On August 1, 2014, Loertscher, then 29, soft-spoken and bespectacled, hit a low point. She had been feeling depressed, she says, by “the small bubble of small-town life” and what she describes as the bleakness of the nursing home where she was working. She quit, and without income or health insurance, Loertscher couldn’t afford her hyperthyroid medication so her thyroid spiraled out of control, causing exhaustion and depression. She had self-medicated sporadically with marijuana and amphetamines; saying the drugs helped her get out of bed in the morning. But in July, suspecting she might be pregnant, she said she went cold turkey off everything. Soon, she found her depression spiraling again, and she and Ellner began fighting. Within a few weeks, she was feeling suicidal.

She went to the county’s social services office to ask for help, and received a referral to the Mayo Clinic in nearby Eau Claire. There she gave an accounting of her medical history, including the drug use before she knew she was pregnant. This is what experts in addiction and public health say she should have done, but Loertscher now regrets having played by the rules. “I figured if I was honest with them, maybe there was something to do to prevent harm to the baby,” Loertscher says. “I didn’t think being honest would put me in a horrible place.”

One doctor was reassuring, but another, she says, told her any damage she’d done was done, and irreparable. She waited a full day for the ultrasound results: “I had to beg them to let me know if it was okay.” Eventually, the tests showed that the baby was 14 weeks along and healthy. She burst into tears, she says, from relief.

The baby wasn’t planned. Loertscher didn’t think it was possible for her to get pregnant because of her thyroid problems, but she and Ellner, 43, had always said that if they were able to conceive, they’d be happy. “Tammy is very pure at heart,” Ellner told me. “She’s a girl next door—down to earth, a sweet and loving person.” And that summer he—for the first time in his life, he says—had “this strange feeling like, I’m going to get you pregnant. And two months later, SHAZAM.”

At the Mayo Clinic, Loertscher breathed a sigh of relief. The new thyroid medication had kicked in. She felt ready to go home. And she felt confident that she would be able to continue staying away from drugs during the pregnancy as she had, she says, for the weeks prior. But that feeling was short-lived. Because of her drug use (at the hospital, there was an unconfirmed positive on methamphetamine, plus her own admission to having used it in the past), she was not allowed to leave. According to court records, a representative of the hospital did what is done in much of the country under those circumstances: He or she called social services and reported her. In some states drug use during pregnancy is not only cause for child-welfare involvement, but also potentially for criminal felony prosecution (the laws in Tennessee and Alabama are particularly tough), or, in the case of Wisconsin, for intervention and detention at any point during pregnancy.