Ectopic pregnancy and the sanctity of life

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.

Abortion is murder – even in cases of rape, incest and when the life of the mother may be at stake. We must never reason from difficult cases to make ethical judgments and we must understand that modern bioethics and medical ethics are not reasoning from God’s law.

Doug Phillips recently broached the question of ethical treatment of ectopic (tubal) pregnancy on his blog when he posed the following question from the Witherspoon School of Law and Public Policy:

A mother conceives a child. The doctor tells the parents that they have a tubal pregnancy and that the baby has little to no chance of survival, but its continued life poses a threat to the life of the mother. What are the relevant biblical principles? What facts must be determined to make a biblical ethical decision? What medical options might be available. Is killing the baby through abortion defensible through Scripture? If so, defend your position? If not, defend your position? Are there other options?

Certain loud sectors of the blogosphere accused him of endangering the lives of countless women because he suggested they might not need to automatically and immediately abort an ectopic pregnancy.

I was intrigued by this question and the possibilities it presented, and I was not ready to accept the assumption that failure to aggressively treat an ectopic pregnancy amounts to suicide.  I stayed up until 1:00 that evening researching the subject, and here is what I learned.

ECTOPIC PREGNANCY

Ectopic pregnancy is a pregnancy in which the fertilized egg implants outside of the uterus. In 95-98% of cases, it implants inside the fallopian tube – this is why it is commonly referred to as tubal pregnancy. Other possible locations are in the cervix, an ovary, or in the abdomen where it will attach to a blood supply such as the bowel or liver.

TREATMENT OPTIONS

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.

PROGNOSIS/OUTCOME

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

update: Here are 5 more documented cases of ectopic survivors. Thank you to Christina for the link.

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:

Prognostic: The abdominal pregnancy is associated with high maternal (0-20%) and perinatal (40-95%) mortality. Maternal mortality is about 5.1:1.000 compared with 0.7:1.000 in other ectopic gestations. The perinatal mortality has been traditionally high. However recent progresses have result in a 70-80% increase in the survival in fetuses older then 30 weeks…

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!

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.

Let’s do the math, shall we? In spite of the fact that hospitalization and surgical treatment pose risks of their own and many women have surgery without having experienced tubal rupture, we will generously assume that all of the reported deaths occur among those women who didn’t receive treatment until after rupture.

If there are 100,000 ectopic pregnancies reported each year and 20% of them result in rupture of the fallopian tube, then about 20,000 women are treated annually in the US for actual tubal rupture. A total maternal death toll of 50 would mean that 1 in 400 of those who experienced tubal rupture died. That’s a death rate of 0.25%.

Since rates of ectopic pregnancies have continued to increase rapidly while mortality rates for the mothers are decreasing, actual current numbers would look far better: a death toll of 25 (the number reported in 1992, the most recent I could find) would bring the chance of death after rupture down to 1 in 800, or 0.125% (20,000 ruptures divided by 25 deaths).

A mother who is aware of the situation and under a physician’s watchful care would likely fare even better. If we accept 40% as the rate of eventual tubal rupture (20% happening initially and the other 20% occurring during treatment and medical care), then we have a death toll of 25 out of 40,000 cases of rupture, or a 1 in 1,600 chance of death.

CONCLUSION

The chance of death for a mother who chooses not to abort an ectopic pregnancy appears to be something less than 0.25% – possibly as little as 0.06%, or about four times the risk of full-term labor and delivery.

Does this sound like a death sentence for those who would refuse to abort an ectopic pregnancy? Or does this sound like a reason to reconsider the standard course of action in a difficult situation?

We should always question the presuppositions of the scientific community – from stem cells to aborting tubal pregnancies – because they DO NOT reason from a Christian foundation. Once we begin to question them and their assumptions we start to realize that they are not as sure of their conclusions (or shouldn’t be) as they claim to be.

As Christians, we must always begin with God’s word and work from there. Some decisions will be easy and others will be difficult, but all must begin from the same foundation: God’s Word is authoritative and sufficient for every facet of life.

When we start from this presupposition, we just might find that the difficult decisions aren’t so difficult after all.

REFERENCES

CDC Ectopic Pregnancy Surveillance 1970-1978

Medline Plus Medical Encyclopedia

Ectopic Pregnancy: Dr. El-Mowafi

Ectopic Pregnancy on Wikipedia

Time and Risk of Ruptured Pregnancy

Study: An Institutional Review of the Management of Ectopic Pregnancy

Fast Facts on Ectopic Pregnancy

eMedicine: Ectopic Pregnancy

Ectopic Pregnancy: Risk Factors

*** Figures from the 1940’s estimated that about 1 in 30,000 pregnancies was ectopic. This number has skyrocketed due to common risk factors: hormonal birth control and IUDs, tubal ligations, STDs, PID (Pelvic Inflammatory Disease, usually a result of STD caused by promiscuity), in vitro fertilization, and abortions – all practices which many Christians find ethically questionable or morally wrong.

follow up here: Ectopic Pregnancy Clarifications

Comments

  1. As a youngman not yet married, I want to thank all you ladies(and guy or two) for the hardy discusion. I am taking this all in for future referrence for when(hopefully) my wife(if I get married) is expecting.

  2. I was told that my first pregnancy was ectopic after going to the ER for severe pain in my abdomen. The doctor, after doing an ultra sound did not find the location of the baby. He went on to suggest terminating the pregnancy anyway. My husband and I prayed when the doctor left the room for a miracle and left saying we would get a second opinion. Our daughter is 9 years old today. God was good to put this conviction on our hearts. God has blessed us with three more children and three more in heaven. Praying for God’s will and trusting in Him alone is what has proved to strengthen our family and what has helped us face difficult trials.

  3. I have a SIL who did not realize she was pregnant with an ectopic pregnancy, and at 8 weeks since the baby was alive and growing, ruptured her tube and the amount of time she had to get to the hospital, it was about 5 min. away from bleeding out.
    I guess what I am saying it is a very short window of time if you decide to watch and wait. She is not able to get pregnant again as far as I know, because of losing not only that tube, but I think one of her ovaries as well.

    You would have to probably stay at the hospital under constant monitoring in order to do this.

  4. I do appreciate your response but I still am outraged at the comments made. It seems you think it is OK that I had to go through life threatening surgery because by that point nature had intended for me to lose my baby. What about my 4 previous losses? 2 of which were treated with methotrexate even though they were classed as pregnancies of unknown origin. Each time the doctors managed them expectantly ie. through blood work done every 48 hours. It was apparent that they were non-viable pregnancies as nothing showed on scans and the hormone levels were low. Would you have preferred me to sit indefinately with pregnancy tissue poisoning my body? But what you are saying is that I aborted those foetus’s. Correct me if I am wrong. I am normally a very open minded person who actually believes that God has helped me survive a horrific experience but your opinion and others around you are making me question my belief. I would just ask you to be aware that women who are going through this may find your strong view intimidating , confusing and mind altering. I am a strong person who IS struggling with the situation I find myself in and for a time today I questioned myself whether I had aborted 5 babies. Ludicrous! I can normally respect other peoples views – but I just can’t this time. What I do struggle with is the fact that you call yourself a Christian, yet seem intent on making even one person (me) feel so worthless and rotten. I do not want to play mind games here so this is my last word on the subject. I have nothing more to say.

  5. Debbie,
    I’m so sorry you suffered your loss – I’ve lost babies as well. The 5th birthday of our stillborn daughter would have been this Saturday and she is very much on my mind.
    But you misunderstand my post. Nobody here is accusing you of an elective abortion. Your tube ruptured; your baby was dead or actively dying, not just expected to die someday. You received necessary medical treatment and nobody killed your child.
    The practice in question is abortion as an automatic and preventative treatment in every case of ectopic pregnancy: killing the child because it poses a risk to the mother.
    What happened in your situation was nothing of the sort and I’m so sorry you took it that way.

  6. I have been considering the subject of murder all night (this article kept me awake most of the night) and here’s what I came up with: Murder is hateful, ugly, viscious and cold-hearted. None of those things I felt the morning I went in for surgery. I spent 7 hours after the pain began praying, crying out to the Lord for guidance (and a miracle). I remember laying in the bed waiting to be wheeled into the ER and asking God if what I was doing was right, and peace unexplainable came over me. I felt no condemnation from my Lord – if anything I felt His compassion on me as His hurting child. I know He was right there with me, holding me through it all. The only condemnation I felt was from a woman who felt it her place to show up at my house a week later and accuse me of having an abortion – all in the name of Jesus, of course.

    There will be those who disagree but I think of this as I think of the Pharisees accusing Jesus of “working” on the Sabbath. They took what he was doing (good works) and tried to use it against him, basing their accusations on their definition of “work”. If there are those who want to tell me I “murdered “my baby then that is their own interpretation. I know what happened, I know what the outcome would have been had I “waited”, and my Judge has not condemned me.

    Meredith – thank you for your clarification of Kim’s post. I read most of it as that as well, but I’m also reading her article as putting ectopic pregnancies as little more than an occurence for mild concern – which I’m sure she doesn’t mean, and I’m still reading a message of “let it rupture before doing anything”. When addressing a topic like this it is bound to raise some questions and strong emotions, particularly for those of us who’ve been through the sorrow of an ectopic pregnancy. To have gone through an ectopic and have the word “murder” used is horrifying and hurtful. Forgive me if I have read things wrong.

    OK, enough on my end. Off to kiss and cuddle my babes, and pray they never have to go through an ordeal like I did.

  7. Well put Margret, very well put.

  8. Margaret says:

    I wonder if people are misunderstanding. I didn’t read anything in Kim’s post saying that treating a ruptured tube would be wrong, or removing a *dead* baby was wrong. If the tube ruptures, the baby dies, that is not an elective abortion, but a miscarriage.

    What I got from the post was that given the numbers, we ought to be leary of jumping to abortion as the only option in an ectopic pregnancy, similarly to how we are finally realizing that jumping to a D&C when a heartbeat isn’t found at 6 weeks along may end up killing viable babies and ending healthy pregnancies. It may not always be necessary.

    I have always had a problem with pre-emptive abortion (“The baby’s going to die anyway, let’s get it over with”). I think this falls into a very tricky area ethically, but knowing that rupture doesn’t happen 100% of the time, and that rupture is not fatal to the mother 100% of the time, I would chose to take the risk in watching and waiting. I might camp out in the hospital parking lot, but I would wait. ;)

  9. A Person Who Has Made a Poor Choice says:

    Kim will know who I am by my email address but I do not choose to make that public.

    I have had an abortion – do I regret it, EVERY DAY OF MY LIFE. I was 18 and pregnant and I watched my mother hold a gun to her head telling me what an embarassment I was to the family and that if I kept that precious life she would kill herself. I knew she would and I was forced to make the decision between the two. Every year on my due date my heart aches, my daughter would be quite old now and it kills me.

    Would I have the wait and see approach had I not had that experience? It is hard to say because I have grown a rapid amount in my Christian life, all I can say is that NOW I would wait and see.

    Murder is murder. Regardless of cause and reason.

    Sin is sin.

    I know that I have a forgiven God and I also know that I have a just God who will deal with me for my sins.

    I do not think people understand the ramifications they will put on themselves by ending a pregnancy out of convience. And yes mine was out of convience so I have the right to say it.

    Before you attack me (whomever might feel necessary to do so), remember that you are not without flaws either.

  10. Lori,
    This is not a matter of opinion; this is a matter of how we apply God’s Word to our lives – in this case, the 6th commandment.
    We may come to different conclusions, but as Christians we must strive to make every decision upon the foundation of Scripture. If you and I don’t agree there, we will get nowhere at all.
    If we do agree, then your question about whether I’ve experienced ectopic pregnancy is irrelevant.

    But honestly, would you want to be held to your own logic? Do you have an opinion on the subject of murder? Have you ever experienced murder?

Trackbacks

  1. […] he know the side effects of the drugs he provides to his patients?  Besides skyrocketing rates of ectopic pregnancies, birth control pills and implants are known to cause abortions and birth defects.  They are known […]

  2. […] fully expected to receive some criticism for my post on Ectopic Pregnancy and the Sanctity of Life, and I felt the need to moderate with a heavier hand than usual since many of the negative comments […]

  3. […] June 11, 2008 by jaybyrd Definitely a must-read article. […]

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