Stanek weekend question: Is treatment for ectopic pregnancy an abortion? Is it moral?
I received the following email this week:
Hi Jill,
I am unfortunately in need of some good insight.
My daughter is 30 and has wanted a baby for a long time. She finally got pregnant, but it was an ectopic pregnancy the doctors missed until she had to be rushed to the hospital. They did emergency surgery and saved the tube but took the “pregnancy.” As you can guess, she was devastated.
We now hear she is at a higher risk for another ectopic pregnancy. She desperately wants a baby, and we have all prayed so much for one. The problem is that if she has another ectopic, the way to treat it is to give a chemical to have the body absorb the baby. She feels that is killing it.
I have always felt life begins at conception and have taught my 5 kids this. But i don’t know what God would have her do in a situation like this. Is this treatment for ectopic pregnancy considered an abortion? Was it considered that when the doctors performed emergency surgery? Should she not try to get pregnant since there is a chance?
Your thoughts and advice?
Jill Stanek is a nurse turned speaker, columnist and blogger, a national figure in the effort to protect both preborn and postborn innocent human life.
An ectopic pregnancy is a miscarriage, there is basically no chance for the baby’s survival, and the mother’s life is in severe danger.
The treatment for an ectopic pregnancy is NOT an abortion.
An abortion intentionally ENDS a life. This treatment is intended to SAVE a life.
I don’t think that it is considered an abortion when a woman has an ectopic pregnancy. I have always thought that when this happens it is a life or death situation for the mother. An embryo, when it is in the fallopian tube, can never survive and grow there. It is a very sad time for her daughter and IMHO she did nothing wrong and neither did the Dr. who saved her life.
The Catholic church does not consider treatment for an ectopic pregnancy an abortion. The aim is not to destroy the child, but to preserve the life of the mother, and without treatment, both will surely die.
With every pregnancy, there is a 25% chance it will end in spontaneous termination. Does this mean no women should get pregnant, since a miscarriage might occur? No. We believe that God desires us to procreate, and that when control is out of our hands that He can provide and protect our little ones.
I am so sorry for what this woman went through. I can’t imagine the feeling of losing a child, and I will pray for her.
This article has excellent information on how to take a pro-life approach to ectopic pregnancies: http://www.prolifephysicians.org/rarecases.htm
When science catches up, the ideal situation would be to re-implant the developing baby into the uterus and allow the child to grow. If there were a way to incubate the baby outside the womb until replantation were possible, that would also be preferable. The action of removing the growing child from the fallopian tube is intended to preserve the woman’s life with the additional side consequence of the demise of the embryo. I believe the inherent consequence is no moral evil, although it is a sad result and reasonable efforts must be made to preserve the tiny life if at all possible. Embryologists, take note! Here is your opportunity to make a discovery and progress that will positively impact many human lives. What a wonderful contribution to society a scientist who figures out how to preserve this young young life would be making. God bless-
Have heart, I know 3 women who have had ectopic pregnancies, and the surgery to remove the fallopian tubes, and have all 3 had healthy full-term pregnancies afterwards:)
http://www.cuf.org/faithfacts/details_view.asp?ffID=57
Here is some additional information regarding the teachings of the Catholic church… I am not Catholic but tend to defer to them on issues such as these. It seems that there is some sort of consensus regarding appropriate treatment for ectopic pregnancy, and that removal of the tube or part of the tube is acceptable while direct removal of the embryo or medication used to dislodge or absorb the embryo are not permissible since it constitutes a direct attack on the child.
Ectopic pregnancies are very sad, but the only other outcome besides removing the baby is death of the mother, so it cannot be immoral.
That said, I do not believe that what this woman experienced was an “abortion” as it was definitely not her intention to destroy her child. Now that she knows she has a bit of a higher propensity toward another ectopic pregnancy, I think she should educate herself on all the options for treatment and make a prayerful decision regarding any future treatment that may become necessary… And I pray that it won’t be!
“removal of the tube or part of the tube is acceptable while direct removal of the embryo or medication used to dislodge or absorb the embryo are not permissible since it constitutes a direct attack on the child. ”
It is my understanding that that is correct, Sara.
My mother had an ectopic pregnancy when I was about three years old. It’s a devastating situation. While I sometimes wonder how my life would be different if my younger sibling were here, I know that there was zero chance of his or her survival. I agree with everyone else here who has said that this is in no way morally similar to abortion.
I had an ectopic pregnancy in 2006. I was treated by “expectant management”, where I had repeat ultrasounds to make sure that the baby died on his/her own and that things resolved on their own. I do have scar tissue inside the tube as a reult, and that tube has been blocked ever since. HOWEVER, God worked around that blocked tube and I have since conceived 6 children since then….three of whom were *not* miscarried (I am prone to miscarriage because of an autoimmune disorder…nothing to do with my ectopic as to why I’ve lost so many). So, have hope! God can and does work around things like this! And, contrary to many opinions, a mother does not ALWAYS die with an ecoptic pregnancy baby dying on his/her own.
Thanks for clearing that up, Lisa! I do think that most practitioners are quicker to actively treat an ectopic pregnancy because of the high risk of rupture and death. However, the management you received sounds like it would be a great option in certain cases!
try again for another baby, it doesn’t mean she will have ectopic again. Medicine to absorb the pregnancy if it is ectopic may not be healthy. If it is a new drug, do not use it, they never know all the side effects. Use surgery if it is ectopic again, but have faith in God, Worrying about what might not happen is so detrimental. This is all about true surrender to God. God Bless.
I don’t know that I agree with that, April. That a miscarriage and the removal of an ectopic pregnancy is the same thing.
And no the removal of an ectopic pregnancy is NOT considered an abortion. And although proaborts would like to lump miscarriage and abortion together as being the same thing, a miscarriage is NOT an abortion either.
I am so sorry for what this young mom and her family have endured. I believe in miracles. I am praying!! I also believe a prolife OB/GYN might be needed to help shed some light on the medical procedures that might be necessary. God love you.
This is the Catholic position. In a nutshell, under the principle of double effect, the only moral option is to remove the diseased tube. In doing so, your primary intent is to remove a diseased organ which has the indirect effect of killing the baby. Any other treatment constitutes a direct abortion on the baby itself, which is morally unacceptable.
I’m sorry, but i can’t believe that 25% of pregnancies end in spontaneous termination. That is not what I’ve read from professionals, including Bernard Nathanson. I lent his books out, but..
Gerard, Jill, do either of you know the actual statistics?
It’s permissible to remove the tube that contains the baby, but it is not permissible to remove the baby only while leaving the tube intact, because that would be a direct attack on the baby itself, whereas removing the tube with the baby in it would be a legitimate treatment in which the doctor is not intentionally attacking the baby.
It’s a bit confusing, but see here for the explanation: http://ncbcenter.org/NetCommunity/Page.aspx?pid=940
Actually, there are currently three approaches to an ectopic pregnancy:
1. Surgically remove the tube, and along with it the now-doomed baby.
2. Use chemicals to kill the baby in the hope that the tube at least will be spared.
3. Wait for it to resolve on its own.
#3 is actually not as reckless as it sounds. It’s called “conservative management.” Here is one study:
http://www.ayubmed.edu.pk/JAMC/PAST/18-4/07%20Dr%20Urooj%20Mehboob.pdfv
Seventy-one percent of women who chose conservative management safely resolved — though in all cases the baby did die. But the mother did nothing to deliberately cause the baby to die.
Women choosing conservative management must be monitored carefully for intervention in case of rupture.
So I would recommend spending a lot of time studying the medical literature and finding a doctor who is comfortable with, and experienced in, conservative management.
A terminoligy note: the “termination” of any pregnancy is clinically refered to as an abortion, so ending an ectopic pregnancy and removing it is technically an abortion. This is a far cry from the senseless killing of human beings carried out through legalized abortion on demand. A baby developing in a woman’s fallopian tube has no hope of survival. In life threatening cases the woman typically is not even aware that her pregnancy is developing in the tube until the situation becomes emergent and removal of that pregnancy and her fallopian tube is necessary to save her life. I believe other treatment was outlined in a previous comment describing how a known tubal pregnancy can be monitored until it spontaneously terminates, and can resolve without surgical intervention. Bottom line, when considering the moral implications of terminating a pregnancy, undetected ectopic pregnancies are one of the true instances of threat to the life of the mother.
I understand what it is clinically called. I would not tell women who have had ectopic pregnancies or D & C’s after a miscarriage that they have had an abortion. If it is written in their medical chart. Fine.
I have a friend who called me in tears before her surgery for an ectopic pregnancy, “Am I having an abortion?” She was near hysterics. Of course I said no. She was not paying an abortionist to deliberately kill her own child. The baby was removed and the tube left as it is the only fallopian tube she has.
It is not an abortion. It is an early birth. The truth is that in an ectopic pregnancy, there is no place in the entire universe where that baby is viable, no place that is not completely inhospitable to that baby’s life. If a person is standing on the surface of Mercury without a space suit, and you move him into space above the planet, nothing has changed — you haven’t murdered him. You’ve just changed his geographic position. But, if moving him thusly would save someone else’s life, then of course it’s the right thing to do. He will die in either location, no matter what you do — you cannot save him.
I know it’s a strange analogy. But, the fact is that the baby cannot be saved, no matter what we do (for now). The baby is going to die, and the mother is going to die. But, if you move the baby over a few inches or a foot to the side (outside the mother), tragically the baby is still going to die but the mother will live.
Later pregnancies happen (at 8 months, or 7, or 6) where the mother is dying because of complications in the pregnancy. So, we wait as long as possible to give the baby the best chance possible, and then we induce birth, and give birth to a live baby, and we thus save the mother’s life, and then we do whatever we can to help the baby live after its premature birth. Ectopic pregnancy is just an earlier version of this.
Abortion, on the other hand, goes into the mother to kill the baby inside her. Or, even more bizarre and dangerous, it induces a breach birth, but then stops in mid-birth (very dangerous to the mother) in order to intentionally kill the baby.
Dealing with an ectopic pregnancy is NOT an abortion. It is not murder. It is a very early birth in which we are unable to save the baby but we can save the mother.
If it were me, I would insist on better care than is “standard,” something that would at least give my son or daughter a chance. I’d sign what I needed to, pay what I needed to, and maybe I’d get a miracle (there are a few cases of children surviving ectopic pregnancies).
Some facts: There are rare cases of a child reimplanting somewhere better after a tubal ruprute, a section of bowel being an implantaion site that both mother and child could survive and the outside of the uterus being the one with the best shot of all (the uterus being made for this sort of thing). So reimplantation is possible. If the tube had already ruptured, and they can find the baby, and and the sac is intact, and the baby is alive, why not try to save her? Use something to hold her outside the uterus, or just cut a hole and stick her in–maybe she won’t reattach but at least she had a chance. If the tube is still whole, and the danger is tubal rupture, why not just preemptively cut the tube and let her grow? I’d rather sacrifice a tube than a baby. The tube could be positioned against the uterus so the placenta could grow into the richer blood source. Again, maybe it wouldn’t work, but at least I gave her a chance. I’m okay with being an experiment. Maybe it would help and one day one of these plans could be standard treatment for ectopic pregnancy. I also don’t believe the risk of death is great if the pregnancy is known to be ectopic and the woman is being closely monitored. I believe deaths occur in emergent situations; if the situation is known and being managed, even conservatively, help will be ready in the case of rupture or other complication.
I would never criticize a woman who chose to try to preserve her life or even her fertility. When the mother’s life is truly in danger, I am pro-choice on treatment which kills the baby. But I want research to find a real solution to ectopic pregnancy. Even if treatment which kills the baby is the only viable option currently, it’s still not good enough. Women and babies deserve better.
My sister-in-law had an ectopic pregnancy, and had complications afterward(not sure what, as she lives in Canada. I didn’t ask what the complications were), yet she went on to get pregnant about 6 months after, and had a normal, healthy pregnancy and baby(their third daughter). Well, perhaps their FOURTH daughter. We’ll never know what sex the baby was that she lost in the Ectopic Pregnancy.
I’ve had five miscarriages myself, but none were Ectopic.
Since (as has been previously stated) it’s not yet possible to re-implant a baby in an EP, there is NO CHANCE of the tiny one’s survival, and to leave it in place more than likely would kill the mother, OF COURSE removal of the baby is NOT considered an abortion. You’re not DELIBERATELY killing the baby just for the sake of killing the baby, but to save the mother. I only wish those situations didn’t present themselves, but we live in an imperfect world, things happen.
@Carla, What I meant was that the ectopic pregnancy ITSELF is a miscarriage, since the child does not survive.
The actual treatment is a life-saving procedure, not an abortion.
I am at a complete loss to understand why this is even a question. An untreated ectopic pregnancy can result in Fallopian Tube rupture. Having seen more than a few women arrive in the ER in horrific pain, diminishing blood pressure, and a darker shade of blue, believe me, this is nothing to take lightly. This is as absurd as asking if a hemorrhaging pregnant woman should be treated, even if it means certain death for her baby.
Vastly improved technology and diagnosis, which I have seen over my career, allows for early treatment(removal) and better preservation of the Fallopian Tube.
There is no chance of fetal survival and a great chance for maternal death. Technically this is an abortion but one that is essential to save a woman’s life. Sorry, but until technology advances, the ectopic fetus is doomed.
Hi April,
An ectopic fetus may be very much alive until such time as it is removed. The body is making no effort to remove it. I wouldn’t call it a miscarriage.
Furthermore, its not unusual, at least not anymore, for women to conceive and carry pregnancies normally after surgery for ectopic pregnancy removal. Years ago with diagnosis not being as advanced as it is now, women were often not diagnosed until rupture, or near rupture, often necessitating opening the abdoman and removing the tube.
Better and earlier diagnosis and vastly improved surgical technique better allows preservation of the Fallopian tube
The bottom line is that you can’t attack a baby, doomed or not, to preserve a fallopian tube. You can remove the tube with the baby inside and the baby’s death is a tragedy but you can’t attack a baby simply because he/she is going to die anyway. The loss of the tube is an additional tragedy, but not worth killing a child to prevent.
Hi Jacqueline,
I’m afraid I don’t understand your rationale. The baby isn’t being “attacked”. The surgery is being performed to prevent Fallopian Tube rupture, and protect the life of the mother. If you’ve ever seen a Fallopian Tube rupture you might have a better appreciation of how serious a situation this is. A woman with a blood pressure that barely registers if at all, who is turning blue from lack of oxygenation and must endure open abdominal surgery with blood transfusions and several days in the hospital leaves a lasting impression. There is no rationale for permitting this to happen. Early diagnosis helps prevent this AND preserve the Fallopian Tube as well for another pregnancy. Please keep in mind the ectopic pregnancy poses a threat to the life of the mother. This way you save one life instead of possibly losing two.
If religious conviction dictates, perhaps “expectant management” is an option. Perhaps. I would think this would have to be determined on a very individual basis and not applicable to all situations, like one woman I know who had twins in a one tube pregnancy.
With all due respect, Jacqueline, I agree with Mary here.
As someone who has had three ectopic pregnancies (25 years ago, 23 years ago and 20 years ago), I have very strong opinions on this topic.
With my first ectopic pregnancy, there was no option. I was bleeding internally and was rushed off to surgery. The doctors removed the baby from the tube and left the tube intact. With my next ectopic pregnancy two years later, the baby ruptured out the end of the tube naturally (more painful than labor) and three years after that, I nearly died from internal bleeding before the tube ruptured so we consented to have the baby removed while leaving the tube in place.
At the time, we trusted our faithful spiritual director, who told us the principle of double effect…that the removal of the baby from the tube was done to stop the bleeding and save my life. We were also trying to preserve my fertility.
I have gone through this three times and have walked acquaintances and others through this emotionally and physically painful experience. I have learned not to judge the choices of others who are put in a difficult position in which no choice is a good one.
In hindsight, if I knew then what I know now, I may have opted to have the entire tube removed, in order to lessen the risk of a future ectopic pregnancy.
For a more complete explanation, my husband, James, (who has no theology degree, but is an intelligent and faithful Catholic man), wrote the following article 11 years ago, when he was responding to another article on ectopic pregnancy:
http://www.domestic-church.com/CONTENT.DCC/20000501/ARTICLES/ectopic_response.htm
My husband and I are teachers of NFP, versed in the Theology of the Body and faithful to the magisterium. We have occasionally had to “defend” the one ectopic pregnancy choice we made in good conscience and with the advice of our spiritual director to remove the baby from the tube.
Women can go on to have healthy full term pregnancies after having ectopic pregnancies. However, the pregnancies are monitored carefully in the beginning to ensure the baby is in the uterus. Although I had three ectopic pregnancies (and four miscarriages), I am blessed to be the mother of five sons (ages 12-24). I am thankful to God that I was able to conceive and carry five babies normally.
Ellen Gable Hrkach, author
Hi Ellen,
No one can better describe or understand this terrible and heartbreaking experience more than someone who has been through it. You are so right, women may have very few options, or none at all in more emergent situations, and none of them in any way desirable. Thank you for your post.
I’m happy to hear of your 5 sons. You are truly blessed. Thankfully fertility can often be maintained. Years ago it was hit and miss, and the woman was more likely to be rendered sterile. Diagnosis and technology have definitely made a difference.
I know how bad a tube rupture is. That is irrelevant. I am not suggesting any woman die from an ectopic pregnancy. What I said was that there are ways to save the mother from that fate that don’t target and attack the baby- the baby instead dies as a tragic consequence of saving the mother. I said the same thing as every other Catholic, only I was more candid about it so that it is understood. YOU CAN’T ATTACK THE BABY.
Removing the baby from a tube to save the mother’s life is not immoral. The baby dies as a tragic consequence of saving the mother and the baby can’t be saved. This is the current state of medical technology. Removing the baby results in the baby’s death, but the baby is not intentionally killed. Note the word INTENTIONALLY. Attacking the baby with a chemical or other agent that intentionally kills the baby so the child will be absorbed is a different matter. The first is the patient who can’t live and will kill the other patient (the mother) being removed to save as much human life as possible while the latter is not a child dying as a consequence of medical care to save the mother’s life- the baby is outright killed in order to preserve the tube. Can you see the difference? Some would argue that since the child dies either way, we should preserve the woman’s tube. Yes, we should preserve our organs, but we can’t kill other human beings to do so. The ends don’t justify the means. My grandma is gonna die anyway, but I am not morally allowed to attack her because I need my inheritance now. We can’t outright kill people because they are otherwise going to die. Children dying in order to preserve the life of the mother is tragic, but we can’t kill children intentionally for any reason.
In cases where a mother has cancer and needs chemo and chooses to deliver her baby early- knowing that the child won’t be able to survive outside the womb- this is a different act that the woman having a D&E and attacking the baby to acheive the same ends.In the case of ectopic pregnancy- the child will almost certainly die, but that doesn’t give us license to kill that child directly. Yes, that would be an attack. Removing the baby in a manner that respects the child’s humanity but also protects fertility (if possible) is the correct way to handle this. Taking a drug designed to kill the baby is not okay.
So I was clarifying- taking a drug to kill the baby is not a morally acceptable treatment for ectopic pregnancy.
Oh my gosh! Mrs. Hrkach! I know some of your kids! I live in Dallas but I frequent Ottawa and the Ottawa Valley. We have marched for life together in the past 3 years on Parlaiment Hill.
It’s a small internet world!
Hello Jacqueline! That’s cool that you know some of my sons! Yes, it is a small internet world, indeed. God bless…
I know there are risks to surgery but I also believe these chemicals they want to give are very dangerous as well.
This question really hits home because when I conceived my son they originally thought it was ectopic. They were going to give me methotrexate. I had the same panic, being a pro-life woman… was this wrong? Would I die if I didn’t? I knew the baby was small but this was still MY BABY and I was incredibly upset.
Fortunately they just monitored me and finally at 5 weeks they saw my son in my womb, heart beating fast and furious. Phew!
Removing a baby in an ectopic pregnancy is not immoral. It is not murder. It is not abortion.
Late to this discussion, but with some comments to add.
Ninek, 25% is too high. I’ll dig out the numbers.
Following on Cristina and Nick’s comments…
The Catholic Church maintains a moral guiding principle called the “Principle of Double-Effect”. Read up on it here:
http://gerardnadal.com/2010/05/23/the-principle-of-double-effect/
Restricting the discussion to ectopic pregnancies where the baby is stuck in the fallopian tube…
In line with this principle, if the tube is rupturing, or about to rupture, the baby has grown well past the point where it could ever dislodge and make its way to the uterus. The baby is doomed, and so is the mother unless that tube containing the baby is removed immediately. The following link shows an 8-week ectopic pregnancy with the tube distorted to 5 cm (2 inches):
http://www.sciencephoto.com/media/294634/enlarge
There are two effects in this procedure. The first is the intended good effect of saving the mother’s life. The second is the evil effect, taking the life of the baby, and that effect must be unintended and a consequence of the removal of the diseased/damaged organ which poses an immediate threat to the mother’s life.
The wait and see approach mentioned by Cristina is the most morally prudent, as many babies dislodge and make their way to the uterus. Chemical procedures such as use of methotrexate to kill the baby in order to preserve the fallopian would not fall under double-effect as the mother’s life is not in immediate danger, and the baby is being directly targeted in order to preserve the integrity of the diseased/damaged organ. There is an open-ended question at the point of methotrexate use as to whether or not the baby will free itself. Thus, neither the baby, nor the mother are in immediate danger.
From my Church’s perspective, methotrexate or some other chemical is an abortion, compared to the photo linked above, where the baby happened to reside in a diseased organ whose rupture is about to kill the mother.
First let me say, given the statistical risks involved I would never denegrate a woman who chose to save her life by a medical procedure (actually *not* technically called an abortion as an abortion can’t reach into the fallopian tubes) in which the baby dies. The baby has a *much* higher chance of death and a *much* lower chance at life than does the mother, and it is well within moral guidelines to do something preemptive when an ectopic pregnancy is detected.
That being said I researched this extensively, spoke to several doctors about it, and read medical literature as well as watched documentaries on it, and my husband and I discussed it deeply before I got pregnant. Given quick access to a hospital the likelihood of a woman in otherwise good health dying from a ruptured ectopic pregnancy is low, below 20% was what was quoted to me by several OBs. Futhermore many ectopics miscarry without life-threatening bleeds (my own mother had one, she just thought it was a heavy period, went to the doc only due to prolonged spotting), some tiny minority will move during early pregnancy and successfuly reimplant. And a statistically insignificant but repeatable amount will actually be brought safely to term. The likelihood is miraculously remote, but healthy babies and healthy moms have come from ectopic pregnancies that went to term or near term. Given all that, my husband and I decided we could not in good faith agree to any treatment other than close monitoring until a rupture actually happened. I realize that puts my life in a comparitively large risk verses the miniscule chance that baby might survive to viability. But that risk, for me, is worth knowing I gave God and my baby every chance to be that 1 in 1,000,000 (yes, I know the odds are even less than that, it’s just a figure of speech, realistically it’s probably closer to 1 in a billion, but there are happy, healthy people alive right now who were born via c-section after an ectopic pregnancy).
The chemical used to end ectopic pregnancies is methotrexate. There are single dose, two dose and mulitidose regimens. All require monitoring of HCG levels to measure “success” Methotrexate kills the embryo by starving it of folate, thereby inhibiting DNA synthesis.
Sara and Bobby Bambino and others touched on the fact that this constitutes a direct attack on the human embryo, whereas removing part or all of the affected fallopian tube containing the embryo is more like any other medically necessary early delivery. The direct purpose in the latter case is not killing, but saving the life of the mother.
Methotrexate is used in an attempt to preserve a patent fallopian tube. It is used in some institutions where you might not expect it to be used, based upon the above discussed religious criteria.
The other difficulty is that methotrexate is also part of an abortion regimen. One might find it being used in institutions to end an “ectopic” pregnancy which isn’t really an ectopic pregnancy. (Abortions through the back door).
A patient might influence the means by which the ectopic pregnancy is treated, based upon their own beliefs and moral constraints. If the Ob-gyn is recalcitrant, find another doctor.
Certain forms of birth control are associated with increased rate of ectopic pregnancies.
Hi Jacqueline 9:18PM
Tubal rupture IS relevant here and every effort must be made to prevent it. Certainly after hearing of Ellen’s experiences you have a better appreciation of that fact. I have seen tubes very near rupture, actually leaking, with the fetus still alive. You would suggest what? Take out the tube and limit the woman’s fertility? What if its her last tube? Or would you agree to surgery to remove the fetus with every effort made to preserve the woman’s fertility? Either way the fetus dies, either is an “attack” that will kill the fetus. Some fetuses have even been alive after rupture. Sorry Jacqueline but there’s no nice way to get around the fact a fetus dies. Its a tragic no-win situation.
Hi Gerard, 10:51PM,
Thank you. You have helped illustrate the seriousness and limited options of this situation very well. Thankfully a tube may not have to be removed, laprascopic surgery may enable the surgeon to remove the fetus and preserve the mother’s tube, though this is not always the case.
The other disadvantage of methotrexate is sometimes, there are heterotopic pregnancies–one baby in the womb, one baby in a tube–and the ectopic pregnancy is detected first. Methotrexate kills both children.
“The wait and see approach mentioned by Cristina is the most morally prudent, as many babies dislodge and make their way to the uterus.” I agree this may be the most “morally prudent,” but with all due respect, Gerard, “many babies?” Just wondering where you get this estimation that many babies will dislodge and make their way to the uterus. I hoped and I prayed, even while I was in extreme pain and hemorrhaging internally that that would happen. (It never did).
In terms of “wait and see,” with my third ectopic pregnancy, I was the mother of three small children. The doctors pushed for surgery immediately and we waited to see if there might be any possibility the baby might move or that he was perhaps in the uterus. The doctors told me that there was ZERO chance of “it” moving. (But we believed in miracles…) They gave me a blood HCG measuring test to see if the HCG was doubling every few days (which it would in a normal pregnancy) and it was not. Later, I fainted and was rushed to the hospital. In the ambulance, my blood pressure was barely detectable. Later I questioned whether the wait and see approach had been the right one for me, given the fact that I nearly died while “waiting and seeing.”
Jespren, while the statistic may be 20% now (and I still find this a high percentage), at the time of my ectopic pregnancies many years ago, there was a much higher chance of death. I did in fact nearly die as the result of complications from my third ectopic pregnancy. BTW, after this third ectopic pregnancy, ALL of my doctors told me NOT to have any more children and urged me to get my remaining tube tied. We refused and instead used NFP for a year. After consulting with our faithful spiritual director and a faithful Catholic doctor (hard to find up here), we eventually decided to be open again. This was not a decision we made lightly. We prayed a lot over the next year, but decided to be open and eventually had two more sons. I know we could have morally avoided pregnancy using NFP permanently, but James and I both felt God calling us to be open. And I’m extremely grateful that we listened to His call.
Just wanted to share my experiences as someone who has gone through three ectopic pregnancies.
Hi Ellen,
You again illustrate the seriousness and unpredictability of these very tragic situations and the painful and inevitable decisions that must be made. You do not owe anyone any explanations. You faced life and death situations. Some women will go to 10 to 12 weeks before rupture, some 4 weeks. Early diagnosis and technology may give some women some options, or absolutely none at all.
I will mention that the years of ectopics that I have been involved with were in Catholic hospitals. Every effort is made to preserve the woman’s fertility if possible, which means removal of the fetus from the tube, whether it is living or not.
Hi Ellen,
My children are in dance recitals all weekend, and I’m just seeing your response and being shown the clock by three anxious performers. I’ll be brief now, and then able to respond in full later tonight when we get home.
First, I’m sorry for your lost babies. I cannot imagine that sort of suffering, et I’m overjoyed that you had the successful outcomes that you have had with NFP. As to your query about percentages of spontaneous resolution, they have been generally promising, with as many as 57% in one study dating back to 1955. From one web source:
Conservative surgical treatment of ectopic pregnancy is well established, and laparoscopic salpingostomy is the preferred operative method in unruptured cases. Nonsurgical therapy for ectopic pregnancy, however, may prevent undesired postoperative adhesions that often result from surgical manipulation of the fallopian tubes.21 Despite the theoretical benefits of medical management, the notion that early tubal pregnancy disruption without surgery will ultimately increase fertility potential remains speculative.1 This section considers the current roles of expectant, medical, and surgical management of ectopic pregnancy.
Observation
Some patients with ectopic pregnancies undergo spontaneous absorption and require no therapy.22 In 1955, Lund23 reported on 119 women with unruptured tubal pregnancies who were treated with bed rest and frequent observation. Of these 119 patients, 68 (57%) were eventually discharged from the hospital without operation, but 60% required hospitalization for more than 1 month. The remainder required operative intervention for tubal rupture or worsening clinical course.”
Get the rest here:
http://www.glowm.com/resources/glowm/cd/pages/v1/v1c068.html?SESSID=hjnf2efpnroc4ltotvr5gvdng0#pro
What you should be careful of in using your own experience as a benchmark is that there are several causes of ectopic pregnancy, and any particular one, coupled with its severity in that particular individual will have a great deal of influence on a positive or negative outcome. There are women such as yourself who never spontaneously resolved, while others will have three, four, five ectopic pregnancies that will. That’s where the power of statistics comes in, as it takes into account the broader population.
Hi Gerard and thanks so much for the response and for all the helpful links. I was responding to your comment that “many babies dislodge and make their way to the uterus.” That to me sounds unusual for the baby to move to the uterus. I was not commenting or questioning that many ectopic babies do dislodge on their own and expel out the tube. I myself know that it’s not unusual because one of my three ectopic pregnancies did expel out the end of the tube. However, this was much more physically painful than the other two ectopic pregnancies which had to be surgically removed…
As well, I recognize that my experience may or may not be usual. Given that my ectopic pregnancies took place many years ago, I realize that some of the treatment options may be different than what was offered to me back in the 80’s and 90’s.
Thanks again!
I suffered 2 ectopic losses. The first was discovered 3 days after my tube had ruptured. The blood filled my abdomen and put pressure on my heart and lungs and other internal organs. It felt just like labor with the pain coming and going in waves. I was taken by ambulance to the ER where they did emergency surgery. They took most of my left tube and a “10cm mass” with “no fetal tissue”.
Apparently (as it was explained to me at the time) ectopic pregnancies often end LONG before they are discovered, with the baby being reabsorbed into mom’s body, but the rest of the pregnancy tissues may keep developing and growing and that’s what causes the pain or rupture. They said it’s actually pretty rare for a tubal baby to survive past 4wks.
My second was similar but since I was at “higher risk” for another ectopic, they kept an eye out for it and saw it early. We did conservative treatment and waited for signs that the pregnancy was ended before doing anything about it. They said, “If you have any pain AT ALL come in RIGHT AWAY.” and I did. Again, the baby had died and been reabsorbed before but the tissue had continued developing. “6cm mass” And it was in the same tube. It hadn’t ruptured yet. They removed the rest of the tube.
Here’s a pic of that surgery! (graphic??)
http://i74.photobucket.com/albums/i251/sioko/surgerypic.jpg
Because I have experienced it twice, I feel I am prepared for another if it happens. I know the pain of a burst tube. I would choose to wait for the pregnancy to end naturally again. I agree with not using methotrexate or attacking the baby directly. I believe the tube should be removed with the baby or pregnancy in it. If it happens again it will likely be in my last remaining tube. I would not trade my baby’s life for what remains of my fertility. I will wait. And what happens will be God’s will.
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I would like to tell the lady that wrote this letter and her daughter that I am very sorry for their loss. No, you didn’t have an abortion and don’t let anyone try and tell you that you did. The principle of double effect is not strictly a religious term, but also medical. Like when chemotherapy is used to treat cancer. It kills the fast growing cells of the cancer, but the double effect is it is highly poisonous and may kill the patient. They do it anyway in the hopes that the cancer dies first. Double effect, killing and saving at the same time. You wouldn’t say the oncologist is “murdering” his patient while administering the chemo drugs would you? So also the OB doesn’t “murder” the baby when he removes her. The dif. between this and abortion is: if there were anyway to save the baby, it would be tried with all gusto! So don’t despair. This is a sad tragedy, and no ones fault.
Try again. Be prepared for the worst, but hope for the best! With God all things are possible. My fave. verse during the 5mo I had my 2 ectopics:
Jeremiah 29:11
For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.
So however bad it seems, God has a plan for us that includes this experience and it is a plan to give us HOPE and a FUTURE! A GOOD PLAN! God bless!
Whether you call it “abortion,” treatment of an ectopic pregnancy by methotrexate is the moral equivalent of an abortion.
This is why we distinguish between direct abortion and indirect abortion. direct abortion is the direct willing of the child to be dead, as the end and the intention. Direct abortion is always intrinsically evil. Indirect abortion results when one must treat a disease or diseased tissue-the affected tube-that must be treated or it will threaten life. The child dies as an indirect result of the treatment. this is not willed, or the intention, of the patient, but the unintended result. Unfortunately, the mother may not feel this way. She must let go of the guilt as there may not be any other options for her. A baby is highly unlikely to survive in a tubal pregnancy.
Seriously? How is this different from having an actual abortion to save the mothers life? How many times have pro-life supporters said ” life begins at conception”? If you are all ok with a mother terminating an ectopic pregnancy, you should be ok with terminating any pregnancy that could harm the mother.
Brandy, there is no occurance that happens in human biology that requires and “abortion” to save a mothers life. There are rare but real medical issues where delivery of the baby is immediately necessary to save the life of the mother. Other than the drug regimen, which you note most of us have been against, treatment for ectopic pregnancy removes a *live* baby that, unfortunately and despite the best medicine currently has to offer, will die. This is the same circumstance as a mother and child who get pinned in a car crash: the mother is reachable but to reach her the baby will die, but there is no way to reach the child regardless (no current medicine that can save the child) in saving the mother, the UNINTENDED consequence is the child dies, which is completely different that if rescue workers reached in with a gun and shot the trapped and doomed child. While the outcome, death child live mother, one if unfortunate but morally acceptable, the other is murder.
Other than ectopic pregnancy, pregnancy issues that put the mother in real, mortal danger almost always (within their incredibly rare occurances) happen in later pregnancy, near to or past viabilty. terminating *the pregnancy* is absolutely ok when continuing it will cause the death of the mother. But that’s no reason to terminate the *child*. Induced labor or emergent c-section is faster and safer for the mother than a late term abortion (which can take up to 3 days), and births the child alive, to live or die on his own, wether he will or not varries greatly, but the baby’s life is not TAKEN it rather MAY BE LOST.
As for ‘any pregnancy that harms the mother’, the term ‘harm’ is so broad as to be ‘reason’ for any elective abortion. Which is one of the ways we got in this mess to begin with. Saying a woman can (and should) end the pregnancy when she is in mortal harm is not even in the same world as saying a woman can end the life of her baby anytime she preceives some ambiguous ‘harm’ to herself.
Look at this miracle baby BOY who survived an ectopic pregnancy! http://www.themoneytimes.com/featured/20110530/039miracle-baby039-born-outside-womb-alive-and-well-id-101701710292.html
“Following the normal protocol, doctors advised Soto to terminate the pregnancy because of the threat it posed to both the mother and child.”
“Dr. Rodney Edwards, one of the medical team involved in the delivery, stated, “This is just a case that proves, in medicine, nothing happens ‘always’ or ‘never.'”
Thank God for his mother’s courage, when most doctors would have “treated” the “pregnancy” much differently! I wish my ectopic baby could have survived, but he/she was further in my tube and died on his/her own.
Isn’t termination even more dangerous to the child? Probably just poor wording, but I have never gotten the “kill the little bugger before he dies” argument.
YCW,
What do you suggest when the tube is leaking and about to burst and the ectopic fetus is very much alive? I have seen it more than once. Sadly the “little bugger” will be killed before he dies.
Hi Lisa,
I have seen women “hold out” on ectopic pregnancies to the point of endangering their lives out of desperation and hope. Its very devastating when this is a much wanted and planned baby. For one woman I know her ectopic pregnancies occured after years of infertility and treatment. No one wanted a baby more desperately than she did. She held out to the point of endangering her life, and never would have a baby.
The example you mention is an exception, a very happy one that I wish more women could enjoy. By your own situation you illustrate how these are very individual cases and situations and must be treated as such. Yes the woman held out and had a happy outcome, but her decision could also have been fatal.
Mary: That was in reference to the general pro-abortion philosophy regarding children who are disabled and likely to die, not ectopic pregnancy in particular.
Why not just cut open the tube so it would not rupture? Why not remove the embryo and put it in the uterus? Probably wouldn’t work, but the baby would have a chance. Why don’t doctors try something that might give the baby a chance?
I agree with YCW in that if there is a way to save the baby it should be tried. I hope they ARE researching ways to transfer or save the baby. All of your ideas I also considered after my losses. I would have agreed with them attaching the tube and baby/pregnancy to my uterus to save baby even if it meant losing my womb. But that wasn’t God’s will at the time, and in His time He gave me my youngest (in my icon <3 ).
I have HOPE that they are working on this, and that in the perfect time God will allow a break through and no more lives will be lost in this way! All good things are from above! <3
Hi YCW and CH,
I support every effort being made to save the baby but unfortunately this is more often than not a situation totally out of our control. That isn’t to say that technology may not one day advance to the point where a baby can be saved. In my own lifetime I have seen great advances in the diagnosing and treating of ectopic pregnancy.
40 years ago Josie Duggar would have only been given “comfort measures” in an incubator as the technology to care for her did not exist or was in its earliest stages.
YCW, since we were discussing ectopic pregnancy, I made the mistake of assuming that was what you were referring to.
That’s understandable, Mary. I do understand why ectopic pregnancy is treated as an emergency.
I had (2) etopic pregnancies, one in each tube while trying to have my first baby. Luckily I had a very talented and progressive doctor (for that day) He didn’t have the medical advances that we do now, used what he had – an ultrasound showed the etopic – but he wanted to ”save my tubes” because I wanted a child. Can’t get behind these Catholic beliefs, old religion run by old men. I was heartbroken that my pregnancies didn’t work out, and I don’t have any doubt about the morality of the surgeries. I had two boys, now 26 & 22 yrs old. I support a women’s right to choice.
a woman’s “right” to “choice” her child to death is quite different than a woman getting surgery for a life-endangering condition which will cause her child’s death anyway. It’s deplorable of you to try and excuse the elective and willful killing of a child by using an instance of life-threatening condition.
My comments had to do with various “catholic” explanations that somehow is was “only ok” if you removed your tubes – of course the ectopic pregnancy would have no where to go and would not develop – if somehow that was even close to a reasonable discussion. In addition, you could wind up with no children. My doctor saved both of my tubes, and I am thankful as I now have 2 wonderful sons. It was my right of choice to continue with trying to have a baby, with the possibilities of having more ectopics, which did happen. I thought about it a lot, examined my beliefs. I don’t believe morally that I “killed a child”, and even if I had an abortion that early on, would have felt the same. Not a “deplorable excuse”, but insight based on my “real life” experience, my belief, my choice, my right, as I believe every individual has those rights.
Well, a child lost his/her life every time, regardless of how you feel about it, but I wouldn’t hold it against you personally, since the child was going to die, anyway.
However, I profoundly disagree about your statement of “every individual should have those rights anyway”, since the most fundamental right is the right to live.
What we disagree on is that is wasn’t a child that was lost, and that is my belief. What was lost was the potential of a child. Besides myself, there was no “individual” to have rights. If it is about killing a child that is one’s belief than any woman who has had an ectopic should not consider trying to have children, because most likely it will happen again. Same as for miscarriages – those who continually have them are putting a “child” at risk, so they should stop. So at some point, if a woman feels that they have lost a child (and not just the potential of a child) at an early stage, then there must be some sort of major rationalization/justification going on in the pursuit of having children, when it is known that “killing a child”, maybe “many children” will most likely happen during this process.