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Archive for June 11th, 2008

The Life in a Shoe blog author has written an article about why ending an ectopic pregnancy is wrong. See the previous link for the original article which I will be quoting and answering here.

As Christians, we are unabashedly, 100% pro-life. We believe that life begins at conception; that every human life is created in the image of God; and that abortion is wrong in every case. This is where we differ from many other “pro-lifers” who are willing to grant that abortion may be merited in certain cases.

I disagree. And I resent her presumption to speak for all Christians on this matter. Being 100% pro-life means giving the life of the mother at least as much importance as the life of the child. And risking the life of the mother as in ectopic pregnancy seems unwise and anti-life, in my opinion. When it comes to one life or the other, I believe it is morally licit to choose to save your own life, as painful as that is. And believe me, I’ve made that choice, and I know. She can call me a murderer until the cows come home, but that doesn’t make it so, and it doesn’t make her right.

The standard treatment for ectopic pregnancy follows one of 3 courses: chemically induced abortion (usually by means of a drug called methotrexate); removal of the entire fallopian tube which contains the baby or a the affected portion of the tube; or removal of the baby and subsequent repair of the affected fallopian tube.

All 3 approaches directly result in the inevitable death of the child.

However, there is at least one more option: Wait. Be ready, but wait. Treat the mother if necessary but do not kill the child. No abortion.

The primary argument against the Watchful Waiting method of treatment is that it is dangerous to the mother. Alarmists will try to equate it to a death sentence – and for what? The child was doomed from the start, right?

No. The outcome is not so easily predicted as some would have you think.

I think this attitude is naive at best. The author is willing to risk the lives of many for the one in a million baby that might survive.

Yes, there is a high likelihood that the child will die. How high? Nobody really knows, because nobody seems to recommend this approach.

Doesn’t she think that perhaps there’s a reason for that? Doctors aren’t in the business of killing people. That’s not why they become doctors. And if they could figure out a way to save mother an baby, they’d be employing it. But overwhelmingly babies die, and if untreated the mother could too.

There was recently a documented case of anundiagnosed ectopic pregnancy that was delivered by c-section at full term. There are others as well: A baby born in 2000 was attached to the mother’s bowel, as was this one in 2005. This 1999 triplet developed in the fallopian tube, while his two sisters grew in the uterus. The triplet article states that there are 60-100 cases of babies growing outside the womb and surviving.

This information is accurate, but misleading. She can name 4 babies who survived as ectopic pregnancies in a 9 year period from around the world. But she fails to mention the 40 maternal deaths that occur each year in the United States alone. The United States, by the way, which is a developed nation with good healthcare. Statistics don’t exist in a vacuum. It’s not fair to mention those few babies who have survived, and ignore the many women who die right along with their babies.

Yes, these cases made headlines and amazed the whole world, but how many more cases would do so if we didn’t diagnose and automatically abort them? This site seems to indicate that the prognosis for the ectopic child is not entirely hopeless, at least in the case of abdominal pregnancy:

I’m certain a few more babies would make it over the years. But how many more mothers would die? Even with the statistics provided here, which is survival from around the world compared to mortality from just the US (worldwide mortality rates are much higher, especially in underdeveloped nations), there are 10 mothers and babies who die for every mother and baby who lives.

But what about the mother? Is it right to sacrifice her life with so little hope of gaining the life of the child? In the case of abdominal pregnancies that are allowed to continue, the article above goes on to state that:

Mortality and maternal morbidity are directly related to the removal of the placenta during childbirth. The remove of the placenta depends on the degree of invasion, the location of insertion, the involvement of the other organs and the surgical access to the placental blood supply. If it is possible, the complete placental extraction should be done. If not, the placenta should be left at the place, following by occlusion of the umbilical cord. The subsequent management is expectant. The placental reabsorption can be accelerated with methotrexate, selective arterial embolization and secondary laparotomy.

So the life of the mother may be in danger, but she is far from doomed! There are procedures for dealing with the risks of advanced abdominal pregnancy – procedures which allow for the possible survival of the child!

What the author is leaving out of this is that it occurs in less than 2% of all ectopic pregnancy cases. And she (lacking a medical background) also leaves out the many dangers along the way when dealing with an abdominal pregnancy. Again, the information is sketchy and not provided in it’s proper context. Ectopic pregnancy occurs in about 19 out of 1000 pregnancies. 98% of those will be located in the tube. That’s less than 1 in a thousand that will occur in the abdomen. The statistic this author provided of survival of an abdominal pregnancy is 1 in 5000. 1 in 5000 when you’ve got a pregnancy that’s already 1 in a 1000. And even she admits that the mortality rate (even with all that we know) is about 50%. We’re way out of the realm of “statistical possibility” as stated by Doug Phillips. We’re in statistical probability. The reality is that the overwhelming majority of babies will die with or without treatment. And a huge number of mothers will die without treatment.

And then they call women murderers for trying to save their own lives while grieving the loss of a baby that they wanted and dreamed of. Where’s the compassion?

For those pregnancies which implant in the fallopian tube (far more common than abdominal pregnancy), the dangers are surprisingly moderate. Although many will succumb to scare tactics, a plain reading of the statistics can be very reassuring.

STATISTICS

  • Currently, up to 1 of every 50-60 pregnancies is estimated to be ectopic.***
  • Over 100,000 ectopic pregnancies were reported in the US in 1992.
  • 1 out of 2000 ectopic pregnancies ended in the death of the mother for the 1970’s and 1980’s. The mortality rate has fallen even lower in recent years due to advances in medical care. Recent estimates put it at ~3 in 10,000.
  • At least 14 studies have documented that 68 to 77 percent of ectopic pregnancies resolve without intervention (American Academy of Family Physicians).
  • Tubal rupture occurs in approximately 20% of cases. The statistics seem to indicate that this is the number of women whose initial symptom is tubal rupture, i.e. they receive no treatment at all prior to rupture. Studies indicate that another 10-30% may experience rupture while under medical care.
  • Contrary to popular belief, death from rupture is rare where medical attention is available. In the US, 25-50 women die from ectopic pregnancy each year out of about 100,000 reported cases.

I’m amazed that she’s calling these statistics reassuring. She’s correct about the number that resolve on their own, but let’s keep in mind that the resolve being talked about here is spontaneous abortion, the medical term for miscarriage. Yes, ladies, let’s remember that the inflammatory word abortion means that a pregnancy has ended, whether spontaneously or not. And when a fallopian tube ruptures, it causes internal bleeding, shock, infection, and can cause death. 20% of tubes rupture, even when under medical care. That these women survive is because of the excellent care they receive at the hands of their doctors. Using the “wait and see” approach offered by the Vision Forum Ministry types makes the chances much more likely that death will occur for both mother and baby.

After that, the authors math is so far off as to be comical if it weren’t so horribly sad. Comparing the risks of ectopic to the risks of dying in childbirth I find to be especially offensive. I’ll take the risk in childbirth where my baby could survive outside of my womb.

The author of this article misses the bigger picture. She fails to see how lucky we are that we live in a developed country where the risk of death from ectopic pregnancy is so reduced. Keep in mind, however, that it is still the number 1 pregnancy related death in the first trimester. She fails to see that the reason that the death toll is as low as it is stems from our good healthcare and the ability to see that a baby is ectopic and deal with it early.

God created our bodies to work a certain way. Babies were supposed to grow safe and protected in the womb. When that doesn’t happen it always poses great risk to the mother. And to sell women the idea that it’s not Christian to be treated to save their own lives, or that they will be murderers if they do is, in my opinion downright shameful.

It’s sad when one loses a baby, especially when it’s either the mother or the baby. But since the baby is in the mother and can’t live without her, and the mother can continue to live without the baby, it seems to defy logic and reason for the mother to risk her life to continue the pregnancy in the hope that the baby will miscarry without taking her life too.

When ending an ectopic pregnancy, the goal is to preserve the life of the mother. The loss of the baby is an unintended and sad consequence, but by no means immoral.

Edited to add: Since the initial publication of this post, Mrs. In-a-shoe added a link provided by one of her readers that gave five more examples of babies who had survived as ectopic pregnancies and follows those examples with the same question, “Yes, these cases made headlines and amazed the whole world, but how many more cases would do so if we didn’t diagnose and automatically abort them?”. Mrs. Shoe, my answer remains the same:

Here in the United States, with our treatment of termination for ectopic pregnancy, 40 women at least still die from the condition yearly. Your total of 9 examples from all over the world over many years doesn’t compare. Should we start treating ectopic pregnancy the way you suggest, more babies might live, but many many more women will die. It seems that you are totally comfortable with the idea of more women dying each year when they don’t have to. But this pro-life Christian woman is not. Those women’s lives are also valuable, and I support their right to preserve them. And I respectfully disagree with the idea proposed that allowing women to die is pro-life.

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Remind Me

I make it my personal policy (cannot speak for Anne here) that I do not argue with those who oppose ending a pregnancy to save a mother’s life. Please, please yell at me to stick to that policy. Remind me how foolish it is to get involved in arguments that are impossible for me to handle without getting emotional. Remind me how I vowed to sever any relationship that stood opposed to our decision 3 years ago without ever looking back. Remind me how my parents, my VERY conservative pastors, my most trusted, pro-life Christian mentors supported us. Remind me that I don’t have to answer every single quack who calls me a murderer. Remind me of Karen’s most encouraging words- that in 30 years of working in the pro-life movement, she did not encounter one person who would oppose what we did in our circumstance.

Remind me that I am accountable to NO ONE but God, my Father, and that the law of Doug Phillips does not trump the law of God and the love and mercy of Jesus Christ.

What you do not have to remind me about is that I love my baby.  Had I received anything but a completely terminal diagnosis for her, I would’ve continued on in that pregnancy without question.  I would’ve risked a hysterectomy (which was also a possibility) or the certainty of C-sections for every subsequent delivery.  I would’ve GLADLY welcomed a disabled child into our lives.  That was not our Grace.  I remember the 27 hours of agony I endured to have her born whole.  I remember how it felt when she was born, the strange sensation of birthing her.  I remember holding my firstborn in my hand, and how her hands were folded together and curled up under her cheek, like a baby asleep.  My mom said that my grandpa passed into glory looking exactly the same way.  I remember singing all the lullabies and hymns I had planned for her.  I remember reading Scripture to her.  I remember my mom and dad holding her and how they looked at her with such utter love.  I rejoice that my dad, one of the 5 people on earth to hold her, was the first to hold her iin Heaven and is now joined with her in the heavenly chorus, singing praises to God Almighty in the Heavenly City.  I remember my courageous, loving, amazing husband tell me that however long I held her would never be enough.

See, I’m too emotional… which is why I should never have posted on In a Shoe.

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