Roughly 10 percent to 20 percent of known pregnancies end in miscarriage, and one in 50 pregnancies will be diagnosed as ectopic pregnancies, a potentially fatal condition in which an embryo develops outside the mother’s uterus.
Both miscarriage and ectopic pregnancy can be physically and emotionally painful. For Christians who believe human life begins at conception, losing a baby even early in pregnancy is a singular kind of grief. There are ministries for families suffering miscarriages, and many churches hold funerals or memorial services for babies who have died before they were born.
But miscarriages and ectopic pregnancy removals aren’t merely a spiritual matter. They also have a clinical term: abortion. Miscarriages are described in medical language as “spontaneous abortions,” while the removal of an ectopic pregnancy can be referred to as an “induced abortion.”
That can lead to confusion as Americans debate abortion policy after a leaked draft opinion from the US Supreme Court signaled the possible overturning of Roe v. Wade. Outside of a medical context, “abortion” is used colloquially to describe “elective abortion,” or the intentional killing of a healthy and growing preborn child.
In the aftermath of the leaked opinion, some abortion advocates have suggested that new abortion restrictions enacted could endanger health care for pregnant women. They worry that pregnancies that end through miscarriages or as a result of ectopic pregnancies will be wrapped into the new state laws.
But many Christian ob-gyns, including those at major antiabortion institutions, such as the Charlotte Lozier Institute and the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) say restrictions on elective abortions have nothing to do with miscarriage care.
There are roughly 50,000 practicing ob-gyns in the United States. Less than a quarter of them perform abortions currently. On the other hand, treating both ectopic pregnancies and early miscarriages is a routine, though tragic, part of their practice, according to Dr. Donna Harrison, a Christian ob-gyn and CEO of AAPLOG.
Both Harrison and Dr. Ingrid Skop, also a Christian ob-gyn and the director of medical affairs at the Charlotte Lozier Institute, said abortion restrictions would have no effect on ectopic pregnancy removal or miscarriage care because those situations are different, both medically and morally, from elective abortion.
Ectopic Pregnancy Care vs. Elective Abortion
But confusion persists. A few years ago, the Ohio state legislature considered a bill to prohibit health insurance companies from covering abortions. The bill never passed, but its sponsor, Republican Rep. John Becker (who no longer holds state office), suggested during a hearing that in cases of ectopic pregnancies, doctors should simply “remove that embryo from the fallopian tube and reinsert it into the uterus.”
But that’s not medically possible.
Representative Becker’s gaffe naturally made headlines. So did an Oklahoma Republican lawmaker during hearings for an abortion ban under consideration in that state last month. Senator Warren Hamilton suggested that including exceptions to the ban for “medical emergencies” such as ectopic pregnancies could violate the spirit of “justice for all.”
Many states have enacted or are considering laws to prohibit abortion earlier in pregnancy than was previously thought to be legal under Roe. Most explicitly include provisions allowing for exceptions for medical emergencies, which would include ectopic pregnancies. But the evident confusion about ectopic pregnancies and abortion more generally has muddied the waters that pro-life advocates are trying now to navigate.
Dr. Skop said the confusion in terms—between using “abortion” to describe the medical procedure after a miscarriage or ectopic pregnancy versus using it to describe an elective abortion—exists only in the public’s imagination and not in medical practice.
“Even the most pro-life obstetrician will care for a woman with an ectopic pregnancy,” she said. In fact, existing laws already protect women in such a situation from being denied care. “That is medical malpractice,” Skop said. “Period.”
Harrison said that in about 5 percent of ectopic pregnancy cases, the baby’s heartbeat is detectable even at the time of removal. Nevertheless, the baby has no chance of survival and could cause the mother’s death if it is not removed.
Harrison, who trained at a Catholic hospital and later worked at a Catholic medical practice, said she’s never seen or heard of a single patient turned away from care for an ectopic pregnancy.
Harrison and Skop said the critical difference between ectopic pregnancy removal and elective abortions is the medical intent of the procedures—and the standards by which they are deemed successful.
“A ‘failed’ abortion is when the child fails to die,” Harrison said. “The purpose of an elective abortion is to produce a dead baby. In treating an ectopic pregnancy…we can separate the mom and the baby so that the mom lives. Even though we know that the baby is going to die, our intent is to save the life of the mom. Our intent is not to produce a dead baby,” she said.
Before treatment for an ectopic pregnancy can begin, however, ob-gyns must first diagnose it. That requires a scan, which isn’t possible unless doctors see their patients in person. That’s why Harrison, Skop, and many other antiabortion advocates oppose the newly relaxed rules surrounding what’s known as the “abortion pill.”
Miscarriage Care vs. Elective Abortion
Skop said there are three common clinical responses to a miscarriage, depending on multiple medical factors. Some women can wait and allow their bodies to naturally expel the baby. Others will require surgery. And some can take medication to induce labor.
One medication commonly used in this situation is misoprostol, which is also the second drug prescribed as part of the two-drug regimen commonly referred to as the “abortion pill.” When doctors prescribe an abortion pill regimen to women seeking an elective abortion, they first prescribe mifepristone (also known as Mifeprex), which starves the growing baby of the progesterone her mother’s body makes to feed her. Misoprostol is then taken hours or days later to induce labor.
During the coronavirus pandemic, the Food and Drug Administration (FDA) temporarily relaxed the rules governing the prescribing of the abortion pill regimen by allowing doctors to prescribe the pills via telemedicine without having examined a woman in person first. A few months ago, the FDA made that change permanent.
The problem, said Harrison, is that without an in-person visit, abortionists can’t determine the age of a women’s pregnancy, which affects the safety of the drug. Neither can they determine whether that pregnancy might be ectopic.
“The symptoms of a rupturing ectopic pregnancy…bleeding, pain, those are the same symptoms as a Mifeprex abortion,” Harrison said. The FDA reports that at least two women have died after their ectopic pregnancy ruptured following the abortion pill regimen.
So far, 19 states have enacted further restrictions on the abortion pill regimen. Some require doctors to see patients in person before prescribing the pills. Others have banned outright sending the pills by mail.
Skop said the inherent risks of Mifeprex, including hemorrhage, make it subject to an FDA protocol called the Risk Evaluation and Mitigation Strategy. Doctors who want to prescribe Mifeprex, like any other drugs under this classification, have to undergo training and qualify for a specific certification. Skop said those FDA-imposed hurdles cost both time and money. As a result, she opted not to register to prescribe the drugs in her private practice.
“We have many other interventions” for women who are suffering a miscarriage, she said.
Still, there has been some media coverage suggesting that pro-life pressure, not FDA regulations, have kept providers from prescribing the abortion pills, even in cases of miscarriage.
Harrison said it is not clear whether taking the first pill, Mifeprex—which starves the baby of progesterone—in addition to the misoprostol offers any clinical advantage in a miscarriage.
“There are a couple of studies where they found that the Mifeprex makes the woman’s womb a little more sensitive to the second drug,” Harrison said. But a known side effect of Mifeprex is increased bleeding, and Harrison said that danger outweighs any potential benefit in treating miscarriage.
Ultimately, Harrison said, restricting abortion—including the prescribing of the abortion pill regimen for an elective abortion—would have no legal impact on a doctor’s ability to prescribe the drugs to treat miscarriage.
“That’s like saying, ‘If you say that we’re not going to have surgical abortion, then you cannot use a curette for anything else,’” Harrison said, referring to a metal instrument commonly used in surgeries and dentistry. “They’re not restricting the use of Mifeprex and misoprostol. What they’re restricting is doing an act, either with surgery or medication, with the primary purpose of killing the baby.”
Ectopic pregnancy, miscarriage, and abortion do have three things in common: a woman, a baby, and a death. Harrison, Skop, and scores of other pro-life ob-gyns and activists believe that to intentionally cause the death of a woman’s baby serves neither the baby nor the woman.
But—in keeping with the Christian ethic of treating the sick and vulnerable with care and dignity—they also believe that a woman facing the natural death of her baby needs compassionate and careful medical care. They insist that care will continue even under legal restrictions on elective abortion.