On June 24, the US Supreme Court overturned Roe v. Wade, by overturning the historic 1973 decision that protected a person’s right to abortion, the highest court in the country moved decisions on this medical care to individual state and local governments.
Some states have already passed laws restricting access to abortion. Now, without the federal protections provided by Roe v. Wade, other states are likely to follow suit. Many of these legislative efforts invoke medical and scientific language in an attempt to define when life begins.
Heart development, fetal pain, and vitality were all justified by the restrictions on abortion. But many of these logics are not in line with early developmental biology. There “Heartbeat law” Texas of 2021, for example, bans abortion after about six weeks, when heart cells start beating.
At that early stage of pregnancy, there is still no fully formed heart to beat. Like most aspects of biology, early human development involves many complex processes. Despite the rhetoric about these issues, the clear lines between having a heart and not having a heart or being able to survive outside the womb are few or nonexistent.
“There is no black or white on this issue”says obstetrician-gynecologist Nisha Verma, a colleague at the American College of Obstetricians and Gynecologists in Washington, DC. Here’s what is known about five key aspects of pregnancy biology that often emerge in abortion debates.
1. The early timeline of a pregnancy is easy to misunderstand.
This is because the way dates are determined is extremely confusing. The standard pregnancy clock actually starts ticking before a sperm encounters an egg, on average two weeks earlier. An ovary releases an egg around day 14 of an average 28-day menstrual cycle. (Day 1 is the first day of your period; day 1 is also when a pregnancy officially begins in the month an egg is fertilized.)
This means that when a sperm fertilizes an egg, a person she is already officially two weeks pregnant. As foolish as it may sound, it is the simplest way medical professionals can explain a pregnancy.
That timeline means that six-week abortion bans enacted in Texas, Oklahoma and Idaho go into effect earlier during pregnancy than many people think, says Verma. In 2020, she interviewed people in Georgia, where she was practicing medicine at the time, about their understanding of the times.
“Some people will say the six weeks are after your first missed period,” he says. “Some people think it’s from the date of conception.” Neither is correct.
The ban would begin four weeks after fertilization. Counting down, it’s two weeks after a missed period, which is often the first indication a person might be pregnant. Such bans leave a person very little time, two weeks after a missed period, to access abortion.
Also, these dates are based on averages. Many women have irregular menstrual cycles. Birth control is not 100% effective and some types can eliminate menstruation altogether, throwing even more uncertainty into the early pregnancy timeline.
2. Pregnancy requires more than the sperm meeting the egg.
That meeting, which usually takes place in one of the two fallopian tubes near the ovaries, is fertilization, a process in which two cells fuse and mix their genetic content, creating what is known as a zygote. But a fertilized egg doesn’t automatically lead to pregnancy, says obstetrician and gynecologist Jonas Swartz of Duke University School of Medicine. “Putting them on the same level does not make sense from a medical point of view”.
Up to 50 percent of fertilized eggs do not implant in the uterus, the researchers estimated. The genetic material has to combine in the right way. The growing ball of cells must travel to the uterus and implant in the right place. And the right hormonal balance must be baked to support the pregnancy.
“There are so many things besides the sperm meeting the egg that really matter for this to become a pregnancy that has a chance to develop further,” says Selina Sandoval, a midwife and gynecologist who specializes in complex family planning at the University of California, San Diego.
Lawmakers in some states are considering abortion rules that apply to a fertilized egg; Oklahoma had already passed such a law. This includes fertilized eggs that are deposited in the wrong place, such as the fallopian tubes. Call ectopic pregnancythis can lead to life-threatening medical emergencies when the growing tissue ruptures the tube and internal bleeding ensues.
“These are pregnancies that in no case can become a healthy pregnancy”says Sandoval. “In fact, if they are not treated and they continue to grow, they will kill the patient.” The laws that apply to a fertilized egg could “Limit our ability to treat patients for ectopic pregnancies”he claims.
3. Abortion and the “heartbeat laws” are not what they seem.
A Texas law prohibits abortions “After detecting the heartbeat of an unborn child”. But the rhythmic sounds heard on an ultrasound in early pregnancy aren’t caused by the opening and closing of heart valves as they move blood through the heart’s chambers, the movement that produces a typical lub dub sound. This is because those chambers have not yet developed.
In the first ultrasound, the sounds similar to the heartbeat they are created by the ultrasound machine itself. “What we are seeing is actually the primitive heart tube and the cells in that heart tube that have electrical activity that causes flicker.”says Verma. “The ultrasounds are actually producing that sound based on the electrical activity and the swinging motion”.
Use the term “heartbeat” to describe flickering makes sense in some situations, such as in conversations with excited future parents, says Verma. “I have cared for countless people who have seen that first ‘heartbeat’ on ultrasound for a desired pregnancy, and it is that moment that is huge and exciting”He says. “I don’t want to be dismissive about it.” It says that two things can be true at the same time: “It can be exciting for a patient. It is also not a scientific thing ”.
4. Fetal pain is difficult to define.
Some biology that is often used to limit miscarriages is the claim that fetuses (which form at week 11 of pregnancy) are in pain. “The pain is a lot complex”, Swartz says. “It requires not just a physical response, but the ability to suffer as a result.”
Knowing what a fetus feels is impossible, but brain development studies provide some clues. The experience of pain it begins with the senses detecting something harmful. Those signals must then travel to the cortex, the outer layer of the brain that helps interpret that sensation. In human fetuses, these brain connections don’t exist until around week 24 or 25 of pregnancy.
In guidelines written by members of the Society for Maternal-Fetal Medicine, the researchers write that these connections are necessary for the experience of pain, but are not sufficient on their own to conclude that pain is possible.
In human fetuses, these connections are not actually operational until week 28 or 29 about pregnancy, other studies suggest. “We can say with really, really good certainty that no earlier than 28 weeks it is possible to feel the pain”says Sandoval.
The vast majority of miscarriages, over 90%, occur in the first trimester, before the 13th week of pregnancy. The number of miscarriages after 24 or 25 weeks is “Incredibly small”says Swartz.
5. When a fetus could survive on its own is a complex medical calculation.
The word “vitality” it is often used as a net breakpoint to mark the age at which a fetus could survive outside the womb. The problem is that there is no clear cut.
“This has been a moving line as science has advanced and our ability to support very young children has advanced”says Swartz. “But it’s not even a fixed line for babies born now.”
On average, babies born between 22 and 24 weeks of gestation do not survive or survive with severe health problems. Whether a fetus will survive if delivered depends on a whole host of other factors, Swartz says. They include fetal sex, weight, developmental issues and the mother’s health, not to mention the skills and training of individual health facilities.
The American College of Obstetricians and Gynecologists recently removed the mentions of “Sustainability” in their guidelines on the treatment of abortion. “It is such a complicated concept that we cannot make general claims about it”says Verma. “It is something that must be left to the doctor who is treating the patient”.
Inaccurate descriptions of biology can influence the restrictions on reproductive health and, consequently, the health care people are able to receive, Swartz says. A colleague of his, for example, was unable to receive adequate medical care when she exhibited signs of a loss of pregnancy.
Due to state restrictions on abortion, her doctor decided to delay treatment, an emotionally distressing experience she wrote about in Obstetrics and Gynecology last year. Abortion norms based on flawed medical and scientific premises, Swartz says, “They prioritize a potential life over the actual life of the person sitting across from me”.
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