KANSAS CITY, Mo. — On Saturday morning, a Missouri woman in her first trimester entered Exam Room 6 inside Planned Parenthood’s Kansas City clinic. When she left, she was no longer pregnant.

After millions of votes and hours of courtroom arguments, this is how legal abortion resumed in Missouri.

Sometime after 10 a.m., Comprehensive Health of Planned Parenthood Great Plains performed the first elective abortion in the state since voters overturned the state’s ban in November. The moment also marked the first abortion at its Kansas City clinic since 2018.

Except for a few extra cars in the parking lot at the Patty Brous Health Center along Emanuel Cleaver II Boulevard, no one passing by would have any inkling of the historic moment unfolding inside. No protesters stood outside in the cold, gray morning.

The abortion capped a whirlwind 18 hours for Planned Parenthood’s staff. After Jackson County Circuit Court Judge Jerri Zhang issued an order at roughly 4 p.m. Friday blocking regulations that require abortion clinics to hold state-issued licenses, the organization’s medical and administrative staff rushed into action.

Employees reached out to future patients to see who would be interested in receiving care closer to home. They found one and also located a doctor available on Saturday – Selina Sandoval, associate medical director at Planned Parenthood Great Plains.

“I think today is incredibly meaningful,” Sandoval, dressed in scrubs, said shortly after performing the abortion. “We know that the voices of Missouri constituents have finally been heard. We were able to finally put into action what the voters asked for back in November.”

In a 51.6% to 48.4% vote on Nov. 5, Missouri residents struck down the state’s abortion ban by approving Amendment 3, which enshrined a right to reproductive freedom in the state’s constitution. The ban had been in place since June 24, 2022, the day the U.S. Supreme Court overturned the federal right to abortion.

But abortion access wasn’t immediately restored. Abortion providers needed to sort out what state-level restrictions remained constitutional and which ones could no longer be enforced.

Planned Parenthood filed a lawsuit in Jackson County Circuit Court. Zhang in December overturned a number of restrictions, including a law that required patients to wait 72 hours. But she kept in place the state’s abortion licensing rules, which would have required providers to conduct pelvic exams on patients. The organization’s lawyers asked Zhang to reconsider, leading to Friday’s three-page decision.

Emily Wales, Planned Parenthood Great Plains president and CEO, was at her child’s Valentine’s Day party when she got a text message about the decision. As Wales read the ruling on her phone, the scale of Planned Parenthood’s victory was quickly apparent – Zhang had blocked everything its lawyers requested.

“Within minutes, we were calling each other and speaking to our senior clinical leaders about what this would mean, how quickly we could relaunch care,” Wales said.

Staff members examined wait lists, with much of the consideration given to how many patients who needed time-sensitive care could be seen if they could begin offering abortion services quickly. Sandoval and other staff members, including many not scheduled to work, agreed to come in.

“They really wanted to make sure care happened,” Wales said.

The Kansas City Star was the only news organization inside the clinic as Planned Parenthood began once again offering abortion services. A reporter and photographer interviewed staff and saw the exam room where the abortion was performed prior to the procedure.

The journalists weren’t provided access to the patient and Planned Parenthood didn’t identify her beyond saying she was a Missouri resident in her first trimester of pregnancy.

Sandoval provided a procedural abortion, technically known as a dilation and curettage, which removes tissue from the uterus. The procedure is also commonly used in miscarriage care – a fact that became a great point of focus during court arguments.

Amendment 3 prohibits discrimination against providers of reproductive health care. Zhang noted in her decision that miscarriage care and abortion procedures often mirror each other, but that miscarriage care can be offered without a special facility license.

Planned Parenthood Great Plains plans to quickly ramp up the availability of abortion services, in Kansas City and elsewhere. While the first abortion was procedural, the organization will also offer medication abortions, a common method of ending a pregnancy.

Wales indicated the patient on Saturday morning was the first statewide to receive an abortion from Planned Parenthood since Zhang’s decision – and, indeed, since the U.S. Supreme Court decision 968 days ago. It was also the first procedural abortion offered by Planned Parenthood in Kansas City in at least 15 years. Even before the U.S. Supreme Court case, access to procedural abortion in Missouri had been whittled down to a single clinic in St. Louis.

In the minutes before the procedure, Sandoval led the Star into Exam Room 6. A patient bed rested against a gray wall and a supply cart had been rolled into a corner. An ultrasound machine sat off to the side of the bed.

“This is a first trimester procedure, so I don’t typically need the ultrasound, but it’s here in case I need it,” Sandoval said. “It takes forever to turn on, so that’s what I’m doing now.”

If the room appeared at first glance like it could be any doctor’s office, Planned Parenthood staff say that’s the point. Abortion care is routine care, they say.

After the procedure, Sandoval said everything had gone “perfectly.”

“The rules and regulations and limitations placed on abortion care are discriminatory,” Sandoval said. “They’re meant to cause shame and prevent care.”

Of course, many view abortion as the taking of a life – anything but routine.

Missouri Attorney General Andrew Bailey, a staunchly anti-abortion Republican, is defending the state’s restrictions in court. His office is certain to appeal Zhang’s decision. Everyone agrees the Missouri Supreme Court will ultimately decide what rules are – and aren’t – constitutional.

As of Saturday afternoon, Bailey hadn’t commented on the decision.

Missouri Stands with Women, a group that opposes abortion and campaigned against Amendment 3, lamented Zhang’s decision, saying that while Valentine’s Day is supposed to reflect happiness and love, the ruling was “sad and heartbreaking.”

“We will not stop fighting to protect both women and unborn children from reckless, profit-driven practices. No woman should suffer, and no innocent life should be taken, in the name of an industry that refuses to be held accountable,” Stephanie Bell, a spokeswoman for Missouri Stands with Women, said in a statement.

Even as Planned Parenthood moved swiftly to resume abortions, the ongoing legal battle will continue to cast some degree of uncertainty over future access.

“We are pretty skilled, unfortunately, with having those conversations, at saying ‘we have availability, we can serve you really close to where you live but there’s a chance for interruption, so let’s have a back-up plan just in case,’” Wales said.

It’s possible a higher court will allow Missouri to reimpose some rules or regulations that would lead the organization to suspend offering abortion services. Planned Parenthood’s lawyers have strenuously objected to any mandatory pelvic exam requirement, for instance.

Whatever happens in the future, employees on Saturday were well aware of the significance of the moment.

As employees prepared for the day they held a morning huddle, Wales said, asking how everyone was feeling and making sure everyone was prepared. It’s the clinic’s normal process.

“But today there was a particular, I think, light in the room because people all recognize it’s a historic moment,” Wales said. “Even for our team members who have loved ones who have needed abortion services, who themselves have needed abortion services – having to travel out of state has been a reality for a long time.

So it meant a lot to a team of health care professionals to say we’re going to see these patients here at home.”

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