October 26, 2022

Treating an ectopic pregnancy is not abortion

I’ve seen some people, mostly on the Internet, claim that the treatment for ectopic pregnancy is abortion. These people are dangerously wrong. I’m going to explain why they are wrong, but first let’s recall that important maxim:

Most of what you read on the Internet is written by insane people.

With this in mind, there are many different groups that all use slightly different definitions of abortion:

Obviously all of these groups have some insane people, but the laymen have a few more than the others. So we’re going to ignore all layman definitions of abortion. What does that leave us with? Well, the CDC keeps track of legal abortions (presumably because illegal abortions would be hard to monitor) and they use this definition:

For the purpose of surveillance, a legal induced abortion is defined as an intervention performed by a licensed clinician (e.g., a physician, nurse-midwife, nurse practitioner, physician assistant) within the limits of state regulations, that is intended to terminate a suspected or known ongoing intrauterine pregnancy and that does not result in a live birth.

This definition excludes the treatment for all or almost all ectopic pregnancies. This is because ectopic pregnancies generally occur in places that are totally outside the uterus (not intrauterine).

At this point I have to mention that there are all sorts of weird things that can happen inside the uterus, and some of these things are sometimes called “ectopic pregnancy.” For example, a woman who has had a cesarean delivery may (very rarely) have a subsequent pregnancy implant in her cesarean scar. This is a bad situation, although not as bad as, say, a fallopian tube pregnancy. And whether this counts as an ectopic pregnancy is apparently a matter of dispute, since it is in the uterus, and the embryo isn’t necessarily doomed. But this is overthinking things. Clearly the CDC acknowledges that weird things can happen during pregnancy, and they want to exclude those things from their definition of abortion, because of course they do. Ectopic pregnancies are very different from normal pregnancies in many ways the CDC would obviously care about.

Besides the CDC, we can also look at medical classification systems. I don’t know much about these, but I found one that might be illuminating: Current Procedural Terminology (CPT), a collection of 5-digit numbers for every medical procedure. Apparently codes 59812–59857 deal with abortion procedures. Let’s take a look at eeny meeny miny moe 59840:

In this procedure, the provider deliberately terminates a pregnancy for elective or therapeutic reasons. He removes the fetus and products of conception by dilating the cervix and then using a suction curette. The provider performs this procedure via a vaginal approach. This procedure is normally done during the first trimester, or less than fourteen complete weeks of gestation.

That’s … not very illuminating. Actually, all of the codes are like this, dealing with seemingly minor details like whether suction was involved. For what it’s worth, many (most?) ectopic pregnancies are treated with methotrexate, as described here, and none of the abortion codes mention this drug.

We can also look at the International Classification of Diseases, which has a section for “abortive outcome of pregnancy.” Straight away we see it keeps abortion (JA00) totally separate from ectopic pregnancy (JA01). Again, this makes perfect sense since the two are very different.

Finally, we can look at what abortion laws say. Let’s take Texas as an example, since it’s a very big state with restrictive abortion laws:

  1. “Abortion” means the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means with the intent to cause the death of an unborn child of a woman known to be pregnant. The term does not include birth control devices or oral contraceptives. An act is not an abortion if the act is done with the intent to:

    1. save the life or preserve the health of an unborn child;

    2. remove a dead, unborn child whose death was caused by spontaneous abortion; or

    3. remove an ectopic pregnancy.

The law defines ectopic pregnancy as a pregnancy outside the uterus, so cesarean scar pregnancies don’t count. However, there’s also an exception for “medical emergency,” which is defined as follows:

“Medical emergency” means a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.

So if you can find a doctor willing to say “this condition carries a serious risk of substantial impairment,” you can get treatment. So even this weird case is covered.

Wrapping up

Ectopic pregnancy is a medical emergency that threatens the life of the mother. Any abortion law that excludes medical emergencies must also exclude ectopic pregnancy, whether or not it’s mentioned specifically. Politifact: “All 18 states expected to ban abortion after the overturning of Roe v. Wade have exceptions for the life of the mother or a medical emergency.” Case closed.

However Politifact also writes “experts say fnord unclear language could impact treatment for an ectopic pregnancy.” I notice I am confused. There’s nothing unclear about the language here. Reading further, we find a link to a different article that includes this gem:

The climate of fear fnord created by SB8 has resulted in patients receiving medically inappropriate care. Some physicians with training in dilation and evacuation (D&E), the standard procedure for abortion after 15 weeks of gestation, have been unable to offer this method even for abortions allowed by SB8 because nurses and anesthesiologists, concerned about being seen as “aiding and abetting,” have declined to participate. Some physicians described relying on induction methods to get patients care more quickly; others reported that their colleagues have resorted to using hysterotomy, a surgical incision into the uterus, because it might not be construed as an abortion.

It’s hard to overstate how fucking stupid this is. Of course, it’s possible that this scenario is just made up, and nobody has ever actually done this. When the story is so sensational, it’s hard to be sure either way. But let’s grant that it’s true. The intended message here seems to be “The law is preventing doctors from doing their jobs.” I look at this and think “Journ*lists are scaring stupid doctors into committing malpractice.” And this is why I say “the treatment for ectopic pregnancy is abortion” is both wrong and dangerous. Government agencies and doctors—the smart ones, anyway—understand that ectopic pregnancy is a special situation that needs to be kept separate from abortion, and the law agrees. Because the law was written by people who want to prevent the abortion of babies who are not dead and not doomed. An ectopic pregnancy is doomed, and therefore medically, socially, morally, and legally different from a normal pregnancy. And this difference needs to be more widely understood, for the sake of women’s health.

Meaningful distinctions deserve to be maintained.