The Tragedy and Hope of Ectopic Pregnancy

This began as something else. I set out to present an objectively reasoned answer to the question, “Is it right to participate in an abortion if the mother’s life is at stake?” but I was interrupted by sadness. My plan was to dedicate a later post to ectopic pregnancies, but the more I explored the issue the more sympathy I felt for parents presented with that scenario.

I tried to imagine sitting next to my wife as a doctor told us our child was going to die and that Jeni was in a life threatening situation as well. What do you say to news like that? Once your heart starts to beat again, your lungs reengage, and your stomach uncoils, you look to your wife to see horror and heartache collide in her stunned expression. The words I wouldn’t be able to find wouldn’t be heard anyway due to the thumping of her heart. The physical comfort I’d be too frozen to provide wouldn’t be noticed due to the numbness in her body. I’d feel hopeless. As the sadness hovered like a San Francisco fog, I came to realize there’s no easy way to talk about an ectopic pregnancy.

But why? Why was I emotionally exhausted trying to fully understand an ectopic pregnancy? Why was it so hard to write about? Why did I feel burdened? Frustrated, I pushed away from the computer and went to bed, and as I teetered on the edge of lucidity and slumber I realized why I felt that way. It’s because when I write about an ectopic pregnancy, I’m writing about a family walking through the crippling grief of losing a child. I’m writing about the death of a loved one and that’s sacred ground. Acknowledging the weight of mourning, I tried to appreciate the hopelessness of the diagnosis as well and I began to feel a righteous anger rising from deep within.

The anger wasn’t directed at the mothers and fathers who’ve had to make a choice like that. To be angry at those moms and dads would be like getting angry at a family who was burned horribly in a forest fire and ignoring the arsonist responsible for the flames. No, I feel deep sympathy for them. The anger was directed at those who’ve worked so hard to create and perpetuate a culture of abortion. The indignation pressed against a medical community that seems to have given up on some of the most desperate and defenseless among us.

What is an ectopic pregnancy?

Ectopic means an abnormal place or position, and in the specific case of pregnancy it refers most commonly to when a developing baby implants itself in the Fallopian Tube instead of the uterus. According to the Center for Disease Control, “Ectopic pregnancies are the leading cause of pregnancy-related deaths in the first trimester and account for 9% of all pregnancy-related deaths in this country.” The reason ectopic pregnancies are so serious is because if the baby continues to develop in the Fallopian Tube he would outgrow the space and cause the tube to rupture. The result is severe, almost always fatal internal bleeding. It’s a dangerous scenario to be sure.

Danger to the mother is normally avoided because at least 50% of the time ectopic pregnancies end with a miscarriage. It’s those that manage to survive that present a dilemma to parents and physicians. At least it should. To the morally and ethically sensitive physician this should be an agonizing scenario, communicated with tenderness and treated with compassion. Every time he has to tell a mother her child is putting her life at risk, he should tremble. There should be scores of physicians and medical researchers sleeplessly devising a way to remedy the situation and rescuing both mother and child. But I couldn’t find them.

Website after website, article after article, forum after forum echoed the same discouraging chorus, “no medical technology exists to move an ectopic pregnancy from the Fallopian tubes to the uterus.” And true as that statement may be, it’s the fact that the idea almost always stood alone that haunted me. I didn’t find a single reference to the research being done. No articles pointed to courageous physicians trying to redeem these maladies. I almost never read a comment to a frightened mother that included the simple, yet hopeful word “yet.” Is this really a tunnel with no light at the end?

What do we do with ectopic pregnancies?

There are two basic methods for addressing an ectopic pregnancy: abortion using a drug called Methotrexate or a surgery that removes the child or both the child and the Fallopian Tube from the mother. The Methotrexate abortion procedure is cheaper, faster, and theoretically poses less risk than the surgery so it’s selected by many as the proper course of action. While neither are positive options, they aren’t the focus here. My question is simplistic in form but challenging in intent, “Why isn’t there another option?”

The old proverb, “necessity is the mother of invention” transcends because it’s so simple and so true. When faced with seemingly impossible situations we have the wonderful tendency to find a way. We found a way to capture a moment in a photograph, to cure numerous diseases, and to cross the widest ocean because a need was present and someone met that need.

What moved Jonas Salk to find a cure for Polio? People were dying and needed to be helped.

Why did James Lind work to cure Scurvy? People were dying and needed to be helped.

Where did Edward Jenner find the motivation to cure Smallpox?  People dying and needed to be helped.

How drastically different is our approach to ectopic pregnancy? Instead of mustering the ingenuity to create and the persistence to endure until a heroic solution is discovered, we just eliminate the “necessity” by removing the person from the equation. No need, no invention, no hope.

Why can’t we move an ectopic pregnancy into the uterus? They say we don’t know how. Not knowing how, though, isn’t the problem. The problem is our apparent contentment with our ignorance. Why are we content with futility in this area? Is it because the procedure is too hard? Are we afraid for the life of the mother? Is it just so improbable it’s not worth the time and money? We don’t behave that way with Cancer or A.I.D.S. so why have we accepted defeat here? It’s probably a combination of things, but beneath all the “reasons” is the reality that our culture of abortion has created a necessity vacuum and thus removed our motivation to find a way.

Searching for hope.

Especially in the medical field, necessity begets invention but the learning curve is steep and the cost is extremely high. Dr. Ben Carson is arguably the best pediatric neurosurgeon on the planet and he recently gave a speech at Emory University where he spoke of the high price of medical learning.

“Not everything that we do, obviously, is successful. And that really is, kind of, the history of surgery. You know, the first kidney transplants, disastrous. Heart transplants, lung transplants, liver transplants, disastrous. You’d say, “why even bother?” But things were learned and that accumulated knowledge made it possible to be able to do those things so vitally important….”

“…You think about Walter Dandy, the incredible neurosurgeon at Johns Hopkins many decades ago. The first one to do all kinds of things. The first one to operate on the posterior fossa. People said, ‘you can’t operate back there, the compartment’s too small, the brain will swell, they will die.’ But he operated on somebody with a lesion of the posterior fossa, and they died. And another, and they died. And another, and they died. The first thirteen, they all died. Can you imagine how discouraged he must have been? I can’t even imagine what he said to the fourteenth patient. When they said how’d the other thirteen do? He probably said, ‘nobody’s complaining,’ but, you know, the fact of the matter is he just, he kept it up and now we’re able to do posterior fossa operations quite safely and quite routinely.”

“And now we’re able to do posterior fossa operations quite safely and quite routinely.” That’s quite the jump from “you can’t operate back there, the compartment’s too small, the brain will swell, they will die.”

What if we stopped using Methotrexate to take the lives of these children and instead began attempting to move the baby from its ectopic location to the uterus. Maybe the first dozen, or first hundred, or first thousand would die, but eventually we’d figure out a way to get it done. Maybe a mother could find some comfort in the fact that her baby died so another could live. Maybe a father could mourn the loss of his son while finding reassurance that he’d never lose another in the same way because we finally figured out how to do it. Maybe one day, rescuing a baby from and ectopic implantation and saving the mother both physically and maternally would be done “quite safely and quite routinely.”

Dr. C.J. Wallace shared Dr. Carson’s sentiment and focused his hope directly at the idea of re-implanting an ectopic pregnancy into the uterus,

“In this day of advanced surgery, with the art of transplanting different parts, and, in fact organs of the body, I wonder at the escape of so important a procedure, entailing so little danger, as the transplanting of an ectopic pregnancy from the fallopian tube into the uterus, thus permitting the child to develop and be born as was its intention before its progress was obstructed…”

“… I think we should make a supreme attempt to save the life of the growing child by opening the tube carefully and dissecting out the pregnancy intact and transplanting it into the uterus where nature intended it should go. It can be very quickly done. It does not endanger the life of the mother and may be her only chance to bear a child.”

Dr. Wallace penned those words in Volume XXIV of the medical journal, “Surgery, Gynecology, and Obstetrics” found in the Harvard Medical Library. That “day of advanced surgery” was January 1917, almost 100 years ago! What could he possibly know right? He had no access to MRI or ultrasound, X-ray technology was rudimentary at best, and he couldn’t possibly know the true improbability of the surgery he proposes. So what gives Dr. Wallace credibility on this topic? The fact that in September of 1915 he successfully pulled it off.

“I found an ectopic gestation in the left tube,” which was “enlarged to the size of a walnut… Knowing their anxiety for raising a child, I decided to try, at least, the only thing at hand – to transplant the ectopic pregnancy. … I carefully opened the tube and dissected the pregnancy out intact, being careful not to injure the sac in any way by keeping wide away and including part of the tub wall. It came out very easily and was in size about equal to a large olive. It was at once placed within the cavity of the open uterus… The tube was closed in like manner and left in place. The patient was watched carefully… for two weeks with no symptoms whatever. … The pregnancy went on normally to full term and resulted in the natural birth of a fine boy, fully developed and without a scar, May 2, 1916.”

1916. Let that sink in for just a moment. World War I was in full swing, Woodrow Wilson was president, BMW and Boy Scouts started, the Cubs played their first game in Wrigley Field, Walter Cronkite was born and Jack London died, and Margaret Sanger opened the first U.S. Birth Control clinic which was the forerunner to Planned Parenthood. And a twenty-seven year old woman  delivered the healthy baby boy that Dr. C.J. Wallace successfully transplanted from the Fallopian Tube to the uterus. He even said, “I have not the least doubt that many such transplanted ectopic pregnancies will be reported in the near future. We may and will have failures in this as in other transplantation procedures, but there is not the danger involved in this transplantation that there is in many of the others.” But for some reason, ninety-seven years later, after putting people on the moon, coding the Human Genome, and cloning sheep we can’t clone Dr. Wallace’s success. In fact, the diagnosis remains one of utter despair.

Culture of death

It goes back to necessity. Dr. Wallace discovered a medical trauma putting two lives at risk and had to do something. He saved both lives. But we’ve eliminated the necessity. About the time the boy Dr. Wallace rescued turned twenty-six, a group of Supreme Court justices decided children like him weren’t actually children after all. And the logic flows that since they aren’t children, there’s no need to rescue them.

Roe v. Wade was argued on behalf of the health and welfare of women to the detriment of children, females included. However, studies show that life-threatening ectopic pregnancies, the ones that are the leading cause of pregnancy related deaths, have seen a “300 percent increase since abortion was legalized. In 1970, the incidence was 4.8 per 1,000 births; by 1980 it had risen to 14.5 per 1,000 births.”(1) It has also been discovered that “the risk of an ectopic pregnancy is twice as high for women who have had one abortion, and up to four times as high for women with two or more previous abortions.”(2) In an effort to “improve women’s health,” the unintended consequence of putting even more women in danger was born. Death begetting death.

It’s no small note of irony that the same year this life saving surgery was performed, the life taking eugenics movement took on a brick and mortar manifestation in Margaret Sanger’s first birth control clinic in these United States. Fast forward to today and her institution is the largest abortion provider in the world, and every time we perform an abortion on a child developing ectopically, we’re forfeiting a chance to develop the transplant procedure, increasing the woman’s risk for another ectopic pregnancy, and taking the life of the child.

As an aside, what we’re observing in the management of ectopic pregnancies can be used to predict what will happen with the elderly. Euthanasia is abortion’s older brother and as the Culture of Death continues to persist,we will see reduced necessity to protect the infirm and an increased rate of those euthanized.  It’s inevitable.

What we must do

By removing the necessity to develop the medical skills to routinely perform ectopic transplants, we’ve created the primary moral dilemma used to justify the need for abortion. It’s circular reasoning in practice. However, were we to prohibit abortions, we’d see an intense necessity to save the mother and child, resulting in the mastery of this surgery, reducing the number of abortions, and therefore reducing the frequency of ectopic pregnancies.

But this article isn’t about the law. This is about a spirit of hope. This is about rejecting our macabre state of contentment as a society and pushing our medical minds to solve this problem. This is about being able to tell a mother one day that her baby is implanted ectopically but after a safe and routine procedure both her and the child will be safe. This is about rising up.

We must have the courage to ask our OB-GYN physicians to try transplants. We must be willing to get behind those who would be willing to try. We must continue to educate women and men about the dangerous side effects of abortion, including the increased risk for ectopic pregnancies. We must change the culture.

1. U.S. Department of Health and Human Services, Morbidity and Mortality Weekly Report 33 (April 1984).
2. Ann Aschengrau Levin, “Ectopic Pregnancy and Prior Induced Abortion,” American Journal of Public Health (March 1982): 253.