In Case of Emergency– When Abortion laws leave no room to save mom’s life
Disclaimer:
Why we’re writing about abortion law
The staff and supporters of Every Mother Counts represent a wide range of opinions on the subject of abortion.
Some support a traditionally “pro-life” philosophy while others are decidedly “pro-choice.” Still others see wide swaths of gray area in a subject too often viewed as black and white.
Regardless of where our individual opinions fall, it’s our mission at EMC to educate and advocate others about the challenges and solutions that contribute to hundreds of thousands of preventable global maternal deaths and injuries each year. Unsafe abortions are responsible for 13% of maternal deaths around the world. Countless women face lifelong injuries and disabilities because of unskilled medical treatment received during an unsafe abortion. Many of these deaths and injuries are self-inflicted by desperate women who have no other options.
This month several headline-generating abortion cases have opened this subject up for discussion. We respect everyone’s right to have and express his or her own opinions. We also feel a commitment to unpack the medical, political and social ingredients that go into challenging discussions like the ones we’re having now on abortion. While we understand that any discussion of abortion makes some people uncomfortable, we feel that carrying on some of this discussion here on our blog is part of our commitment to share information as it relates to prevention of maternal deaths and injuries.
This issue is personal and every woman has an opinion about it but it is also not personal and in many instances, it’s just plain medical. We must step outside of our ourselves or who we think we are to contemplate those who continue to suffer and remain at risk because of limiting circumstances, let alone perceived choices.
In Case of Emergency– When Abortion laws leave no room to save mom’s life.
Abortion is making headlines again, this time about those required in emergency situations to save mothers’ lives in countries where all abortions are illegal. The decision to have an abortion for any reason is always fraught with ethical, cultural, religious, political and moral complexities, but in cases where it’s a matter of mom’s life or health or the baby’s, the decision seems more clear-cut. When baby has no chance of survival, regardless of whether it’s aborted or not and mom’s health is in danger, the decision might even seem to offer only one choice. In reality however, the legal implications surrounding abortion in countries that outlaw even those deemed medically necessary have become somewhat of a riddle. It’s not a matter of whether abortions happen. They occur in all countries, even when outlawed. It’s more a puzzle of how they are managed and at what cost.
We spoke with Amanda French MD, an OB-Gyn at Brigham and Women’s Hospital and co-author of the Complete Illustrated Birthing Companion about how doctors advise women on medically necessary abortions. French says, “A fetus depends 100% on the mother’s health. The perception that there is actually a “choice” between the mother and the fetus during a medical emergency is in fact rarely the case. Instead, the physician nearly always must focus on optimizing the health of the mother because if mom isn’t healthy or alive, the fetus won’t be either.”
In the case making headlines last week, a pregnant El Salvadorian woman with lupus (an autoimmune disorder) and kidney disease was becoming increasingly ill. She’d had complications with a previous pregnancy, had fragile health and was at very high risk for multiple life-threatening pregnancy-related complications. When she discovered her baby was anencephalic (a rare, always fatal anomaly where baby develops without a brain and dies during pregnancy or shortly after birth) she requested an abortion. The hospital and court system refused, but the case was taken to an International court. She was required to wait until the baby was of viable age (27 weeks gestation) to have a c-section. after which, she was admitted to intensive care. If baby had been delivered before “viable age” (under 20–24 weeks) it would have been considered an abortion. After “viable age” it was an induction. Her baby died within hours.
Dr. French says, “Usually lupus isn’t a reason to have an abortion, but pregnancy aggravates lupus and can result in life-threatening complications like kidney failure. Abortion might be advised for serious cardiac issues where changes in blood volume and increased venous return are dangerous. It might also be advised in extreme cases of severe hypertension and related conditions like preeclampsia, which even women in developed countries still die from. Some types of cancer qualify, when treatment is toxic to the fetus and/or the mother would die without prompt treatment. In cases like these, even if the mother doesn’t die in pregnancy, the health repercussions from continuing a pregnancy can last throughout her life.”
Last spring, a woman in Ireland died from blood poisoning as a result of complicated miscarriage. In severe pain and knowing she was miscarrying, the woman asked for an abortion. The baby still had a heartbeat and though miscarriage was inevitable her request was refused. Days went by and the woman’s health deteriorated. Again she asked for and was denied an abortion. She died from massive infection and organ failure. Her husband sued for malpractice and won. Now Ireland and other countries with total abortion bans are forced to consider whether their laws are too restrictive.
Photo from BBC News
Sometimes, the problem isn’t whether or not to do a medically indicated abortion. It’s how to stay out of jail. In countries with ironclad laws banning all abortions (like Ireland, Poland, El Salvador, Nicaragua and others), doctors and patients can be prosecuted for murder and imprisoned. Still, doctors perform abortions on mothers who desperately need them by finding loopholes, like burying the procedure under alternate diagnoses. For example, a woman with an ectopic pregnancy (the fetus grows in the fallopian tube) presents to the hospital with excruciating abdominal pain (as her fallopian tube swells and ruptures) and severe bleeding. Ectopic pregnancies occur in approximately 1 out of every 40 to 100 pregnancies and often they result in spontaneous miscarriage. When they don’t and the fetus continues to grow in the fallopian tube, the only way to treat this life-threatening condition is to remove the fallopian tube and fetus growing inside it. The fetus will die (and would even if the mother didn’t have her tube removed because it can’t develop outside the uterus), but the medical procedure might be documented as a laparotomy or exploratory surgery, not an abortion. If the procedure is not performed, the mother will very likely die.
In each of the countries that ban all abortions their governments and healthcare systems are strongly influenced by conservative religions whose stance is described as “pro-life.” Yet the value of the unborn fetus seems to rank higher than that of the mother carrying it. It might be less devisive to consider a “pro-lives” approach rather than putting mothers and their children in opposition. On the flip side, one could argue that those against “pro-choice” policies are really fighting for “no-choice.”
There are religiously conservative organizations that make room to save a mother’s life with language that focuses on medical intent. Even those that oppose all direct abortions don’t necessarily condemn procedures that result indirectly in the loss of the unborn child as a secondary effect, such as with an ectopic pregnancy.
What happens to women who live in countries where all abortions are illegal? They have the procedure under conditions that aren’t safe and often result in death for both mother and child. Abortions happen worldwide regardless of legalities. Whether for medical or other reasons, the World Health Organization says 21.6 million unsafe abortions are estimated to occur globally every year, causing the deaths of 47,000 women. It appears, from statistics like these and recent headlines that this issue is far from being black and white or “pro-life/pro-choice.” While statistics show that unsafe abortions represent 13% of all maternal deaths, the issue isn’t really about the numbers. It’s about individuals and communities coming to terms with life and death.
