Before we proceed, I have to confess that I originally wrote this post because I was irritated about an obnoxious email I received from the Georgia Department of Public Health and the Georgia Department of Community Health.
Then I saw the Vice-Presidential Debate and realized that the reason I got the irritating email was because two Georgia women, Amber Nicole Thurman and Candi Miller, died because they couldn't get timely medical care regarding their unique pregnancy situations in this state. You can read about their particular situations online.
Here is the actual blog post (slightly amended after seeing the debate).
Definition. Abortion is the termination of a pregnancy before the fetus can survive outside the uterus. It can occur spontaneously, known as a miscarriage, or be induced intentionally through medical or surgical procedures.
This definition was copied from the Yale School of Medicine website.
Why am I bringing this up??
I just read an email sent to me (I'm an Obgyn in Georgia) from the Georgia Department of Public Health and the Georgia Department of Community Health. It was titled 'Regarding Misinformation About Abortion in Georgia'. Apparently the bureaucrats and politicians in Georgia feel they have the knowledge and authority to inform practicing Obgyns on abortion.
In the email, they quote a definition which they wrote that states that abortion is the use of intervention to deliberately terminate a pregnancy.
Well this is a perfect example of why bureaucrats should not try to control what happens between a physician and their patient or meddle in any private medical decisions -they go so far as to state in the email in bold letters - .a miscarriage is not an abortion!
Let me enlighten you and maybe them - abortion is a MEDICAL TERM to describe the loss of a pregnancy. (see definition from Yale Medical School website above)
If the person has passed some tissue but there is still bleeding and fetal or other tissue are still visible in the uterus on ultrasound, then it is an Incomplete Abortion. If tissue was passed and there is no bleeding and nothing visible inside the uterus, then it is a Spontaneous Abortion (or complete abortion). If the person presents for an ultrasound in early pregnancy and there is no heartbeat and no signs of miscarriage then it is a Missed Abortion.
I feel the need to clarify because their letter also states 'The (Georgia) law does not prohibit the removal of a dead unborn child (note - the correct medical term here is embryo (8 weeks or less) or fetus(up to 9 months)) caused by a spontaneous abortion'.
If you are astute you will note in the prior paragraph that in the case of a spontaneous abortion there isn't anything left inside the uterus to remove and they seem to be saying that unless the fetus is dead, it is illegal to remove it.
Since the email title was 'Regarding Misinformation About Abortion in Georgia' I feel the need to clarify for them and the public why there is confusion. It stems mainly from politicians with no medical knowledge whatsoever trying to dictate medical policies regarding woman and their bodies - primarily based on the particular religious belief systems of those making the laws, not based on actual knowledge of the medicine and complexities involved in decision-making regarding these cases.
I was in the Pro-Life movement when I was in medical school and residency and I am telling you from experience that their literature and mailings are all based on lies, sensationalism and distortions of the truth in order to raise funds for their cause. In many of the mailings I received they had a photograph of a trash can filled with fetuses. There is NO hospital or clinic in America where a fetus is disposed of in the trash. There are laws in place that dictate where the fetal tissue goes, depending on the gestational age at the time of the abortion. They either go to pathology or to the morgue.
Those in the 'Pro-Life' organization aren't trying to shed light on why people have abortions (that wouldn't help them raise money!) or about real life scenarios that happen to real people - they just care for 'the cause' and plotting to prevent anyone from ever having an elective abortion - the actual term for pregnancy loss resulting from an elective procedure or medication to terminate a pregnancy.
Why do they feel that the government has the right to decide what happens to a woman's body just because she has a positive pregnancy test?
Do the 'pro-lifers' realize (as quoted here) that 'The American Society of Reproductive Medicine notes that in natural reproduction, 70 percent of fertilized embryos don’t result in live births.
And in the same article, referring to embryos - "They’re potential,” she (Deb Roberts, founder of a secular embryo adoption agencys) says. “It’s not a question of ‘life begins at a certain point.’ It’s just that they have the potential to be children.”'?
Why do the 'pro-life' supporters insist that a fertilized egg should be equated with a fully alive and reproducing human female? Is an egg equal to a chicken or duck or bluebird?
And if they really are 'pro-life' - why don't they care about the life of the mother?
What about the Golden Rule? (side note - a version of the Golden Rule appears in every major faith tradition.)
What about 'Love your Neighbor (all of humankind) As You Love Yourself'?
So let's consider some real life situations that happen every day in America (I have encountered all of these in my years of practice) -
Married white women in her 30s is newly pregnant (about 8 weeks) for the fourth time and her pap smear and followup biopsy show cervical cancer. She's otherwise perfectly healthy.
The current 'LIFE' Act in Georgia (enacted after Roe v Wade was overturned) 'prohibits abortive care once cardiac activity is detectable in an embryo', typically around six weeks.
What care would you want for yourself (or spouse, sister, mother, niece, granddaughter) in this situation?
Is it 'legal' to terminate this pregnancy in Georgia?
It's not the pregnancy that is threatening her life but the cancer in her cervix. If she carries to term it is very likely the cancer will have spread to other areas outside of the cervix and her anticipated survival rate would be very low. She would like to have an elective abortion so she will have a much greater chance of survival of the cancer and be around to take care of her living children.
How would you feel if you were forced to carry this pregnancy to term?
The offensive email also states 'abortion is permissible at any stage of pregnancy to save the life and health of the mother in the event of a medical emergency'.
Does this constitute a medical emergency? I hate to have to state the obvious, but she is not in immediate danger, not in an emergency room or in an emergency situation.
Let's look at another situation that I've seen multiple times - a young girl, age 10-14, pregnant because she was raped by someone she knows (mother's boyfriend or spouse, neighbor checking in on her while her mother is at work, etc). Very young girls have very irregular menses around the time of menarche (the start of their cycles) and very often are further along when the pregnancy is discovered (usually 14-18 weeks).
Would you want your child or anyone at 10-14 years old to be forced to bear a pregnancy resulting from rape at this young age?
Another case - married white woman in her late 30s has been battling infertility and has finally gotten pregnant but at her early ultrasound around 8 weeks they spot unusual anatomy and do a genetics test and the fetus has anomalies incompatible with life. She and her husband were so excited about this possible child but this pregnancy stands in the way of her possibly having a child at all. If she carries this pregnancy to term the fetus will not live and her possibility of having a living child will dwindle, as she will be older and every passing year diminishes her chances of a successful pregnancy.
If this were you or your loved one, would you want them to be forced to carry this fetus who will not live long after birth?
It may be helpful to keep in mind that in the United States, the mortality rate (death rate) from pregnancy is over 90 times greater than the mortality rate from abortion. Yes, Virginia, people do die from pregnancy and pregnancy complications in the U.S. of A., and, because of the reversal of Roe v Wade by the current Supreme Court, those rates are climbing higher every day in those states that immediately enacted abortion bans after Roe v Wade was overturned, like Georgia.
Let's look at another case I've seen - a 41 year old LatinX comes in for birth control. They had been diligently getting their contraceptive injection every 3 months at the Health Department until the last visit when the nurse would not give it to them because they were 'over 40' and it was not in the protocol to approve the injection for someone over 40. They were given an appointment to see me for approval but no interim birth control because they were also diabetic and hypertensive.
Unfortunately, I had a long waiting list of people to see me and by the time they got in for the appointment they were pregnant (even though they used condoms and withdrawal). ' They already had 5 children and did not wish to risk their life to have more. This would be a very high risk pregnancy with their medical conditions. They are found to be 8 weeks along and desire elective termination.
Would it be legal to offer termination of this pregnancy in Georgia?
A very common scenario that occurs is when a pregnant person's water breaks before viability. The fetus will not live if delivered but the mother may get a life threatening infection because of the rupture of the amniotic membranes. There have been many women who have died in this situation because the doctors feared prosecution for aborting a live fetus who would die upon delivery at a non-viable gestational age.
In this case, there isn't a 'medical emergency' until the infection sets in but by then it may be too late to save the mother from the sepsis. I will again state the obvious here - when the infection is bad enough to kill the mother it will also then kill the fetus.
What do you think the law allows in Georgia?
I have many more scenarios - a patient in her second trimester with a newly diagnosed brain tumor, a 19 year old black woman with an AVM (arteriovenous malformation) in her brain which has a 50% chance of rupturing during pregnancy and killing her, a young Latina with twins and lupus (she did not opt to get her termination and she died at 20 weeks gestation, along with her non-viable twin fetuses - but she at least had the option to terminate back in the 90s when I was in residency at Emory).
When do we stop trying to control people's autonomy over their own bodies and use some common sense and show some love and respect for the fully realized living breathing human woman who is having these experiences?
One of the most 'cringey' quotes (IMHO) from this current election cycle was from a series of interviews done by the New York Times in Georgia, and one woman, asked about abortion laws, said, "They should think about that before conception".
Does she mean 'think about all of the life threatening things that can happen while you are pregnant?'
Or does she actually think that rape never happens? Does she live such a sheltered life that she's never even heard of rape?
When I was a second year resident doing my Obgyn residency at Emory University and working in the GEC (Gyn Emergency Clinic), I had to work the night shift for an entire month. As the second year resident on duty, it was my responsibility to handle all of the rape cases. My schedule included working a 12 hour shift Monday night through Friday night that month, so about 20 nights out of the month, and during my ONE month I handled 50 rape cases.
And we know that not every rape victim goes in for an exam. The purpose of the exam is to record the evidence of assault for the victim so that she can press charges. Not every victim decides to press charges. The vast majority of women have some type of relationship with the person who raped them and never report it.
So imagine how many women - every day in America - are victims of rape.
And the persons who want to set up an ultraconservative government (the architects of Project 2025) want to make every voluntary pregnancy termination illegal. They even want to do away with the word abortion, according to this quote from an article regarding Project 2025 by GLAAD.org:
'The plan includes firing federal employees that oppose or insufficiently support right-wing policies, ending access to abortion and contraception, and eliminating protections for LGBTQ people. The document even calls for erasing LGBTQ-inclusive language throughout federal agencies such as “the terms sexual orientation and gender identity (“SOGI”), diversity, equity, and inclusion, gender, gender equality, gender equity, gender awareness, gender-sensitive, abortion, reproductive health, reproductive rights.” '
They are also opposed to free access to contraception and the morning after pill (currently covered under the Affordable Care Act) - in the name of 'safe-guarding women' - as if all women need is the government to decide what is best for their health and family planning.
And in this policy they ignore the fact that access to contraception actually decreases the number of abortions.
How do these policies 'promote life'? If a woman has a condition that makes pregnancy life-threatening for her, how do these policies help her?
Would the Universe, God, the Source of all that exists want us to care more about a 'cause' or an actual living breathing fully realized human person?
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