Effie Goodson, 37, entered the Hughes County courtroom slumped on the arms of deputies, her long hair hanging over her face.
As the judge read the charges, she leaned forward, spitting into a wastebasket at her feet.
Asked by Associate District Judge Gregg Smith if she was sick, Goodson said, "Yes, sir." She said she was going through withdrawal because she hasn't had her medication.
Assistant District Attorney Linda Evans said she did not know what medication Goodson was referring to.
Goodson, who is facing a charge of kidnapping and two counts of first-degree murder, declined to make a statement as she was led from the courtroom. Her next appearance is scheduled for Jan. 27.
She is accused of killing Carolyn Simpson, 21, with a .22-caliber firearm and Simpson's fetus by removing it from the womb with a sharp object.
Authorities believe Simpson, who was 25 weeks pregnant, willingly left her workplace Dec. 22 at the Okemah Bingo and Casino with Goodson, whom she had befriended.
Goodson had convinced people — including her husband — that she was pregnant and was even thrown a baby shower, authorities said.
A hunter found Simpson's body in a field near Lamar, about 100 miles from Oklahoma City, on Friday. She had been shot in the head, authorities said.
On Dec. 23, Goodson brought a dead male fetus to a Holdenville hospital. Goodson claimed to be the mother, but investigators determined she could not have given birth, and she was taken into custody, authorities said.
Oklahoma courts have ruled that murder charges can be filed in the killing of a fetus if the fetus was viable — that is, if it could survive outside the womb. Under the state's abortion law, a fetus is presumed viable after the 24th week.