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Friday, June 7, 2019

Pro-choice articles euphemizing "heartbeat."

Definitions of "heartbeat."
To my knowledge there's no unifying authoritative definition of "heartbeat." Embryology textbooks do use the term. For example:
"Blood flow begins during the fourth week, and heartbeats can be visualized by Doppler ultrasonography." - The Developing Human, Moore et al, 10th Edition (2013) 
"The heartbeat is initiated around the twenty-first day, and its continual beating is required for normal heart development." - Larsen's Human Embryology, Schoenwolf et al, 5th Edition (2015) 
But in neither case do they explicitly define the word "heartbeat." Merriam Webster defines the term as "one complete pulsation of the heart." Mosby's Dictionary of Medicine, Nursing & Health Professions (9th Edition) defines "heartbeat" as "a complete cycle of cardiac muscle contraction and relaxation." By these definitions the embryo does have a heartbeat from approximately 3-4 weeks postfertilization/5-6 weeks LMP onward.

The embryonic heart.
As we explained in more detail here, by 4 weeks postfertilization/6 weeks LMP, the embryo's heart is beating as it uses coordinated muscle contractions to unidirectionally pump blood, exchanging well-oxygenated blood from the chorionic sac with poorly oxygenated blood from the embryo's body via multiple paired veins. The heart has also started partitioning into four chambers (atria and ventricles), which are observable by 5 weeks postfertilization/7 weeks LMP.

All of this information is taken directly from the embryology textbook The Developing Human by Moore et al, 10th Edition, 2013. Keep these facts in mind as you read the descriptions below.


(Click to enlarge.)

Vague and evasive articles.
A number of outlets have run articles quoting pro-choice medical professionals making at best misleading and at worst flatly false claims about the embryonic heart. As we go over these articles, please notice the following themes:

1) None of these articles specifically define "heartbeat." Most just describe the embryonic heart in markedly vague terms and then declare its activity doesn't qualify as a heartbeat without explaining why not.

2) Nearly all the articles quote medical professionals directly working for or affiliated with abortion rights advocacy groups, but generally the articles omit mention of these affiliations (the exception being Jezebel, which is refreshingly upfront).


Anti-Abortion Extremists Are Controlling the Narrative on 'Heartbeat Bills' Jezebel, 6/5/19
  • Nowhere does the article define "heartbeat."
  • The author references the Guardian article listed below.
  • Dr. Catherine Romanos, family physician and abortion provider: Calling the embryo's cardiac flutter a "heartbeat," she said, is tantamount to pseudoscience--and capitulation to the efforts of Republicans and anti-abortion activists who have forced their language into the mainstream.

Doctors' organization: calling abortion bans 'fetal heartbeat bills' is misleading, The Guardian, 6/5/19
  • Nowhere does the article define "heartbeat."
  • Dr. Ted Anderson, president of the American College of Obstetricians and Gynecologists (ACOG), states "What is interpreted as a heartbeat in these bills is actually electrically induced flickering of a portion of the fetal tissue that will become the heart as the embryo develops."
  • Author Jessica Glenza states "Instead of using 'fetal heartbeat bills', as the laws are often called by anti-abortion campaigners, the Guardian will make 'six-week abortion ban' the preferred term for the laws, unless quoting someone, in order to better reflect the practical effect of the laws."
    • Glenza is either unaware of or neglects to mention the fact that so far nearly all of the legislation outlaws abortion not at a specific gestational age but when a heartbeat is detectable. (See the text of the bills for Georgia, Iowa, Kentucky, Louisiana, Mississippi, and Ohio.) 
    • Currently, only Missouri's heartbeat legislation outlaws abortion based on gestational age: the bill states no abortion shall be performed at 8 weeks or later.
    • It's unclear, then, why "six week abortion ban" would better reflect the laws than "fetal heartbeat bills."

Dear News Media: It's not a heartbeat when there is no heart, Medium, 5/28/19
  • Nowhere does the article define "heartbeat."
  • Author Kathy Gill: "At four weeks after conception, an embryo has no heart."
  • Gill references the LiveScience and Wired articles listed below.
  • Gill implies there's no heartbeat until the 20th week: "It takes muscle to generate a heartbeat. British researchers reported in February that the fetal heart 'does not have fully organized muscle tissue until the 20th week.'"

Embryos Don't Have Hearts, The Cut, 5/24/19
  • Nowhere does the article define "heartbeat." although OBGYN Sarah Horvath (also of ACOG) implies a colloquial understanding - the "lub dub":
    • Horvath: "The characteristic 'lub-dub' of the heart is created by the valves in a four-chambered heart opening and closing." 
    • This definition wouldn't exclude the embryonic heart. As early as the 4th and 5th week (postfertilization) valves control the blood flow into and through the heart (Moore et al, Figures 13-10 & 13-11).
    • The article neglects to mention that ACOG is committed to increasing access to abortion
  • Author Katie Heaney: "Though pulsing cells can be detected in embryos as early as six weeks, this rhythm--detected by a doctor, via ultrasound--cannot be called a 'heartbeat,' because embryos don't have hearts."
  • OBGYN Robyn Schickler: What is detectable at or around 6 weeks can more accurately be called "cardiac activity." Essentially communication between a group of what will eventually become cardiac cells. 
    • This article at least states up front that Schickler is a fellow with Physicians for Reproductive Health, although it doesn't mention the group's stance on abortion. On their website they talk about "anti-choice politicians" and explain that they "advocate for the right to access safe and affordable abortion care in our communities."
  • OBGYN Jennifer Kerns: "These are cells that are programmed with electrical activity, which will eventually control the heart rate--they send a signal telling the heart to contract, once there is a heart."

  • Nowhere does the article define "heartbeat," although author Rachael Rettner potentially implies a colloquial understanding:
    • Rettner:"The 'beat' isn't audible; if doctors put a stethoscope up to a woman's belly this early on in her pregnancy, they would not hear a heartbeat." So possibly she believes a heartbeat must be audible via stethoscope to count as a heartbeat?
    • But audio detection of heartbeat is imprecise. Even fetal Doppler (significantly more sensitive than a stethoscope) can't reliably detect heartbeat until 10 to 12 weeks according to WebMD.
    • Whether we can yet hear the heartbeat doesn't change whether the process that causes the sound--the heart's contractions as it pumps blood--is already happening.
  • Dr. Saima Aftab: At 6 weeks the ultrasound detects "a little flutter in the area that will become the future heart of the baby." She says this happens when a group of cells gain the capacity to fire electrical signals.

  • Nowhere does the article define "heartbeat."
  • Author Adam Rogers: "What the bills call a heartbeat--it's not that." "It's a cluster of pulsing cells."
  • OBGYN Sarah Horvath of ACOG: "Our ultrasound technology has gotten good enough to be able to detect electrical activity in a rudimentary group of cells." "Heartbeat" conjures an organ which expands and contracts, but a six-week embryo has yet to develop that structure.
  • OBGYN Jennifer Kerns: "[The rhythm specified in the bans] is a group of cells with electrical activity. ... We are in no way talking about any kind of cardiovascular system."

Euphemism list:
  • cardiac flutter - Jezebel
  • electrically induced flickering of a portion of the fetal tissue - Guardian
  • pulsing cells - The Cut
  • cardiac activity - The Cut
  • what will eventually become cardiac cells - The Cut
  • cells programmed with electrical activity - The Cut
  • little flicker - The Cut
  • a little flutter - LiveScience
  • detection of cardiac rhythm - Wired
  • cluster of pulsing cells - Wired
  • fetal pole cardiac activity - Wired
  • electrical activity in a rudimentary group of cells - Wired
  • group of cells with electrical activity - Wired

Further Reading:

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