Catholic World News News Feature
"My Baby!" May 01, 2004
In the course of the past generation, ultrasound examination has become accepted as a routine aspect of medical care for pregnant women in America. Ultrasound images are enormously valuable to doctors, who can use them to determine gestational age, assess fetal development, and even anticipate problems that might arise in the course of the pregnancy. For the pregnant women, too, the ultrasound image of a healthy baby can provide a welcome reassurance, along with an enormous infusion of excitement and pride.
Ultrasound technicians report that an extraordinary number of women, seeing the image from inside their wombs for the first time, will utter precisely the same two words: "My baby!" As anyone who has been through the experience can testify, that is an emotional moment; tears of joy are commonplace.
But for many women—those facing unplanned pregnancies, and considering an abortion—the first glimpse of an unborn child can have an especially powerful impact. A woman who may be confused and unhappy about her pregnancy may suddenly see things in a new light when she has her first glimpse of her unborn child. And if she reacts to the ultrasound image in the same way that the vast majority of pregnant women do—by recognizing "my baby!"—the future prospects of that child change dramatically. Once a probable candidate for the abortionist's scalpel, the unborn child is now more likely to be born. For the first time in his young, hidden life, the odds suddenly swing in favor of his survival.
In fact, the odds that an unborn child will be brought to term, rather than aborted, can be very nearly inverted by an ultrasound examination, according to a study undertaken by A Woman's Concern, a group of crisis-pregnancy centers in eastern Massachusetts. Before introducing routine ultrasound examinations for the women who visited their centers, A Woman's Concern (AWC) found that 61 percent of the women classified by counselors as "abortion-vulnerable" would opt for abortion prior to an ultrasound examination, while 33.7 percent would choose to carry the pregnancy to term. Once ultrasound examinations were provided, 63.5 percent of the same "abortion-vulnerable" women decided to continue their pregnancies, and only 24.5 percent chose abortion.
Founded in 1993 by an Evangelical Protestant pastor, the Rev. John Ensor, A Woman's Concern began modestly with a single storefront crisis-pregnancy center (CPC) in Boston's inner city. In the space of a decade, with strong ecumenical support, AWC has expanded enormously, opening centers at four other locations near Boston. These centers now provide counseling and assistance for more than 200 women every month, and in 2003 they celebrated the births of 236 children, the vast majority of whom would probably have been aborted if their mothers had not encountered AWC. [In the interests of fair disclosure, this writer should note that he serves on the AWC board of directors.]
Like most other CPCs, AWC was established to serve women who are alarmed by the prospect of pregnancy, and actively considering abortion. At the centers, trained counselors do their best to provide moral guidance and support to women who are often facing objectively horrific situations. If the women are living in poverty, the counselors discuss the various forms of help that might be available to them through government agencies, church groups, and private donors. Over the years AWC has managed to find work for unemployed single mothers, win legal status for undocumented aliens, secure temporary lodging for women who had been living in abusive households, and persuade frightened young fathers to shoulder their responsibilities. But in many cases, the best efforts of AWC counselors are not enough to change a woman's mind. For the first several years of the organization's existence, roughly two-thirds of the women who entered an AWC center planning to procure an abortion carried through with that plan.
From its outset, AWC has been committed to offering women objective information about pregnancy, fetal development, childbirth, and abortion. The organization gives counselors a checklist of topics that should be covered in conversations with pregnant women, including the stages of fetal development, viability, the possibility of miscarriage, the types of abortion, and the possible complications. All centers were provided with photos and models of babies in utero, giving the woman a way to picture her own unborn child.
As ultrasound technology became more sophisticated, and the clarity of ultrasound images reached the point at which untrained eyes could readily identify the fetus, AWC began offering free ultrasound examinations as well. These examinations served a twofold purpose: they provided a great deal of objective information about the woman's pregnancy, and they gave the woman an opportunity to see not a plastic model showing what her unborn child might look like, but an actual glimpse of her baby.
The results of these ultrasound examinations, beginning in 2000, were so impressive that AWC soon adopted "the medical model" for all five centers. Each location is now equipped with an ultrasound machine, operated by a trained and certified technician; the ultrasound examination has become a standard part of the AWC services for any women who request it. The results of the ultrasound examination are assessed by AWC's medical director, Dr. Eric Keroack, a board-certified ob/gyn. (To allow Dr. Keroack to examine images from the different centers without traveling back and forth across eastern Massachusetts, AWC set up a high-speed computer network, by which the electronic images are transferred from one location to another. Because federal law prohibits the transfer of medical information over the Internet, a custom-designed internal network was established, linking the five centers.)
THE INTRODUCTION OF ULTRASOUND
AWC counselors keep careful records of each visit with clients, and whenever possible remain in contact with women throughout their pregnancies and after their children are born. (The organization schedules occasional baby showers, and invites mothers to pose with their newborn babies for photos that line the message boards at the centers.) The counselors also make a determined effort to learn, in each case, whether a pregnant woman who visited a center even once ultimately chose to continue her pregnancy or procure an abortion.
These detailed records made it possible to compare the effect of the pro-life counseling efforts before and after the ultrasound examination became a routine part of AWC service. Dr. Keroack studied data collected from an 18-month period before ultrasound was used (from July 1998 through December 1999), in comparison with similar data covering an 18-month period after the introduction of ultrasound (from October 2000 through April 2002). In a research paper presented to medical colleagues, he concluded: "Cumulatively, ultrasound with intra-uterine fetal visualization influenced 75.5 percent of our clients to reconsider elective abortion."
The data collected by the AWC counselors were not perfect. Many of the women disappear from sight after a single visit to the centers, and since AWC treats all counseling sessions as confidential, it is often difficult to trace a woman for a follow-up interview. Some women ask counselors not to pursue them, and AWC respects that request. So a significant number of women—precisely one-third, in the course of the two 18-month periods of the study—were "lost to contact." There was no reliable way to determine whether or not they continued their pregnancies.
On the other hand, the number of clients "lost to contact" was roughly similar for the two sample groups in the study. In the 18 months prior to ultrasound, AWC was unable to determine what had happened to 38 percent of the women visiting the centers; in the later 18-month period, 28 percent of the outcomes were unknown. Otherwise there was no noteworthy variation between the two samples. The samples were of similar size (559 for 1998-1999, 611 for 2000-2002); the women had visited the same AWC centers. The counseling routine had been unchanged except by the introduction of a routine ultrasound examination for women who chose to accept it. All of the women involved in the study were given a pregnancy test, tested positive, and indicated in an initial interview that they were considering an abortion.
For those women who chose an ultrasound examination, a video monitor was set up to allow them to watch the process if they wanted to do so. Dr. Keroack conducted the examination, answering questions as he did so. The women were provided with photos taken from the electronic images, and with a written record of the examination that could be used for later obstetrical care. Additional counseling sessions were scheduled if the women requested them, and in some cases a second ultrasound examination was offered to answer unresolved questions.
The AWC study showed that among the women for whom counselors could obtain complete information, those who underwent an ultrasound examination were almost twice as likely to continue their pregnancies than those who did not, and less than half as likely to choose abortion. [See Table A]
Commenting on these remarkable findings, Dr. Keroack made the observation that while AWC is an avowedly pro-life organization, whose counselors seek to help women continue their pregnancies, the ultrasound examinations were conducted dispassionately, without any effort to stir the women's maternal emotions. Nevertheless, the impact of the ultrasound pictures was undeniable. He wrote to colleagues:
We also observed that during the utilization of these technical advances, our clients frequently demonstrated bonding responses to their pregnancies as well. Our examinations were not performed with the intention of creating such responses; they were performed in a fashion consistent with accepted medical standards for diagnostic ultrasonography. Location of the pregnancy was identified, fetal measurements were made, fetal heart rates were recorded, and other pertinent structures were identified according to the client’s gestational age. Clients were permitted to view these aspects of their examinations in real time whenever the physician was present. The viewing of their own ultrasound exams may have played a role in creating the observed effects on the decision-making process of our clients.
Whatever the subjective reasons may have been for the women's decisions, the objective results were clear. "In the final analysis," Keroack wrote, "only 1 out of 4 women initially considering abortion actually chose abortion in their unplanned pregnancy after receiving an ultrasound examination."
OTHER FACTORS IN PREGNANCY
In addition to the stunning increase in the number of women who chose to carry their pregnancies to term, the AWC study [Table A] showed one other noteworthy result. Among the women who were offered ultrasound examinations, a much larger percentage of the pregnancies (9.2 percent, as opposed to 5.2 percent) ended in miscarriage. This statistical anomaly is not the result of the ultrasound test itself; the test is non-invasive, and cannot increase the risk of miscarriage. Rather, the figures illustrate a seamy but little-known truth about the abortion business.
Roughly 10 percent of all pregnancies end in miscarriage. Thus the number of women in the later AWC study who suffered miscarriages was in line with the overall statistics for American women in general. That number was suspiciously low in the earlier study—presumably because abortionists performed expensive and dangerous surgery on many women whose pregnancies would soon have ended spontaneously.
Standard over-the-counter pregnancy tests give women a simple, Yes-or-No result. But from a medical perspective the situation is not quite so simple. As Dr. Keroack notes, "the pink line on a urine test does not ensure that a woman has a viable intra-uterine pregnancy; it only confirms the presence of bHCG (a hormone associated with pregnancy) in her system." That hormone will also be present in the body of a woman who has an ectopic pregnancy (a serious condition that can be fatal if it is not promptly diagnosed), a blighted ovum, or any of several other conditions that generally result in miscarriage. While a urine test cannot diagnose these conditions, an ultrasound examination can.
A woman who confronts an unintended pregnancy will generally take some action between the 5th and 10th weeks after conception. At that point in her pregnancy, she is still a candidate for an early spontaneous abortion—better known as a miscarriage. But if she visits an abortion clinic, a positive pregnancy test may be enough to persuade her to undergo a surgical abortion. Abortion clinics rarely provide ultrasound services; the entrepreneurs who operate them obviously have no financial incentive to perform an extra procedure that could cut down on their business.
At a CPC, on the other hand, an ultrasound examination by a qualified physician might alert the pregnant woman to the presence of a condition that is likely to cause a miscarriage. Early in pregnancy, a woman has nothing to lose by waiting to see if that diagnosis is correct. Even if she is determined to end her pregnancy, she will still have the option of surgical abortion if the miscarriage does not take place; waiting 2 or 3 weeks will not make that procedure any more expensive or traumatic. If the miscarriage does occur, of course, she will have avoided a surgical procedure that is painful, expensive, and unnecessary by any standards. For the CPC counselors, meanwhile, the extra 2-3 weeks provide another opportunity to persuade the woman that she should continue her pregnancy. And if the process calls for a follow-up ultrasound examination, there is one more opportunity for the mother to bond with her unborn child.
In practice, an experienced doctor can generally recognize the signs of a likely miscarriage on the basis of an ultrasound examination. In the AWC study between 2000 and 2002, 39 out of 40 eventual miscarriages were predicted on the basis of ultrasound evidence prior to the 9th week of pregnancy. The ultrasound tests also produced the eye-catching result that 12 women—2.75 percent of the total sample—were not pregnant at all, but had some other medical condition that produced a false positive on a urine test.
Not even the most ardent feminist can recommend abortion for a woman who is not pregnant, or is likely to miscarry her pregnancy without surgical intervention. In the AWC study, 51 women fell into that category. And the figures were still more suggestive when the AWC results were broken down by the gestational age of the unborn child at the time of the ultrasound examination.
In 335 out of the 436 women involved in the later AWC study, the ultrasound examination showed that the pregnancy was in its first trimester. Of the 263 pregnancies observed during the early part of that trimester (the 5th through 8th weeks), 39 were diagnosed as likely miscarriages and all 12 non-pregnancies were detected. Thus at that stage, 19.8 percent of the women were not candidates for surgical abortions by any standards, despite their positive pregnancy tests. Moreover, since only 1 miscarriage was diagnosed by AWC after the 9th week of gestation [see Table B], the ultrasound results were 98 percent successful in pinpointing, during the first 8 weeks of pregnancy, the cases in which elective abortion would be indefensible from any perspective. If the AWC results are indicative of national trends, and 19.8 percent of the women who test positive on an early pregnancy test are either not pregnant, or likely to end the pregnancy through miscarriage, then as many as 250,000 American women may be undergoing unnecessary abortions every year.
Although AWC was formed by pro-life activists who were, and still are, actively involved in the American public debate over abortion, the services offered to individual women in the CPCs are not marked by partisan rhetoric. The vast majority of the woman involved in the AWC study between 2000 and 2002 reported that their experience had been helpful to them, and even the women who were determined to abort their children shared that perception.
But in fact, even if the ultrasound examination was conducted dispassionately, most women reported that the experience changed their attitude regarding their pregnancies. During the first six months of the ultrasound survey, AWC asked clients to answer a few questions about their experience. [See Table C] A striking 81.4 percent said that the ultrasound test had changed their minds, and 9.5 percent had become uncertain about their abortion plans; only 9.1 percent said that they were unmoved by the image of their unborn child on the video screen.
An ultrasound examination is a diagnostic procedure, not an emotional argument; the image that appears on the video screen is not affected by the feelings of the technician performing the test. So the woman who voluntarily undergoes the examination implicitly knows that she is not being manipulated; she is being offered concrete information, which—as the results of the AWC exit interview attest—she is most likely to recognize as valuable.
But the results of the AWC test raise another question: Why aren't all pregnant women given the same valuable information before they are expected to make a decision for or against abortion? Writing to fellow ob-gyn professionals, Dr. Keroack raised a similar point:
If all women were given this essential information regarding their choices during an unplanned pregnancy, would this reduce the number of elective abortions that occur annually in the United States? Are women who do not see the ultrasonic evidence of viability in their pregnancy being given adequate informed consent? In this era of increasing malpractice liability and growing emphasis on patient education prior to elective procedures, the importance of a client’s pre-operative understanding of her medical condition and therapeutic alternatives must not be dismissed. It behooves us as medical professionals to ensure that all of our patients are clearly informed of the basic facts concerning their conditions.
American society is seriously divided on the issue of abortion, but there is a broad consensus that patients should be given every possible opportunity to give their "informed consent" prior to any surgical procedure. As Dr. Keroack observes:
Most of us would insist upon seeing the X-ray of our fractured arm before we let an orthopedist place a cast on us, and casting is an easily reversible procedure. Shouldn't the standards for an irreversible elective termination of pregnancy be at least as high?
Women who undergo ultrasound examinations report that they receive useful information, and that information helps them to form—indeed, to change—their decisions regarding abortion. On the basis of those findings, clearly supported by the evidence of the AWC, it is difficult to avoid the conclusion that an ultrasound examination is a prerequisite for "informed consent" to an abortion.
For pro-life activists in the political sphere, the AWC study suggests a promising new avenue of approach. In the current American political climate it may be impractical to seek new legislative restrictions on abortion itself, but the argument for "informed consent" is much easier to carry. Legislators might be convinced to require an ultrasound examination—ideally, conducted by an independent party with no financial interest in the result—as a precondition for abortion.
For medical personnel in the ob-gyn field, and for lawyers and insurers handling malpractice cases, the AWC study suggests that the question of "informed consent" has implications beyond the legislative realm. Even if the law does not require an ultrasound prior to abortion, a jury might be persuaded that the abortionist was negligent in failing to provide that service prior to an abortion that caused serious medical complications.
For crisis-pregnancy centers, the AWC study suggests that investment in ultrasound equipment—and qualified medical personnel handle that equipment—could be the most effective way to drive down the number of abortions. Women facing problem pregnancies have no reason not to accept the offer of a free ultrasound test, and the results of that offer could be dramatic.
According to Family Planning Perspectives—a journal with close ties to Planned Parenthood—45 percent of all pregnancies in American today can be classified as "unplanned." While that number may be high, and the definition of what constitutes an "unplanned" pregnancy could certainly be open to discussion, there is no doubt that many thousands of women each year face a crisis when they learn that they are pregnant. For these women, abortion represents not an abstract political issue but an immediate personal dilemma. In this crisis, women who are tempted toward abortion strive to determine what is best for them, in their particular circumstances. An ultrasound test, at this point, can answer the need of a troubled woman by providing not another abstract argument, but a very concrete, practical, and personal perspective. For the first time, the young mother finds herself almost literally face-to-face with her unborn child.
Proponents of abortion might argue that the ultrasound test is a form of psychological manipulation. But the ultrasound machine, like the camera, does not lie. It is "my baby!"
[SIDEBARS] Table A AWC clients with known outcomes Before ultrasound With ultrasound (7/98- 12-99) (10/00-4/02) Total women considering abortion 344 100.0% 436 100.0% Chose to continue pregnancy 116 33.7% 277 63.5% Chose to abort 210 61.0% 107 24.5% Miscarried 18 5.2% 40 9.2% Other diagnosis 0 0.0% 12 2.8% Total not pursuing abortion 134 39.0% 329 75.5%
Table B Diagnosis of first-trimester clients Total Miscarriage Not Pregnant % Diagnosed 346 40 12 —- ultrasound in 5th-8th week 263 39 12 98.1% ultrasound in 9th-12th week 83 1 0 100.0%
Table C—CA Client U/S Exit Surveys
Ultrasound exit Surveys filled out by Clients —— 220 (100%)
Visit was helpful/very helpful to Client —— 211 (96%) Visit not helpful/unclear to Client —— 9 (4%)
Ultrasound changed Client’s mind about aborting pregnancy —— 179 (81.4%) Ultrasound caused Client to become unsure of abortion plans —— 21 (9.5%) Ultrasound had no impact on Client’s plans to abort pregnancy —— 20 (9.1%)