The Texas law that prohibits abortions after about six weeks of pregnancy is based on a single premise disputed by many medical experts: that once an ultrasound detects electrical heart activity in an embryo, the heart starts beating and a live birth is imminent.
At this very early stage of a pregnancy, however, the embryo is the size of a pomegranate seed and has only a primitive tube of heart cells that send out electrical pulses and pump blood.
Language has long been a battleground in the political battle over abortion, and the sparring now revolves around a word of deep resonance: “heartbeat.”
Texas law, which makes no exceptions for rape or incest cases, prohibits abortion the moment a “heartbeat” is heard, which usually occurs after six weeks of pregnancy. The appeal is emotional: many expectant parents are moved by sounds during an ultrasound. But what the law defines as the sound of a heartbeat is not considered by medical experts to come from a developed heart, which forms later in pregnancy.
At least a dozen states have passed similar heartbeat laws that could be enacted if Roe v. Wade were overturned. At present, the Supreme Court appears to be leaning towards enforcing a Mississippi law that prohibits abortion after 15 weeks of pregnancy, effectively ending the right to abortion established by the Roe decision in 1973.
The potential seismic shifts have brought renewed attention to both the scientific underpinnings of these laws and the medical claims of educational materials that in many states must be given to women seeking abortions.
Opponents of abortion say women should be better informed about the possible consequences, even the unlikely ones.
“We really want women to get more information,” says Dr. Christina Francis, president of the American Association of Pro-Life Obstetricians and Gynecologists, who opposes abortion. “Women are intelligent creatures and can make powerful choices if they have all the information they need.”
But many medical associations and experts say the laws and state-mandated educational materials are based on deep misconceptions about embryonic and fetal development and abortion risks. For example, the Texas statute requires doctors to warn women that they have a higher risk of breast cancer or infertility if they have an abortion, despite a lack of evidence.
Women are told they can die from an abortion, although the procedure is generally considered safer than a tonsillectomy and much safer than pregnancy and childbirth. The materials also warn that having an abortion can make women depressed or suicidal, although studies have not shown this to be the case.
According to an analysis by the Informed Consent Project at Rutgers University, nearly a third of abortion statements made in patient material from more than two dozen states are medically inaccurate. Most inaccuracies relate to first trimester descriptions. They generally misrepresent certain body systems as being complete or present at earlier stages of development than they actually are.
“Laws written by non-medical people to regulate the practice of medicine, or dictate what clinicians should say to their patients, are dangerous and affect our ability to care for patients,” said Dr. Nisha Verma, a fellow at the American College of Obstetricians and Gynecologists, who has objected to the idea that a fetus has a heart at six weeks.
Indeed, the most loaded proposition, embedded in Texas abortion law, is that the fetus has a heart at that stage and that its beating is a “major medical predictor that an unborn child will achieve a live birth.”
This noise, detectable on an ultrasound, has become a demarcation line in anti-abortion laws in dozens of states, although most opponents of abortion rights argue that life begins at conception.
While there is little disagreement about basic developmental biology, there are sharp differences over its meaning.
The heart is one of the first organs to begin to develop, as the growth and survival of the embryo depend on the circulation of blood that carries oxygen and nutrients. The electrical activity begins after about six weeks in a tube of cells that will turn into a heart after several turns.
It will bend and loop and twist itself into an S shape. Thick pads of embryonic tissue will grow together to create walls, and a ridge on the floor of the ventricle will rise to meet them to divide the heart.
If all goes well, four chambers and valves will form by the ninth or 10th week of pregnancy, and the heart will continue to develop throughout the pregnancy. But the familiar “lub-dub, lub-dub” sound of a heartbeat is created by the closing of the heart valves, which don’t exist in the six-week-old heart tube.
For opponents of abortion, that is a distinction without a difference. “It’s a heart tube, but it’s still a heart,” said Dr. francis. “The shape is different, but that doesn’t change the essence of what it is,” she added.
dr. Robin Pierucci, a neonatologist affiliated with the Charlotte Lozier Institute, which opposes abortion, said in an email, “Finding a fetal heartbeat is a sign of health.”
A 2004 study found that when a moving heart tube could be detected after six to eight weeks of pregnancy, a live birth resulted 98 percent of the time, said Dr. pierucci.
But that study — which compared women who had lost previous pregnancies with those who had not — also found that heart activity did not lead to a live birth in one in five women who had lost previous pregnancies.
Most medical experts agree that the electrical activity seen on an ultrasound after six weeks is not the sound of a beating heart and does not guarantee a live birth. The sound expectant mothers hear during a scan is created by the machine itself, which translates the waves of electrical activity into something audible.
Doctors are partly to blame for the confusion. Many doctors whose patients are excited about a desired pregnancy will use the word “heartbeat” to describe the heart activity heard on an early ultrasound. The word has even crept into the medical literature.
“What you see and hear on an early ultrasound is embryonic activity — electrical currents sent through cells that will develop into a heart at a much later time,” said Dr. Gabriela Aguilar, an obstetrician-gynecologist and a former colleague at Physicians for Reproductive Health, which supports access to abortion.
In September, representatives of the ACOG, which supports the right to abortion, said at a Senate hearing that “while contemporary ultrasound can detect an electrically induced flickering of a portion of embryonic tissue at approximately six weeks’ gestation, structurally and in function, a The heart of the fetus develops throughout pregnancy.”
Heartbeat laws and other state measures designed to discourage abortion often require women to be warned about risks such as infertility and cancer. Healthcare providers are required to provide the material to patients even if they believe the information exaggerates the risks of abortion or is otherwise misleading.
The current Texas booklet offers two pages of warnings. Under the heading “Death,” the booklet informs women that the risk of dying from a legal abortion is 0.73 in 100,000, according to the Centers for Disease Control and Prevention.
Understand Texas Abortion Law
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The most restrictive in the country. The Texas abortion law, known as Senate Bill 8, amounts to an almost complete ban on abortion in the state. It bans most abortions after about six weeks and makes no exceptions for pregnancies resulting from incest or rape. The law has been in effect since September 1.
The paragraph does not say that the risk of death during childbirth is much greater. There are 17.4 maternal deaths for every 100,000 live births, and the numbers are even higher among some minority women.
At the same time, the most risky abortions are late, after 20 weeks of pregnancy. Still, the vast majority of abortions in the US — more than 90 percent — are performed within the first 13 weeks and pose little risk of death.
dr. Francis, of the group of anti-abortion doctors, said US statistics were incomplete, as state reporting was voluntary, and the risks could be greater.
According to the Texas brochure, “If you give birth to your baby, you are less likely to develop breast cancer in the future.”
The relationship between abortion, pregnancy and breast cancer is complex. Scientists have long known that women who are childless or have their first child after their 30s appear to be at a higher risk of developing breast cancer, a link that first came to light when the nuns developed high levels of breast cancer.
But most women who have abortions — 60 percent — have already had at least one child, according to 2019 CDC data. The current consensus from the National Cancer Institute, the American College of Obstetricians and Gynecologists and the American Cancer Society is that abortions not increase the risk of breast cancer.
In a section titled “Future Infertility,” women are told that late-term abortions carry a higher risk of death and medical complications “which could make you infertile” and “make it difficult or impossible to conceive in the future.” turn into”.
Infertility experts have rejected the claim. “There may be older data making this association, from when abortions were illegal” and women developed life-threatening infections, said Dr. Marcelle Cedars, president of the American Society for Reproductive Medicine.
But she said she was not aware of any research showing a connection. “I wouldn’t list infertility as a potential risk of abortion,” she said.
According to the Texas education material, women report “a range of emotions after an abortion,” including depression or suicidal thoughts.
But one of the largest studies of American women’s experiences who had had abortions followed them five years after the procedure and found that the most common emotion they experienced was relief.
“We found that refusing an abortion to women had more negative effects on their mental health than having an abortion,” said M. Antonia Biggs, an associate professor and social psychologist at the University of California, San Francisco, who teaches the mental health professional. health of women who have been refused an abortion.
Other research shows that women who have had abortions are not at increased risk for depression, post-traumatic stress disorder or suicidal thoughts, said Dr. biggs.
On the other hand, women who were denied abortions experienced higher household poverty rates, three times higher unemployment rates, a greater likelihood of dependence on public aid and a higher risk of food, housing and transportation insecurity, Dr. Biggs and her colleagues found.
Christine Mann, Texas Health and Human Services Commission press officer, declined to respond to questions about the state’s pamphlets.
Employees “review the booklet to ensure it is up-to-date, in accordance with state law, and contains necessary scientific and factual information to help women make an informed decision about their pregnancy,” she said in a statement. an e-mail.
This post Opponents of abortion hear a ‘heartbeat’. Most experts hear otherwise.
was original published at “https://www.nytimes.com/2022/02/14/health/abortion-heartbeat-debate.html”