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,  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.