Midwifery: January 2003 Archives

Doctors who refuse abortion


An intriguing article
from a family practice doc about why many docs refuse to perform abortions. Loads of internal links in the article, as well. Link courtesy of Catholic and Enjoying It aka Mark Shea's blog. Lots of other good stuff there today, as well.

Life and Birth


Read the comments attached to the post about the "R-rated" conversation. Sometimes posts take on a life of their own. Hard cases make bad law, I have been told. Hard cases held up before the public eye have all too often been the first step down the famous slippery slope. Hard cases became the incentive for the infamous Lambeth declaration, in which the Church of England reversed centuries of opposition to artificial birth control. Hard cases became the reason behind intentional sterilization, behind abortion, behind divorce. Anyone reading Humanae vitae can see how prescient it was. What started as a difficult, thoughtful, anguished decision eventually became commonplace and even expected.
I have been involved in the care of pregnant and birthing women for nearly 20 years, the last 7 as a certified nurse-midwife. I started my professional career as an RN on the High-Risk OB unit of Los Angeles County's biggest hospital. I saw women who were pregnant and had medical conditions that I had not seen before (or since). By far, the vast majority of these women went on to have pregnancies and births from which they and their babies emerged in reasonable shape. Some of them had miserable pregnancies, some had very scary births, but most did OK.
There are in reality very few medical or obstetrical conditions that make a pregnancy (first or repeat) truly life threatening. In many medical conditions that make pregnancy unwise, God also makes the woman infertile (for example untreated insulin-requiring diabetes). I have been trying to bring to mind the permanent or not easily treatable conditions that might make pregnancy life threatening to the mother. I can only name a few - there are probably some others, but here are the few I can think of.
Cardiomyopathy: This is a heart condition that sometimes strikes during or just after pregnancy. The heart muscle is weakened. If there is a spontaneous recovery with no residual damage, repeat pregnancy still carries an increased risk which cannot be quantified.
Severe diabetes: diabetes which is under control carries added risk to both mother and baby. Diabetes accompanied by heart, kidney, or nerve damage can cause pregnancy to be a life and health threatening event to the mother, and babies born to moms with severe diabetes have a higher than normal rate of several birth defects.
Prior organ transplant: this is variable. There have been successful pregnancies with little or no damage to mother or baby, but the care during and after pregnancy is intensive for both mother and baby.
Active cancer: again, there is a lot of variation. I have been involved in the care of pregnant women with cancer. It is a challenge, but not impossible. It would be preferable to delay pregnancy until the cancer is in remission and shows no signs of recurrence, but this is not always possible.
AIDS - Being HIV positive is not an absolute contraindication to pregnancy, but pregnancy is probably unwise from several points of view. Active AIDS - a pregnancy would probably shorten mom's lifespan, by how much is unknown.
Recurrent hyperemesis of pregnancy - this is a difficult call, because so little is known about this condition.
Things that do NOT necessarily mandate no further childbearing are such complications as post-partum hemorrhage, eclampsia or pre-eclampsia, gestational diabetes, prior cesarean delivery (even prior uterine rupture is not an absolute contraindication), chronic hypertension, advanced maternal age. Each of these does carry a certain level of risk, but then so does getting out of bed in the morning or riding in a car at any time.
I plead with anyone who is contemplating sterilization or other irreversable decision, please get all the facts. Get your records and review them with an expert or two. A book I highly recommend is Life Giving Love by Kimberly Hahn. There is sage advice about many hard cases, from a profoundly pro-life and Catholic point of view. and, first, last and always, pray.

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About this Archive

This page is a archive of entries in the Midwifery category from January 2003.

Midwifery: February 2003 is the next archive.

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