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abortion, pregnancy, war on women

Why did Wendy Davis call her ectopic pregnancy an abortion? An OB/GYN investigates

Unknown-4Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid slated for release this week. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube — which in Texas is technically considered an abortion, and doctors have to report it as such.” Many major outlets are now reporting that Ms. Davis had two abortions. As an OB/GYN I’m confused by her choice of words.

An ectopic pregnancy occurs when the embryo implants outside of the uterus in the fallopian tube or ovary. Some ectopic pregnancies abort (end) spontaneously, but many require medical intervention. Ectopic pregnancies require treatment if they continue to grow as the placental tissue (trophoblast) invades the fallopian tube (like a cancer). Without the support of the thick uterine wall, which has evolved to contain trophoblast, the placental tissue will invade blood vessels resulting in catastrophic bleeding and potentially death of the woman.

An abortion is an intrauterine pregnancy that ends before viability, regardless of the reason or method. Abortion is further qualified as spontaneous (what the public knows as a miscarriage) and therapeutic (often referred to as induced abortion).

An ectopic pregnancy is not an abortion. Many years ago the term tubal abortion was used by some, but that is imprecise and no longer in use. Distinguishing between ectopic pregnancies and intrauterine pregnancies is important part of the obstetrical history. One very important reason is the biggest risk factors for an ectopic pregnancy is a previous history of one.

Most recent reporting form (2013) for induced abortion in Texas. No mention of methods used to treat ectopic pregnancies.

Most recent reporting form (2013) for induced abortion in Texas. No mention of methods used to treat ectopic pregnancies.

So OB/GYNs don’t consider ectopic pregnancies abortions, but what about Texas?  (By the way, I take Ms. Davis to mean induced abortion when we writes about “abortion” and her ectopic pregnancy). While I don’t practice in Texas I was able to find that state’s reporting form for induced abortions and there is no mention of ectopic pregnancy. The way the form is written doesn’t lead me to believe it is meant to include ectopic pregnancies. If there is another form that I’ve missed, please leave a link below.

Looking at the most recent complete vital statistics reports from Texas it is clear that induced abortion means just that, terminating an otherwise viable pregnancy and not treating an ectopic pregnancy. The Texas definition of reporting requirements for live births, fetal deaths, and induced abortions does not mention ectopic pregnancies, but states the following:

An abortion is any act or procedure performed after pregnancy has been medically verified with the intent to cause the termination of a pregnancy other than for the purpose of either the birth of a live fetus or removing a dead fetus, and shall not include birth control devices or oral contraceptives. (Texas Abortion Facility Reporting and Licensing Act, Health and Safety Code, Chapter 245).

Health departments track pregnancy outcomes including live birth, abortions, and ectopic pregnancies. There are a variety of public health related reasons to do this. Texas, like every the CDC, does not include ectopic pregnancy in the induced abortion column. Therefore I can not verify Ms. Davis’ claim that in Texas her doctors would have reported the treatment of her ectopic pregnancy as an abortion, not now and certainly not 20 or more years ago.

This doesn’t mean things won’t change and so we must be vigilant. Personhood laws would technically make an ectopic pregnancy a person. Who knows when the next medically illiterate Senator or Representative will listen to the lunatics who actually believe that ectopic pregnancies are not dangerous and seek to add even more nonsensical definitions to gynecology. Some Catholic hospitals already refuse to treat ectopic pregnancies on the grounds that a non viable pregnancy is more important than a living woman, so personhood legislation would have a grave effect on the safety of women with ectopic pregnancies (never mind all the other ramifications).

I think it is a good idea for women to share pregnancy experiences that don’t end in a live birth. Whether it is a termination (meaning an induced abortion and what the general public generally considers an abortion), a miscarriage, or an ectopic pregnancy there is a lot of shame, stigma, and confusion which is both sad and wrong. It never ceases to amaze me as an OB/GYN that so many women really believe that they are the only one to ever have a miscarriage or ectopic pregnancy or that having an abortion is an uncommon experience. Let me be very clear Ms. Davis addressing her reproductive history is a positive thing. It’s one of the reasons I talk about my premature delivery and the death of my son from prematurity. Knowing you are not alone can be very helpful.

So what did Ms. Davis mean? I haven’t read the whole book as it’s not available until Tuesday so perhaps with the full context I’ll know better. If her camp has an answer, I’d love to hear it. However, my guess is this error in description of her ectopic pregnancy as an abortion was simply that. An error. I’d like to say that as a politician invested in choice she should know better, but I’ve seen well-informed pro-choice people get tripped up by medical definitions.

What’s my take?

Medical definitions are tricky when you are not practicing medicine and best left to doctors and out of the hands of politicians.

Discussion

27 thoughts on “Why did Wendy Davis call her ectopic pregnancy an abortion? An OB/GYN investigates

  1. Apparently (though I have not read the book either) Ms Davis states that both “abortions” were performed in her doctor’s office. I can’t imagine that would be the case for an ectopic pregnancy.

    Posted by Jennifer | September 6, 2014, 11:12 pm
    • An ectopic pregnancy could be treated as an abortion as an outpatient with methotrexate. However, she said she had her tube removed….

      Posted by Dr. Jen Gunter | September 6, 2014, 11:23 pm
      • She had a what is called treatment of ectopic pregnancy with salpingectomy which is removal of the tube involved. I code this procedure in an OB GYN office and it is not considered an abortion. A fetus cannot grow to term in a fallopian tube.

        Posted by Harriet Meaders | February 11, 2015, 8:21 pm
    • There is no way in hell she had an “Ectopic ” pregnancy taken care of in her doctor’s office! How do I know? Because I am an “Ectopic” pregnancy survivor! I was in critical condition when they found out it was an “Ectopic” pregnancy and underwent about a 5 hour surgery! She’s a liar to advance her political agenda!

      Posted by REB | September 8, 2014, 11:27 pm
      • She could have had methotrexate given in a doctor’s office if the ectopic didn’t spontaneously resolve itself. She could have had a laparoscopy with salpingectomy in a hospital … I don’t know what she had as far as treatment because I didn’t come across those details. There is NO doubt that ectopics can be life-threatening!

        There are people who believe that treatment of the ectopic pregnancy is like killing their baby even though the learn the odds of survival for the fetus are nil. A woman can grieve an ectopic pregnancy, just like a miscarriage and sometimes like a chemical pregnancy. The pregnancy is real to the woman and her grief is too.

        Most politicians lie and most want to advance their political agenda — this is not special to democrats, republicans, Nazis, socialists, totalitarians, dictators, etc. I really haven’t seen a politician outside of the local level who doesn’t want to advance their own agenda and interests — Wendy Davis along with Greg Abbott, David Dewhurst and Rick Perry to name several are no different. I haven’t seen the politician saint angel yet and I don’t think he/she is coming down the pike anytime soon!

        Wendy Davis is using the ultimate term of abortion in a misapplied sense I believe to bring normalcy to abortion … like most politicians she probably has little biology or science knowledge; afterall, most politicians are attorneys first. So, yep, ringing to the general ringtone of being a politician she has an agenda.

        Posted by elizabetcetera | September 9, 2014, 9:29 am
      • She may have had methotrexate given in a doctor’s office for an ectopic. many women are managed without surgical intervention. However, some women do require surgery and some even require emergent surgery as you describe.

        Posted by Dr. Jen Gunter | September 9, 2014, 12:34 pm
  2. Thank you for your thoughtful article. As a woman who has had five miscarriages I find the use of the word “abortion” for any type of miscarriage confusing. Sure I had my babies removed because they had died, but I would never call that an abortion. That would be cruel. My doctor never called it an abortion. I know it was the same procedure but due to the political nonsense going on right now no woman deserves to have it all so confusing and twisted.

    I find the situation in Texas sad and unfortunate. Ms Davis needs to stop, think and reword her thoughts before speaking out again. Then again, her words could have been taken out of context. We won’t know until we read the book.

    No woman wakes up and thinks I’m going to get pregnant today and have an abortion. Nobody takes it lightly. But no matter what, it is a private matter between a woman and her doctor, not between her and a bunch of ignorant strangers who just happen to be elected officials. Anyway, that is just my ramblings on the subject. Thank you again for your post.

    Posted by Juliette Kings | September 6, 2014, 11:58 pm
  3. Hi Jen , going by reports the terminations were done 15 years ago . The form you are showing , as you say are up to date , could have been different back then ?
    Could another reason why she wrote about it/them be personal …………..?

    Posted by bojimbo26 | September 7, 2014, 12:06 am
    • Looking at vital statistics from the 90s I think it is highly unlikely ectopic pregnancies were recorded as abortions.

      She may have been told the wrong thing by her doctor. She is saying that is what the doctor told her, rather than her own opinion. As I said, when the full context is known we may have a better idea.

      However, I do think that politicians use pregnancy terminology loosely and if they are the ones making laws about reproduction then I do insist they be 100% accurate.

      Posted by Dr. Jen Gunter | September 7, 2014, 3:44 am
  4. I have had to make a very difficult decision 6 years ago and was so very afraid of everyone’s judgement. This is even though I myself am a medico. I totally agree with your last paragraph. Politicians twist and manipulate words and figures to suit their agenda… Recently we have had a pro-life politician who publically claimed that terminations lead to a higher incidence of breast cancer. How irresponsible!!!! It is commendable that you are taking the time and trouble to clarify the misnomers and put it out there for all to understand!

    Posted by surgeryattiffanys | September 7, 2014, 2:48 am
  5. There seems to be a great many people who think they know what they’re talking about when they don’t. Unfortunately, many even less informed people listen to them! I’ve always found that curious.
    When I’m seeking information, I look for an expert. Not a politician or clergy person or an exPlayboy centerfold!

    Posted by erin bliss | September 7, 2014, 5:57 am
  6. Some Pro-Life people consider ectopic pregnancy terminations “abortions” and seek to have them banned. A Catholic friend with an ectopic pregnancy was told by the priest the only acceptable treatment would be Fallopian tube removal; methotrexate would be considered murder (removing damaged tissue vs. deliberately killing). Even so, she has been accosted for even having the tube removed.

    Davis may not have been speaking to the medical professionals but to the Pro-Lifers and those sympathetic to their cause.

    Posted by Rob | September 7, 2014, 10:16 am
  7. I’m a public health person (not a physician) who worked a great deal with vital statistics data from the states. The items required for vital statistics reports are limited and specific — the National Center for Health Statistics gathers all this data from the states and is always trying for some uniformity among the states in what is reported. But individual states may also have their own sets of reporting requirements that have nothing to do with vital statistics data.
    I have no idea if Wendy Davis is correct in saying that in Texas, removal of an ectopic pregnancy is “technically considered an abortion,” but since she’s been dealing with the abortion laws in Texas, I’ll give her the benefit of the doubt. Maybe one of the nasty details in the very nasty new anti-abortion laws in Texas require this kind of reporting even though it would never show up in a vital statistics report.

    Posted by Martha Teitelbaum | September 7, 2014, 11:37 am
    • I understand she has been dealing with abortion legislation, but there is no form I can find in the public domain that supports her claim that Texas would currently or > 20 yrs ago classify an ectopic pregnancy as an abortion. As the induced abortion reporting forms are in the public domain and there is no entry for ectopic or methods to treat ectopic that supports my questioning.

      It is possible she write this when personhood legislation was on the table. It didn’t pass and perhaps it was an oversight that it wasn’t removed in editing.

      It is my experience that politicians, both pro choice and anti abortion, get the medical facts mixed up. After all, they didn’t learn this in school.

      Hopefully the complete text will shed more light

      Posted by Dr. Jen Gunter | September 7, 2014, 12:31 pm
      • I also searched and couldn’t find anything. Maybe you’re right that it was when the legislature was dealing with a personhood bill.
        Wanted to tell you how much I liked the column you wrote on the Indiana woman charged with feticide. Just discovered your blog when I was reading up on that case.

        Posted by Martha Teitelbaum | September 7, 2014, 3:30 pm
  8. A miscarriage has often been referred to as a “spontaneous abortion.” When politicians, especially men, who know little about women’s health, throw terms around they can confuse a situation that only a medical person would totally understand. Years ago when a woman lost a child by miscarriage it was hardly talked about. And if a woman had cancer of any part of her reproductive system it was hushed and she suffered silently. I am glad that now we write and talk openly about these issues. Thanks for your blog. It is absolutely unconscionable that a government official can dictate what a woman can do to take care of her health. I applaud Davis for her strength.

    Posted by bethhavey | September 7, 2014, 11:56 am
  9. As you know, abortion can mean the end of a pregnancy, for whatever reason. I work for planned parenthood in Texas and we ask for: G, P, TAB or SAB. So, maybe with those categories , she meant they literally were a termination of the pregnancy, no matter the reason??

    Posted by ErinfromTexas | September 7, 2014, 4:04 pm
  10. Dr. Jen, thank you for taking the time to address this unconventional use of the word abortion by Wendy Davis’. I was wondering the same thing and am glad you wrote a post addressing this subject.

    Maybe Wendy Davis does not know that a definition of abortion must / should include expulsion of contents from the uterus — that abortion is either “medical” or “surgical” but to be considered abortion the embryo or fetus must be INSIDE the uterus.

    “The term abortion most commonly refers to the induced abortion of a human pregnancy.” source Wikipedia.

    In Ms. Davis’ example, she is thinking that indeed she did have an abortion. Perhaps she is using the term “abort” in the simplest of terms — to remove, to get ride of, to take away, to end — while not considering the pregnancy be contained within the womb.

    When I heard her describe she had two abortions for medical reasons I was interested why. One of the pregnancies she cited was that of ectopic. Until that point, I am a nurse, I had never heard of ectopic pregnancies that were treated by methotrexate or salpingectomy referred to as abortions.

    I’m assuming she wants to make public that abortion is OK and these are the reasons she chose believing that many women who have had ectopic pregnancies will be able to relate to her thinking they too have had abortions that were necessary to save their lives. This could make Wendy Davis more relatable to some anti-choice / pro-life women (and their partners) who have experienced ectopics. However, gynecologists treat women for ectopic pregnancies in ALL countries, even in countries where access to abortion is very restricted and even prohibited — thus those countries must not term the treatment of ectopic as abortion. (see excerpt from Irish pro-life group below).

    But … those anti-choicers / pro-lifers may be more interested in a woman carrying to term and having the baby with severe structural defects (or other incompatible life condition — chromosomal and/or genetic) go through perinatal hospice instead — and that’s a whole other topic — perinatal hospice!

    According to one source on ectopic pregnancy and abortion, from Ireland (the Republic of Ireland — not part of the UK) where abortions are very restricted:

    “Ectopic pregnancy is not an issue in the abortion debate. The removal of an ectopic pregnancy is not an abortion and has never been considered as such either under the terms of the 1861 Offences Against the Person Act or the 1983 Eight Amendment to the Irish Constitution.” http://www.prolifeinfo.ie/women/medical-matters/ectopic-pregnancy/#sthash.W92GECaX.dpuf

    … and Dr. Jen if and when you do read Wendy Davis’ book I’d love to read a follow-up post on this subject!

    Posted by elizabetcetera | September 7, 2014, 4:27 pm
  11. This is the first site I’ve seen questioning the accuracy of Mrs.Davis’ statements. I have not read her book but there have been so many conflicting statements bandied about in the press. As a retired RN, I am well aware that the term abortion includes spontaneous ‘miscarriage’ as well as induced termination of a pregnancy but I have never heard of abortion in relation to ectopic pregnancy. Mrs.Davis’ claim that she had her ectopic pregnancy treated in a doctor’s office was a bit alarming to me, considering her fight against Texas’ recent desire to have abortion providers achieve the same standards as surgical centers and to insist on providers gaining admitting privileges to a nearby hospital ( why do I think of Joan Rivers’ tragic situation?) Somehow, I simply can not imagine experiencing signs and symptoms of an ectopic pregnancy only to present myself to a local abortion clinic for termination of that pregnancy.

    Posted by Christine Phillips | September 7, 2014, 4:45 pm
  12. As a nurse practitioner, I’m hope she meant methotrexate and then close monitoring of her beta HCG levels with her physician. Not normal practice to go to an abortion clinic for this kind of a “termination”

    Posted by ErinfromTexas | September 7, 2014, 7:29 pm
  13. Unfortunately, I experienced an ectopic pregnancy 18 years ago at 11 weeks of a very much wanted planned pregnancy. (Just two months before I became pregnant with my first child). So when I read articles like this http://www.personhoodinitiative.com/ectopic-personhood.html I am very concerned about women’s rights to chose.

    After reading this site, I totally agree with Wendy Davis. When there are nuts out there that want to pass personhood laws protecting the right of life of a non-vital embryo that has almost no chance of survival, over the life of the Mother, I would do my best at protecting the rights of women. These personhood initiatives are dangerous! And ill informed. In the article, it gave the impression that a way was found in Germany to avoid to terminate an ectopic pregnancy. My ectopic pregnancy was discovered & handled in Germany in an emergency op. My first question To the doctors was “is there anyway to save the pregnancy?” The doctors looked at me with amazement & bewilderment that I didn’t realize that I only had one choice, end the pregnancy to save my life, and there was absolutely no chance at saving the baby. It scares me to think that a personhood initiative would allow me to die to protect the rights of a virtually non-vital embryo. I chose to save my life as well as my future children’s lives.

    So the link http://www.personhoodinitiative.com/ectopic-personhood.html gives a completely a false impression to medically uneducated & inexperienced. I think Wendy Davis wants to protect women like me from such initiatives that are ill informed and very dangerous!

    I think that one chooses to end an ectopic pregnancy, so that it can be understood or described as a pregnancy termination or abortion to some.

    Posted by P.Jaeger | October 28, 2014, 4:32 pm
    • I had an ectopic pregnancy that resulted in a termination. And yes, I consider it a medically necessary abortion. if you illegalize abortions, those with medical requirements of termination will also be affected. We see it happening even now. All anyone needs to do is read this: http://www.salon.com/2011/05/26/abortion_saved_my_life/

      After that, research a little bit about how doctors and nurses have refused to perform terminations (abortions) to save a mother’s life, time after time. It is especially frequent in the Catholic hospitals. And then also research how the Catholic church has made it a mission of sorts to buy up as many hospitals as possible.

      Once you have done that, you will understand how some of us can be politically pro-choice, but personally we are pro-life.

      Posted by tattooedsnakelady | September 15, 2015, 11:44 am
  14. While I agree that treatment for an ectopic pregnancy is normally not considered an abortion, I think Ms Davis was referring to the political climate in Texas and elsewhere due to antiabortion extremists. Quite a few of them do indeed refer to terminating an ectopic pregnancy as equivalent to abortion and some think a woman should be refused any treatment until the embryo has died. If the woman dies during the waiting process, it’s “God’s will.” I’ve seen the fanatics cite the extremely tiny number of cases where ectopic pregnancies went on to the birth of a viable infant as the excuse to deny treatment that would end the pregnancy.

    Posted by foxfroggy | August 13, 2015, 9:27 am
    • Thank you. My mother is an ectopic pregnancy survivor. I watched her almost die when I was almost 4 years old. I read those articles and I was so angry, they could have saved my sibling. Though probably not. My mother begged for her dr to terminate her pregnancy. They would not, this was in 1980. They kept telling her the baby would fall into place. She lasted until right around her 2nd trimester. She had a belly. I could feel the baby.
      I love the semantics going on here. An abortion is to the general public and people like my mother refers to terminating a pregnancy. Getting technical while appreciated maybe isn’t necessary. Maybe it is.

      Posted by J | September 14, 2015, 9:51 pm
  15. I had an ectopic pregnancy surgically removed in Utah in 1997. We did not have insurance, but were able to qualify for a program through the state which paid for the procedure as if it was paying for a live birth. The state did technically classify it as an “abortion,” even though it was covered under the program. They actually called me a year after the procedure to wish my baby a happy birthday. Poor woman was very embarrassed when I had to remind her I did not have the baby. Ectopic pregnancy can be incredibly painful. We went through 3 years of infertility treatments to get pregnant again and now we have four beautiful children. The mormon church has a life of the mother exception, thankfully. Since my OB\GYN was mormon I did not question when he told me it would have to be removed, period.

    Posted by kerrielou | October 4, 2015, 9:42 pm

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