An ectopic pregnancy is a pregnancy that implants outside of the uterus. It occurs in approximately 1% of conceptions. It typically grows in the fallopian tube, but rarely an ectopic pregnancy can grow in the ovary or cervix.
A pregnancy has trophoblastic tissue, the purpose of which is to invade deep into the wall of the uterus and set up a system of nutrient and oxygen delivery from the mother to the embryo. Trophoblastic tissue is aggressive, because the muscle of the uterus is thick. Now imagine these aggressive, invasive cells when faced with the wrong tissue. Thinner tissue. These mini Ms. Pacman-like trophoblasts chew up the relatively flimsy fallopian tube tissue, damage blood vessels, and catastrophic bleeding ensues. The pregnancy can literally blow a hole in the side of the fallopian tube, the result is typically catastrophic bleeding.
This is how women die from ectopic pregnancies, they bleed to death. Although thankfully this is very uncommon as we have ultrasounds that identifies these pregnancies very early on, surgery or medication to treat them, and blood transfusions just in case.
The recommended treatment for an ectopic pregnancy is surgical removal or systemic methotrexate (a cancer drug that kills the rapidly dividing trophoblasts, which are in many ways like cancer cells). According to the latest Cochrane review (Interventions for tubal ectopic pregnancy, 2009) there is insufficient data to support expectant management, i.e. watch and wait is not standard of care.
An ectopic pregnancy is not destined to be a baby. It can never, ever grow to viability. It will, however, grow to injure the pregnant woman. So you’d think treatment shouldn’t be controversial…unless of course you want care at some Catholic hospitals.
Yes, some Catholic ethicists argue that the catholic “Directives” preclude physicians at Catholic hospitals from managing ectopic pregnancies in a way that involves direct action on the embryo. So a woman can have her whole tube removed (an unnecessary procedure that could reduce her future fertility), but she can not have the pregnancy plucked out (as is done with the standard therapy, a salpingostomy, where a small incision is made in the tube and the pregnancy removed) and she most certainly could not have the methotrexate.
How common is this practice? Well, it is pretty sad that someone had to study it. According to a study from 2011 by Foster e. al., (Womens Health Issues, 2011) some Catholic hospitals refuse to offer methotrexate (three in this study of 16 hospitals). The lack of methotrexate resulted in changes in therapy, transferring patients to other facilities, and even administering it surreptitiously. All of these expose women to unnecessary risks, expense and are, quite frankly, wrong.
It amazes me that with ectopic pregnancy, such a clear-cut case of life of the mother with therapies well supported in the literature, that any physician or hospital could have any other moral or ethical agenda than delivering the right medical care.
Putting religious beliefs ahead of urgent/emergent medical care in never right and I shudder to think how the management of ectopic pregnancies would change should a national personhood amendment pass.
Dr. Jen Gunter 
Holy moly, I can’t believe it. \I came upon this post as I was recalling the time when my wife’s eyes rolled back in her forehead while she passed out due to a hemorrhaging Fallopian tube. And Catholic hospitals these days are endangering women’s lives when it comes to this? And here in the comments we have some slackjaw quoting Thomas Aquinas and Augustine arguing that there is any question about the right thing to do? This is outrageous. When it comes down to it, life begins with ovulation and ejaculation, since ova and sperm are just as alive as any blastocyst. And the scientific consensus is most fertilized eggs never implant. Simplifying it down to the Catholic terms: God is the world’s foremost babykiller. Innocent embryos cast aside in menses. This slaughter of the innocents, who will speak for these menstruated masses? There are lines that should be drawn of course, and I think coming down on the side of fetal viability, as the Supreme Court did, is a sound one. But seriously, I am pissed to find these 15th century ideas are being preached in the 21st century.
Stillstanding, I had a similar experience. I bled out and nearly died because of a delayed D&C at a Catholic hospital in New York. If you or anyone else who has had a similar experience wants to get in touch, I would like to hear from you – kathswrites@gmail.com.
“Personhood” in itself does not entail a ban on abortion, since normally a person has no rights over the body of an other person.
But if a foetus is considered a person, then a woman surely would have the right to sue her foetus for things such as use of her body without permission, or sue for health damages etc. inflicted on her by the foetus, before giving up her child for adoption or renouncing her parental rights and delivering it to her rapist. – Nice outlook, isn’t it?
i don’t understand why some of the comments on this web site are so sarcastic. Why can’t comments refer to factual information and leave out emotional comments. I think that the comments of educated individuals don’t distort and misinterpret the basic issues that they are commenting on. On the other hand, people who are ignorant in many ways tend to be sarcastic and ANGRY in their responses.There was no reason to reply to what I had written in such a nasty manner.
Please google “tone trolling.” This is what you are doing. Also, damn right I get “emotional” when someone asserts that they have more of a right to determine what happens to my own body than I do. And I won’t apologize.
You don’t have to apologize but perhaps you might change the way congress and the senate act if you get politically involved instead of accusing me of tone trolling. Anger gets you nowhere. It gets none of us anywhere. All anger does is make the opposing side more diligent in their pursuits.—whatever they may be. My purpose in makimng comments is to seperate fact from fiction and ofcourse I happen to belief that RELIGION is the biggest fictional fairytale of all time. Religion should have no place in Politics of the practice of Medicine….PERIOD! And for the phraze that, ” Life is sacred’, This is a religious belief that shouldn’t be forced upon the non religious. Wars, Torture and Human Carnage have .been implimented in the name of Relifion. Remember the Spanish Inquision and other Atrocities where RELIGION was at the core of the abuse?
I’m on your side.Perhaps you might become a little less defensive and write without expressing your anger so violently. More people will listen to what you have to say.
Elizabeth Gillman BSN –Nurse with a degree in science.
Elizabeth, you have no idea what I do in terms of activism other than arguing online, so kindly stuff your assumptions.
Fuck, am I tired of Nice Polite Liberals who ass-ume that anger never gets you anywhere and “civility” is the key. Yeah, that’s why ACT-UP led to the further marginalization of gay men, and “compromising” has expanded rather than shrank abortion rights in the U.S.
Anger is good.
Men, especially religious men, are not used to being challenged. It terrifies them when the truth is out, because knowledge and truth are devastating to religion.
Also, you’re a woman. We’re automatically viewed as inferior, interchangeable, tainted, disposable, ambulatory incubators. The only reason we’re treated as “well” as we are is because sometimes we produce male babies.
Any religion that endorses child rape, excommunicates the mother and doctors who saved a nine year old-s. life by ending the twin pregnancy that was killing her, yet stood up for the man that impregnated her, that butchered young healthy women with symphisiotomy so that they would suffer in labour, that. imprisoned raped women and sold their babies, that encouraged priests to have sex with nuns in Africa, rather than prostitutes, and then threw the nuns onto the street when they got AIDS… They HATE women.
Interestingly enough, I actually commented on this because I found it an interesting topic and wanted to learn more about your point of view. I’ll look for differing sources on ectopic pregnancies, as they’re an important issue to discuss, and I appreciate other viewpoints. I’ll get back to my uneducated life and fairy tales now…
To origami;
You have no0 idea what my religous or non relidous beliefs are. Your explitives make you appaer child like and don’t allow you to clearly get intelligent thoughts across to your audiance. You assume a great deal about me while in actuality your knowledge of me is zero. Anger is okay. However, its expression needs to be channeled properly so that its target gets the message.
Elizabeth
Fr. Ka, ectopic pregnancies will NEVER be children, but they WILL kill a woman. There is no “reconciling” medical facts with religious fantasies, and anyone who supports Catholic hospitals failing to treat an ectopic pregnancy according to standard practice supports MURDER of women.
Do Catholic hospitals murder women? I’d like to see the statistics, if they do. I haven’t seen it in the news.
And doesn’t science say that life begins at conception? If not, when does it begin?
So what if it does? MY life, or the life of my daughter, is more important than the existence of some cancer-like ball of cells that will never grow into a child and could kill me or destroy my future fertility. What is *wrong* with people that they cannot see that?!
It’s nothing short of idolatry.
Primitive life may begin at conception, but personhood does not.
At Fr KA:
Really? Really? One hopes the “Fr”. does not mean “a priest” who assumedly has some education? Please stop the obfuscation.
ROXANNE BROWN does not say that Catholic hospitals murder women. She says that failing to treat an ectopic pregnancy according to standard practice supports MURDER of women. Did you change her words in your question on purpose or can you just not read properly? It’s one or the other – unless your question is unrelated to her post – which would be difficult to believe since you replied specifically to her comment.
Furthermore, you ought to know that the debate is not about “life” per se, as even sesame seeds and poppy seeds begin “life” at conception — the big important SCIENCE that you so want on your side even says so doesn’t it? And yet we so carelessly sprinkle them on our bagels after baking them – Oh the shock, the horror. Stop pretending that science says anything about the humanity of a conceptus that is remotely in your favour. Instead, SCIENCE assures everyone that a conceptus is a single cell – a zygote, and to assure us that zygotes do not have brains, or nervous systems or moral operating systems, or ANY of the things resembling full grown, pregnant, HUMAN, women, who science also assures us do have a brain and a functioning nervous system and a moral sense. This by the way, is contrary to the beliefs and teachings of many of the “great” “Saints” and “Moral Leaders” of the church (mostly of the past – but the way you sound – hey you never know – maybe in the present too). Of course if you are a priest, you would actually know this but maybe you have chosen to choose to pretend it isn’t so. A fried egg is not a chicken as you surely know.
Your statements or rhetorical questions, are not clever nor thoughtful. They demonstrate deliberate ignorance or profound lack of education and do not add much to anyone’s understanding – although confusion and obfuscation seem to be more what you are aiming for.
I couldn’t have said it better!
Thank you for clarifying the issue.
Elizabeth
“And doesn’t science say that life begins at conception? If not, when does it begin?”
At conception, you have one genetically unique cell, but that is not one unique human individual. That cell replicates itself into a ball of cells, which may become one human individual, or divide into two, or more rarely, four. Even more rarely two of these balls of cells will join and one human individual will have cells with two different DNA codes, originating from two separate conceptions, forming his or her ONE body. Science has not in fact determined with certainty when the embryo is a human individual.
“Science” answered this question quite some time ago: Life began in the Precambrian, billions of years ago. All life has come from other life since then. Spontaneous generation is centuries out of date as a scientific theory.
As to how many women Catholic hospitals murder, read the post. Or, better yet, the linked article. And then keep going. Medline’s full of evidence that anti-choicers kill.
Father KA,
Ever hear of the principle of self defense? It is Biblically supported and legally recognized.
An ectopic embryo’s placental tissues are always a mortal threat to the mom. God-Jesus would never deny a person the legitimate right to self defense.
Just a week before you posted that, and it was a big news story at the time:
https://en.wikipedia.org/wiki/Death_of_Savita_Halappanavar
and another example that happened after your post:
https://www.glamour.com/story/woman-dies-after-hospital-refuses-to-treat-her-for-a-miscarriage
That makes two murders by Catholic hospitals that I found in a couple of minutes with Google.
Miss Brown, until you can quote St. Thomas Aquinas, St. Bonaventure, or St. Augustine with clear understanding, perhaps you should not refer to religious beliefs as fantasy. The only fantasy I have seen expressed here is how the Catholic tradition has been represented.
Yes, and you can’t talk about the factualness of Lord of the Rings or Spiderman unless you have a thesis on the subject. Please, produce some evidence that your god is not entirely rooted in fiction, or shut up, preferably forever.
At WBBRITTON: Here’s some quotes:
1. By St. Bonaventure: Regarding Arrogance
“Do not therefore, judge anybody to be more imperfect than yourself if he do not do all the things that you do”.
“And although they seem to you to be so very imperfect, yet perchance, they are more stirred up with one interior motion than you with many – yea it may be more than you with all that you have. And because you do not know this, do not therefore, judge others to be inferior to yourself…….. These things I have said to repress the temptations of the devil.”
2. By St. Thomas Aquinas: Regarding women:
” As regards the individual nature, woman is defective and misbegotten, for the active power of the male seed tends to the production of a perfect likeness in the masculine sex; while the production of a woman comes from defect in the active power”.
3.By St Augustine: Regarding sex and women and holy men:
“Nothing is so much to be shunned as sex relations.”
“Women should not be enlightened or educated in any way. They should, in fact, be segregated as they are the cause of hideous and involuntary erections in holy men.”
4. By St. Augustine: Regarding science and math – pretty important stuff for someone who signs their name as MD doncha think?:
“The good Christian should beware of mathematicians and all those who make empty prophecies. The danger already exists that mathematicians have made a covenant with the devil to darken the spirit and confine man in the bonds of Hell.”
Contradicted by this statement:
“Often a non-Christian knows something about the earth, the heavens, and the other parts of the world, about the motions and orbits of the stars and even their sizes and distances,… and this knowledge he holds with certainty from reason and experience. It is thus offensive and disgraceful for an unbeliever to hear a Christian talk nonsense about such things, claiming that what he is saying is based in Scripture. We should do all that we can to avoid such an embarrassing situation, which people see as ignorance in the Christian and laugh to scorn.”
You want to talk St Augustine, do you? OK.
(354-430) ” Any woman who acts in such a way that she cannot give birth to as many children as she is capable of, makes herself guilty of that many murders.”
All religion is fantasy, science is life itself. Science is not invested in the hatred and disparagement of women, based on a fairy story about an apple and a talking snake.
How does that totally-not-woman-hating passage go again…
Oh yeah, that’s right – ” I will greatly multiply your grief and your suffering in pregnancy and the pangs of childbearing; with spasms of distress you will bring forth children. Yet your desire and cravings will be for your husband, and he will rule over you.” (Genesis 3:16)
Any intelligent person should read Darwin’s Survival of the Fittest before choosing a religion. There is nothing to support the INVISABLE UNICORN( GOD) IN THE LIVING ROOM. The bible was written by HUMAN BEINGS. If you read it carefully you will see the most outrageous stories aimed at denigrating women. Your comment is full of vitreolic hatred aimed at anyone who doesn’t believe as you do. Through out history RELIGION has caused Wars, Torture and Divisiveness.We can be Moral, Kind, Caring etc. without the teaching of religion. You sound fanatical!
All those three dudes have been refuted multiple times by many different people. Dawkins has a particularly good refutation of Aquinas in the god delusion. But it doesn’t really matter anyway, can’t you come up with any modern reasons for why you have women have to have their choices removed from them?
And know you don’t need a deep understanding of BS to label it as such. People don’t need degrees in fashion design to tell them the emperor has no clothes. I don’t need a keen understanding of the anatomy of a unicorn to tell you it doesn’t exist. I don’t need to know every tenant of chistianity to tell you that it’s position on the treatment of women and homosexuals is wrong.
Where does that quote from Augustine come from? I’ve looked for it and traced it to the 1995 book “The Cry of Tamar: Violence Against Women and the Church’s Response” (Pamela Cooper-White) on page 50. She is quoting from “Bible Study: Spirit of Freedom, Not Slavery” (Margot Kaessmann [Gr. Käßmann]) an essay/article in “Women in a Changing World” 30 (June 1991) published by the World Council of Churches.
Ms. Cooper-White also cites from Ms. Käßmann’s work the account of a Church council in Macon in the 6th century that only narrowly affirmed that women are human beings; this story is a myth. I’d like to see a copy of the essay/article (even if it’s in German) because I would like to see the citation of the quote from Augustine.
I’m not denying the Church Fathers wrote some pretty awful things about women, I just prefer to see the quotes cited for truth’s sake.
Ah, yes, you can always tell the paleo-misogynists by their insistence on using “Miss” or “Mrs.” FSM forbid women be identified by anything other than whether a man properly “owns” us. Probably also the source of your contempt for nurses.
Also, yes, religious beliefs are supernatural nonsense, and I’d like you to keep yours the hell off my body, you arrogant ass.
Sorry for offending, Origami, but I sincerely, honestly though “Ms.” was the proper form of address to use.
@Jeffrey Pinyan,
Origami is talking to Britton, who addressed “Miss Brown.” You used “Ms.” which is the correct form, as it does not address women by their marital status like “Miss” or “Mrs.” do.
A Catholic viewpoint looks at the life of both persons. And a “personhood amendment” acknowledges the life which science itself says is there.
Ultimate Truth has only one expression, and the Church, and Science, both seek to understand and express it.
So this issue wil be reconciled at some point in the minds of all. Thank you for the informative post.
An ectopic pregnancy is no more a “person” than a tumour is. It’s death, pure and simple.
But hey! Had it implanted correctly it would have had a 50% of being male, therefore, per your doctrine, that means it totally outweighs the useless sack of flesh carrying it, am I right?
Disgusting. That’s what any doctrine is that gives a deadly ball of cells equal rights to the woman it’s about to kill.
Religion has NO PLACE in medicine. That’s especially true of the woman-hating Abrahamic traditions.
“Had it implanted correctly it would have had a 50% of being male, therefore, per your doctrine, that means it totally outweighs the useless sack of flesh carrying it, am I right?”
No, you’re not right. Catholic doctrine does not consider pregnant women to be “useless sacks of flesh”, and science shows that a zygote’s gender is determined before implantation, at the moment of conception, based on the X or Y chromosome supplied by the sperm.
Jeffrey – Catholicism is built on. the backs of women. It need not say “Women are inferior” in doctrine in order. for that to be the truth as the RCC sees it.
Catholics abhor the feminine, simple as that. Women are seen as entirely expendable walking uterine cavities. No more, no less.
Do you know what a symphisiotomy is? Do you realise that this barbaric procedure was performed on women without their consent, leaving them crippled for life, while the church shrugged, and said “Tough”.
Caesarian section had been the gold standard for stalled/impossible deliveries for decades. Nobody used symphisiotomy, it was. decried as “barbaric” in the mid 1800s, yet it was taught and used in Catholic hospitals as a) c-section did not bring about the mandatory suffering in childbirth, and b) if a woman had a section, she might limit the number of pregnancies she would. have in the future.
So yes, the RCC does hate women, and does consider men to be superior. That’s how they were able to conduct their campaigns of rape and abuse for decades, because women were not to be believed.
But what do you care, you’ll never be at risk of death due to pregnancy, so there’s nothing to challenge your brainwashing.
Did you even READ the article? An ectopic pregnancy is NEVER viable. There is no personhood ever coming to this one. This means it can never, ever, ever become a baby…but it is ALWAYS fatal to the mother, if it is not removed before she bleeds to death. What part of this don’t you get? Once more, she arrives in the ER bleeding internally, and the embryo is already dead or dying. The mother’s pain (which leads her to seek help) is her body being ruptured by the embryo growing to the point where it is tearing it’s habititat to shreds, and the bleeding is her begining to bleed to death. If she has other children, you have rendered them orphans by your short-sighted medical neglect created a misguided religious notion that this is what our loving God wants for us. Well said by Boostick, “Religion has no place in mediine”. Sent away from a Catholic hospital, I nearly bled to death too. If not for the help of a pediatrician volunteer in a women’s health center one evening, I would not be here to make this argument. God bless her.
And how is this not medical malpractice?
I wasn’t able to edit my comment and change the spelling of religion…Elizabeth
Religious beliefs have no place in medicine ,and any physician who makes a medical decision based on what his/her Church thinks is not practicing EVIDENCE BASED MEDICINE, and therefore should seek another profession.Furthermore I don’t understand how any scientifically minded individual can ignore Darwin’s Survival of the Fittest. Religeon is based on blind faith in contrast to the practice of medicine which is based on modalities of patient care that have been scientifically proven to bring about the best outcomes given the patient’s circumstances.
Elizabeth Gillman BSN
Spoken like a nurse. Mind you nurses think they know a lot about practicing medicine when in reality they don’t. If you want to speak to the methods doctors use when making medical decisions, then you should put down your bedpans and enema bags and go to medical school. Otherwise, stick to speaking for your own discipline, ma’am
W. B. Britton, MD
Nice ad hominem reply. Does your medical training qualify you to discuss issues, or just to insult people and dodge the point.
Spoken like a rude idiot. Did you refute her point? No. Did you offer any evidence for your point of view? No. Did you even have a point of your own? Barely as your point was somewhat obstructed by your condescending bullshit. If a patient asks you why your doing something are you able to give them the logical reason behind the science that allowed you to come to your conclusion or do you just shrug your shoulders and say “God told me to do it”?
I am not a nurse, and could have just as easily made the same statement. Any living, breathing individual can agree with scientific principles – they don’t need to be a Doctor to have an educated opinion. Perhaps you should put down your ego and spend more time in real life. Otherwise, stick to fixing broken bodies, Dr. Britton.
I haven’t met a doctor yet who can function on thier own without nurses to help. I have epilepsy, and every single doctor I have had to deal with has displayed that same arrogance. Do they teach you how to be a prick in medical school? My mother, brother, two cousins and an aunt are all nurses, and every one of knows the ins and outs of the medical field than any doctor I’ve ever met, all of whom were fine at their narrow field of expertise but had no clue how to actually care for a patient. So don’t go insulting nurses, you would be useless without them. As regards this article, maybe you need to go back and take a hard look at that oath you took.
Nurses do more than carry bed pans. You show your ignorance by insulting us. We are responsible for programming drug solution that can kill a patient if we don’t do it correctly. We also have various kinds of degrees such as Bachelor of Science , Masters and PHD.. We have to interpret patient symptoms and act accordingly. In ccu and ICU units doctors have given us standing orders to administer potentially dangerous drugs to patients that are based on our assessment of their condition where time is of the essence and we have to act immediately.Nurses represent the backbone of patient care. You obviouslyb have misrepresented the way nurses function to help accelerate positive patient outcomes.Your comments are IDIOTIC…and I am being KIND to you.
How embarrassing. Dr Britton is likely young, and more than likely based in the US. He does not represent the rest of us physicians at all.
Your respnse to my comments are typical of an arrogant personality type.As nurses we have the responsibility of caring for parients and overseeing physician errors. In the old days nurses acted upon physician orders with no thought of their own liability when giving medications that were incorrect in terms of dosage which was written by an MD. I have seen so many critical errors that have led to patient complications due to physician lack of knowledge that I have learned a great deal about the practice of medicine. As an examp:’A patient has a heart valve disorder and the Cardiologist talks about valve replacement while ignoring the patient’s complaint about interrmittant chest pain. One week later the patient has a heart attack and needs a triple bypass. It’s common knowledge that doctors look away when their collegues make mistakes for fear that they might be on the chopping block if they too err!.
Your sacasm tells me that you think that religion belongs in the practice of medicine. The person who should put down their bedpan and enema bag is obviously YOU!
Elizabeth
Aw, look another ultracrepadarian on the Internet. You do realize that while doctors can diagnose and perform specific narrow procedures based on their speciality concentration, it is nurses who know how to care for a patient, perform multiple different emergency transfers and procedures, and assist the doctor with the medical history and lowdown of each and every patient on the ward…now that you’ve been educated, go spread the word that comparing doctors to nurses isn’t even just like comparing apples to oranges, it comparing apples to dogs…different leagues entirely. Both are incredible at what they do but neither is better than the other.
Dear Dr. Britton,
Ms. Gillman did not offer an opinion on a Medical treatment or course of action. A person with a bachelor degree in nursing is fully qualified to comment on medical ethics, which is what her post addressed. I’m sure you didn’t mean to, but you have managed to come off sounding like a thick-skulled misogynist, sire. May we assume that you disagree with the concept of practice based on evidence that she advocates?
These doctors are at least being true to what they know is right; which sadly most people don’t have the guts to do anymore. I have had two miscarriages and suffered greatly from the loss of my babies. I personally would want to know that I did not directly kill my baby to save my life.