In a rural Iowa community, a young woman sits in an examination room, lips pressed together. She’s just received a urine pregnancy test and a vaginal ultrasound. Now her doctor asks: How confident do you feel about your decision today? Very, she answers. Any questions? No, she answers.

With a “pop,” a drawer next to the woman unlocks. It slides open to reveal two bottles of pills: mifepristone and misoprostol. The prescription is simple. Take the first drug to kill the baby, the second to expel it.

The drugs, sometimes collectively called RU-486 after the first pill in the series, are a familiar combination in abortion centers throughout the United States. Iowa abortionists are leveraging technology to make the pills even more accessible to women in rural areas. In the above scenario, the “doctor” and “patient” weren’t in the same room, or even the same town: The doctor was 200 miles away in Des Moines, talking to the patient through a webcam and unlocking the drawer from his computer.

Hundreds of U.S. hospitals and clinics are experimenting with “telemedicine,” where doctors often prescribe medication or conduct exams by internet video conference. The island hospital on Nantucket, Mass., for example, saves $29,000 a year outsourcing dermatology exams with cameras and video monitors.

Iowa law allows only a physician to prescribe abortion drugs. By using telemedicine, Des Moines-based Planned Parenthood of the Heartland saves thousands of dollars in travel expenses it would otherwise spend sending a doctor to each of its 16 Iowa locations currently providing abortions. Besides being deadly for first-trimester babies, Iowa’s telemed abortions are dangerous for women: RU-486 is prone to unforeseen complications, and Planned Parenthood typically has no doctors or emergency workers at its rural centers. The company also prescribes RU-486 “off label,” flouting Food and Drug Administration recommendations. In view of these dangers, pro-life lawmakers in Iowa and other states are working to ban webcam abortions before they spread across the nation.

No person in the pro-life movement knows more about webcam abortions than Sue Thayer, the former manager of a Planned Parenthood center in Storm Lake, Iowa. Along with other center managers in mid-2007, Thayer attended the original staff meeting where Planned Parenthood of the Heartland CEO Jill June announced her plan of prescribing medical abortions by webcam (June had gotten the idea after seeing a telemedicine procedure on a TV drama).

“We were sworn to secrecy,” says Thayer. Planned Parenthood executives told the gathered managers they wanted to do 500 to 1,000 telemed abortions before anybody knew about the procedure—a way of establishing a standardized practice before anyone raised legal or medical quibbles. “We weren’t even supposed to tell our own staff members at our own clinic, until it was time for our clinic to start doing them.”

The Storm Lake Planned Parenthood had never provided abortions. Thayer personally believed they were wrong. From the time she began managing the center in 1991, she felt her mission was to reduce the need for abortions by providing family planning resources. Now, rural centers like hers are supposed to provide medical abortions by webcam, without a doctor on hand, and Thayer—who is not a nurse—had to perform vaginal ultrasounds.

She balked. Since women who use RU-486 sometimes end up in local emergency rooms to treat excessive bleeding, Thayer asked Planned Parenthood administrators whether they would notify local doctors about the telemed initiative: “They said, ‘No, absolutely not.’”

For Thayer, the meeting played a key role in opening her eyes to her employer’s true goals. As Planned Parenthood began rolling out the webcam procedure to its Iowa centers in the ensuing months, Thayer, in the midst of a spiritual awakening, wondered what she would do when they came to Storm Lake.

Her superiors offered a simple answer: They fired Thayer in December 2008, claiming they were downsizing. They offered her several months’ salary if she would sign a statement agreeing not to talk publicly about Planned Parenthood’s practices.

Thayer didn’t sign. Although it was two years before she gained the courage to speak out about Iowa’s webcam abortions, her warnings have ultimately encouraged both state and federal lawmakers to push preemptive bans on webcam abortions.

“The Lord is working through Sue Thayer,” says U.S. Rep. Steve King, whose Iowa district includes Storm Lake. “I’m awfully glad to know she’s my neighbor.” King has introduced legislation that would outlaw federal funding for webcam abortions, and told me he’d like to ban the procedure outright, assuming he can get the needed support in the House and Senate. 

Laws effectively prohibiting telemed abortions are in place in Arizona, Nebraska, Oklahoma, Tennessee, and Michigan. Others are enduring court challenges in Wisconsin, Kansas, North Dakota, South Dakota, and Ohio.

Although Iowa legislators have failed to pass a ban, Iowa Right to Life executive director Jenifer Bowen said her organization would make it a top priority in 2013. Iowa Gov. Terry Branstad is “sitting with pen in hand waiting to support us,” she said.

By 2010 Planned Parenthood said it had performed at least 2,000 webcam abortions in Iowa. According to a study published in the January 2013 issue of the American Journal of Public Health, rural women in Iowa became more likely to obtain abortions after the telemed scheme was launched.

Outside of Iowa, it appears the only other place where Planned Parenthood has introduced webcam abortions is in Rochester, Minn. Bill Poehler, communications director for Minnesota Citizens Concerned for Life, said he expects the abortion provider to try expanding the telemed procedure across the state.

“Planned Parenthood had intended to spread this plan for telemed abortions to its affiliates throughout the nation,” said Mailee Smith, a staff attorney at Americans United for Life.

AUL is hoping to head off any such plan: It has written six pages of model legislation outlawing telemed abortions, named the “Abortion-Inducing Drugs Safety Act.” Three of the states already banning the procedure adopted all or portions of AUL’s model, and Smith said other states are considering doing so in 2013, though she couldn’t comment on which ones.

The model addresses a major concern Smith and others have: Planned Parenthood’s doctors, in prescribing the RU-486 regimen, don’t even comply with FDA approved guidelines for administering the first drug, mifepristone (brand name Mifeprex). Although the Mifeprex label requires the woman to be no more than 49 days pregnant, and to return to the doctor’s office for the second drug dose (misoprostol) two days later, Planned Parenthood prescribes the tablets to women up to 63 days pregnant, and sends them home to take the second dose, which initiates contractions.

“Women would take these pills without fully understanding that they would probably be seeing a little, tiny baby at home, alone, in their bathroom,” says Thayer. “I remember at least a couple of other managers in the Planned Parenthood affiliate that I worked at, [who] said they would have women come back in with this little baby in a Ziploc bag.”

Legally, doctors can prescribe drugs off label, but in the case of Mifeprex, ignoring FDA warnings could increase the chance of a dangerous complication. The FDA hasn’t studied the safety of the drugs in girls under the age of 18, yet Planned Parenthood routinely offers it to them. In one study of women who used the abortion pill, 1 out of every 13 required follow-up surgery to treat prolonged bleeding or to abort their baby surgically after RU-486 failed to do so. When the abortion pill fails to kill the baby, there is a risk of fetal defects because of the drug’s effect.

The FDA warns that all women who use RU-486 experience bleeding for nine to 16 days afterward, and women with heavy bleeding will need emergency medical care. When Planned Parenthood performs medical abortions in Iowa over webcam, however, there’s no physician with the woman to give advice in such a situation. From the time the RU-486 regimen was approved in September 2000 to April 2011, at least 612 women had to be hospitalized after taking the drugs, with most of them requiring blood transfusions. Eight RU-486 users died after developing sepsis, blood poisoning caused by an infection of microorganisms.

Iowa Planned Parenthood executives like to say telemedicine allows them to offer their so-called healthcare services to more women, said Smith of AUL: “In reality what telemed abortion is doing is allowing them to increase their profit. It is not safe for women.”

Thayer, who today works as a post-adoption support specialist with Lutheran Services in Iowa, isn’t against telemedicine in general. As a longtime foster parent (she’s taken in at least 130 children and adopted three) Thayer has driven teens to a clinic to have webcam interviews with a pediatric psychiatrist, who prescribed medication after asking questions about feelings and symptoms. That’s much different than prescribing abortion via webcam, she says.

After alerting a few people in Storm Lake to the telemed abortions that were happening at the Planned Parenthood center there, Thayer decided to lead a 40 Days for Life campaign in the fall of 2011. With a little over 10,000 residents, Storm Lake isn’t a huge community, but enough people joined in the effort—both Catholics and Protestants—that they were able to conduct a prayer vigil for 480 collective hours.