blessing. In her seventh month of pregnancy she had learned Daniel had a fatal genetic disorder and his life would be brief and brutal. She wanted to spare him that.

"For the love of God, the last thing I wanted to do was to murder my own child," she said recently. "This was something we did out of love and respect for him."

Becker, who asked to be identified by her middle and maiden names, tells Daniel's story to other pregnant women who find out when they are many months along that their babies are terminally ill or severely disabled. Through an online support group, she listens as they work through their options; if they choose abortion, she tells them what to expect.

These days she also prays for one of the few doctors in the nation who will take them as patients: Dr. George R. Tiller, who performed her abortion. Specializing in late second- and third-trimester abortions, his clinic here draws women from across the country and around the world.

Tiller's clinic aborted 295 viable fetuses last year and 318 the year before; his website says that he has performed more late-term abortions than anyone else practicing in the Western Hemisphere.

But the clinic is now under criminal investigation for some of those procedures.

Like most states, Kansas does not permit abortions of viable fetuses unless carrying the pregnancy to term would substantially and irreversibly damage the mother's health. Kansas Atty. Gen. Phill Kline is investigating whether Tiller's patients were truly in that much danger. Tiller's lawyers respond that he has "always consistently, carefully and appropriately followed the law in all respects."

Kline, who opposes all abortions, maintains that the mental health concerns some women cite as their main reason for terminating — including depression or anxiety about raising a disabled child — do not justify late-term abortions under Kansas law. He has demanded access to the medical records of dozens of patients. The clinic has appealed to the state Supreme Court; a decision is expected within weeks.

Tiller's patients await the ruling with mounting anger. They say no outsider could ever understand the complex tangle of emotions that brought them to Women's Health Care Services — the psychological and physical strains that made continuing their pregnancies unbearable.

"I don't know what I would have done had [Dr. Tiller] not been available to me," said Katie Plazio, a financial analyst from New Jersey. "That's selfish, I know. I feel selfish. But … doesn't everyone want the best for themselves and their family?"

Like Becker and most women who spoke for this story, Plazio asked to use her middle and maiden names to protect her privacy. Many of Tiller's patients have not told their co-workers, friends or even close relatives that they had terminated pregnancies. Their abortions were verified by a review of clinic records they supplied.

For Plazio, the heartache began with the unexpected. After a decade of infertility, she was stunned to feel a kick to her ribs as she sat through a meeting in February 2001. She had been dieting for weeks, running five miles a day — and wondering why she still couldn't squeeze into her pants. She was six months pregnant.

Overjoyed, Plazio and her husband scheduled an amniocentesis. The preliminary results were clean; bursting with excitement, Plazio, then 43, bought a baby blanket dotted with pale blue bunnies. Ten days later, her doctor called with devastating news: More complete genetic tests had determined that their son had Down syndrome.

Plazio had studied special education in college; working with adults with Down syndrome, she had seen their lives as lonely, frustrating, full of hurt. She was not sure she could find joy in raising her son to such a future. She didn't think she could cope with what she expected would be a lifetime of sadness and struggle.

Giving her son up for adoption seemed even worse — to wake each morning not knowing where he was, imagining him scared and alone. "I could not live with that fear all my life," Plazio said.

"I don't want anyone to think that I did this all for Matthew," she said. "I was not just sparing him problems. I was sparing my daughter, my husband, me and all those who depend on me…. I knew the limits of my family and my marriage. Maybe there are families who can handle it all. Maybe they are better people. But I knew I could not do it."

In March 2001, a week into her third trimester, she and her husband flew to Tiller's clinic. They took the bunny blanket and a teddy bear with a big red heart on its chest — a gift to the baby from their daughter, then 11.

Since her abortion, Plazio has suffered such severe panic attacks that she can't drive even as far as the high school to watch her daughter cheerlead. She has gained 60 pounds as she battles depression. The abortion she sought to preserve her mental health has left her deeply shaken; doctors say she suffers from post-traumatic stress syndrome.

Her mental health, she is convinced, would be even worse had she tried to raise a profoundly disabled son — or had she given him up for adoption.

The abortion "released my poor sick baby back to the angels," she said. "The only thing I wish I had done differently was realize I was pregnant months earlier."

Third-trimester terminations like Plazio's are unusual.

About 95% of U.S. abortions are performed within the first 15 weeks of pregnancy, according to the Alan Guttmacher Institute, a nonprofit center for reproductive rights and health research.

About 20,000 women a year seek abortions after the 21st week, which marks roughly the midway point in a pregnancy. Perhaps 1,000 terminate after 24 weeks, when the fetus is generally considered viable. The practice, though rare, makes many Americans uneasy. While 60% say abortion should be legal in the first trimester of pregnancy, 12% say it should be legal in the third trimester, according to a Harris poll conducted in February.

Three clinics in the nation perform abortions in the third trimester. One is in Los Angeles, one in Boulder, Colo. The best-known — recommended by many genetic counselors — is Tiller's bunker-like clinic on a freeway frontage road in Wichita, next to a car dealership. Outside, protesters have erected dozens of white crosses; they maintain a prayer vigil by the gate and try to pull women aside for counseling — especially on Tuesday mornings, when Tiller sees patients seeking late-term abortions.

The women who push past the protesters Tuesdays include young victims of rape or incest who did not realize they were pregnant until just weeks from their due dates. Most are married women with much-wanted pregnancies who got a late diagnosis of fetal anomaly: a malformed heart, a missing brain, an open spinal column, an extra chromosome.

Some of the deformities are lethal. Others are not. A few fall in a gray area: The physical problems might be reparable through surgery, but the operations are risky and grueling.

One patient who had an abortion at 25 weeks in November said she could not bear to imagine surgeons cutting open her daughter's tiny chest to rebuild her heart. The thought of her Emma spending months of her childhood in the hospital overwhelmed the woman, a 30-year-old technology educator from Virginia who asked to be identified by her middle name, Paige.

"Part of me just wanted to let her die," Paige said. "Is that horrible?"

Marie Becker had the same impulse — and the same question — about her son.

At a four-month ultrasound, the doctor noticed that Daniel's limbs seemed short. She told Becker not to worry, but suggested another ultrasound in a few weeks. At that appointment, Daniel again measured short. Becker was told to come back in another month.

Becker, an accounting clerk, and her husband, a teacher, tried not to dwell on their fears for their first child. They delighted in the ultrasound pictures: Blurry black-and-white images of an arm, a leg, a face. In one, Daniel appeared to be waving; the technician typed a caption: "Hi, mom!"

Becker was 27 weeks pregnant when she went in for her next appointment. By then, it was clear that something was wrong.

A few days later, her doctor confirmed that Daniel had a rare and lethal skeletal disease. His organs were growing normally, but his bones were not; his tiny rib cage was slowly crushing his expanding heart and lungs. "His prognosis was death," Becker said. "Not at 8 years old. Not at 10 years old. Within a few months at most."

In her Florida home, with her husband at her side, Becker wept and prayed for days. Conflicting emotions overwhelmed her. She was scared to carry Daniel to term — scared of how she would react to his deformities. She was afraid to abort, sure she would burn in hell. Her son disgusted her; she wanted him out of her body. She loved him. She wanted to protect him.

Becker, who was then 30, blamed herself for making Daniel sick: Hadn't she taken migraine pills before she knew she was pregnant? Hadn't she sipped a few glasses of wine? Was it that ride at SeaWorld, the one that whirled her around? Had that caused his genes to mutate?

"I was so afraid," she said. "It was bad enough that I had inflicted this on him. I didn't want him to suffer any more."

The week before Christmas, at the start of her third trimester, Becker and her husband flew to Kansas.

Every detail of the trip remains vivid. She remembers staring, transfixed, at the freshly cleaned carpet in the Wichita airport. She remembers driving to the hotel through ice and snow — and turning away from a billboard plastered with gruesome photos of aborted fetuses. On the morning of the appointment, she threw up in the hotel shower, then insisted she needed time to style her hair; her looks seemed the one thing she could control, and she took long minutes applying her lipstick.

When she and her husband turned into the clinic parking lot, a handful of elderly protesters swarmed them, yelling, "Don't go in!" and "You don't have to do this!"

The activists were peaceful that day, but there had been scattered violence: The clinic was bombed in 1986 and blockaded for six weeks in the summer of 1991. In 1993, an antiabortion activist shot Tiller through both arms. He now works in a bulletproof vest.

Armed guards pat down patients and walk them through a metal detector at the clinic door. After paying for their abortions — which can cost more than $5,000, depending on the stage of pregnancy — patients wait in a room decorated floor to ceiling with framed letters from grateful women.

"We couldn't stop reading them," Becker said. "When you see how many people wrote letters, when you see how much they love this man, it almost feels like you're being hugged."

Becker still believes that abortion is wrong in most cases. Sitting in her Florida bungalow, her two young daughters playing beside her, she recalled a movie she once saw in Catholic school, of a baby being ripped limb from limb. The image haunts her.

She finds it reprehensible that Tiller aborts healthy fetuses in the first and second trimester (and even, sometimes, in the third trimester when the mother is very young, or a victim of rape). But she cannot censure him too harshly.

For children like Daniel, "the man is a savior," she said. "He's there for women who have nowhere else to go."

With most advanced pregnancies, Tiller performs abortions by injecting the fetus with digoxin to stop its heart. He then gradually dilates the woman's cervix to induce labor. After two or three days of contractions, the women — heavily dosed with pain medication — deliver their babies intact.

Some refuse to look. But many hug their dead children. "It was very important to us to be able to hold her, to give her that kind of respect," said Paige, who aborted her daughter at the end of the second trimester. "This was not just a fetus to me. She was my child."

After Susan Crocker's second-trimester abortion in August, she and her fiance spent three hours cradling their daughter, Isabella, who had Down syndrome. They stroked her scrunched red face and kissed her rounded cheeks. They took pictures of her tiny, almost translucent hands, folded across a green-and-pink striped blanket.

Crocker, a 34-year-old customer service manager, keeps Isabella's ashes in a marble urn decorated with dolphins; she kisses it before she goes to bed each night. Her sons follow her lead. On Halloween, they each gave a Tootsie Roll to Isabella. Jordan, 5, shares his toys with her, propping a little plastic skateboard against the urn. Sick, sick , sick !!!

When a doctor once referred to Crocker as a mother of two, Jamie, the 9-year-old, interrupted indignantly: "No, she has three kids."

"Her daughter's in her heart," said Jordan.

Despite her family's support, Crocker, who lives in Texas, has struggled with doubt and depression. "I did the unthinkable," she said. "I ended my baby's life. Sometimes I think, oh God, what if I was wrong?"

Then she thinks about the room where Tiller stopped Isabella's heart. There was a poster on the ceiling of a leaping dolphin. Underneath, it said: "Set them free."

She believes Isabella is free.

"I ended her suffering," she said. "I owe Dr. Tiller greatly. I can never, ever thank him enough."

Crocker sometimes wishes she could talk to the protesters who shouted as she entered the clinic: "Think about your baby!" She would tell them she was thinking of Isabella then, and thinks of her still, every day, with love. She would ask them not to judge.

"You don't know," she'd tell them. "You have no idea. Until it happens to you, you don't know."