Make pregnancy safe again

Perhaps the abortion issue could be framed another way: Could we not say: Make pregnancy safe again? Better, perhaps, than abortion is healthcare, which must be explained.

Besides, abortion connotes an end of something while a safe pregnancy does the opposite by implying a life to come. Does it cover every need? No, but it applies to all women and their families.

In any pregnancy a lot can go wrong, from chromosome anomalies to heart defects to several thousand inborn errors of metabolism. Consider one of the most important causes of fetal failure and danger to the mother — ectopic pregnancies. In 2022 there were 3,661,220 babies born in the United States. Ectopic pregnancies occur in about 70,000 women a year, or 2% of pregnancies, according to The March of Dimes. None of these embryos survive.

An ectopic pregnancy occurs when an embryo implants in a fallopian tube or elsewhere, burrows into the tissue, attaches to an artery, and often causes a hemorrhage. Normally, an embryo burrows into the lining of the uterus, which is gloriously set up not to bleed, but to nurture, and to supply oxygen and to remove CO 2. We teach medical students with microscope slides and models and have them reconstruct what happens over nine months. It is topologically challenging to envisage and yet so astonishing that over 30 years of teaching, that has been my favorite lab exercise.

Ectopic pregnancy is the leading cause of maternal death in the first trimester, especially in underserved communities. Most ectopic embryos or other anomalies are found by ultrasound and disrupted with a drug inhibitor or surgery usually before three months. There are many reasons that a pregnancy may be in trouble — the absence of a skull, in a recent example, or the failure of an organ to develop. Often the definition of viability is a heartbeat, which prevents intervention in some states. It is an archaic measure. Hearts beat when a fetus cannot survive. It is cruel to send a women to her car to wait for the fetal heart to stop before terminating the pregnancy. (Did the hospital not have a bed?)

There is no reason to risk a woman’s life or fertility, or to make orphans of her children. Is it necessary for a hospital to hire liability lawyers to decide when a woman can be treated? Why cause her physicians the despair of losing their patient? They are sworn to do otherwise. Many will decide to practice elsewhere, making the problem worse.

Many know the story of Kate Cox, the Texas woman who was pregnant with her third child who had an extra chromosome 18. This syndrome, Trisomy 18, is well studied and is lethal to the baby shortly after birth; it sometimes results in rupture of the mother’s uterus and then hysterectomy. One would think that the Texas Medical Board would have defined exceptions before Texas passed their law, but they did not. The Texas Supreme Court rejected a lower court’s permission to end the pregnancy, on the grounds that Cox could not prove that a birth would harm her. They did, bless them, urge the Texas Medical Board to hurry up, which means defining thousands of different conditions. According to the report I read, Attorney General Ken Paxton felt it necessary to call Ms. Cox’s physician and warn her of the consequences if she helped Ms. Cox. She could lose her license, be fined $100,000, and spend the rest of her life in jail. Ms. Cox was at the president’s State of the Union address not only as a heroine, but as a voice of good sense.

What is to happen to the Ken Paxtons of the world? The story reminded me of Skipper Ireson, a whaling captain from Marblehead Massachusetts. I went to high school in New Hampshire, where we read “Skipper Ireson’s Ride” by John Greenleaf Whittier. Skipper Ireson went to sea and managed to wreck his ship and then sail away in a small boat, leaving his crew on deck. All the men drowned, leaving wives and families in poverty. When he returned to Marblehead, he was run out of town in a cart, “Tarred and feathered by the women of Marblehead,” in Whittier’s phrase.

There are now 20 women and two providers suing the State of Texas. Their numbers will grow. I am not sure that they are bringing tar, but they are not going to put up with Ken Paxton.

Richard Kessin is Emeritus Professor of Pathology and Cell Biology at the Columbia University Irving Medical Center. Email: Richard.Kessin@gmail.com.

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