Sunday, September 26, 2021
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Ectopic tissue? That’s our baby you’re talking about


MY wife was pregnant with our first child – and bleeding. Mild spotting at first, but when it got heavier, we went to the hospital. The ultrasound technician informed us that she could see no sign of pregnancy in the womb. My wife must have miscarried, I thought. Or maybe she hadn’t actually been pregnant at all. ‘But,’ the nurse continued, ‘there is a small amount of ectopic tissue in the left fallopian tube.’ 

Ectopic tissue? How’s that for a euphemism? My wife was seven weeks pregnant – even from the coldest scientific perspective we were talking about a tiny developing organism. Perhaps it’s no surprise that hospital staff will prefer to use euphemistic language in place of ‘baby’ or ‘child’ when there’s no chance of survival. Yet even in such cases, terms such as zygote, blastocyst, embryo or foetus would be preferable, having the advantage of being correct (depending on the gestational stage). But I’m not sure that most parents want their child’s humanity to be downplayed in this way. Feeling the loss of a child is a part of loving that child. Every parent knows this. 

The literature we were given by the hospital continued in this vein, referring to ‘the pregnancy’ rather than using any term that might suggest a human life. On the phone, too, the nurse who called with the blood test results referred to the (gestational) sac, but avoided telling us whether the baby was alive. When we put the question directly she told us unconvincingly that it didn’t appear to be ‘a live ectopic’. An ectopic. Is that even a noun? 

I can only conclude that this is a consequence of the incongruity of a medical field that brings new life into the world one moment and destroys it in the next. A miscarriage or an ectopic pregnancy will cause a mother real grief and heartbreak, eliciting the sympathy of hospital staff. Down the corridor, however, the woman who’s chosen to have an abortion – perhaps by taking RU-486, which essentially forces a miscarriage – is meant to celebrate the free exercise of her reproductive rights and yet is often likely to experience a similar grief. It might seem counterintuitive to speak to a woman who’s chosen to have an abortion by referring to the baby she’s decided not to keep. But even here, shouldn’t a woman choosing a termination be given full accurate knowledge of what ‘terminating a pregnancy’ means and entails? 

One might be forgiven for assuming that childbirth and abortion happen at opposite ends of a hospital. But they are both considered women’s issues, so they’re often overseen and performed by the same doctors who, reasonably enough, wish to employ a common glossary of terms when dealing with patients suffering miscarriages and those seeking abortions. But what about mothers who have absolutely no understanding of the medical science or whose English isn’t good enough to comprehend the real meaning behind these euphemisms? Maybe it’s the intention of medical professionals to keep such patients in ignorance. My wife shouldn’t have had to ask the nurses whether the baby was alive; the answer to that question ought to have been their top priority.

Of course, when it comes to wanted babies in viable pregnancies, women are spoken to using the correct terminology. And this brings us to the real issue. The ‘ectopic tissue’ in my wife’s left fallopian tube would have had a heartbeat at six weeks, brain activity a few days earlier and a unique DNA complex from fertilisation. Given these empirical facts, is the value of an unborn human organism nowhere else than in the subjective desire and experience of the mother or is the value intrinsic to that organism?

The NHS appears to take the first position, that the value is subjective, determined by whether the child is wanted. If this is true, then the pregnancy is rather like an eBay auction. At worst it was an item you really wanted but you were outbid in the end. It’s a shame but no more than that. On the other hand, you might have placed a bid by accident or in an impulsive moment and are relieved that you didn’t win. Miscarriages and abortions can both fit into this view with the obvious caveat that a baby is certainly of more subjective worth than an eBay commodity. But my point is that on this view the baby is valued precisely to the degree that it’s desired as an extension of the mother’s identity and experience — almost as an accessory.

The second position is that the value of the baby is in the baby, just as the value of every human being is intrinsic to that human being. On this view, future generations will look back on our treatment of the unborn with horror. This view forces us to confront the bioethical issues that surround both abortion and ectopic pregnancies.

Is it, for example, morally defensible to terminate the embryo in order to save the mother? Either by using methotrexate, which stops cells from dividing and thus causes the death of any embryo still alive, or surgically, with a salpingostomy – incising the fallopian tube to remove the gestational sac so the tube can heal? Both these options treat the embryo as the threat, targeting it directly to save the mother and her fallopian tube.

Or is it morally preferable to treat the fallopian tube as the threat? In a salpingectomy the entire tube is removed with the embryo inside. Here the goal is to stop the fallopian tube from endangering the mother, not to kill the embryo directly. The ensuing death of the embryo is secondary and indirect. The difference might seem small but ethically it’s everything.

Or should we take the more nuanced approach that it’s neither the baby nor the tube, but the disordered relationship between the two that is the real threat, however that should be addressed? Construing it this way may be useful in dealing with more complex ectopic pregnancies, where the blastocyst implants somewhere other than the fallopian tubes, and the treatment options are fewer and more dangerous. At the very least this attitude ought to be the starting point for doctors and researchers as they try to find ways to save the lives of both the mother and the baby. Is this research being carried out at all? Judging from the language used, the NHS appears to be trying to prevent us from even beginning the ethical conversation. 

Ask any couple who’ve had a miscarriage whether it hurts because they didn’t get something they wanted, or because they lost a child they loved for itself even before they had the chance to show it any affection. Whatever one’s opinion on abortion, it isn’t right that in order to justify its legality and to placate the feelings of the women seeking one, parents are forced to listen to hospital staff refer to their soon-to-be-dead children with dehumanising and misleading language.

A day later I listened as my wife tried to get the information from another nurse over the phone. 

‘Is the foetus alive?’ my wife asked. ‘I don’t think we have seen the foetus,’ came the response. ‘Just a gestational sac.’ ‘But the foetus is still in the sac?’ ‘No no, we haven’t seen it; there’s no foetus.’ ‘Is there an organism in the sac?’ ‘No, nothing . . . we have seen the pregnancy, but inside it there is nothing.’ ‘Is there a heartbeat? Is the organism still alive, or it is just a sac?’ ‘There’s no organism inside the pregnancy . . . but if the pregnancy is growing there’s a possibility that it might grow as well . . . the rising hormone levels suggest the pregnancy is progressing and there is a possibility that it may develop the foetus and all those things inside the pregnancy.’

Either we were being told lies or the nurse didn’t understand the relevant biology. Maybe they couldn’t see anything inside the sac, but that doesn’t mean there was nothing there. And if there’s a possibility that the pregnancy ‘may develop the foetus and all those things’ then the organism is certainly already there. But I’m no doctor.

I don’t mean to be so harsh on the nurses – perhaps it isn’t their job to know all the details or to answer such questions. And my wife and I are grateful to the hospital staff for discovering the ectopic pregnancy so early and for the timely treatment my wife received from both the doctors and nurses. She would be dead without their expertise. But there’s a serious ethical problem if the life of the unborn child is disregarded entirely throughout the entire process. We had to do our own research; we consulted bioethicists. And we had to tell the doctors what we wanted using information that had been denied to us. 

When we eventually spoke with a doctor, we learned that my wife’s hCG (human chorionic gonadotropin, a hormone produced during pregnancy) was continuing to rise to dangerous levels, requiring emergency treatment. She opted for a salpingectomy, but mercifully any ethical dilemma was taken out of our hands as the doctor finally informed us that, despite its continued growth, our ‘ectopic tissue’ was already dead.

We named our baby Francis.

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Andrew Mahon
Andrew Mahon is a Canadian-British writer based in London.

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