h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

The women I have met who have had pre-eclampsia (although not necessarily to the severity you have described, with convulsions present), have had c-sections to deliver the baby. Of course it's not a fool-proof procedure when it needs to be done so urgently, and with the mother in such a desperate condition (the types of anesthesia and other medications used to attempt to bring the blood pressure under control are the work of the anesthesiologist, who has loads of medications to choose from, many of which can be used to counteract side effects from other medications that might be used), but the obstetrician is not about to try to decide which one is more worth saving - he's too busy trying to save the lives of both of his patients.

And yes, he does consider both the baby/fetus to be one of his patients also. Why wouldn't he? The fetus has it's own heart/heartbeat, circulatory system, often a different bloodtype from the mother, about half the time is the opposite sex of the mother, and always has some genetic material which is different from the mother's. Sounds like a completely different person to me, which is why I always have to wonder why there is this big argument about "keep your laws off my body". (not those exact words necessarily, but you know what I'm talking about, so I don't need any criticism that no one used that particular phrase here, ok?) With the exception of the physically visible sexual organs which do not develop until further along in the pregnancy, all of the other signs that this is indeed another person are present in the developing fetus, most of them before the mother even knows she is pregnant. That includes the heartbeat - the cells which will eventually form the heart begin beating in unison while the developing embryo is still only a cluster of cells, long before any currently available monitoring device could detect them. (I saw footage of this microscopic phenomena on a Discovery/TLC show about fetal development years ago, and was astounded that the heart cells began beating before they'd even become organized enough to form a heart!)

I found the comment about how horrible it would be to be pregnant and have to give birth, outside of the desire for a child to be curious. I've had two children, and it was wonderful to be pregnant both times. Yes, there were some discomforts, but the wonder of being pregnant more than made up for the little inconveniences. As far as labor was concerned, I had c-secs both times... the first was a breech, so I wasn't even allowed to labor, precisely because of the situation which was described earlier where the baby's head might not be able to pass through the birth canal quickly enough. The second time, I had been in labor for 36 hours, but had made little progress, so when the fetal monitors showed possible signs of distress (combined with the dangers of rupturing the old uterine surgical scar if they'd tried to speed things up using pitocin), the decision was made to deliver this baby surgically also.

I've taken so long to write this that the conversation has probably already shifted to several other subjects in the meanwhile... so feel free to continue on whatever you're talking about now...

Well that comment how horrible it must be was from me who is male.. it seems horrible to me!

Considering the differences in male and female anatomy... it *would* be rather horrible for a male to be pregnant and give birth!


Aside from the fact that all women know that men can't take the pain of childbirth, and aren't patient enough to endure 9 months of pregnancy...

I was just trying to prove the point that if men tried to imagine giving birth then I expect that one or two would changed their views on abortion...

From what I understand, abortion is a very painful proceedure also (both physically and emotionally), so it would behoove both men and women to consider carefully the consequences of their actions - any time you have sex there is *always* the possibility of a pregnancy (no matter what kind of birth control is used, there isn't one yet devised which is 100% effective), so all would do well to be prepared for the responsibility associated with the possible failure of birth control.

Pardon me in not giving all the details. I thought someone would have described it by now. Some partial birth terminations involve one cut up into the upper spinal cord /brain stem area. Death due to the brain not being able to get the message to breath. The head and upper spinal cord are out of the mothers body, in order to do this.

Non--technical explanation as I understood it many years ago.

Lady Scott - when I referring to pre-eclampsia, I was only really typing about HELLP syndrome, a particularly severe form to which termination is considered as an option if it occurs before 24 weeks - but as you put in your post, there are varying severities and you are right, a caesarian is usually what is required in the vast majority of cases.

However, Z wanted to know when a late medical termination would be used, and HELLP syndrome before 24 weeks would be one case which it would be considered as an option.

WD

Abbi - a description of the procedure is given here http://bmj.com/cgi/content/full/326/7390/619/a?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&titleabstract=%22partial+birth+abortion%22&searchid=1049365577868_4362&stored_search=&FIRSTINDEX=0&resourcetype=1,2,3,4,10

(sorry about the wrap guys)

It's from the BMJ, and for thouse who are loath to clicking in links, here's a cut and paste of the procedure:

'Partial birth abortion is what the American College of Obstetricians and Gynecologists calls a non-medical term for "intact dilatation and extraction," a rarely used technique for late abortions. The fetus is partially delivered feet first, up to the neck. Then the base of the skull is punctured and the intracranial contents removed so that the head collapses, enabling the rest of the fetus to be delivered.'

This may be why I've been struggling in trying to find references to this - I'm more familiar with the term 'dilatation and extraction', and also that it is so rarely used.

Will get back to you on this

WD

Thanks, WD - it is good to have medical facts included in such an emotive discussion.

B

No probs Ben

Also - no problems with wrapping long addresses too! Wonderful

WD

This is an interesting article which tries to be as neutral as it possible to be on such a sensitive subject. It draws together some of the more factual evidence presented by all sides of the debate and tries to present the whole lot in a balanced and understandable form.

http://www.religioustolerance.org/abo_pba.htm


IMO the legislation passed in the US is an extremely dangerous piece of PR.

The legislation bans PBA, except in those cases where it IS medically necessary, i.e. loss of life of the mother, serious disability to the mother, the foetus is already dead or the foetus will not survive the birth.

In other words the procedure will continue to be used for its current purpose, however doctors using the procedure may now face prosecution unless they can demonstrate after the fact that the one of the conditions given above applied.

It is also worth bearing in mind that while some of the numbers presented in articles such as the one given above, can appear large simply because they are based on large populations.

How many conceptions occur daily? How many spontaneous abortions occur daily? How often do complications arise during pregnancy? etc.

IMO all of these questions amongst many others deserve proper attention before one can even consider being in a position to make a judgement.

Curious?

Well. You have to think outside yourself for a second. How would you feel if you were an individual who just didn't want children. You would have no interest in bringing up another human being, no education to do so, maybe not even the financial or emotional capability as well. Not everyone who gets pregnant is happy doing so (I would be, but that is an entirely different situation)...and the results of that : depression being one of them, are incredibly severe. It's not always the glowing happiness that some women experience.

And the very idea of labour is terrifying. So many things can go wrong!! In hindsight, LL, you might not be worried. But I'm not sure I am alone in being a female worried about pregnancy, labour and the aftermath in having a child.

PS - apologies for last nights rant-fest. I should burn my soap box at some point in my life. Specific apologies to the people I either misread or insulted. Not the best way to conduct ones self. But hell, I am young. Still got learning to do.

Here is some information for patients about ToPs from the Royal College of Obstetricians and Gynaecologists - it's very accessible and quite good in telling you about the different methods of termination at different stages of gestation:

http://www.rcog.org.uk/mainpages.asp?PageID=701

In particular, this is a good diagram: http://www.rcog.org.uk/images/abortion_care.gif

WD

...and from the same website, there is also advice about late ToPs, which can be found here:

http://www.rcog.org.uk/mainpages.asp?PageID=768

For those who are loath to click on links, here is the relevant paragraph:

'Late abortion can be an extremely traumatic event, not only for the patient but also for the attendant, medical and nursing staff. There are serious clinical, ethical and legal issues and the patient should be managed according to the recommendations in the RCOG report Late termination of pregnancy for fetal abnormality in England, Wales and Scotland.

Parents must receive sympathetic and supportive counselling before and particularly after the procedure. For all terminations at gestational age of more than 21 weeks and 6 days, the method chosen should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Intracardiac potassium chloride is the recommended method and the dose chosen should ensure that fetal asystole has been achieved. It should be confirmed by observing the fetal heart by an ultrasound scan for five minutes. Additionally, it is mandatory to confirm asystole by an ultrasound scan 30-60 minutes after the procedure, and definitely before the patient leaves hospital. Consideration can be given to abolishing fetal movements by the instillation of anaesthetic and/or muscle relaxant agents immediately prior to potassium chloride administration.

It is essential to have an agreed multidisciplinary management plan prior to late termination, taking account of issues such as conscientious objection. The multidisciplinary team should include, where appropriate, obstetricians, neonatologists, midwives and nursing staff. Where the patient chooses not to have feticide in the presence of a lethal abnormality, discussion must take place within the appropriate team, and the patient’s wishes and agreement sought on the management of the fetus after birth.'

WD

Wow, it has took me so long to read all this I now have no time to re-write my reply. I'll be back later!

If there ever is a One World Government, I want AGCBen and TBTPM to be in charge - even when they disagree with someone, they do it with so much wisdom and grace. (And WD, how do you fit in h2g2 with *all* that studying?).

Good you posted a link and the journal info WD

The irony is that we disagree with each other a lot too, but with wisdom and grace, naturally.

Thanks Potholer, that was a lovely compliment.

B

I have noticed that too about AGCBen, but who is TBTPM?