Texas Abortion Ban Relies on 'Fetal Heartbeat. This is what doctors call misleading
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Texas' abortion law went into effect this week. It states: "A physician cannot knowingly perform an abortion on a woman who is pregnant if he detects a fetal beat for the unborn child."
New law defines "fetal beat" as "cardiac activity, or the steady and repetitive rhythmic contracting of the fetal heart within the gestational Sac" and allows pregnant women to use this signal to determine "the likelihood that her unborn child will survive to full-term birth."
However, the misleading use of "fetal heartbeat", a medical term that sounds very medical, is occurring in this law and similar laws. This is according to doctors who specialize in reproductive healthcare.
We are detecting a group of cells that initiate some electrical activity. This is not a way to detect a functional cardiovascular system, or functional heart.
"When I use a stethoscope [to listen to an adult patient's] heart, the sound I'm hearing is caused the opening and closing of cardiac valves," says Dr. Nisha verma, an OB/GYN who specializes on abortion care and works at American College of Obstetricians and Gynologists.
She says that the sound produced by an ultrasound during very early pregnancy is quite distinct.
She explains that at six weeks gestation those valves are not present. "The ultrasound shows that the ultrasound machine produces the sound you hear, which is electrical activity. The flickering we see on the ultrasound is very early in the pregnancy's development.
This is why Dr. Jennifer Kerns, an OB/GYN and associate Professor at the University of California San Francisco, says that "fetal heartbeat" can be misleading.
She explains that what we are really looking for is a group of cells initiating electrical activity. "This is not a way to detect a functional cardiovascular system, or functional heart."
Kerns says that while health care professionals might use the term "fetal pulsebeat" to talk with patients in this stage of pregnancy, it is not a clinical term.
Kern states, "This term is not commonly used in medicine." Kern says, "This is an example of when we sometimes try to translate medical terminology in a way patients understand. This is a really unfortunate side effect."
Verma compares it to "stomach bugs" which she may use with patients suffering from gastroenteritis. However, Verma says that she would not use the term "stomach bugs" to discuss the patient. "But I wouldn't use that term to talk about my colleagues or in my documentation because it's a vague term and not a scientific term."
Kerns says that "fetus", although technically correct at six weeks gestation, is not accurate. "Embryo" is the scientific name for this stage of development. Usually, obstetricians won't use the term "fetus", until eight weeks after the start of a pregnancy.
Kern says that "fetus" might have a different appeal than "embryo". Kern says that "fetus" evokes images that are reminiscent of a well-formed baby. "She explains that "fetus", which is not a term that can be used to describe an embryo, may not be as appealing to the public because embryos don’t look like babies. These terms have been deliberately used in these laws and can be misleading.
A clinician may use the term "fetal beat" later in pregnancy. She says that after hearing the sound of the heart valves, the clinician might say this. This sound is "usually not heard with our Doppler devices until approximately 10 weeks."
Since years, the term "fetal heartbeat", has been used in restrictive abortion laws. The Guttmacher Institute tracks reproductive health policy and reports that the first such law was passed by North Dakota in 2013. However, it was overturned in court. Over a dozen other states have since passed similar laws. Texas is the first one to take effect.
What does early pregnancy mean for cardiac activity?
According to Texas law, the "fetal heartbeat" has been deemed a "key medical predictor of an unborn baby's survival rate."
However, obstetricians claim that this is not the way health care providers use this information. "We don’t use it to date of labor," Dr. Samantha Kaplan of Boston Medical Center, an OB/GYN and assistant professor at Boston University’s School of Medicine says.
"Or, honest to God, to predict that the pregnancy will continue until delivery." She says that this activity can be detected in many cases and the pregnancy ends in a miscarriage.
Kerns says that there is nothing that can be interpreted as meaningful or relevant to the detection of cardiac activity during this gestation. This could not mean that it's relevant for women’s health, or for pregnancies. It is just one indicator that a pregnancy may be moving towards certain milestones.
Texas law requires that women know very quickly if they are pregnant. "Six weeks is not enough time."
It would be difficult for a woman, in reality, to find out if she is pregnant before her heart activity can be detected by ultrasound. To confirm her pregnancy, she would need to keep track of her periods and notice when her period is late.
Kaplan states that periods vary in length and can last from 21 to 42 consecutive days. He also says that late periods can occur for many reasons which are not related to being pregnant. It could be stress, or it can be due to changes in sleep, weight, travel, all those things can cause it. Women are advised to not panic about being late by a week or two.
The date of a woman’s last period is used to date her pregnancy. Kerns says that if fertilization or implantation occurs within a few weeks, Kern states there is a window of time where you can detect intrauterine pregnancy with an ultrasound. However, before you detect any cardiac motion or electrical activity, Kerns says.
She adds that Texas law "clearly tries to move the needle back almost to the point where pregnancy is detected with the goal to outlaw nearly all abortions."
Verma says that the way pregnancies have been clinically dated does not make sense and people misunderstand its true impact. She says, "I did some research on the public's understandings of "six weeks." "Most people believed that six weeks was six weeks after your first missed period. But it is actually six weeks after your last period.
She adds that six weeks is not enough time. "If someone has regular periods, they have a period every other month. That means that if they miss a period it's [just] 2 weeks before they are'six week pregnant. "
Many women don't find out that they are pregnant as quickly as they should. Kaplan says that women who are more aware of their cycles and can get to a clinic quickly tend to be more educated and wealthy.
"Anyone who has easy access health care will say that they feel nauseated. I feel a bit tender in my breasts. She says she thinks she'll have a test for pregnancy.
"Someone who works to get by the day and get food on the tables is not going to do this." She says that getting a pregnancy test is "not going to be on their priority list." By the time they get to it, it will be too late.
