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abortion, Ethics, evidence based medicine, pregnancy

Ectopic pregnancies, exploding gifts from God at some Catholic hospitals

An ectopic pregnancy is a pregnancy that implants outside of the uterus. It occurs in approximately 1% of conceptions. It typically grows in the fallopian tube, but rarely an ectopic pregnancy can grow in the ovary or cervix.

A pregnancy has trophoblastic tissue, the purpose of which is to invade deep into the wall of the uterus and set up a system of nutrient and oxygen delivery from the mother to the embryo. Trophoblastic tissue is aggressive, because the muscle of the uterus is thick. Now imagine these aggressive, invasive cells when faced with the wrong tissue. Thinner tissue. These mini Ms. Pacman-like trophoblasts chew up the relatively flimsy fallopian tube tissue, damage blood vessels, and catastrophic bleeding ensues. The pregnancy can literally blow a hole in the side of the fallopian tube, the result is typically catastrophic bleeding.

This is how women die from ectopic pregnancies, they bleed to death. Although thankfully this is very uncommon as we have ultrasounds that identifies these pregnancies very early on, surgery or medication to treat them, and blood transfusions just in case.

The recommended treatment for an ectopic pregnancy is surgical removal or systemic methotrexate (a cancer drug that kills the rapidly dividing trophoblasts, which are in many ways like cancer cells). According to the latest Cochrane review (Interventions for tubal ectopic pregnancy, 2009) there is insufficient data to support expectant management, i.e. watch and wait is not standard of care.

An ectopic pregnancy is not destined to be a baby. It can never, ever grow to viability. It will, however, grow to injure the pregnant woman. So you’d think treatment shouldn’t be controversial…unless of course you want care at some Catholic hospitals.

Yes, some Catholic ethicists argue that the catholic “Directives” preclude physicians at Catholic hospitals from managing ectopic pregnancies in a way that involves direct action on the embryo. So a woman can have her whole tube removed (an unnecessary procedure that could reduce her future fertility), but she can not have the pregnancy plucked out (as is done with the standard therapy, a salpingostomy, where a small incision is made in the tube and the pregnancy removed) and she most certainly could not have the methotrexate.

How common is this practice? Well, it is pretty sad that someone had to study it. According to a study from 2011 by Foster e. al., (Womens Health Issues, 2011) some Catholic hospitals refuse to offer methotrexate (three in this study of 16 hospitals). The lack of methotrexate resulted in changes in therapy, transferring patients to other facilities, and even administering it surreptitiously. All of these expose women to unnecessary risks, expense and are, quite frankly, wrong.

It amazes me that with ectopic pregnancy, such a clear-cut case of life of the mother with therapies well supported in the literature, that any physician or hospital could have any other moral or ethical agenda than delivering the right medical care.

Putting religious beliefs ahead of urgent/emergent medical care in never right and I shudder to think how the management of ectopic pregnancies would change should a national personhood amendment pass.

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Discussion

52 thoughts on “Ectopic pregnancies, exploding gifts from God at some Catholic hospitals

  1. Religious beliefs have no place in medicine ,and any physician who makes a medical decision based on what his/her Church thinks is not practicing EVIDENCE BASED MEDICINE, and therefore should seek another profession.Furthermore I don’t understand how any scientifically minded individual can ignore Darwin’s Survival of the Fittest. Religeon is based on blind faith in contrast to the practice of medicine which is based on modalities of patient care that have been scientifically proven to bring about the best outcomes given the patient’s circumstances.

    Elizabeth Gillman BSN

    Posted by Elizabeth Gillman BSN | November 5, 2012, 7:45 am
    • Spoken like a nurse. Mind you nurses think they know a lot about practicing medicine when in reality they don’t. If you want to speak to the methods doctors use when making medical decisions, then you should put down your bedpans and enema bags and go to medical school. Otherwise, stick to speaking for your own discipline, ma’am

      W. B. Britton, MD

      Posted by WBBritton | November 5, 2012, 7:06 pm
      • Nice ad hominem reply. Does your medical training qualify you to discuss issues, or just to insult people and dodge the point.

        Posted by Kieran | November 6, 2012, 2:10 am
      • Spoken like a rude idiot. Did you refute her point? No. Did you offer any evidence for your point of view? No. Did you even have a point of your own? Barely as your point was somewhat obstructed by your condescending bullshit. If a patient asks you why your doing something are you able to give them the logical reason behind the science that allowed you to come to your conclusion or do you just shrug your shoulders and say “God told me to do it”?

        Posted by foolishwolf | November 6, 2012, 3:58 am
      • I am not a nurse, and could have just as easily made the same statement. Any living, breathing individual can agree with scientific principles – they don’t need to be a Doctor to have an educated opinion. Perhaps you should put down your ego and spend more time in real life. Otherwise, stick to fixing broken bodies, Dr. Britton.

        Posted by aratingarides | November 6, 2012, 6:18 am
      • I haven’t met a doctor yet who can function on thier own without nurses to help. I have epilepsy, and every single doctor I have had to deal with has displayed that same arrogance. Do they teach you how to be a prick in medical school? My mother, brother, two cousins and an aunt are all nurses, and every one of knows the ins and outs of the medical field than any doctor I’ve ever met, all of whom were fine at their narrow field of expertise but had no clue how to actually care for a patient. So don’t go insulting nurses, you would be useless without them. As regards this article, maybe you need to go back and take a hard look at that oath you took.

        Posted by Chris Doring | November 6, 2012, 6:41 am
      • Nurses do more than carry bed pans. You show your ignorance by insulting us. We are responsible for programming drug solution that can kill a patient if we don’t do it correctly. We also have various kinds of degrees such as Bachelor of Science , Masters and PHD.. We have to interpret patient symptoms and act accordingly. In ccu and ICU units doctors have given us standing orders to administer potentially dangerous drugs to patients that are based on our assessment of their condition where time is of the essence and we have to act immediately.Nurses represent the backbone of patient care. You obviouslyb have misrepresented the way nurses function to help accelerate positive patient outcomes.Your comments are IDIOTIC…and I am being KIND to you.

        Posted by Elizabeth | November 6, 2012, 6:53 am
      • How embarrassing. Dr Britton is likely young, and more than likely based in the US. He does not represent the rest of us physicians at all.

        Posted by Lancelot Gobbo | November 11, 2012, 7:29 am
      • Your respnse to my comments are typical of an arrogant personality type.As nurses we have the responsibility of caring for parients and overseeing physician errors. In the old days nurses acted upon physician orders with no thought of their own liability when giving medications that were incorrect in terms of dosage which was written by an MD. I have seen so many critical errors that have led to patient complications due to physician lack of knowledge that I have learned a great deal about the practice of medicine. As an examp:’A patient has a heart valve disorder and the Cardiologist talks about valve replacement while ignoring the patient’s complaint about interrmittant chest pain. One week later the patient has a heart attack and needs a triple bypass. It’s common knowledge that doctors look away when their collegues make mistakes for fear that they might be on the chopping block if they too err!.
        Your sacasm tells me that you think that religion belongs in the practice of medicine. The person who should put down their bedpan and enema bag is obviously YOU!

        Elizabeth

        Posted by Elizabeth Gillman | December 2, 2012, 6:21 am
    • These doctors are at least being true to what they know is right; which sadly most people don’t have the guts to do anymore. I have had two miscarriages and suffered greatly from the loss of my babies. I personally would want to know that I did not directly kill my baby to save my life.

      Posted by Concerned Mother | January 31, 2013, 11:07 pm
  2. I wasn’t able to edit my comment and change the spelling of religion…Elizabeth

    Posted by Elizabeth Gillman BSN | November 5, 2012, 7:49 am
  3. And how is this not medical malpractice?

    Posted by Loren | November 5, 2012, 12:40 pm
  4. A Catholic viewpoint looks at the life of both persons. And a “personhood amendment” acknowledges the life which science itself says is there.

    Ultimate Truth has only one expression, and the Church, and Science, both seek to understand and express it.

    So this issue wil be reconciled at some point in the minds of all. Thank you for the informative post.

    Posted by Fr . KA | November 5, 2012, 3:57 pm
    • An ectopic pregnancy is no more a “person” than a tumour is. It’s death, pure and simple.

      But hey! Had it implanted correctly it would have had a 50% of being male, therefore, per your doctrine, that means it totally outweighs the useless sack of flesh carrying it, am I right?

      Disgusting. That’s what any doctrine is that gives a deadly ball of cells equal rights to the woman it’s about to kill.

      Religion has NO PLACE in medicine. That’s especially true of the woman-hating Abrahamic traditions.

      Posted by boostick | November 5, 2012, 6:15 pm
      • “Had it implanted correctly it would have had a 50% of being male, therefore, per your doctrine, that means it totally outweighs the useless sack of flesh carrying it, am I right?”

        No, you’re not right. Catholic doctrine does not consider pregnant women to be “useless sacks of flesh”, and science shows that a zygote’s gender is determined before implantation, at the moment of conception, based on the X or Y chromosome supplied by the sperm.

        Posted by Jeffrey Pinyan (@PrayingTheMass) | November 5, 2012, 7:15 pm
      • Jeffrey – Catholicism is built on. the backs of women. It need not say “Women are inferior” in doctrine in order. for that to be the truth as the RCC sees it.

        Catholics abhor the feminine, simple as that. Women are seen as entirely expendable walking uterine cavities. No more, no less.

        Do you know what a symphisiotomy is? Do you realise that this barbaric procedure was performed on women without their consent, leaving them crippled for life, while the church shrugged, and said “Tough”.

        Caesarian section had been the gold standard for stalled/impossible deliveries for decades. Nobody used symphisiotomy, it was. decried as “barbaric” in the mid 1800s, yet it was taught and used in Catholic hospitals as a) c-section did not bring about the mandatory suffering in childbirth, and b) if a woman had a section, she might limit the number of pregnancies she would. have in the future.

        So yes, the RCC does hate women, and does consider men to be superior. That’s how they were able to conduct their campaigns of rape and abuse for decades, because women were not to be believed.

        But what do you care, you’ll never be at risk of death due to pregnancy, so there’s nothing to challenge your brainwashing.

        Posted by boostick | November 6, 2012, 3:51 am
    • Did you even READ the article? An ectopic pregnancy is NEVER viable. There is no personhood ever coming to this one. This means it can never, ever, ever become a baby…but it is ALWAYS fatal to the mother, if it is not removed before she bleeds to death. What part of this don’t you get? Once more, she arrives in the ER bleeding internally, and the embryo is already dead or dying. The mother’s pain (which leads her to seek help) is her body being ruptured by the embryo growing to the point where it is tearing it’s habititat to shreds, and the bleeding is her begining to bleed to death. If she has other children, you have rendered them orphans by your short-sighted medical neglect created a misguided religious notion that this is what our loving God wants for us. Well said by Boostick, “Religion has no place in mediine”. Sent away from a Catholic hospital, I nearly bled to death too. If not for the help of a pediatrician volunteer in a women’s health center one evening, I would not be here to make this argument. God bless her.

      Posted by StillStanding | January 23, 2013, 9:40 pm
  5. Fr. Ka, ectopic pregnancies will NEVER be children, but they WILL kill a woman. There is no “reconciling” medical facts with religious fantasies, and anyone who supports Catholic hospitals failing to treat an ectopic pregnancy according to standard practice supports MURDER of women.

    Posted by Roxanne Brown | November 5, 2012, 4:47 pm
    • Do Catholic hospitals murder women? I’d like to see the statistics, if they do. I haven’t seen it in the news.

      And doesn’t science say that life begins at conception? If not, when does it begin?

      Posted by Fr . KA | November 5, 2012, 6:38 pm
      • So what if it does? MY life, or the life of my daughter, is more important than the existence of some cancer-like ball of cells that will never grow into a child and could kill me or destroy my future fertility. What is *wrong* with people that they cannot see that?!

        It’s nothing short of idolatry.

        Posted by Doxy | November 5, 2012, 9:07 pm
      • Primitive life may begin at conception, but personhood does not.

        Posted by boostick | November 6, 2012, 3:57 am
      • At Fr KA:

        Really? Really? One hopes the “Fr”. does not mean “a priest” who assumedly has some education? Please stop the obfuscation.

        ROXANNE BROWN does not say that Catholic hospitals murder women. She says that failing to treat an ectopic pregnancy according to standard practice supports MURDER of women. Did you change her words in your question on purpose or can you just not read properly? It’s one or the other – unless your question is unrelated to her post – which would be difficult to believe since you replied specifically to her comment.

        Furthermore, you ought to know that the debate is not about “life” per se, as even sesame seeds and poppy seeds begin “life” at conception — the big important SCIENCE that you so want on your side even says so doesn’t it? And yet we so carelessly sprinkle them on our bagels after baking them – Oh the shock, the horror. Stop pretending that science says anything about the humanity of a conceptus that is remotely in your favour. Instead, SCIENCE assures everyone that a conceptus is a single cell – a zygote, and to assure us that zygotes do not have brains, or nervous systems or moral operating systems, or ANY of the things resembling full grown, pregnant, HUMAN, women, who science also assures us do have a brain and a functioning nervous system and a moral sense. This by the way, is contrary to the beliefs and teachings of many of the “great” “Saints” and “Moral Leaders” of the church (mostly of the past – but the way you sound – hey you never know – maybe in the present too). Of course if you are a priest, you would actually know this but maybe you have chosen to choose to pretend it isn’t so. A fried egg is not a chicken as you surely know.

        Your statements or rhetorical questions, are not clever nor thoughtful. They demonstrate deliberate ignorance or profound lack of education and do not add much to anyone’s understanding – although confusion and obfuscation seem to be more what you are aiming for.

        Posted by SH | November 6, 2012, 9:42 am
      • I couldn’t have said it better!
        Thank you for clarifying the issue.
        Elizabeth

        Posted by Elizabeth | November 6, 2012, 10:05 am
      • “And doesn’t science say that life begins at conception? If not, when does it begin?”

        At conception, you have one genetically unique cell, but that is not one unique human individual. That cell replicates itself into a ball of cells, which may become one human individual, or divide into two, or more rarely, four. Even more rarely two of these balls of cells will join and one human individual will have cells with two different DNA codes, originating from two separate conceptions, forming his or her ONE body. Science has not in fact determined with certainty when the embryo is a human individual.

        Posted by veritasmater | November 14, 2012, 7:27 pm
      • “Science” answered this question quite some time ago: Life began in the Precambrian, billions of years ago. All life has come from other life since then. Spontaneous generation is centuries out of date as a scientific theory.

        As to how many women Catholic hospitals murder, read the post. Or, better yet, the linked article. And then keep going. Medline’s full of evidence that anti-choicers kill.

        Posted by Random internet user | November 27, 2012, 4:05 pm
    • Miss Brown, until you can quote St. Thomas Aquinas, St. Bonaventure, or St. Augustine with clear understanding, perhaps you should not refer to religious beliefs as fantasy. The only fantasy I have seen expressed here is how the Catholic tradition has been represented.

      Posted by WBBritton | November 5, 2012, 7:36 pm
      • Yes, and you can’t talk about the factualness of Lord of the Rings or Spiderman unless you have a thesis on the subject. Please, produce some evidence that your god is not entirely rooted in fiction, or shut up, preferably forever.

        Posted by Kieran | November 6, 2012, 2:14 am
      • At WBBRITTON: Here’s some quotes:

        1. By St. Bonaventure: Regarding Arrogance

        “Do not therefore, judge anybody to be more imperfect than yourself if he do not do all the things that you do”.

        “And although they seem to you to be so very imperfect, yet perchance, they are more stirred up with one interior motion than you with many – yea it may be more than you with all that you have. And because you do not know this, do not therefore, judge others to be inferior to yourself…….. These things I have said to repress the temptations of the devil.”

        2. By St. Thomas Aquinas: Regarding women:
        ” As regards the individual nature, woman is defective and misbegotten, for the active power of the male seed tends to the production of a perfect likeness in the masculine sex; while the production of a woman comes from defect in the active power”.

        3.By St Augustine: Regarding sex and women and holy men:

        “Nothing is so much to be shunned as sex relations.”

        “Women should not be enlightened or educated in any way. They should, in fact, be segregated as they are the cause of hideous and involuntary erections in holy men.”

        4. By St. Augustine: Regarding science and math – pretty important stuff for someone who signs their name as MD doncha think?:

        “The good Christian should beware of mathematicians and all those who make empty prophecies. The danger already exists that mathematicians have made a covenant with the devil to darken the spirit and confine man in the bonds of Hell.”

        Contradicted by this statement:

        “Often a non-Christian knows something about the earth, the heavens, and the other parts of the world, about the motions and orbits of the stars and even their sizes and distances,… and this knowledge he holds with certainty from reason and experience. It is thus offensive and disgraceful for an unbeliever to hear a Christian talk nonsense about such things, claiming that what he is saying is based in Scripture. We should do all that we can to avoid such an embarrassing situation, which people see as ignorance in the Christian and laugh to scorn.”

        Posted by SH | November 6, 2012, 3:51 am
      • You want to talk St Augustine, do you? OK.

        (354-430) ” Any woman who acts in such a way that she cannot give birth to as many children as she is capable of, makes herself guilty of that many murders.”

        All religion is fantasy, science is life itself. Science is not invested in the hatred and disparagement of women, based on a fairy story about an apple and a talking snake.

        How does that totally-not-woman-hating passage go again…

        Oh yeah, that’s right – ” I will greatly multiply your grief and your suffering in pregnancy and the pangs of childbearing; with spasms of distress you will bring forth children. Yet your desire and cravings will be for your husband, and he will rule over you.” (Genesis 3:16)

        Posted by boostick | November 6, 2012, 4:06 am
      • Any intelligent person should read Darwin’s Survival of the Fittest before choosing a religion. There is nothing to support the INVISABLE UNICORN( GOD) IN THE LIVING ROOM. The bible was written by HUMAN BEINGS. If you read it carefully you will see the most outrageous stories aimed at denigrating women. Your comment is full of vitreolic hatred aimed at anyone who doesn’t believe as you do. Through out history RELIGION has caused Wars, Torture and Divisiveness.We can be Moral, Kind, Caring etc. without the teaching of religion. You sound fanatical!

        Posted by Elizabeth | November 6, 2012, 5:13 am
      • All those three dudes have been refuted multiple times by many different people. Dawkins has a particularly good refutation of Aquinas in the god delusion. But it doesn’t really matter anyway, can’t you come up with any modern reasons for why you have women have to have their choices removed from them?

        And know you don’t need a deep understanding of BS to label it as such. People don’t need degrees in fashion design to tell them the emperor has no clothes. I don’t need a keen understanding of the anatomy of a unicorn to tell you it doesn’t exist. I don’t need to know every tenant of chistianity to tell you that it’s position on the treatment of women and homosexuals is wrong.

        Posted by foolishwolf | November 6, 2012, 4:17 am
      • Where does that quote from Augustine come from? I’ve looked for it and traced it to the 1995 book “The Cry of Tamar: Violence Against Women and the Church’s Response” (Pamela Cooper-White) on page 50. She is quoting from “Bible Study: Spirit of Freedom, Not Slavery” (Margot Kaessmann [Gr. Käßmann]) an essay/article in “Women in a Changing World” 30 (June 1991) published by the World Council of Churches.

        Ms. Cooper-White also cites from Ms. Käßmann’s work the account of a Church council in Macon in the 6th century that only narrowly affirmed that women are human beings; this story is a myth. I’d like to see a copy of the essay/article (even if it’s in German) because I would like to see the citation of the quote from Augustine.

        I’m not denying the Church Fathers wrote some pretty awful things about women, I just prefer to see the quotes cited for truth’s sake.

        Posted by Jeffrey Pinyan (@PrayingTheMass) | November 6, 2012, 6:31 am
      • Ah, yes, you can always tell the paleo-misogynists by their insistence on using “Miss” or “Mrs.” FSM forbid women be identified by anything other than whether a man properly “owns” us. Probably also the source of your contempt for nurses.

        Also, yes, religious beliefs are supernatural nonsense, and I’d like you to keep yours the hell off my body, you arrogant ass.

        Posted by Origami Isopod | November 6, 2012, 11:49 am
      • Sorry for offending, Origami, but I sincerely, honestly though “Ms.” was the proper form of address to use.

        Posted by Jeffrey Pinyan (@PrayingTheMass) | November 7, 2012, 8:22 am
      • @Jeffrey Pinyan,

        Origami is talking to Britton, who addressed “Miss Brown.” You used “Ms.” which is the correct form, as it does not address women by their marital status like “Miss” or “Mrs.” do.

        Posted by Yessenia | November 27, 2012, 6:04 pm
  6. i don’t understand why some of the comments on this web site are so sarcastic. Why can’t comments refer to factual information and leave out emotional comments. I think that the comments of educated individuals don’t distort and misinterpret the basic issues that they are commenting on. On the other hand, people who are ignorant in many ways tend to be sarcastic and ANGRY in their responses.There was no reason to reply to what I had written in such a nasty manner.

    Posted by Elizabeth | November 6, 2012, 6:59 am
    • Please google “tone trolling.” This is what you are doing. Also, damn right I get “emotional” when someone asserts that they have more of a right to determine what happens to my own body than I do. And I won’t apologize.

      Posted by Origami Isopod | November 6, 2012, 11:51 am
      • You don’t have to apologize but perhaps you might change the way congress and the senate act if you get politically involved instead of accusing me of tone trolling. Anger gets you nowhere. It gets none of us anywhere. All anger does is make the opposing side more diligent in their pursuits.—whatever they may be. My purpose in makimng comments is to seperate fact from fiction and ofcourse I happen to belief that RELIGION is the biggest fictional fairytale of all time. Religion should have no place in Politics of the practice of Medicine….PERIOD! And for the phraze that, ” Life is sacred’, This is a religious belief that shouldn’t be forced upon the non religious. Wars, Torture and Human Carnage have .been implimented in the name of Relifion. Remember the Spanish Inquision and other Atrocities where RELIGION was at the core of the abuse?
        I’m on your side.Perhaps you might become a little less defensive and write without expressing your anger so violently. More people will listen to what you have to say.

        Elizabeth Gillman BSN –Nurse with a degree in science.

        Posted by Elizabeth Gillman BSN | November 11, 2012, 8:42 am
      • Elizabeth, you have no idea what I do in terms of activism other than arguing online, so kindly stuff your assumptions.

        Fuck, am I tired of Nice Polite Liberals who ass-ume that anger never gets you anywhere and “civility” is the key. Yeah, that’s why ACT-UP led to the further marginalization of gay men, and “compromising” has expanded rather than shrank abortion rights in the U.S.

        Anger is good.

        Posted by origami isopod | December 2, 2012, 3:07 am
    • Men, especially religious men, are not used to being challenged. It terrifies them when the truth is out, because knowledge and truth are devastating to religion.

      Also, you’re a woman. We’re automatically viewed as inferior, interchangeable, tainted, disposable, ambulatory incubators. The only reason we’re treated as “well” as we are is because sometimes we produce male babies.

      Any religion that endorses child rape, excommunicates the mother and doctors who saved a nine year old-s. life by ending the twin pregnancy that was killing her, yet stood up for the man that impregnated her, that butchered young healthy women with symphisiotomy so that they would suffer in labour, that. imprisoned raped women and sold their babies, that encouraged priests to have sex with nuns in Africa, rather than prostitutes, and then threw the nuns onto the street when they got AIDS… They HATE women.

      Posted by boostick | November 6, 2012, 12:57 pm
      • Interestingly enough, I actually commented on this because I found it an interesting topic and wanted to learn more about your point of view. I’ll look for differing sources on ectopic pregnancies, as they’re an important issue to discuss, and I appreciate other viewpoints. I’ll get back to my uneducated life and fairy tales now…

        Posted by Fr. KA | November 7, 2012, 5:16 pm
      • To origami;
        You have no0 idea what my religous or non relidous beliefs are. Your explitives make you appaer child like and don’t allow you to clearly get intelligent thoughts across to your audiance. You assume a great deal about me while in actuality your knowledge of me is zero. Anger is okay. However, its expression needs to be channeled properly so that its target gets the message.

        Elizabeth

        Posted by Elizabeth Gillman | December 2, 2012, 6:36 am
  7. “Personhood” in itself does not entail a ban on abortion, since normally a person has no rights over the body of an other person.
    But if a foetus is considered a person, then a woman surely would have the right to sue her foetus for things such as use of her body without permission, or sue for health damages etc. inflicted on her by the foetus, before giving up her child for adoption or renouncing her parental rights and delivering it to her rapist. – Nice outlook, isn’t it? :-/

    Posted by kg | December 2, 2012, 7:48 am

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