The Georgia legislature passed a new abortion bill (HB 954). Yet another law (it’s only a matter of time before it’s signed) governing the practice of medicine based on nothing resembling science.
The issues:
- Fetal pain. The law will make Georgia the seventh state to enact a gestational age limit based on the false belief that a “20 week” fetus can feel pain. The lack of cortical connections as well as the absence of connections between the thalamus and the subplate before 23 weeks means that a 20 week fetus does not have the neural ability to feel pain.
- No rape or mental health exception. Abortions are only allowed after 20 weeks for a congenital or chromosomal anomaly incompatible with life and to preserve the life/prevent irreversible physical impairment of the mother).
- Any abortions after 20 weeks must be done so the fetus has “the best opportunity…to survive” There are 2 ways to perform a 20+ week abortion: a dilation and evacuation (D&E), which is a surgical procedure where the cervix is dilated and the fetus is removed in parts, and an induction of labor, which can take several days in the hospital. What this law means is if a woman has an abortion for genetic reasons she must have her labor induced. The life of the mother clause does allow doctors to offer a D and E in specific situations. A fetus can’t survive before viability, so this “best opportunity” seems moot and just another way to make the experience more challenging and expensive, although if you read further it is clearly a set up for…
- “Any baby born alive that is capable of sustained life must get medical aid.” Meaning if you have an induction at 22 weeks for a severe congenital anomaly, a pro-life doctor or nurse can swoop in and resuscitate your baby against your wishes. Of course, nowhere does it say the government will pay for this medical care. This medical aid against the parents’ wishes could also be applied to situations where parents have made the difficult decision not to resuscitate their premature baby.
And finally the mistake? Well, I’m not going to disclose it until after it’s signed into law. I had to read the bill multiple times to make sure I was reading, well, what I was reading. This error makes it crystal clear that no one with any basic medical knowledge read the bill.
But hey, it’s only women’s health care we’re talking about.
Dr. Jen Gunter 
The bill (like others being passed in other states) is based on model legislation that cites a study that used “probable post fertilization age” (PPFA) as a rationale for this restriction. However, medically a fetus is aged by gestational age, which is based on the woman’s last period. The legislation mixes up the 2 terms in several places, although the last period and the date of fertilization are roughly 2 weeks apart. For example, the language in section 4.1 is just wrong. The mistake is repeated in the definition section, where the GA is defined as the post fertilization age, and that’s just not medically possible.
Thus there’s no black and white standard for when an abortion becomes a crime based on my reading of this, and not knowing other GA statutes that exist.
I am not sure if the phrase that references pregnancies that are “medically futile” is sufficient to allow treatment of ectopic pregnancies, which are life threatening to the mother, and cannot result in a viable pregnancy. If so, it certainly is not clear. That poses a problem, not only to Catholic hospitals, but to wonderful doctors who treat them in their practice to preserve women’s ability to bear children in the future… and have never considered this to be an abortion.
Finally, ectopics are often treated with a chemo drug administered by a chemo RN, not a doctor, as required in this legislation.
Even worse is the consideration that women who have been raped will not be able to obtain an abortion after the first trimester. I suspect that number is fairly low, but in cases where women have conditions like PCOS (which I have myself) where their cycles are few and far between, how would a woman trying to simply deal with the trauma of being raped know that she was pregnant? Its not something you’d want to be thinking about and testing for.
There are NO exceptions for mental health issues at all. Which means that anyone with a mental health condition who would be forced to forgo their medication, or they would be breaking the law because of jeopardizing the health of the baby they are forced to carry.
I didn’t see anything clarifying “sustained life,” except a removal of the term “meaningful” from that part of the law. Given the existence of respirators, total parenteral nutrition, and the like, this law could condemn parents to indefinite support of a baby incapable of living off machines. And the objection that certain cerebral defects preclude meaningful life will no longer hold any water, because that criterion was specifically removed.
What a living hell. How vile; how cruel.
“And finally the mistake? Well, I’m not going to disclose it until after it’s signed into law. I had to read the bill multiple times to make sure I was reading, well, what I was reading. This error makes it crystal clear that no one with any basic medical knowledge read the bill.”
Wow, I’m not a doctor, I just fix their computers, and damn, I read this and could see the error. Amazing. I guess that’s what happens when you have farmers deciding women’s health issues.
This is the same bill sponsored by Rep England, who while speaking about it, compared women to the cows and chickens on his farm. http://thinkprogress.org/health/2012/03/12/442637/georgia-rep-compares-women-to-animals/
Apparently in his world if cows have to carry stillborn calves to term, so should women in Georgia. Because women are pets or farm animals, and owned by their husbands.
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Deep breath:
While I write this, I look down at my now 4 month old beautiful daughter, and realize that if we lived in a state with laws like this, I would not have her. Two years ago, my wonderful wife and I were pregnant with a baby we had been trying for over a year to have. We named her, we bought clothes and toys, got a baby registry, scheduled a shower with friends, moved into a larger home, and in short, did everything new parents can do to welcome a much loved and wanted baby.
At 22 weeks, we went in for a followup diagnostic ultrasound. At 19 weeks we’d been in and gotten through everything with flying colors, except for part of the baby’s head she (yes, she) kept covering with her arm. During the visit we chatted with each other and the ultrasound tech, got more pictures for the album and blog, and then towards the end the tech started scanning the baby’s skull. A few moments in, she paused and said “Hmm”, then asked to leave the room for a moment. We were still in the throes of delight after seeing so many images of our baby.
A few minutes later a doctor came in, and asked us to come and have a sonogram down the hall. An hour later, we knew that our baby had a massive fluid cyst instead of brain tissue, but we still thought to ourselves “We’re in the most advanced hospital in the country, surely one of my coworkers can do some sort of surgery to fix this”, what we still thought ourselves was hydrocephalus. Two days later and a huge battery of tests we knew these things:
Our baby had an incredibly strong heart. She also had perfect limbs, body, and was very strong in utero.
She also had no brain worth speaking of at all, the amount of damage done was confirmed by MRI. If you’ve never seen a fetal MRI, take every negative thing about having an MRI done, double it, and try to get a baby in utero to hold still for it. They let me stay in the room with my wife. Nearly two hours it took, me wearing very useless earplugs while holding her hands and begging her to breathe and stay calm so the baby wouldn’t freak out so much. I have never felt so out of control in my life.
That afternoon, one of the best people I know, and the one I thought could save my baby if anyone could (a fetal neurosurgeon who is absolute tops), called me to tell me the test results. There was simply not enough brain in our baby’s skull to sustain any life at all outside of the womb. The amniotic fluid tests were all negative, so to this day we still don’t know if it was injury or illness that caused the brain tissue to scar and stop building.
Our “choices” were three:
1. have an immediate D&E (abortion) at 23 weeks.
2. Carry a baby we knew would be stillborn, but still kicking up to the end to full term, only to watch her die.
3. Force early labor and deliver the baby at 23 weeks, knowing she would immediately die.
I could not ask my wife to carry our baby to term. Could you? I also could not ask her to go into early forced labor, go through all the pain, suffering, and torment of delivering a dead baby we could hold for a few minutes before burying. We opted for the D&E.
Few medical schools still teach the D&E to OB/GYN residents. Thankfully I work at one of them. The OB that we were referred to by our OB was truly the most compassionate doctor I’ve ever met. She was apparently almost exactly as far along in her own pregnancy as we were, and she could tell how desperately we wanted this baby. That we would have done anything–regardless of cost or future problems–that we could have to keep her. It just wasn’t in the cards. She cried with us, she helped us mourn our loss, and she helped us realize that if we’d gotten this far, we had the strength inside to do it again. Without her, we would never have tried once more to have a baby.
When we finally got pregnant again, our previous OB was out on maternity leave herself, so we looked at each other and both said the name of our OB that helped us with the D&E. We knew that we could not ask for someone better to help watch and guide us through what was going to be a nerve-racking pregnancy. Could it happen again? Unlikely, but since we didn’t know the cause, we didn’t know what to watch out for.
On November 30th, 2011, my wife delivered a healthy baby girl. If we had lived in Georgia (I lived there for a decade myself) during this, we would NOT have a baby now. There is simply no way we could have gone to full-term, delivered a dead baby, then turned around and tried again.
So thank you Dr. Jen, both for your compassionate care for those that cannot have a child for one reason or another, and for your care for those that can. You weren’t our OB during all this, but I can see you treating us just as well, and with just as much empathy and care.
Thank you for sharing your story. Sharing is caring. I am also so happy for you and your family!
Thanks. Its still very hard to talk about, but it is exactly the sort of thing that legislators and those trying to pass these bills need to hear. That women sometimes have to have abortions, even late 2nd trimester (and even 3rd sometimes) of very much wanted children.
but seriously, what’s the mistake?
Not gonna post it until the bill becomes law!!!
Hi Jen,
I’ll take your word that the GA bill states everything you say it does.
I agree with three out of four of your points. There’s a problem with point #2. We can stipulate that State should NOT extend freedom protections to a fetus. By ‘freedom protections’, I mean the State’s dispensation to protect citizens from those who would deprive them of inalienable rights such as life and liberty.
Georgia’s statute, however, stipulates that the fetus DOES merit freedom protections. That being the case, the circumstances of the fetus’s conception or the mental health of the mother are irrelevant with respect to the fetus’s right to life.
Your attack on the bill’s weaknesses is spot-on. But you can’t argue against the only part of the bill that is logically consistent!
This is what happens when we elect people who hate science to office.
I don’t know whether I mostly feel happy about not living there, or sorry for those who do live there. I guess it’s a combination, actually.
I don’t understand how all these laws can be passed, because they all seem so stupid. And it makes me angry. I hope such laws will never occur where I live…