Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. 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.
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 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.
Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.