I had a routine checkup in 2006 when I was 16 weeks pregnant. On my previous date, I was thrilled to hear the fetal heartbeat, which sounded like the blades of a helicopter whizzing past frantically at top speed.
This time, there was only silence as the nurse placed the Doppler monitor on my slightly swollen belly. “Where’s the heartbeat,” I asked casually. Instead of answering, the nurse moved the monitor around my abdomen. “Where’s the heartbeat,” I repeated anxiously. The nurse made an excuse to call the doctor.
A few hours later, I was taken to the hospital and given medication to induce labor. My child died sometime before, but my body hadn’t realized it yet. This is a so-called “missed labor” that requires medical intervention to end the pregnancy and clear the uterus to avoid sepsis or potentially fatal bleeding.
Having gone through the grim and arduous process of releasing a child I would never have known, I was acutely aware of just how dangerous female childbirth has been over the past few centuries.I’ve been thinking about that traumatic experience in recent days since the US Supreme Court overturned it Luo vs Wade, prompting Republican-led states to introduce new abortion bans. On the tiny island of Malta, doctors are challenging their country’s own draconian abortion ban this month, which prevents them from providing life-saving treatment to a foreign tourist who suffered his own complicated late miscarriage.
I’m lucky — or you can be lucky when the first pregnancy ends heartbreakingly in the middle. Because the fetus was dead, doctors in Thailand, where I lived at the time, didn’t have to make difficult decisions about my medical care in a legal gray area.
But things are not always that simple. Second-trimester miscarriages are often much longer and carry a higher risk of serious complications than early miscarriages, so prompt and appropriate medical intervention is critical. The abortion ban confuses and prevents this treatment.
In 2012, Indian dentist Savita Halappanavar, who was 17 weeks pregnant, died of sepsis in Ireland after doctors refused to urgently terminate her pregnancy. long term miscarriageEven though doctors knew her baby would not survive, they refused to abort a failed pregnancy – or hasten a painfully slow miscarriage – while having a fetal heartbeat, citing Irish Catholicism.
When the tragedy hit the headlines in India, people were shocked that such a developed country refused to provide life-saving care on religious grounds. In 2018, Irish voters repealed a law giving fetuses and their mothers equal rights to life legalization of abortion.
In Malta, doctors demanded that the country’s abortion ban be eased after an American tourist had to be flown by air ambulance to Spain for urgent care last month. She suffered a partial miscarriage at 16 weeks, which left her fetus with no hope of surviving – but Maltese doctors refused to terminate the pregnancy until the fetus’ heart stopped, citing the strict prohibition of abortion in the 1850s, even to save the mother’s life . Clinicians who flout this rule face up to four years in prison.
Some 135 Maltese doctors have now signed a judicial petition calling for a review of the law, which they say hinders proper treatment of women and violates Europe’s human rights charter.
Gynaecologist Isabel Stabile, who is a member of the campaign group Choose Doctors of Malta, said doctors would sue if local authorities refused to participate. “The law has had a chilling effect on the ability of doctors to practice,” she told me, complaining that clinicians are working “in a rut.”
In the U.S., states that now criminalize abortion may grant immunity to women whose lives are at risk. In practice, however, Stabile warns that such a ban would still hinder care, as doctors fearing criminal prosecution could delay necessary intervention until the danger to a woman’s life is so indisputable that it is too late. When a pregnancy goes awry, women “may go from good to bad to very bad and then die very quickly,” Stubier told me. “Who decides when you’re on the edge?”