Quantcast

«

»

Nov 20 2012

Not just Ireland

Dr Jen Gunter has a terrific post today on Savita Halappanavar – yes, another one. It starts with the fact that the hospital was checking fetal heart tones, not once, but several times a day. That’s a tell.

Fetal heart tones are not checked with any medical purpose in mind until viability (around 23-24 weeks). The presence of fetal heart tones was irrelevant because survival of a baby at 17 weeks with ruptured membranes and/or advanced cervical dilation is impossible. Ms. Halappanavar was not 22 weeks pregnant where there might be a 3% chance of survival (depending on weight, sex of the baby, gestational age, whether it is a singleton or a multiple gestation etc). At 17 weeks with ruptured membranes, regardless of cervical dilation, this pregnancy could only end in with a fetal demise. In a study from 2006, when membranes ruptured at 21 weeks or less the outcome was “dismal.” In fact, in this study there were no survivors when membranes ruptured between 18 and 19 weeks. Whether a fetus has cardiac activity at 17 weeks with ruptured membranes and a dilated cervix is simply not part of the medical decision making tree.

And then there’s the risk of infection. The hospital was checking the fetal heart when that was completely futile, while not doing what needed to be done about the infection that developed.

We know why. Catholic hospitals in the US do the same thing.

Jen Gunter continues.

I’m told that while Irish law technically allows abortion to save the life of the mother, many practitioners fear recrimination and exactly when the life of the mother is “at risk” is a murky question. I can easily argue that Savita’s life was at risk the moment her membranes ruptured at 17 weeks. However, does Irish law mean a different kind of risk? And if so, how would doctors judge that risk to be present? Ruptured membranes and fever? Shaking chills? Bacteria in the amniotic fluid? Positive blood cultures? Sepsis? Cardiovascular collapse? How sick must a pregnant woman be in Ireland be for a doctor to state that her life is at risk?

Whether the delay in Ms. Halappanavar’s care was fear of criminal repercussions or personal dogma, both of these scenarios are permitted to exist because of laws that trounce evidence based medicine. Her husband’s claim that Irish law played a role rings true because the team was checking for fetal heart tones when the only vital signs that mattered were Savita’s.

And it’s not just Irish law that does this. It’s the “Ethical and Religious Directives” governing Catholic health care that do it in the US.

Hospitals are Required by Law to provide the Standard of Care, [6] Yet Hospitals Fail to do so Because of their Adherence to the Directives.

In some of the miscarriage cases described in the Ibis Study, the standard of care requires immediate treatment. Yet doctors practicing at Catholic-affiliated hospitals were forced to delay treatment while performing medically unnecessary tests. Even though these miscarriages were inevitable and no medical treatment was available to save the fetus, some patients were transferred because doctors could still detect a fetal heartbeat or required to wait until there was no longer a fetal heartbeat to provide the needed medical care. 

Italics added. That’s not Ireland, that’s the US.

12 comments

Skip to comment form

  1. 1
    Valde

    And I still cannot believe that there are people who think that the *right* thing happened!

    http://www.upworthy.com/dear-america-this-is-what-happens-when-you-ban-all-abortions-sincerely-ireland?c=fea

    In this video, an old man and an anti-choice politician not only defend the doctors, but state that savita’s death was a moral outcome!

  2. 2
    Argle Bargle

    When the placenta ruptured the fetus was dead. Its heart may not have ceased functioning, but the fetus was not going to survive more than a couple of days. So the Catholic bishops and the Irish doctors were using a purely artificial criteria to determine whether the woman dies or not.

  3. 3
    Valde

    cross posting this, cuz I think its awesome

    http://idwarrior.wordpress.com/2012/04/22/no-compromise-no-surrender/

    one of the best, and longest, pro-choice manifestos I have ever come across

  4. 4
    briane

    From Bobo’s link:

    An embryo is not a human being. A blastocyst is not a human being. A fetus is not a human being. If you say that they are, then you are saying that all women are gestational slaves (either potential or actual).

    I say a fetus is a human being and I say that women are not gestational slaves. It’s a non-sequitur to suggest that calling a fetus a human being means that women are gestational slaves.

    Two points:
    1. A human being is no more than an organism with human dna that is alive. A fetus, active child, healthy adult and vegetative accident victim all are human beings. Only the child and adult are persons who have desires, wishes and are morally autonomous. As such an adult woman is worth more in moral consideration than a fetus.

    2. Even if a fetus was considered a person, it’s still not moral to force a woman to carry it if she chooses not to. Whether previously she’d wanted to get pregnant or not. See http://spot.colorado.edu/~heathwoo/Phil160,Fall02/thomson.htm

  5. 5
    Valde

    briane: the value of the link, for me, is the list of side effects of pregnancy. I have pasted them to anti-choicers who like to insist that pregnancy is a ‘minor inconvenience’. said pro-choicers choose to ignore the information, and to go on pretending that pregnancy is the equivalent of an itchy scalp!

  6. 6
    Valde

    *said pro-choicers should read ‘said anti-choicers’

  7. 7
    Maureen Brian

    Fortunately, Mr Halappanavar is having no truck with any wooly-mindedness.

    He has insisted that 3 of the original proposed members of the “official inquiry” be ditched as they are senior staff at the very same hospital where his wife died.

    He’s basically said no co-operation, no evidence from him, no access to the medical records unless they get a grip and do this inquiry thing properly!

    A man of great courage, clearly.

    http://www.independent.co.uk/news/world/europe/uturn-for-irish-health-chiefs-as-senior-consultants-are-axed-from-team-leading-probe-into-death-of-savita-halappanavar-8335072.html

  8. 8
    briane

    Apologies Bobo. I read that paragraph and stopped right there. It pushed a few buttons, because whether a fetus (conceptus, blastocyst, embryo) is a human being is beside the point. A woman is a person, so morally equal to all other persons, and as you cannot do more than request that one person inconvenience their own life for another person (it’d be nice of you to damage your own body for nine months to save this other person, but it’s not immoral to say no), then a fortiori no human being (from zygote to elder) is the responsibility of any person, thus any woman. But, let’s grant the fetus personhood, (for the sake of argument), still no woman is morally obligated to carry the pregnancy to full term.

  9. 9
    No Light

    @Rodney -

    When the placenta ruptured the fetus was dead. Its heart may not have ceased functioning, but the fetus was not going to survive more than a couple of days.

    Sorry to nitpick, but it was the amniotic sac (bag of fluid that contains the foetus in utero) that ruptured. Without amniotic fluid the foetus suffocates. Sometimes smaller leaks stop spontaneously and the fluid regenerates sufficiently that the foetus is ok. Sometimes it’s such a slow leak that nobody notices, and foetal death occursa as the only symptom*. It’s not immediately dangerous for the woman?

    Placental abruption, where the placenta detaches from the uterine wall, is another complication that can range from the “Scary but manageable” to “Both dead from internal haemorrhage”.

    Not treating placental abruption at all, just like giving no treatment for incomplete spontaneous abortion as in the Irish case, is a death sentence.

    *Happened to a friend of the family. Healthy 18 year old, textbook first pregnancy with active foetus. She went past her estimated due date, and local practice is watchful waiting up to 42 weeks if woman and foetus are healthy.

    At 41w6d foetal movement stopped.. On examination it was found that there was no amniotic fluid surrounding the foetus, who had tragically suffocated. An inquest ruled that it could have been a spontaneous leak brought on by Braxton-Hicks contractions, or caused by the sac being snagged during an examination.

    Incredibly sad event. The girl was thankfully physically ok, but spent a long time in psychiatric inpatient care as a result of the death of her much-wanted child.

  10. 10
    Argle Bargle

    I apologize that my lack of knowledge of obstetrics caused me to use the wrong terminology. Aside from that minor, inconsequential detail, my point stands.

  11. 11
    sgailebeairt

    ….latest irish tweets, saying, key infomatin missing from hosp records, also 2006 acconts of bad OBGYN treatment in irelnd!!

    http://www.independent.ie/opinion/analysis/magdalene-laundry-ethos-is-alive-and-well-and-rules-our-hospitals-136577.html

  12. 12
    No Light

    Sorry Rodney, yes, your point is spot on. I should have been clearer earlier on. The correction wasn’t personal, it was because it’s been argued (by anti-abortion muppets) on FTB and elsewhere, that we can’t say that the doctors were wrong, as we don’t know the facts.

    I saw the argument descend into horrible pro-liar derailing and propaganda at one site I use, all justified by them because of a very tiny elision. If they turn up here it’s one less shitsack in their trebuchet if they can’t say “Hah! You don’t even know what was wrong with her!”

    I’ve been having this argument for a week, all over the internet. I want to reduce the pleasure of the mental masturbation for catholic apologists.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>