Ectopic pregnancies, miscarriage: Abortion is ‘never necessary,’ these doctors say

A pregnant woman caresses her stomach as she and other young mothers gather at Immaculate Heart of Mary Parish in Buenos Aires. (CNS photo/Enrique Cangas)

WASHINGTON (CNA) -- Abortion — a procedure with the sole or primary intent and purpose of ending human life in the womb — is never medically necessary, according to medical experts.

Three doctors spoke with CNA about the necessity of abortion, or lack of it, following the Supreme Court’s recent decision to overturn Roe v. Wade, which legalized abortion nationwide in 1973. Following that decision, several myths circulated its impact, including the claim that women will die without access to abortion in cases of ectopic pregnancies, miscarriages, and other dangerous situations.

In these situations, medical experts either call abortion irrelevant or emphasize that women can choose life-affirming alternatives.

Abortion, they say, is “never necessary” while caring for both mother and baby. Understanding this begins with understanding what abortion is — and is not.

What is 'abortion'?

Procedures used to perform abortion are not abortions in and of themselves. The definition of abortion includes intent and purpose.

Dr. Kathleen Raviele, an OB-GYN and the former president of the Catholic Medical Association, the largest association of Catholic individuals in health care, called abortion a “direct attack on an embryo or fetus by surgery or chemicals with the intention of ending the life of the baby.”

Dr. Grazie Pozo Christie, a radiology specialist and a senior fellow with The Catholic Association, an organization dedicated to defending religious liberty, life, and the Church in the public square, also pointed to the importance of intent.

Abortion, she said, “colloquially means the purposeful ending of a human life.”

Dr. Donna Harrison, an OB-GYN and the CEO of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), cited the definition that she said is used by a majority of state laws.

Abortion, or elective abortion, here, “is defined as any drug, device or procedure used to terminate a pregnancy for the primary purpose of ensuring the death of the human being in utero before, during, or in the process of separation of the mother and her embryo or fetus,” she said.

Is abortion ever necessary to save a woman’s life?

Dr. Christie said that abortion, defined as the purposeful ending of a human life, is “never medically necessary.”

“In certain circumstances, lifesaving treatment that involves the early interruption of a pregnancy may be indicated,” she said. “In this case, the intent is not to end the life of the baby but to save the mother, and this intent is manifest in the fact that a physician would make every effort to preserve the life of a preterm baby where possible.”

Likewise, Dr. Raviele stressed that an abortion “is never necessary to save the life of the mother.” And, she added, a large majority of abortions are “for convenience” rather than life-threatening situations.

According to the Guttmacher Institute, just 7% of women cited their physical health or the problems affecting the health of their unborn baby as their “most important reason” for an abortion in 2004.

For her part, Dr. Harrison called attention to the difference between elective abortions — or abortions induced for no medical reason — and the separation of the mother and her unborn child to save the mother’s life.

“It's not semantics. It's human rights,” she said. “It's the difference between doctors making difficult decisions to save both patients if possible or at least to save one as compared to abortion providers taking it upon themselves to end the life of their most vulnerable patient for no medical reason.”

Do women need abortion for ectopic pregnancies?

Ectopic pregnancies occur when an embryo implants outside the uterus or womb, usually in one of the fallopian tubes. Once implanted, the embryo’s growth is likely to rupture the fallopian tube.

Ectopic pregnancies are life-threatening for the mother and the baby’s chance of survival is highly unlikely. While relatively rare, the rate of ectopic pregnancies may be as high as 2% of all U.S. pregnancies, according to data available from the CDC.

Dr. Raviele said that, by the time an ectopic pregnancy has been identified, the unborn baby is dead in 90% of the cases. In this situation, any of the three treatments currently available — salpingectomy, linear salpingostomy, or treatment with methotrexate — are allowed, she said.

A 2014 article published by the Catholic Health Association of the United States describes these treatments.

A salpingectomy is a surgical procedure where a doctor partially or entirely removes the fallopian tube housing the embryo. With a salpingostomy, the doctor cuts into the fallopian tube and removes invasive trophoblastic cells and damaged tubal tissue, which, in the process, also removes the embryo.

Methotrexate, a drug commonly used to treat cancer, prevents trophoblastic cells (cells that help with embryo implantation and make up a part of the placenta) from continuing to divide and stops the growth of the embryo.

If the unborn baby is alive, Dr. Raviele pointed to the option of a salpingectomy.

“If the criteria are present that would indicate a live embryo is present … then removal of the tube with the embryo present in it is moral by the Principle of Double Effect,” Dr. Raviele said. “Your intention is to remove the damaged tube, not to kill the baby.”

A 2018 article co-written by Dr. Harrison explains this Principle of Double Effect, found in Catholic moral theology and often attributed to St. Thomas Aquinas, who drew from Aristotle.

“In general, this principle asserts that an action directed toward a good end (e.g., a medical intervention designed to save the life of the mother) can be licitly conducted, even when this action has an unavoidable secondary effect that is not good (e.g., the death of the fetus),” Dr. Harrison wrote with Maureen L. Condic, an associate professor of neurobiology and anatomy at the University of Utah school of medicine.

Three criteria must be met: The act itself must not be unethical; the intention must be to achieve the good effect and not the bad effect, and the good effect must outweigh or at least equal the bad effect in ethical gravity.

The article adds that a “central requirement” of the principle is that the bad effect, or the baby’s death, cannot be how the good effect is achieved.

Dr. Harrison told CNA that the treatment for ectopic pregnancy has nothing to do with abortion, calling them “completely different procedures.”

“While abortion aims to end the life of the fetus or embryo, treating an ectopic pregnancy requires removing the embryo through surgery (salpingostomy) or medication to save the mother's life, with the death of the preborn child being a tragic but inevitable side effect,” she said.

Do women need abortion for miscarriages?

Roughly 10-25% of known pregnancies end in miscarriage, according to CDC estimates. Dr. Raviele said that a woman generally begins bleeding, indicating that she is going to miscarry, after her baby has already died.

“If an ultrasound is done and detects a fetal demise but the patient is not bleeding, it is considered a missed ab,” she said, referring to a “missed abortion” where the baby is dead but remains inside of the mother. “If she does not pass the products of conception in a reasonable length of time, a D&C [dilation and curettage] may be necessary or she may be given misoprostol to facilitate contractions.”

While D&C or misoprostol can be used in abortions, they are not considered abortions in this case, because the baby is already dead.

Dr. Harrison added: “In a miscarriage, the baby has already died of natural causes, and the aim of any procedure to treat the miscarriage is to help the woman's body pass the baby and any other pregnancy tissue.”

In contrast, with an elective abortion, “the baby is alive, and the goal of the procedure is to end its life,” she said.

Do women need abortion for other life-threatening situations?

The American College of Obstetricians and Gynecologists (ACOG) says that women need abortion in certain cases to avoid death — or that certain complications or conditions “may be so severe that abortion is the only measure to preserve a woman’s health or save her life.”

In response, Dr. Raviele said that ACOG is “contributing to misinformation” and described what would happen in a life-threatening situation.

“If the woman has a serious complication of pregnancy and has to be delivered, you would either induce labor (pre-eclampsia or a cardiac condition) or you would do an emergency cesarean section to save both the mother and the baby,” she said, emphasizing that babies can survive outside the womb as early as 22 weeks.

“You never have to kill the baby to save the mother,” she concluded. “We try to save both.”

Here, Dr. Harrison said, “ACOG is conflating different old definitions of abortion to deliberately obscure the fact that an elective abortion is specifically designed to end the life of the human being in the womb for no medical reason.”

She repeatedly stressed that the separation of a mother and her unborn baby to save the mother’s life is not the same as an elective abortion.

“Sometimes, women face life-threatening complications … in which the only way to save their lives is to separate them from their preborn children,” she said, providing the examples of ectopic pregnancy, severe preeclampsia, chorioamnionitis, and HELLP syndrome.

“In the case of an ectopic pregnancy, this involves removing the embryo from the woman's fallopian tube,” she said. “In the case of the other complications listed, it involves prematurely inducing labor or performing a C-section.

These “lifesaving procedures” are not abortions, she said, because “they do not have as their primary purpose to kill the preborn child in the process.”

“In fact, in many cases, the added goal of killing the child would prove counterproductive if the woman is facing a health emergency, as it takes up to several days to prep the mother's cervix for a late-term abortion, whereas a C-section can be completed in less than 30 minutes,” she added.

What does the Catholic Church say about abortion?

The Catholic Church teaches that abortion is “never permitted,” according to the “Ethical and Religious Directives for Catholic Health Care Services,” published by the United States Conference of Catholic Bishops (USCCB).

The U.S. bishops go on to define abortion as the “directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus,” or a baby who can survive outside the womb.

A Catholic woman is allowed to undergo life-saving treatment — even if it means that her unborn baby will die indirectly as a result of that treatment, according to the directives. The intention and action, in that case, are to save the mother’s life. It is not to end her baby’s life through abortion.

“Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child,” the directives read.


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