Abortion debate thread

Morbert wrote: »

But if it is true that the husband was told this is "a Catholic country", then God help the pro-life movement here. They will need all the help they can get.

Context is everything. We are hearing an account from a grieving husband, whose first language does not appear to be English, over a crackly phone line from India.

I can think of several possible scenarios.

a) It could have been a bit of semi-racist Catholic triumphalism against a non-national. While I think this highly unlikely, if it were true I would sincerely hope that the person concerned would be fired and banned from ever working in medicine again in this country.

b) The comment could have been made by a bitter anti-Catholic (the kind of people who post regularly on A&A) airing their usual gripes against the culture and Church - "Ah, what do you expect in this priest-ridden Catholic backwater?"

c) The most plausible way I could see this happening (based on working for the last ten years with many non-nationals and visiting them in hospital) would be a simple conversation broadly along the lines of the following:
Consultant: We think the safest course of treatment is to let the miscarriage run it's course."
Patient: No, I want rid of the foetus now.
Consultant: I'm afraid that's not your call to make. You can't get that on demand.
Patient: Why not?
Consultant: Well, historically Ireland is a Catholic country and doesn't have abortion on demand.

Hopefully the investigation will reveal whether the Catholic comment was as bad as it initially sounds.

I might add that over the last few months I have had many conversations with many doctors and consultants due to my wife's continuing ill health. It has been immensely frustrating. Some have been rude, some have been bullies, and some haven't appeared to have a clue what they are doing. With the notable exception of one consultant who has explained things very well (possibly because I am also his pastor!) I have found their communication skills to range between poor and abysmal.

doctoremma wrote: »

I will remember, if I ever choose to spawn, to never visit Ireland while pregnant. It appears that presenting at a hospital with a life-threatening condition might not garner me the treatment I require. I hadn't really registered the potential reality of this situation.

ETA: just realised that my travel insurance might cover a medical flight home.

Are there any public records for frequency of abortions on the grounds of maternal health in Irish hospitals?

According to the WHO, as a pregnant mother, you will be 8 times as safe in Ireland as in the UK. http://whqlibdoc.who.int/publications/2007/9789241596213_eng.pdf

doctoremma wrote: »

Ah, but having not had access to the Irish health care system for my fertile years (or even just during pregnancy), it's plausible that I would be an outlier on any stats such as those you've posted. I could hardly expect to receive the majority of antenatal care in the UK, then visit Ireland for my annual homage to the family and suddenly become less likely to die from pregnancy-related factors over the course of a lifetime, could I?

I'm thinking of a sudden and unpredictable event, early eclampsia or something. I'm not sure I want to ask or know but would I be treated for that, even if treatment would (with full knowledge) cause the baby to die? I want you to say 'Of course, we might be rampant pro-lifers but we don't let women die' because that's what I thought the situation was. As of today, I'm actually scared of your answer.

Women die everywhere, sadly. You, as a doctor, should know that.

doctoremma wrote: »

Brilliant. Thanks for that. Very helpful. I'll take that as a tacit admission that there is a high likelihood that a termination would likely not be offered, even in dire medical circumstances.

You would be foolish in the extreme to take it is any such admission. Where in the name of God did I say anything that could be construed as that? :rolleyes:

doctoremma wrote: »

Ah, but having not had access to the Irish health care system for my fertile years (or even just during pregnancy), it's plausible that I would be an outlier on any stats such as those you've posted. I could hardly expect to receive the majority of antenatal care in the UK, then visit Ireland for my annual homage to the family and suddenly become less likely to die from pregnancy-related factors over the course of a lifetime, could I?

I'm thinking of a sudden and unpredictable event, early eclampsia or something. I'm not sure I want to ask or know but would I be treated for that, even if treatment would (with full knowledge) cause the baby to die? I want you to say 'Of course, we might be rampant pro-lifers but we don't let women die' because that's what I thought the situation was. As of today, I'm actually scared of your answer.

Doctoremma, eclampsia is treated with emergency c-section. I personally know two women in ireland who had this, in one case the child did not survive, in both cases the mother did. The section is carried out without question.

In this case, as far as I can tell, they did not expect the infection to occur, or the infection to kill.

doctoremma wrote: »

I find it immensely difficult to believe that a medical team will recommend a c-section for a pregnant woman with eclampsia at only 20 weeks gestation (it can happen). Do you think when the chances of fetal viability are nil, an abortion would be offered?

In the cases I mentioned, one was 29 weeks, and the other 24. I have never heard of a baby born at 24 weeks surviving, and even the 29 week one was extremely unlikely. Eclampsia is a different scenario to a miscarriage though. It is very clear cut. The woman will most certainly die unless the pregnancy ends with eclampsia. There are no two ways about it. The choice is clear.

Miscarriage usually does not end with the womans death though, and I suspect this is where the problem occured in this case. It was not obvious to the medica team that ending the pregnancy would save the woman, I would guess.

Having very recently had a miscarriage myself I am familiar with how we are treated in Ireland. They advise "Conservative Treatment" until there is evidence not to. Your body goes into labour and you deliver. I was told this is the safest option the time, and I expect they tell all women the same thing. The surgerical option to remove the fetus carries the risk of damaging the womb permanently, as it is 'blind', without cameras. There is a third option where you are given drugs to increase the intensity of the contractions and hasten it.

What I don't understand here is why these people were not given the options I was. Perhaps the doctors thought they could still save the pregnancy as there was still a heartbeat?

The "catholic country" thing also makes no senses to me. As a catholic surely leaving any woman suffer so badly is not showing any kind of christian care whatsoever. I think it was a horrific thing to say to someone, so I can only imagine it was said in anger or to stiffle the complaints of the husband, as PDN as suggested.

I have huge sympathy for him, he has lost both his wife and baby in one awful swoop.

doctoremma wrote: »

It must be a dreadful choice to make.

There was no choice, the pre-eclampsia symptoms were missed, the woman was in full eclamptic fits. Her heart stopped and was restarted, she has permanent damage to the wall of her heart and cannot risk another pregnancy, she lost her child, who was alive at the time, but she is alive herself.

Without wanting to undermine their experiences, I wonder (only wonder, not assert) if the decision by the medical team (with Mums' consents) to deliver was in any way tempered by the fact that the babies were at an age where they could possibly survive. I completely accept that at 24 weeks, the odds are heavily against survival but at 29 weeks, you're up to +90% survival with good care.

I can't say either way, but honestly I doubt it. With full blown eclampsia, they were guaranteed to to lose either both of them or one of them. Thank goodness one survived.

In my proposed scenario, where the baby would have zero chance of survival, the induction of birth might be considered as certain murder of said child. Do you think (and I appreciate it's speculation) that medics would be so quick to proceed with an induced birth or surgical 'abortion'?

As your proposed scenario is eclampsia, which is so clear cut, I believe they have no choice but to end the pregnancy, but I can't say for sure of course.

I agree with what you say re: miscarriage and an unpredictable outcome.

I am not sure the doctors thought the baby might hang on. As I understand, the miscarriage was deemed 'irretrievable' very soon after admission. From my point of view, heartbeat or not, prolonging the miscarriage unnecessarily was pointless and a very real threat to physical and mental health.

I know that is what the papers have speculated, but until all 3 reports are back, I am not sure how they can know it was irretrievable. I know with my own miscarriage, I was offered another scan straight away on another machine. To come back the next day in case the position was making a difference, anything at all just in case there was any way a heartbeat was there. They go to huge lengths to to confirm that there is no way the pregnancy can continue. (Which I was very glad of).

I've asked a medical colleague here in the UK how this case would have been dealt with (I am a scientist, not a medic, BTW). She has never known of an ERPC (evacuation of retained products of conception) to be performed while there was still a fetal heartbeat but her opinion is that it would not be considered or noted as an abortive procedure. That is just her gut feeling though (and, obviously, in the UK, there would be no problem if it WAS considered an abortion).

That makes sense, I am not sure why this is being linked to an abortion either. ERPC (or D&C in old terms) is not an abortion.