Make Pregnancy Safe Again

Make Pregnancy Safe Again

Richard Kessin

Perhaps the abortion issue could be framed another way: Could we not say: Make Pregnancy Safe Again? Better, perhaps, than Abortion is Healthcare, which must be explained. Besides, abortion connotes an end of something while a safe pregnancy does the opposite by implying a life to come. Does it cover every need of women? No, but it applies to most women and their families. When I started writing this column, the IVF issue had not begun, but I doubted that it had legs, but we could say, in the same vein: Let Women Be Mothers Again. Getting between a mother and her healthy child is not a place a politician wants to be.

In any pregnancy a lot can go wrong, from chromosome anomalies and heart defects to thousands of inborn errors of metabolism. Consider one of the most important causes of fetal failure and danger to the mother—ectopic pregnancies. In 2022 there were 3,661,220 babies born in the United States. Ectopic pregnancies occur in about 70,000 women a year, or almost 2% of pregnancies, according to The March of Dimes. None of these 70.000 embryos survive. An ectopic pregnancy occurs when an embryo cannot move down a Fallopian tube, usually because of a blockage. It burrows into the tissue, attaches to an artery, continues to grow for a while, and causes pain, nausea and other symptoms. It also can cause a hemorrhage leading to an abdomen full of blood.

Fertilization takes place in the upper Fallopian tube. For 6- or 7-days the embryos increase in cell number and move down the Fallopian tube to the top of the uterus. Meanwhile hormones from the ovary have been working on the uterus, which grows thick with special blood vessels and other adaptations to nourish the embryo. The endometrium is gloriously set up not to bleed, but to nurture, to supply oxygen and to remove CO2 while the embryo develops into a baby. We teach medical students with microscope slides and images and have them reconstruct what happens to support a baby’s growth over 9 months. It is challenging to envisage in 3 dimensions because it is so dynamic, and yet it so astonishing that over 30 years of teaching that has been one of my favorite classes.

Ectopic pregnancy is the leading cause of maternal death in the first trimester, especially in medically underserved communities where it is more likely to go undetected. Most ectopic embryos are found by ultrasound and disrupted with a drug inhibitor or surgery usually before 3 months. There are many other reasons that a pregnancy may be in trouble—the absence of a skull, in a recent example, or the failure of an organ to develop. Often the definition of viability is a heartbeat, which prevents intervention in some states. It is an archaic measure. Hearts beat when a fetus cannot survive. It is cruel to send a women to her car to wait for the fetal heart to

stop before terminating the pregnancy. (Did the hospital not have a bed?) There is no reason to risk a woman’s life or fertility. Why cause her children and husband this trauma? Why cause her physicians the despair of losing their patient? They are sworn to do otherwise. Many will decide to practice elsewhere, making the problem worse.

Many people know the story of Kate Cox, the Texas woman who was pregnant with her third child who had an extra chromosome 18. This syndrome, Trisomy 18, is well studied and is always lethal to the baby shortly after birth; it sometimes also results in rupture of the mother’s uterus and then hysterectomy. One would think that the Texas Medical Board would have defined exceptions before Texas passed their law, but they did not. The Texas Supreme Court rejected a lower court’s permission to end the pregnancy, on the grounds that Ms. Cox could not prove that a birth would harm her. They did, bless them, urge the Texas Medical Board to hurry up, which means defining thousands of different conditions. According to the report I read, Attorney General Ken Paxton felt it necessary to call Ms. Cox’s physician and warn her of the consequences if she helped Ms. Cox. She could lose her license, be fined $100,000, and spend the rest of her life in prkison. Seriously? Ms. Cox was at the President’s State of the Union Address, a voice of good sense.

What is to happen to the Ken Paxton’s of the world, people who cannot see the consequences of their impulsive actions? The story reminded me of Skipper Ireson, a whaling captain from Marblehead Mass. In my New Hampshire high school, we read Skipper Ireson’s Ride by John Greenleaf Whittier. Skipper Ireson was a whaling captain who went to sea and managed to wreck his ship. He sailed away in a small boat, leaving his crew on the sinking deck. All the men drowned, leaving wives and families bereft and in poverty. When he returned, Ireson was run out of town in a cart, “tarred and feathered by the women of Marblehead” in Whittier’s memorable phrase. There are now 20 women and two providers (perhaps more by now) suing the State of Texas. Their numbers will grow. I am not sure that they are bringing tar, but they are not going to put up with Ken Paxton.

Richard Kessin, PhD is Emeritus Professor of Pathology and Cell Biology at the Columbia University Irving Medical Center. Email: Richard.Kessin@gmail.com. Since 2010 he has been writing scientific columns with a rural focus for the Lakeville Journal in Connecticut, and The Berkshire Edge in Massachusetts. Richardkessin.com, a website, contains Body Scientific columns and articles on a variety of scientific subjects. His novel, The Leydig Virus will appear soon.