Pregnancy Issues


I started to post a comment over at the Kairos Guy and realized that I would exceed the box's limits, so I am posting it here. You see, J.B. included some comments in his post about pregnancy, a topic on which I do know a little bit. Here is an excerpt from his much longer post (J.B., I hope you don't mind that I have truncated your writing - there is a lot of stuff there and I only want to address a few small points!).
Last summer, one of the pregnancy issues before us was the possibility that Mrs. Kairos Guy had a tubal pregnancy (which turned out not in fact to be the case). Now, I have no essential qualms with the Church's ban on abortion: it is fundamentally sound, and I support it. In fact, "support" is much too weak a verb to describe my attitude. I believe it to be True.[You're waiting for me to say "but," aren't you?]But. I learned, after the fact, and after consulting a couple of people on my cell phone standing outside the Emergency Room but getting only partially correct information, that even though a fetus implanted in a tube cannot live, and a mother who allows that fetus to continue gestating will certainly die, it is not licit for that woman to have an abortion. What IS licit is the removal of the entire fallopian tube in which the fetus is implanted, even though that too means the death of the fetus. At that point, we all get to pretend that the unburst tube is the problem, rather than the fetus, and we maintain the fiction that we did not seek nor receive an abortion, but that the death was the result of a "double effect." (I hasten to remind you again: there was not in fact a tubal pregnancy in our case). But it requires a great deal of fooling oneself to pretend that the only thing going on with the tubectomy was the treatment of the tube, and not the removal of the fetus before the fetus kills the mother. (As it happens, recent studies have suggested that there are medical benefits to a tubectomy not present in the "Dilation and Evacuation" procedure that is common for most women. The scarring of the tube that a D&E can cause greatly increases the chances of further ectopic pregnancies and miscarriages. With a single tube, unscarred, pregnancy remains eminently possible, with little increased risk.
Let me recommend a resource for information on Catholic Bioethics. This center will answer questions by email. Also, the Pope Paul VI Institute, directed by Dr. Thomas Hilgers at Creighton University has a center for reproductive bioethics. Now for my comments.
I will be using mostly medical terminology . Embryo is a baby in the first trimester of pregnancy, fetus is the baby thereafter. By using these terms, I do not mean to imply any diminuation of the humanity or right to life of that child! Ectopic means not in the right spot, in medical terminology. Things other than pregnancies can be ectopic (like heartbeats). The most common kind of ectopic pregnancy is in the Fallopian tube. Rarely, a pregnancy will implant in other places outside the uterus. Such abdominal pregnancies can be carried to viability or even to term, and although abdominal surgery (laparotomy, not Cesarean as the uterus is not entered) is required for delivery, there have been multiple cases reported in the medical literature. It does carry an increased risk to the mother's health, depending on where the placenta implants. There have even been some pregnancies reported after hysterectomy, probably where conception occured but was not known before the surgery was done. At least one of these babies survived to be born healthy. Before ultrasound, we had no way to know for sure where and sometimes even if there was an ectopic pregnancy, and prudent physicians hesitated to subject mothers to possibly unneeded surgery, but also faced the spector of missing the diagnosis of ruptured tubal pregnancy until the mother was in extremis. 30 years ago, a friend of mine was clerking in a law office preparing a suit on just such a missed diagnosis that ended in a maternal death. So we who work with women in their childbearing years are hyper vigilant. Thankfully we have tools now that have made diagnosis of tubal and other ectopic pregnancies much easier and quicker.
It is generally believed that tubal pregnancies will inevitably end in the rupture of the tube and loss of the baby. This may not always be the case, as there is a theory that at least some abdominal pregnancies started out as tubal pregnancies but the embryo was expelled out the end of the tube into the abdomen. No one knows, and no one will probabaly ever find out, because now that we have the tools to watch, we intervene early to prevent this. The standard treatment for tubal pregnancy is to end the pregnancy as soon as the diagnosis is comfirmed. The Catholic teaching is and continues to be that removing the tube is licit, even though that will also abort (technical definition - end prematurely, cause untimely death) the pregnancy. The tube is damaged - at least that section of the tube containing the embryo. I know of at least one physician (Dr. Hilgers) who will attempt to place the embryo from the tube into the uterus when doing microsurgery for tubal pregnancy. I don't know if he has had any successes, but as a committed Catholic physician he believes that he has that duty to at least try to give the baby a chance. I am not sure that the principle of the double effect requires that the tube actually rupture or just that it be certain that the tube is damaged. I will defer that to a professional ethicist. What I do know is that the medical (non-surgical) treatment for tubal pregnancy is not morally licit. This treatment involves injecting the woman with a drug (usually methotrexate) that has the effect of directly killing the embryonic life, and thereby preventing further growth that could cause the tube to rupture. This technique is quite similar to early induced abortions done with RU-486.
Dilatation and Evacuation (D&E) or Dilitation and Curettage (D&C) have NO place in the treatment of ectopic pregnancy. These procedures are used to empty the uterus with vacuum (Evacuation) or scraping tools (Curettage). They are used both to complete a miscarriage (spontaneous abortion) where there is excessive bleeding or parts of the baby and placenta are not expelled naturally, as well as to perform induced abortions. Any time the uterus is instrumented, there is a risk of infection or physical damage, and infected tubes are more likely to get scarred and therefore more likely to not transport the embryo to the uterus in the timely manner required to implant properly.
Ectopic and tubal pregnancies have become epidemic in our society. There are many totally blameless women who have suffered the agony of a tubal pregnancy. However, the risk of a tubal pregnancy is known to be higher in women in the following categories - women who have had pelvic infections (usually from sexually transmitted diseases, occasionally from such conditions as a ruptured appendix or other abdominal infection causing scars), women with endometriosis, women who have had tubal ligations (even after reversal surgery), women who get pregnant while using an IUD, Depo-provera, other hormonal contraception. (the hormones make the tubes slower at moving the embyro down to the uterus, and they also make the lining of the uterus less hospitable).
I realize this is a lot of info, and I don't mean to slight anyone or anything here. Please feel free to correct me if I have anything wrong, or to ask for clarification if I have been fuzzy in my speech.

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This page contains a single entry by alicia published on March 13, 2003 7:14 PM.

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