The importance of being a parent when children won't live long after birth

Editor's note: We believe it's important for more of the public to be aware of perinatal hospice services. We recently published overviews of what perinatal hospice entails and state laws regarding patient notification of perinatal hospice options. In today's post, guest blogger Leslie Corbly summarizes a recent article published in The Journal of Pediatric Nursing: "Being a parent: Findings from a grounded theory of memory-making in neonatal end-of-life care," which details ways to help parents process and grieve their children who live only a short time after birth. Everyone grieves differently. There's no right or wrong way. But we hope this information will help more parents who may not know how to process or what to do.

Photo credit: Pixabay from Pexels

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This research article deals with neonatal palliative care guidelines which increasingly encourage parents to (1) provide care to their dying babies, and (2) spend time with their babies before and after death. The purpose of this specific article was to explore and better understand how parental actions of providing care and spending time with their dying babies impacted the memory-making process of the grieving parents.

Although globally millions of babies die within the first month after birth, most parents grieving such a loss face a unique challenge because their grief is rarely recognized by society, meaning it is rarely publicly acknowledged, mourned or socially supported. This “disenfranchised grief” makes it more difficult for parents to find appropriate ways to create meaning during the emotional turmoil inherent in losing an infant.

The acts of spending time with the baby before and after death, as well as caring for the baby in a paternal manner—such as bathing, dressing, and holding the child—transform the intangible nature of such a loss into a tangible engagement between parent and child. This article focuses specifically on creating a substantive theory of memory-making in neonatal end-of-life care. In doing so it relies on a study from 2015 grounded in the theory of “affirmed parenthood.” The core of affirmed parenthood relies on three psychosocial procedures: (1) creating evidence, (2) being guided, and (3) being a parent. When a parent losing a baby engages in these three processes, the parent is able to create strong memories and images associated with the child, rely upon those who can help the parent to engage with the baby despite fear, and accept the role of parent, even in the brief period of the baby’s life.

Researchers used a qualitative method and interviewed couples who had faced the trauma of losing a baby during the neonatal time period. Parents spoke candidly of the importance of having time spent with their child. One parent noted the “precious” nature of the time spent with his child. Even though he only had an hour and a half with his baby, this time provided him the ability to say goodbye to his child. A mother who lost her twin children described the time spent with them as humanizing, allowing her to see her babies as “real people” rather than “just something that happened.” Indeed, this time made her children “a real part of our lives, and not just this bad thing that happened in the hospital one time.”

No parents interviewed expressed regret spending time with their baby just prior to, or even after, death. In fact, having the opportunity to touch and hold the baby was a memory parents cherished. One mother described the profound emotional impact of having the opportunity to nurse her child prior to his untimely death, “[h]olding him was huge. Huge.” A grieving father recalled the importance of cuddling his baby: “We had many cuddles. Up on our chests, in our arms. We cuddled heaps…Physical touch was very important.” The simple act of holding the baby gives parents the ability to engage with their child in a unique manner. One mother described studying every detail of her children, a memory she still clings to, “I can still close my eyes and see their faces eight years later.”

Although holding, touching, and otherwise engaging with the child were important aspects of taking on the role of parent and seeing the child as a unique individual, caring for the child in tangible ways, such as bathing, also proved to be an important and cathartic experience for parents. One parent described the act in a simple, yet profound manner, “I’m really, really glad we got to bathe him.” For parents who were unable to bathe their child, this can be a source of further grief and regret. One parent describes longing for the chance to bathe his baby, even after the baby’s untimely death. One mother recalls similar longings, reiterating that the chance to bathe her child was something she desired.

Clothing is also a way in which parents can meaningfully engage with their child. One parent recalled her desire to utilize the baby clothing made by her mother. Another recalled going through a pack of clothing at the hospital with the assistance of her nurse and piecing together an outfit for her child based on what she wanted her child to be adorned in. Unfortunately, some parents found a lack of control over the clothing of their child as a source of regret. One parent described feeling as though her desire to cloth her child in preferred clothing rather than the clothing on hand at the hospital was “superficial,” yet important “I really wanted him in the clothes that I had,” she said.

Parents engaged with their children in various ways to form bonds with their infants. Parents sang, read, and spoke to their children as a way of engaging with them and building a bond where the parent could see their child as a unique individual while also solidifying their role as the child’s parent in a tangible manner. In this way the parents were able to overcome the feelings of helplessness by doing something for and with their child, even if the action was as simple as singing a nighttime song. Parents were able to transform their experiences and become the parents to their vulnerable babies, despite the short time they had.

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Help make sure parents know the options available to them: advocate for perinatal hospice notifcation in your state. Read more here, from HowToBeProLife.com.

When Should States Enact Perinatal Hospice Notification Laws?

In a recent Note in the Washington University Law Review, author Ashley Flakus examines when, if at all, it is appropriate for the state to require pregnant women be told about perinatal hospice. (Click here for a general overview perinatal hospice services.)

While Flakus is obviously pro-choice, she makes some valid points about abortion, perinatal hospice, and informed consent. Here I give a fairly quick summary of the four parts of her paper without value judgments about the content. Following that, I’ll point out some of the concepts on which I think she missed the mark as well as some of the points on which I agree with her. 

Part One: History of perinatal hospice and evolution of laws concerning it

Flakus explains that perinatal hospice arose out of general palliative care and hospice care fields in the early 1970s, and by the early 1980s neonatal palliative hospice was starting to get recognized as a subspecialty in the medical field. It is recognized as a legitimate medical service to both the prenatal human who has received the life-limiting diagnosis and the family members of the baby. While some organizations try to be carefully neutral about a woman's pregnancy choices when a fetal diagnosis has been given, positioning perinatal hospice and abortion as only two of many choices a woman has, other organizations choose to frame perinatal hospice care as directly opposite the choice of abortion. In reality, there is a spectrum of choices available to women who have received a fetal diagnosis, and acting like there are only two choices and pitting them against each other detracts from the nuance of the situation. 

Part Two: Comparing and contrasting state laws about perinatal hospice

Flakus lays out the four ways States currently approach laws about notifying women of perinatal hospice services. She assesses what events trigger notification and whether notification is overinclusive, underinclusive, both, or neither.

She categorizes approaches by the triggering event: diagnosis-triggered approaches are responses to the parent(s) receiving a life-limiting  fetal diagnosis, and abortion-triggered approaches are responses when the pregnant woman is seeking an abortion. Flakus measures inclusivity by how well the laws reach the target population (women who have received a life-limiting fetal diagnosis). Overinclusive laws result in notifying some women who have not received a fetal diagnosis. Underinclusive laws result in failing to notify some women who have received a fetal diagnosis. Flakus gives examples of states which have one or the other of these approaches.

The first approach is abortion-triggered; it requires notification be given to any woman seeking an abortion who has also received a fetal diagnosis. Flakus categorizes such laws as underinclusive, since they don't require notifying women who received a fetal diagnosis but who are not seeking abortion of perinatal hospice services. She listed five states which have this notification trigger: AZ, AR, IN, MN, and OK.

The second approach is also abortion-triggered; it requires notification be given to all women seeking abortion. Flakus categorizes this approach as both over- and underinclusive. It is underinclusive because, just like the first approach, women who got a fetal diagnosis but are not seeking abortion would not have to be notified. At the same time the approach is overinclusive because many women seeking abortion (and thus required to be notified) do not have a fetal diagnosis. Two states are listed as having this type of approach: KS and WI.

The third approach is diagnosis-triggered: notifying all women who receive a fetal diagnosis. This approach is neither over- or underinclusive. In other words, it’s just right. It works to alert exactly the population of women who could make use of perinatal hospice services. Two states have this diagnosis-triggered approach: IN and NE. 

[Note: I am unclear on whether Indiana’s laws would make it so that a woman who received a fetal diagnosis and sought an abortion would actually get two notifications about perinatal hospice — once at the time of diagnosis, and once again at the time of abortion.]

The majority of states take the fourth and final approach: they have no laws pertaining to notification of perinatal hospice services. While a valid option, nonregulation is of course categorized as underinclusive, since no woman eligible for those services is required to be informed. This approach allows states to get out of the matter of medical decisions entirely while relying on internal regulation within the medical community and legal redress from patients via tort law. However, it also allows discrimination from doctors toward patients, with no set path for legal redress.

Part Three: The state's role in providing information in the spirit of informed consent

The third section of the Note is Flakus' lengthiest, with time devoted to examining what informed consent is and the various interests states may have in requiring the provision of information about perinatal hospice services. Flakus analyzes these state interests and assesses which interests are legitimate and should be used to create these laws versus which interests are invalid and should not be used.

What is informed consent in the medical context? "Generally, informed consent consists of providing a patient with the material information necessary to make a particular decision." In 1972, the Canterbury v. Spence case defined"material": "[a] risk is thus material when a reasonable person, in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding where or not to forego the proposed therapy."

She outlines four reasons states might give for requiring perinatal hospice service notification as a part of informed consent at some point in pregnancy:

1. "Protecting life and improving quality of life"

• This is a legitimate state interest for passing laws.
• Perinatal hospice may not extend an infant's life, but it can improve the quality of the infant’s life and the quality of life of the parents and family members.
• This legitimate interest may not be the true driving force of a notification law if the notification is abortion-triggered instead of diagnosis-triggered.

2. "Impeding abortion access"

• Abortion before fetal viability is a constitutional right, and a state has no legitimate interest in impeding such a right.
• Abortion-triggered notification laws are almost certainly intended to impede access, even if it's not explicitly stated.
• This reason is "impermissibly coercing individuals to not get an abortion."

3. "Promoting best medical practices"

• This is a legitimate state interest for the sake of protecting public health. 
• States regulating notification of perinatal hospice but not adolescent or general hospice are likely motivated to impede abortion access, not to promote best medical practices.
• Alternatively, perinatal hospice may be medically unique from other hospice services in a manner which justifies regulating notification of these services but not other types of hospice services, but if these reasons are not mentioned in the making of the law, it is unlikely this is the true justification of the law.

4. "Protecting individuals from emotional distress"

• Protecting anyone from the possible emotional distress or regret of their choice to act upon a constitutional right is not a legitimate interest of the state. 
• Laws or torts protecting people from undue emotional distress or "intentional infliction of emotional harm" require two parties: the person inflicting the harm and the person emotionally distressed by it. "Protecting individuals from accidentally inflicting emotional distress upon themselves by exercising their own rights in a perfectly legal way which they may later regret is not comparable."
• Abortion-triggered notification laws based on this reasoning are a type of "sexist paternalism" where only women making "high-pressure, potentially emotional medical decisions" are regulated in their decision-making so heavily (compared to men).

Part Four: Conclusion

Flakus asserts that the two best approaches to notification laws for perinatal hospice services are either diagnosis-triggered notifications or no regulations at all. Abortion-triggered notification laws miss the mark for a variety of reasons, most notable being "failing to deliver the intended benefits" of such a law. 

A diagnosis-triggered notification is in line with legitimate state interest in promoting best medical practices and improving quality of life, while avoiding overreach of the state into women's decisions to exercise their constitutional rights. Diagnosis-triggered notification laws also have the advantage of being in line with the concept of informed consent by providing information at the beginning of a woman’s decision-making process. 

No regulation on notification of perinatal hospice services is a valid option as well. This approach completely sidesteps the issue of possible overreach into constitutionally-protected medical decisions available to women and avoids "misogynistic restrictions on women's decision-making, infringement upon constitutional rights, and unnecessary governmental red tape."

Where I Agree

I think Flakus makes some very good points throughout the Note, especially with respect to the intent of perinatal hospice notification laws. I am going to outline several specific areas where I think pro-life people can have common ground with this pro-choice author.

• Perinatal hospice is not the opposite of abortion, but abortion-triggered notification laws set up these two options as opposites.
• Abortion-triggered notification laws set up perinatal hospice as an alternative to abortion, which sets up abortion as the biggest concern a pregnant woman might have when learning about the diagnosis. This is not a fair assumption.
• Abortion-triggered notification laws are underinclusive of the population of women who could make use of the knowledge or perinatal hospice.
• The possible emotional consequences one may inflict upon oneself by acting out a constitutional right should not be a driving force in making a law.
• The state has a legitimate interest in incentivizing or requiring behavior or actions to try to improve the lives of the constituents, or to de-incentivize or ban behavior which harms the lives of its constituents.
• A state does not have legitimate interest in impeding residents' exercise of their constitutional rights.
• If perinatal hospice laws can be triggered when a life-limiting fetal diagnosis is given, what about pediatric palliative care laws? Why are there none of those? Is it because abortion is not involved?
• By the time most women show up to the clinic or hospital to abort, they are set in their decision and are unlikely to change their minds. (Note: Both pro-choice and pro-life evidence shows this. Undecided women are the ones most likely to be influenced either way depending on the information they are given and the support they have. The more information given sooner in the decision-making period, the better.)

Where I Disagree

Flakus makes many of the common pro-choice assumptions I see from the average pro-choice person, which did disappoint me a bit since I expected more from a law student. She made some large leaps to a few conclusions that she did not provide adequate evidence to support. 

Her greatest assumptions are that fetuses lack personhood and rights until a later point in pregnancy and that abortion is a constitutional right. 

She actually used a Slate article to show that Americans have a wide range of views on when life begins. Unfortunately, she spends no time using valid scientific sources of information regarding when a human organism's life begins, nor does she spend any time justifying why fetal personhood should not start until viability. She also ignores the fact that many people, pro-choice legal experts and judges included, think Roe v. Wade was a terrible decision, and that there are very good legal arguments against the idea that abortion is a constitutional right protected under the 14th Amendment. 

She also argues that abortion-triggered regulations couched in "informed consent" language are paternalistic and misogynistic because they treat women as helpless and/or unable to make good decisions on their own. She states there are no comparable laws for requiring info in such high-pressure, potentially emotional situations for men. But the implied assumption here, as it is everywhere in her article, is that abortion does not kill. If we acknowledge that abortion kills humans, what possible comparable decision do men have? One does not exist. Pregnancy is unique to women, just as the ability to legally kill one's offspring is unique to us, too. She further argues that abortion-triggered notification laws are coercion by the state to prevent women from exercising their constitutional rights. 

When championing perinatal hospice notification laws, we pro-lifers need to ask: what is the primary point of the law? Are we trying to reduce abortions in an at-risk population or make all eligible women aware of all their options? A diagnosis-triggered law would be a good legal step to accomplishing both of those goals. Diagnosis-triggered laws give women the info up front, in contrast with abortion-triggered laws which give information last-minute, often after women have already decided. Upfront info making her aware of perinatal hospice services may prevent her from ever deciding to abort to begin with. Diagnosis-triggered laws are also preferable to no regulation. Doctors make judgment calls, and some doctors would likely withhold such information from eligible patients based on socioeconomic, ethnic, religious, or other biases. Making notification a legal requirement is a step to ensure women are either informed or have legal redress if not. 

[Today's guest post is by Petra Wallenmeyer, who is the Content Director at Human Defense Initiative. Photo credit: Tingey Injury Law Firm on Unsplash.

Help make sure parents know the options available to them: advocate for perinatal hospice notifcation in your state. Read more here, from HowToBeProLife.com.]

A Pro-Life Introduction to Perinatal Hospice

What is Perinatal Hospice?

Unless you or a loved one have utilized the services of a perinatal hospice program, you likely didn't even know such a thing existed. Hospice, as we know, is for dying people… so why would we be contemplating such a system for a newly born baby? Especially in a first-world country, where women have access to adequate medical care and babies are always born healthy?

Perinatal hospice exists because the unfortunate reality is babies do die, even with the best available medicine. Used when a poor prenatal diagnosis has been given, it allows families an opportunity to embrace their child's life, however limited that life will be. 

Built upon traditional hospice practices, perinatal hospice guides parents through both medical and anticipatory and post-partum grief processes, by coordinating care to assure their needs are met with the least additional distress. Specific items which may be included in a perinatal hospice program include (this is not an all-inclusive list):

Coordinated care — Over the course of a pregnancy where a fetal anomaly is detected, typical prenatal appointments can be multiplied at least three-fold. Excess diagnostic appointments may include multiple anatomy scans, fetal echocardiograms, fetal non-stress tests, or fetal MRI. For the family facing a prenatal diagnosis, streamlining appointments by scheduling multiple tests in one day can help cut down on time spent in physicians' offices, as well as in the environs of other expectant mothers who will be taking babies home at the end of their pregnancies. 

Access to a social worker and/or hospital clergy — A medical practice or hospital staff can assign a social worker or chaplain to you who will provide social and spiritual support for non-medical needs. These professionals can help with assuring medical staff are equipped to handle both your, and their, emotional responses to visits and can help you access programs which suit your needs. This could include not only support for clinical practices, but things like bypassing regular hospital restrictions on the number of people in the delivery room, as well as extending visiting hours so that family and friends can attend mom, dad, and baby for the entire length of baby's life. 

A medical plan for palliative care for baby — Often a family’s biggest concern when delivering a baby with a serious birth defect surrounds the issue of comfort. Hospice can assure the proper medical professionals are involved in baby’s life to deliver pain relief, if necessary, as well as to monitor nutrition and any other needs which arise.

What Does Perinatal Hospice Look Like?

With the plethora of prenatal tests available, families generally learn early in pregnancy there's a problem. Once they've made the decision to carry to term, hospice starts. Prenatal care focuses on mom and dad's comfort, at this point, with assuring the most positive experiences during visits. Over the course of the pregnancy, a care plan is developed for when baby is born. 

Some parents will choose to make plans for a funeral and burial/cremation during pregnancy, anticipating the post-partum period will be rough and giving themselves time to immerse themselves in the grieving process. 

Most parents will be encouraged to make memories with their children — trips to a favorite family restaurant, the beach, or sporting events may be options. Including their unborn baby in family traditions will be important as well. The focus is on including baby in whatever activities s/he would be involved in, if s/he were expected to live. 

Often the birth is planned via induction or C-section, in order to control the process and assure all of a family's needs are addressed. If a family is religious a pastor or priest may be permitted to attend the family during birth to comfort them and baptize/bless baby. Additional birth support may also be present — including doulas specifically trained to help families navigate this terrain. Typical post-birth practices, such as testing and assessments, may be put on hold in order to get baby to mom and dad as quickly as possible. Baby will most likely not leave mom as she's wheeled out of the delivery room and into recovery. 

During this time, mother's health is top priority. No hospice practice will be utilized which may endanger a woman's life. Baby is also cared for as an individual patient, and if parents wish, assessed at birth to assure the diagnosis is correct, and given pain relief if needed. 

Once settled in a private room (moms whose babies will soon die are generally not housed in the maternity ward), family and friends are liberally admitted according to parents' desires. Professional photographers may be called to document baby's life. A special cooling bed called a cuddle cot may be used so parents can room-in with baby. Plaster hand and footprints may be taken, Christmas or other holiday-focused ornaments created, and favorite hand-me-down clothing may be used. During this time, hospice staff is available both for counsel and to help facilitate streamlined and non-intrusive medical care and emotional support for parents. Some of the biggest obstacles come from family members and staff who may object to practices like using a cuddle cot. Hospice staff can help families navigate these conversations in a calm and productive way.

Hospice care may continue with a doula working post-partum with mom after she leaves the hospital, and through the funeral process in regards to chaplains and social workers. 

How Should Pro-Life Advocates Promote Perinatal Hospice?

Like a typical hospice program, there are things which pro-life advocates must consider — most importantly, have opportunities for treatment been exhausted? 

Whether for an adult, child, or neonate, hospice should never be considered in the case where a child can benefit from medical care. Many times this consideration comes with the understanding a child may endure extensive medical treatments to maximize their potential happiness. We must be vigilant to ensure parents are not encouraged to forgo treatments for a child who would survive with disabilities out of what they perceive as compassion: this is an ableist viewpoint, and one which those with disabilities speak on more eloquently than I ever could. 

Neonates are human beings, with the same rights to proper medical care as any other child. By permitting parents of children who've received prenatal diagnoses to limit treatment for their children, we have inadvertently set up a system of passive euthanasia. Hospice workers and family advocates must be discouraged from promoting this course of action. Pro-life advocates must continue to speak up for the life of the disabled neonate just as they speak for the life of the disabled fetus. Allowing a child who could live, to die, could be colloquially referred to as a "fourth-trimester abortion," an action, or in this case inaction, which denies the humanity of the human being involved. 

Moving Forward 

Hospice, like any other medical-related treatment, should be embarked upon from a life-affirming position. Working towards educating your peers on practices which will help families consider life rather than abortion is always the most important aspect of pro-life work, and in this context perinatal hospice can be a wonderful tool to utilize. Encouraging physicians as well as local hospitals to adopt these practices benefits everyone whether pro-life or pro-choice, in addition to encouraging a culture of life to bloom.

For more information, to see if this type of care is available in your area, and to learn how you can promote these programs, please see: 

PerinatalHospice.org.

For information on supporting parents who are facing a poor prenatal diagnosis, please see below. Please note that to my knowledge there are currently no secular sources for this type of care, but the following organizations serve all families regardless of religious beliefs or lack thereof.

Sufficient Grace Ministries

String of Pearls

Be Not Afraid

Prenatal Partners for Life

[Today's guest author is Sarah St. Onge, who writes about child-loss, grief, and issues pertaining to continuing a pregnancy after a lethal anomaly has been diagnosed. You can read more of her work at shebringsjoy.com. She’s also a savethe1.com board member and founder of limbbodywallcomplex.net, a pro-life, diagnosis-specific website which supports parents who continue their pregnancy after receiving the same lethal diagnosis which took her daughter, Beatrix Elizabeth. You can find Sarah on Facebook, Twitter, and Instagram.

Photo credit: Andreas Wohlfahrt on Pexels

Help make sure parents know the options available to them: advocate for perinatal hospice notifcation in your state. Read more here, from HowToBeProLife.com.]

Our cultural gaslighting of women who miscarry before 20 weeks

In early 2019, I miscarried one of my twins. I had already known how common miscarriage is, and I suspected that when I began talking publicly about my miscarriage, people I've known for years would quietly let me know they had also had pregnancy losses. It was bittersweet for that prediction to come true; their understanding and support meant a lot to me, but I was sorry to learn of their own heartbreaks.

It helped me process to talk about my lost babe with others who have been through it. I joined some online support groups for pregnancy loss where I found additional consolation and connection. Miscarriage is common, but people don't speak about it much publicly. As I talked privately with so many other women about their losses, I began to see why. 

First, many women feel guilty that they miscarried; they worry that some action they took caused their miscarriage, even though there's usually no reason to believe that's the case. Some even think the miscarriage is some kind of fate—a punishment for some past mistake or a reflection of their inability to parent. It's terrible. Grief is hard enough on its own, without added layers of guilt and shame.

Second, many women worry their grief is stupid or irrational. They experience a lot of gaslighting—nearly all of it, I think, unintentional—from medical personnel, friends, and family. And the lack of compassion seems to get more pronounced the earlier in pregnancy we miscarry.  

Research has found that "gestational age was not shown to affect the degree, intensity, or duration of the grief, anxiety, or depression" for mothers who had miscarried, and yet one of the hallmarks of early miscarriage is "the minimization of the loss by others." My pregnancy loss groups regularly feature posts lamenting when loved ones make well-meaning but dismissive comments ("You can always try again." "At least you weren't further along." "At least it wasn't an actual baby.")

Even therapists don't always react appropriately. I lost my babe around 6 weeks. The first counselor I saw commented about how that gestational age is "super early." During our session she mentioned more than once that I may find my grief over miscarrying is a surface emotion for other, deeper issues—seeming to imply losing a baby, on its own, wouldn't normally warrant this much anguish. At the end of our session, she said "Well I'm glad to work with you, and we can work on processing your... well I guess it's like a miscarriage, isn't it?" (I did not continue seeing her.)

These responses are tragic but not especially shocking. Thanks to our fiery, never-ending national abortion debate, there are countless voices loudly and incessantly insisting that human embryos and fetuses are not babies. Worse, they often go further and imply that viewing preborn humans as children is ignorant or superstitious. Example:

Original tweet here.

This kind of condescension insults and silences people (pro-choice and pro-life alike) who grieve their miscarriages as the deaths of their children. 

Original tweet here.

In an article about miscarriage and post-traumatic stress, the BBC interviewed a woman whose reaction underscores the problem:

Toni Edwards-Beighton, 36, says she felt she was losing her mind after a miscarriage in 2016. "I felt my grief was wrong because it wasn't a real baby - but I was in complete shock," she says. ... "It wasn't 'tissue' to me, it was our baby," Toni says.

My miscarriage broke my heart, but stories like the above make me grateful I have so many pro-life friends and family. I have people in my life who affirm the value and significance of my lost babe not merely as a potential child who will not come to be, but as my actual child, once living and now gone. I have never felt my grief is misplaced or irrational. I have never struggled to reconcile my overwhelming instinct about the reality and value of my child with cultural messaging or social circles persistently arguing otherwise. I have had four children; three of them are with me now, and one is gone. The grief is difficult, but I'm thankful I don't have to also navigate the gaslighting.

Unfortunately, in addition to dealing with dismissive comments in their interpersonal relationships, people struggling through miscarriage often also encounter insensitive responses from the medical community.

In her recent article "Hospital attitude adds to couple's heartache," Sarah Terzo highlights these themes. Lindsey and April Woods lost their daughter through miscarriage in the second trimester, and their grief was only compounded when medical staff repeatedly referred to their baby as "tissue" and—only after persistent requests—provided their daughter's remains for burial in a bright orange biohazard bucket.

This apparently indifferent approach has been all too common in medical settings. In 2010, Critical Care Nursing Quarterly published "Proof of life: a protocol for pregnant women who experience pre-20-week perinatal loss," in which the authors conducted a literature review and found there were no protocols for the emotional care for women who experience pregnancy loss prior to 20 weeks gestation. The authors suggested options for better respecting the experience of loss (such as offering a prayer, moment of silence, naming ceremony, referral for perinatal support groups, etc.). But implementation of such protocols has been slow. A 2017 article in the Journal of Perinatology explained that, in an emergency room setting, women under 20 weeks gestation who miscarry get appropriate physical care, but "psychological and bereavement support they need is provided less consistently, or, more often, not at all." The research found that when women do not receive appropriate emotional and psychological support, their grief is deeper and longer-lasting, and their losses are more likely to trigger unresolved grief and depression during subsequent pregnancies. In contrast, providing proper emotional support to women who have miscarried improves both their mental health outcomes and medical personnel's work satisfaction.

To that end, in the last few years key stakeholders in emergency room management and pregnancy loss bereavement have worked together to create a position paper addressing care for women miscarrying—at any gestational age. The paper details best principles and practices, emphasizing sensitive and dignified care for the family such as offering bereavement care and culturally competent options for disposition of the child's remains.

This is a step in the right direction, and I'm hopeful more medical staff can access the education and training needed to better care for people mourning miscarriage. I'm less optimistic about positive changes in our culture as a whole. It's difficult to see how the abortion rights narrative—that prenatal life is effectively irrelevant—can coexist with our lived experiences of our offspring alive, then gone. I expect as long as so much of society is incentivized to dehumanize our children, my pregnancy loss groups will continue to have posts like this:

"It is just a fetus, tissue, they say
But I know better
It was my child, my baby
A living being
A part of my family"

How Legal Abortion Twists Society's Response to Miscarriages

Photograph by Joy Real on Unsplash. Image description: A cemetery in snow.

October is Pregnancy & Infant Loss Awareness Month, a time when we remember children lost to miscarriage, stillbirth, and SIDS (Sudden Infant Death Syndrome), and the families they have left behind. As a mother who has lost two of my children to miscarriage, I appreciate the need for awareness. Despite the fact that one out of every four women has suffered a miscarriage, the subject is rarely discussed.

Our reluctance to discuss miscarriage is partly a product of our reluctance to discuss death and mortality in general. But there is more going on here. I am convinced that a major cause of women's suffering and silence is legal abortion.

Legal abortion means with miscarriage, someone will get slapped in the face by our response. Either post-abortive women get slapped by the truth that their unborn child was an actual living human who died on their demand—or—grieving mothers of miscarriage will get gaslighted and mocked for melodramatically mourning a disappointing pregnancy as if they can't still have a baby if that's what they want.

It's impossible to validate the loss and grief that we face when we lose a child to miscarriage without acknowledging the humanity and life that existed. And if what I mourn is the loss of a human child's life, abortion is taking the life of a human child. Naming the child and otherwise acknowledging this was an irreplaceable son or daughter reminds women who lose children by choice of what they have willingly done. This truth is not a pleasant message for post-abortive mothers.

On the other hand, denying this truth is a huge slap in the face to grieving moms. If all I lost was a "potential person"—basically I am just disappointed that pregnancy didn't end with a full-term baby. In that case, miscarriage is just temporary bummer and "better luck next time." It denigrates our grief and pain and for no other reason than it makes society feel better about disposing of children at will.

Lies told to enable evil toward unborn children also hurt those who love (and lose) these babies. It is just another bonus gift from the culture of death.

[Today's guest article is by Dr. Jacqueline Abernathy, Assistant Professor of Public Administration at Tarleton State University.]

When we say "heartbeat" we don't mean "fetal pole cardiac activity." We mean "heartbeat."

Recently a FB follower shared this post to our page:

(Click to enlarge)

The text reads, in part:

This is what an embryo at 6 weeks looks like. There is no real heart beat because it’s heart isn’t nearly complete - they’re heart “vibrations” (vibrations are caused my cellular activity where the heart WILL be. Meaning, yes, the title of the “heartbeat bill” is misleading, purposely). There is no brain, meaning no pain receptors. It does not feel pain. This is what you’re stripping women’s right away for. I, your sisters, your mothers, aunts, friends - we all have beating hearts and brains. Our lives are more important than this. 

**Stop listening to pro life talking heads that use purposely emotional language to manipulate your view. They are not doctors or scientists.**

•This is not a “baby”. They use pictures of 6 month old babies to pull on your heart strings. This is an embryo. This is not “10 fingers, 10 toes” babbling cooing baby they’re trying to get you to imagine.

The post is certainly right that this image is not of a "baby." The image is actually from Etsy, described as "Baby Memorial/Honor Sculpture." The tiny figures pictured are clay sculptures which the seller says are "for those who have experienced the loss of a pregnancy during the first trimester and are searching for a tangible keepsake to honor their precious Angel." The Etsy page includes reviews from mothers describing how much it means to them to have a way to mark their grief and loss. How ironic that the OP uses art specifically meant to help people value and mourn prenatal life to instead deride those very viewpoints--and all while claiming to be representing science. It's kind of amazing.

Here's an image of an embryo around 6 weeks post-fertilization (or 8 weeks LMP - after the beginning of the last menstrual period) courtesy of The Bump:

As the prenatal website explains, "You may have your first prenatal appointment right around now. At this visit an ultrasound may be performed to determine how far along you are. You may even hear—and see—baby’s heartbeat."

The Bump's use of the word "heartbeat" is representative of not only many prenatal websites but also descriptions medical professionals give pregnant women during routine prenatal care. Using "heartbeat" to describe embryonic activity at this stage is neither new nor unique to anti-abortion advocates.

Some pro-choice people argue that when medical professionals say "heartbeat" in these contexts, they're just using layman's language with their patients, just as an OBGYN might say "baby" when talking to a woman with a wanted pregnancy. That doesn't make "baby" a medical or technical term.

But "heartbeat" is appropriate both for the layman and as a medical description. As The Developing Human by Moore et al (10th Edition, 2013) explains in "Chapter 13: Cardiovascular System":

The cardiovascular system is the first major system to function in the embryo. The primordial heart and vascular system appear in the middle of the third week (Fig. 13-1). This precocious cardiac development occurs because the rapidly growing embryo can no longer satisfy its nutritional and oxygen requirements by diffusion alone. Consequently, there is a need for an efficient method of acquiring oxygen and nutrients from the maternal blood and disposing of carbon dioxide and waste products.

In other words the embryonic heart exchanges oxygen and carbon dioxide even before it fully develops into the more complex heart we're familiar with. Those insisting we say "fetal pole cardiac activity" instead of "heartbeat" or describing the embryonic heart as just "electrically induced flickering" or--more ridiculously--"vibrations" try to imply that the four chambered heart doesn't happen until months later; that's completely incorrect. Here's a diagram from Moore et al of the heart at 35 days (approximately 5 weeks post-fertilization):

(Click to enlarge)

At this point the embryonic heart already has four chambers. It's reductive to describe this development as no more than "pulsing cells."

Additionally, by 4 weeks the embryo has three paired veins draining into the heart: vitelline veins return poorly oxygenated blood from the umbilical vessel, umbilical veins carry well-oxygenated blood from the chorionic sac, and cardinal veins return poorly oxygenated blood from the embryo's body to the heart. Here is an illustration from figure 13-5 of Moore of the heart at 24 days postfertilization:

Here are the veins illustrated at 6 weeks:

This image is from Figure 13-4, the caption for which states, "Initially, three systems of veins are present: the umbilical veins from the chorion, vitelline veins from the umbilical vesicle, and cardinal veins from the body of the embryos."

More from Moore:

• "The heart begins to beat at 22 to 23 days (Fig. 13-2)."
• "Blood flow begins during the fourth week, and heartbeats can be visualized by Doppler ultrasonography (Fig. 13-3)."
• "The initial contractions of the heart are of myogenic origin (in or starting from muscle). ... At first, circulation through the primordial heart is an ebb-and-flow type; however, by the end of the fourth week, coordinated contractions of the heart result in unidirectional flow."
• "Partitioning of the AV canal, primordial atrium, ventricle, and outflow tract begins during the middle of the fourth week."

By 6 weeks the heart is chambered and moving blood unidirectionally through coordinated contractions--that is, the heart is rhythmically pumping blood. Of course the heart has more development to do, but the pro-choice side is hand wavy at best to insist we can't say "heartbeat"--and they are flatly wrong to say embryos don't have hearts! Which side is anti-science, again? 

The embryonic heart is "a bunch of pulsing cells" in the exact same way the embryo herself is "a clump of cells"--in a way meant to downplay that abortion kills prenatal humans. It's continually remarkable to me that the pro-choice side seems to badly need to obfuscate the humans abortion destroys. I suspect if arguments regarding bodily rights and fetal personhood were stronger, fewer pro-choice people would recoil so hard at what are otherwise basic and generally uncontroversial facts.

Of course, and as always, the fact that a human organism has a heartbeat doesn't in itself establish moral worth. But it's one thing to argue that the embryonic heart is irrelevant; it's another to suggest it doesn't exist. I'll take my scientific education from an embryology book, not Etsy, thanks.

Post-publication update: I've seen so many stories now purporting to scientifically explain away the embryonic heart, I'm just going to start collecting them here:

• 'Heartbeat' Bills Get The Science of Fetal Heartbeats All Wrong, Wired, 5/14/19
• Is a 'Fetal Heartbeat' Really a Heartbeat at 6 Weeks? LiveScience, 5/17/19
• Embryos Don't Have Hearts, The Cut, 5/24/19
• Doctors' organization: calling abortion bans 'fetal heartbeat bills' is misleading, The Guardian, 6/5/19

Read more details about why these articles are misleading here.

We asked, you answered: why did you convert from being pro-choice to pro-life?

Original FB post here. At the time I started organizing these answers, there were about 200 comments.

Many people became pro-life because of their own pregnancy experiences:

Sasja: I was pro choice, and even against the gestation of embryos that showed signs of hereditary diseases or birth defects ... And then I fell in love when I first saw the beating heart of my 12 weeks into development unborn child—at that time nothing more than a blinking lo-res pixel on the ultrasound screen.

Myles: Having our first child and thinking we were going to lose him at one point during the pregnancy. Made it crystal clear.

Cassie: I was raised by a feminist mom to be pro-choice. I believed it was a "blob of tissue" until I was pregnant with my first child. When they handed me all the info on prenatal care and my "growing baby" I was like, "Wait what?" I pretty much changed my mind right then and there though it probably took me 3 or 4 more years to talk about my change of mind with friends and family.

Mandy: Seeing my 12 week old baby miscarriage.

Rachael: Pregnancy changed my mind. I had an unplanned pregnancy and I just felt different after that. It is hard to explain.

Heather: I was rather uncommitted either way, just not a problem I had to consider. Until I miscarried at 5 weeks. That was a life. I felt real loss, real grief. And the pro-abortion side tells me it's just a clump of cells. It wasn't. It mattered. It had meaning. I know that now.

Shayla:

I found myself getting pressured into abortions with both my kids by people in the healthcare and mental health services industry. Later on, I was told that I should have not even had kids if I had an intellectual disability. On top of that, my boyfriend wanted me to abort.

I made two appointments with PP who were actually fair saying I have to really want it. I dreamed my baby was being attacked by a large snake. I had to protect and defend my baby as her mother! That's when I knew I wasn't going through with it.

Things actually worked out for us. Section 8 gave us a home. When things went south with my relationships, there were shelters, I had a legal advocate and counselors, we always had enough food. Later on, we got a new apartment and thrived. Point being things were never as bad as things were painted.

I want to advocate for other women going through this. I want them to know the Truth that someone dies during an abortion and someone could be saved and things can turn out even when things are at their worst when they choose life!

Kathleen:

I think when I was very young I didn’t give it much thought. Then gradually as Roe v. Wade was passed I thought more about it and my understanding of how the baby developed brought me to be pro-life. Lastly becoming a mom cemented it in me. Especially mother of a baby who died at 22/3 weeks gestation.

I still can’t reconcile how people can be sympathetic to that sort of loss and yet still think abortion is okay. Yet I know pro-choice folks who were very appropriate to me at that time and later when I lost three grandbabies. How do they say "I understand your loss is painful" but at the same time say it’s okay to take the life of a baby in the uterus? Is a baby at that stage valuable in one circumstance but not the other?

Rhonda: I was one that said I wouldn’t do it unless there was an extreme abnormality, but then our first pregnancy ended up being a partial molar pregnancy. Our baby died at 15 weeks and I had to deliver him. Watching my husband hold our fully formed baby and confirm his gender at this early stage did it for me. Doctors tried to comfort me with the fact that if he had survived he would have had severe problems. But to me the pain and emptiness I was feeling was worse than anything else I could imagine. It’s been 20 years and I still grieve that loss. And for people to dismiss his humanity cuts right through me.

Whitney: Incredibly, I used to be pro-choice even though I was given up for adoption as a baby. I thought it wasn't my business what other women did with their bodies. Changing my mind was a process. It started with seeing my daughter on an ultrasound. I knew then that I could never have an abortion and that she was a living person. It took years to break down the mental walls, though, before I became fully pro-life.

Phoebe: I was more of like its not my business, but I was not gonna go out and fight for choice either. Then I carried a child, a child I almost lost. I spent a week in a NICU and saw babies smaller than my hand. That was my turning point. A few years later I realized if I was pro-life I also needed to stop supporting the death penalty. That's my evolution.

Lesli: I was because I was ignorant of how babies developed and what the procedure was actually like. Once I became pregnant, learned about fetal development and found out they have a heartbeat so early on my entire outlook on it changed. Then I read about the procedures themselves and became disgusted that I ever supported it.

Alexis: I've had two unplanned pregnancies. One when I was 17. Abortion was thrown around by others around me, but that wasn't an option. I was determined to raise that baby. Unfortunately she didn't survive and her heart stopped at 16 weeks. My second unplanned pregnancy was when I was 21. I JUST started my career as a paramedic and was not in a committed relationship. I had been on birth control since 18. Once again abortion was thrown around by others, and once again I wouldn't hear it. My beautiful daughter is now 8 years old; my husband and I (her father) have two more children together. We chose life with the odds stacked against us, and we are thriving. Not all stories are like mine. All these babies have a purpose and it is not right to kill them. Abortion is legalized genocide.

Karen: I was. I saw my child on ultrasound and realized she was a child. I expected to see a blob, not a baby sucking her thumb, at 20 weeks gestation. I knew then I'd been lied to and was furious.

For others it was their experiences with abortion itself (or abortion providers) that changed their minds:

Valerie: I was raised pro-life, but became pro-choice in adulthood. It wasn’t until the devastation of my own abortion that I realized those pro-lifers really knew what they were talking about.

Autumn: Working in an abortion clinic changed my mind. It took time.

Monique: I was pro-choice just not for me. Then I had an unexpected pregnancy and went to Planned Parenthood to confirm. They pushed me to not tell anyone and have an abortion. The more I resisted, the more aggressive they got. I literally had to run out of the office. She's 7 now, I'm married to her dad, and just thinking about the possibility of not having our little family is crushing. Abortion hurts women and most are coerced into it.

Rachel: My best friend was 17 when she became pregnant. I went with her for the pregnancy test at PP. She was scared but wanted to keep the baby. Her parents and boyfriend pushed her to terminate. Our state had a mandatory ultrasound and 48-hour waiting period; she shared the ultrasound photo with me. It was not a clump of cells. We could see the head, the defined jaw and chin, a small arm. She wanted to refuse. Her parents sedated her and forced her to go in for the termination. She had a total breakdown. In the months that came she drank, did drugs, became self-destructive. She later killed herself. Every time I hear someone say "clump of cells" and "not human," I think back to an ultrasound photo from 1996.

For some it was increased knowledge of biology:

Lauren: Me. #1 Science; recognizing that's a human in the early part of the human life cycle and we shouldn't kill humans. I can't reason out of that fact.

Jackie: I’m liberal so being pro-choice came with the territory, but I'm also a professor and I’ve been teaching Anatomy & Physiology since 2002. When I started teaching an advanced Human Physiology class in 2008, something huge shifted inside of me. I can't teach about the wonders of development and ignore the wonders of development. I'm also inherently a tree-hugger and can’t handle it when trees and animals are harmed and the cognitive dissonance started breaking.

Lori:

I was pro-choice for many years. I finally found it too exhausting trying to justify abortion while also supporting my values in science, equality, non-violence, and non-discrimination.

The science doesn't lie. It's a scientific fact of biology that life begins right after the fusion of the two cells, where our unique human genetic makeup now exists, with our own individual DNA.

Every pro-choice person (including me once) tries to say this may be what happens to the cells but it's not "alive." Which is ridiculous! I was that once. A zygote. We all were.
So if I wasn't "alive" then, then how am I here now? That's when I changed. I can't deny the science.

No human should lose their only chance to experience this physical conscious life as we are enjoying, simply because we ignored the reproduction process that's been happening for thousands of years, and don't want to take responsibility for our actions.

Andrew: I used to think that it was nobody's business. I was against abortion being funded publicly but if people wanted to pay for their abortion procedures I thought that was fine. But then I read about and started to think about when human life begins and biologically speaking it starts at conception and saying it begins somewhere after that is to impose your scientifically unfounded beliefs. And if that is a human life you cannot kill it just because it inconveniences you.

Some people changed their minds after talking to pro-lifers:

Karen: A discussion with a pro-life person outside a Planned Parenthood in Washington D.C. At the time, I was assisting PP with political strategies. And thought I was doing so as a strike against the Patriarchy. This woman challenged me to read what the first feminists had to say about abortion. That led to more reading and finally the scales fell from my eyes.

Mike: I was pro-choice because of the media. Eddie Vedder was my hero and I took a lot of my social justice beliefs from him. Once I met pro-life people and started having open discussions about it, I realized I had no foundation to why I believed the government should not be involved in a woman's decision. Once you recognize a fetus as a human life, or even a potential human life, you can't stay pro-choice very long.

Heidi: I read Abby Johnson's book seven years ago. Completely changed my mind. I started educating myself and learning more about what abortion really was and how we can embrace life and protect it at its most vulnerable stage. How can we be a species that kills our young simply because it’s convenient?

Darinka: I thought I'd never do it, but I wouldn't dictate the choice to someone else. But then a friend asked me a simple question. "Why would you never do it?" And when I thought about it, I realized that it's for the same reasons nobody else should.

Kristin: I was pro-choice until a few years ago. A close pro-life family member was challenging my conscience with facts against abortion. I felt I had to strengthen my argument with facts too, so I went on a mission to educate myself with as much unbiased information as I could find. That journey led me to the truth, and the truth led me to becoming pro-life. I watched "The Silent Scream" and an interview with Dr. Levatino, and I was forever changed, and glad for it.

Abby: I started to change my mind when I held my own miscarried baby in my hands. I completely changed my mind when I read about Abby Johnson. If she could cross over to pro-life I could too and it didn't make me a hypocrite.

Ellen: I was heavily indoctrinated into everything hard left, including radical support for abortion, coming of age in a large east coast city government school environment. I was also raised Catholic, while my catechesis was... Not great... So that probably planted the seeds of a consistent view on the dignity of human life. As a young adult, I decided I was personally pro-life, but politically pro-choice (I didn't want to force my view on others). It was my then-boyfriend (now husband), who identified as atheist/agnostic at the time, who highlighted the logical inconsistency of my position; if I was against abortion personally, the fact that it was a human rights violation didn't change depending on who was committing it. Over the next few years, I formed a highly consistent life ethic—all human life, regardless of circumstances, from conception through natural death.

And, maybe surprisingly, some changed their minds after talking to pro-choicers:

Stephen: I met other pro-choicers, heard their arguments, tried to research some of them, and ended up finding a good number of fallacies or terrible ethics. Sooner or later I adopted into my moral philosophy that all humans have an intrinsic value, and abortion under any circumstances is incompatible with that philosophy.

Shelby: I used to be pro-choice as I believe that if you get rid of it before it has a heartbeat it isn't as bad. But what pushed me to just be pro-life is pro-choicers pushing for second and third trimester abortions. Acting like abortions are normal.

Cian: To an extent I still am pro-choice but what's driving me out of that camp is seeing the enthusiasm and wanting to terminate and display it as something that should be celebrated.

Stephanie: I was always an "Abortion is murder but..." thinker but the left's cultural shift from "Abortion is a necessary evil sometimes" to "celebrate your abortion" has prompted me to think "Abortion is murder." Period. I cannot be on board with the celebration of the murder of the most innocent for convenience's sake.

Katherine: Two things: (1) going to a sex week event in college and seeing pro-choice people misrepresent statistics. I thought "If we have the right argument, we shouldn’t need to lie and manipulate numbers." (2) I shadowed in a hospital and went through pages and pages of women's gynecological history, seeing that most of the women had at least one abortion. The prevalence was shocking. Then I came across a 24-year-old woman who had been pregnant ELEVEN times and had SEVEN abortions. THAT is the moment I completely switched to pro-life and realized abortion is completely abused and not "rare."

See more stories about conversion on FB here. Also check out this Twitter thread by a pro-choice woman explaining how her friends and family's experiences made her views on abortion "more cautious."

Nearly half of all fertilized eggs fail to implant.

The human zygote is the first developmental stage of a human organism’s life cycle. Sometimes when I state this fact, people respond by pointing out that many zygotes never implant. Bill Nye made the same point in his video on abortion rights:

Many many many more hundreds of eggs are fertilized than become humans. Eggs get fertilized—by that I mean sperm get accepted by ova—a lot. But that’s not all you need. You have to attach to the uterine wall, the inside of a womb.

It’s true that a large proportion—possibly even up to half—of zygotes never implant and instead pass through the woman and die. I’m just not sure why people think this fact undermines the claim that human zygotes are human organisms. We don’t decide whether an entity is an organism based on how easily that entity dies. Consider the fact that as recently as the 1800s over 40% of children between birth and age 5 died. Despite their high mortality rate, those children were clearly still human organisms.

Consider also that very elderly people die more easily than younger people. If we plotted the human life cycle against our survival rates, it might look something like this (this is not an official graph, just a rough drawing to illustrate the point):

There are developmental stages when human organisms have lower survival rates. That’s true. I’m just not sure what it has to do with whether those entities are human organisms. Elderly people, very young children, and zygotes all die more easily than people my age, and they are all still human organisms.

Jake and Amanda's Story: A Terrifying Diagnosis

I don’t think any man is prepared for hearing that a pregnancy he helped create may be the cause of death for the mother of his child. I know the father of my child wasn’t prepared to hear that, but he did nonetheless. In his words: "You hear people say a person could die having a baby, but we don’t really think about what that looks like. It’s so different than say a person having cancer because we see that and know what it looks like. People just don’t talk about what it’s like when you’re told you’re gonna die having a baby." I wanted to present our story from his perspective because men are often overlooked in maternal issues.

Mine and Jake's relationship began in July 2016. We hit it off immediately and felt there was something solid about the connection we had. Jake had no children and I had 3. I told him immediately that I didn't want more kids and in fact wasn't able medically to become pregnant. He said he was okay with loving the children I had, so we continued our budding romance. However, in August 2016 we discovered the doctors had been wrong and that I could become pregnant because I was definitely pregnant.

We were in disbelief and although he was shocked and scared, he handled it with grace. He was excited despite the fact we'd only been together a month. Unfortunately we both knew that with my medical history, our pregnancy would be difficult and statistically the odds were in favor of miscarriage. I'd had a uterine ablation a few years back and that makes conceiving and maintaining a pregnancy exceptionally difficult. We miscarried at 6 weeks... but at 12 weeks found out we were still pregnant. We had lost a twin.

It was then that my doctor presented us with the scary statistics of my pregnancy and that if I continued with it, my fatality was the overwhelming outcome. We chose to continue the pregnancy. Jake was angry when we were told to terminate, and scared for the implications of not terminating, but he supported my decision.

At 26 weeks I had a massive hemorrhage and was admitted to the hospital. We lived over an hour away from the hospital so he and I moved into a hospital room together. He got up each day, went to work and came "home" to me and did everything in his power to keep our lives normal. I can't imagine how difficult those days were for him but he says they weren't hard, it was just our life. It's funny how you can adjust to anything as long as you're with the one you love.

We had to stay in the hospital until my delivery, which was set for 33 weeks. The days leading up to my delivery were hard for Jake. This was his first and only child, but due to my medical issues I'd have to be under general anesthesia for delivery which meant he couldn't be in the room when our daughter was born. He would have to wait until she was stabilized to see her because of her prematurity, and he'd have to meet her without me because I'd still be in surgery.

On March 8, we were scheduled for delivery. Both of us were scared and anxious. Our main concern was would our daughter be okay? Would she have complications? It's so hard to be excited when your whole pregnancy has been doom and gloom. But we held fast to the belief that our daughter was a fighter and that she would be okay.

At 1:45 that day, Sadie Kayte Holliday entered the world weighing 5 lbs and was 17 inches long. She was every bit the fighter we knew she would be and came off intubation within the first hour of her birth. Jake only knew she had been born via a phone call to the waiting room from a nurse. He didn't get to meet her for several hours. It was only upon him getting to meet our daughter that he learned things were seriously wrong with me.

I was still in surgery, he was told. He knew I should have been out by now and that something was wrong. Later that evening my doctors met with Jake and my family and told them they'd done all they could do but it wasn't enough. I had bled out several times during surgery and they couldn't find or stop the bleeding. My body had had enough, so they packed my incision and stapled me up and put me on life support until they could come up with a new plan.

Jake finally got to see me in ICU around 11pm that night. He says seeing me like that was the hardest part. He held my hand, cried, and prayed for me to live. He thought about how life would be raising Sadie without me. He never left my side and slept with his head on my damaged body.

The next day I was operated on again. The doctors successfully found and fixed the arteries that had been damaged. I’ll never forget the look of relief on Jake's face or our hug through his tears when I saw him after surgery in ICU.

We are about to celebrate our daughter's first birthday. We are now married. Our experience shaped our relationship in so many ways. We grew together and became so strong. We could have so easily said we haven't been together long enough to have a baby, or the doctors know best, but we didn't. We chose to fight together instead of doing what was convenient, and I am grateful for that every day.

[Today's guest post by Amanda Solomon is part of our paid blogging program. She is Vice President of Life Defenders.]

Baby Nielson and the humanity of the preborn child

Jaelyn Barnes had a miscarriage at eleven weeks. Baby Nielson, as you can see in this family photo, was a human being.

This being Jaelyn's fifth child, she was an experienced mother and their entire family was ecstatic for the newest addition. Jaelyn's husband was serving their community as police officer when they first discovered there wasn't a heartbeat. They were urged not to worry and the midwife advised rechecking in a few days; however, her husband was injured badly on the job and the fetal heartbeat check was put on hold another few days. Nearly a week later, the heartbeat still could not be found. After an ultrasound, it was confirmed that the baby they looked forward to meeting had passed away a week prior.

At this gestation, many people believe that babies are a clump of cells and nothing more. Jaelyn bravely shared this photo of her miscarried baby to spread awareness about how human these children truly are, even at only eleven weeks. In addition, there is a common misconception that because these precious lives are "just a clump of cells," they feel zero pain during abortion.

Dr. Maureen Condic is a professor of neurology at the University of Utah. She testified before Congress that a person's experience of pain evolves over time, beginning in the first trimester:

The neural circuitry responsible for the most primitive response to pain, the spinal reflex, is in place by 8 weeks of development. ... This is the earliest point at which the fetus experiences pain in any capacity. ... A fetus responds just as humans at later stages of development respond; by withdrawing from the painful stimulus.

By 8 to 10 weeks, Dr. Condic says many of the neural connections are formed. How can any person who has the knowledge that a baby can feel the pain of abortion and see this beautiful and perfectly formed child, still think abortion is humane?

[Today's guest post by Heather Hobbs is part of our paid blogging program. Heather is an editor and blogger at Life Defenders.]

Empty-Handed: The Lie of Convenience

I’ve never had an abortion. I’ve had three healthy babies, one singleton and a set of twins. During my third pregnancy, the worst occurred: a miscarriage. I was walked to the precipice of choice on how to proceed. I could allow the miscarriage to happen naturally; use a chemical option, misoprostol; or opt for a D&C.

In reality, my choices were gone. My child was dead. It took my breath away to confront the reality.

Women’s bodies, when functioning properly, cradle and support that life. When the worst happens, women’s bodies are supposed to take action. Only... my body did not take action. I decided to use misoprostol, hoping to avoid the necessity of a D&C.

When I decided to use the chemical option, misoprostol, the experience would strike me as hauntingly similar to a chemical abortion. My heart was broken, and it broke my heart for all the women that have and will experience this either through abortion or miscarriage.

I’m not sure exactly what women are told when they walk through the doors of an abortion clinic. However, I have heard testimony from both former clinic workers, and women who tell their own story of abortion. I get a sense culturally that abortion is a seen as a more convenient option than a full-term pregnancy. A woman can just take care of this one little problem as simple as a trip to the dentist for a filling. Then, she can get on with her life as though nothing has changed. It’s a medical service after all, or “women’s health care,” sometimes unpleasant, but necessary.

What I would tell any woman who considers this to be true is that abortion is not convenient.

Merriam-Webster defines convenience as “freedom from discomfort.” Having experienced the discomfort involved with labor and delivery of my three living children, I can attest that the experience of misoprostol was even less free from discomfort, more inconvenient in reality.

This drug was handed to me as a prescription to be filled. I knew it was going to cause me immense physical pain. There was a mix up in the pharmacy. The prescription was taking longer to fill. I wanted to get things in motion. I wanted convenience. The emotional pain was hitting me in waves for the week before I took the pill. Now, the physical discomfort would join.

I experienced pain similar to labor. There was heavy bleeding and cramping. Thankfully, my husband was able to care for my children. I was definitely out of commission. At one point in my bathroom, the pain was so intense I was blacking out.

It was in this almost surreal moment that I felt my baby pass from body. The pain medication they had prescribed did not touch what I felt.

The days following, I couldn’t go without using the bathroom every half hour or so to pass large clots. My bleeding lasted much longer than a “normal period.” I still had little ones to care for and a busy schedule. No maternity leave. No time off. I experienced the hormonal shift similar to the “baby blues” most women experience post-delivery. I had migraines for days once my bleeding stopped. My body had done all the work of labor, only this time my arms were empty.

Miscarriage Support Auckland Inc. describes the unique issues women experience post-miscarriage as “suffering from the effects of both a birth and a death.” I share my story of miscarriage in the effort of transparency. I was not in a desperate situation that some women who choose abortion may find themselves in. However, I have been scared, and felt the weight of the world on my shoulders. I have made hard medical decisions. I’ve dealt with death, grief, and inconvenience.

Women need to know that they are capable of giving their child life. You are capable of choosing a gift on the other end of the inevitable physical discomfort of birth. There is beauty in birth. There is inconvenience either way. Make the choice that leads to someone’s, beginning not their end. Don’t choose to experience birth, only to come away empty-handed.

[Today’s guest post by Allison Maluchnik is part of our paid blogging program.]

Human Beings Begin as Zygotes: Refutations to 8 Common Pro-Choice Arguments

DISCLAIMER: This blog post is meant for biological definition purposes. It is not meant to establish or argue any moral or philosophical points.
 

A zygote is a human being.  

1.  The zygote is an organism.

Fertilization – the fusion of gametes to produce a new organism – is the culmination of a multitude of intricately regulated cellular processes. [Marcello et al., Fertilization, ADV. EXP. BIOL. 757:321 (2013)]

This is not a new concept. The zygote has been recognized as an organism for decades:

"The zygote and early embryo are living human organisms.”[Keith L. Moore & T.V.N. Persaud Before We Are Born – Essentials of Embryology and Birth Defects (W.B. Saunders Company, 1998. Fifth edition.) Page 500]

"Embryo: the developing organism from the time of fertilization until significant differentiation has occurred, when the organism becomes known as a fetus."[Cloning Human Beings. Report and Recommendations of the National Bioethics Advisory Commission. Rockville, MD: GPO, 1997, Appendix-2.]

"Although life is a continuous process, fertilization is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is thereby formed."[O'Rahilly, Ronan and Muller, Fabiola. Human Embryology & Teratology. 2nd edition. New York: Wiley-Liss, 1996, pp. 8, 29.]

"The development of a human begins with fertilization, a process by which the spermatozoon from the male and the oocyte from the female unite to give rise to a new organism, the zygote."[Sadler, T.W. Langman's Medical Embryology. 7th edition. Baltimore: Williams & Wilkins 1995, p. 3]

Some pro-choicers imply that the zygote is in some nebulous “in between phase” – not a gamete but not a human organism. But biologically, life cycles do not contain such a phase. In humans (animals), our life cycle goes from diploid organism, which produces haploid gametes, which combine to form a new diploid organism. The zygote isn’t in an unknown stage; it's the same organism as the grown adult, but at an earlier stage of life.

The Diplontic Life Cycle

2. Every organism is part of some species, and the human ZEF is part of the human species (Homo sapiens) by virtue of its human DNA.

A species is defined as

 (2) An individual belonging to a group of organisms (or the entire group itself) having common characteristics and (usually) are capable of mating with one another to produce fertile offspring. 

Please note that "capable of mating" does not mean at any given instant. For example, newborns are not capable of mating, but are still organisms of the human species. "Capable of mating" refers to an organism who should be capable of mating in their lifetime, barring sterility. And on that note, also keep in mind that there's a difference between an individual organism being sterile vs. an organism having developed genetic changes which render reproduction with his origin species impossible (speciation).

Every organism is part of some species. There are no "non-species" organisms. The organism is part of its parents’ species. For example, two honey-badgers cannot reproduce and create a frog; their offspring would also be a honey-badger. Furthermore, an organism can never change its species mid-development (in the middle of its life). A honey-badger zygote develops into a honey-badger adult; a honey-badger zygote can’t develop into a frog adult.

One species can develop into another species over many generations. This is called speciation. Speciation most often occurs when one species is split into two or more geographical groups (allopatric speciation). Genetic changes accumulate over many generations, not within a single lifespan, such that if the groups ever met again, they would not be able to produce viable offspring. That's when you can say "these are now two different species."

But we would never say "this offspring is an organism but has no species membership."

Human zygotes are human, both because their parents are human and because they have human DNA. They are not part of some other species, nor do they lack species membership.

3. An organism that is a member of the species Homo sapiens is a human being.

There are other definitions of human being, including “a person, especially as distinguished from other animals or as representing the human species.” I am only referring to the biological definition of human being when I use the term:

1. any individual of the genus Homo, especially a member of the species Homo sapiens.  

CONCLUSION: Since the zygote is an organism and a member of the species Homo sapiens, it is a human organism and therefore biologically a human being.

Below we present some topics that have been brought up as questions or objections.

Q1. Chimerism

Put simply, a chimera is a single organism composed of more than one unique DNA type (or antigenic marker on red blood cells). In animals, this can result from the merging of 2+ zygotes into one entity (tetragametic), or from twins sharing blood supply in gestation ("blood chimeras" have more than one blood type). You can be a microchimera if you received blood from mom early in gestation, if as a mother you received fetal cells during pregnancy (as most do), or just from a blood transfusion. You're even considered a chimera if you received an organ transplant. Chimerism is usually asymptomatic, but rarely it can result in things like intersexuality if it results from absorption of a twin.

The important thing to note is that a chimera is still one individual human organism. From the britannica article:

Chimera, in genetics, an organism or tissue that contains at least two different sets of DNA. In dispermic chimeras, two eggs that have been fertilized by two sperm fuse together, producing a so-called tetragametic individual—an individual originating from four gametes, or sex cells.When two zygotes do not undergo fusion but exchange cells and genetic material during development, two individuals, or twin chimeras, one or both of whom contain two genetically distinct cell populations, are produced. 

You may be a chimera and not even realize it. You may have multiple DNA types due to absorption of some cell types or an entire other organism -- and this doesn't change the fact that you are still an individual human organism.

The reason this is brought up as an objection is because people sometimes think of DNA as some sort of marker of individuality, and therefore they may see multiple markers of DNA as a sign of "multiple individuals." DNA can function as an individuality marker, but it doesn't always as is evident in the case of identical twins. DNA is simply a code of instructions for the body to function effectively as an organism. That's it. If it is unique to you, and you only have one set of DNA -- great! If you do not have unique DNA, or you have multiple unique DNA sets -- you're still a singular human organism. 

Q2. Twinning

This objection usually goes something like: A zygote can twin, therefore how can you say it's an individual human being before the potential twinning stage is over?

This objection is interesting because by extension, none of us are individual human beings. Why? Well twinning is essentially the same thing as cloning. The main difference is that one happens "naturally" and the other happens artificially. The point is, if your DNA can be taken from an epithelial cell on your arm and made into a clone, would spawning a clone mean you were not an individual human being to begin with? With advanced technology, we could all conceivably be in the "twinning" (cloning) phase indefinitely! Yet we're all still singular human organisms.

This is basically the backwards version of chimerism, by the way. Absorbing or spawning organisms does not change the fact that a single organism is still a single organism.   

Read more: Monozygotic twinning, Weasley brothers, flatworms, and cow clones.

Q3. In Vitro Fertilization (IVF)

"In vitro" means "outside the body." IVF is when we use sperm to fertilize an egg in a laboratory dish instead of a uterine tube (in vivo). The resulting embryo is then placed into the woman's uterus to allow implantation and thus a pregnancy, which is why IVF is considered a type of assisted reproductive technology (ART).

The pro-life objection to IVF is that -- due to time, cost, and failure rates -- companies performing the procedure will always fertilize more than one embryo at a time. Many will then select the highest quality embryos to increase chances of a successful pregnancy. This means either cryopreservation (freezing) of the remaining embryos if the couple wants to pay for it, or destroying them.

In some countries, including the US, multiple embryos can be transferred to the woman's uterus to increase chances of a successful pregnancy. This can sometimes result in multiple implantations (twins or more), but this isn't usually the case, which means the other embryo will have been miscarried.

It's worth noting that although survival rates for IVF are poor, nothing about IVF alters the basic biological process outlined above: gametes join to form a new human organism. It is merely accomplished in a laboratory rather than in the womb. People conceived through IVF are as human as anyone else.

From my perspective, there is nothing inherently wrong with IVF if it were done on one embryo at a time, which gives every embryo the best possible chance of life. But this is not standard practice. Rather, IVF is used to make multiple embryos with the foreknowledge that not all will be allowed to grow and live their life, and in most cases with the foreknowledge that some will die.

One objection to this is: But a large percentage of conceptions die before ever implanting, or soon after. Why is that foreknowledge ok in natural conception, but suddenly wrong if done in a petri dish? 

In natural conception, couples are trying their best to give every zygote a chance to live. If a zygote dies naturally, that is not the preemptive work of the couple creating him/her as it is in most cases of IVF.  

And while I greatly sympathize with men and women who have fertility problems but have a great desire to create their own offspring, the solution is not to treat human organisms as disposable.

Q4. Random Mutations

Through your life, your body replenishes cells via mitosis. Every time a cell is copied, the replication machinery -- while mostly very accurate -- will make mistakes in copying the template DNA. Not to worry, there is proofreading machinery too. However, even this can make mistakes. So in the end, there is some non-zero number of mutations that are incorporated into the new cell which are propagated in that cell line (although you still have your original batch of stem cells).

What this means is that as you get older, some portion of your cells will have a specific DNA sequence that is different than the one you had when you were younger. Some people see DNA as a unique identifier, like a name, and therefore a change in this identifier might mean you are not the same individual.

We all change as we grow. I am not the same person I was when I was 5; I have different memories, experiences, mindsets, functionality, and slightly different DNA. But guess what? I'm still the same organism. While some people may ascribe to the belief that we are not the same "person" we were yesterday, in a scientific sense we are still the same organism. An organism goes through changes in its life, but it doesn't end its life and begin a new one in the same body.

Q5. Life as a Continuum vs Individual Life

We have written about this topic before. The objection goes something like: "Human life doesn’t begin at fertilization; it began millions of years ago."

The objection confuses the life of an individual human organism with life arising from life (also known as the Law of Biogenesis.) The Law of Biogenesis points out that living matter has to come from other living matter. However you, as an organism, were not the precursor molecules that eventually formed you, as an organism. For example you were not sperm and egg. Or an early primate. The precursors that create an organism are not equivalent to the organism itself.

The fact that all life comes from preexisting life does not change the fact that an individual organism's life has a start and end point. And for human organisms, that starting point is always as a zygote.

Q6. Hydatidiform Mole

[November 2018 update: in the original version of this section we incorrectly stated that partial moles are never viable. We have sense learned there are rare cases where such humans have survived to infancy.]

A hydatidiform mole (1/1000 pregnancies in the US) is an abnormal fertilized egg which implants in the uterus.

(Q6a) Complete Mole: This abnormality can occur when one (90%) or even two (10%) sperm combine with an ovum that has no maternal DNA; the sperm then replicates its DNA to create an artificially "diploid" cell. This results in a mass of abnormal tissue which can develop into cancer (15-20%) and/or invade the uterine wall (10-15% of all molar pregnancies will invade if not removed). Complete moles have no embryonic growth; there is only abnormal placental tissue. Maureen Condic said it much better than I ever could (the bolded part is most important):

Despite an initial (superficial) similarity to embryos, hydatidiform moles do not start out as embryos and later transform into tumors, they are intrinsically tumors from their initiation. Moreover, they are not frustrated embryos that are “trying” (yet unable) to develop normally. Just as a CD recording of “Twinkle, twinkle little star” is not somehow thwarted in its attempt to play the “Alphabet song” by a deficiency of notes in the fourth measure ..., hydatidiform moles are not “blocked” from proceeding along an embryonic path of development by a lack of maternally-imprinted DNA. Rather, hydatidiform moles are manifesting their own inherent properties—the properties of a tumor. Even in the optimal environment for embryonic development (the uterus), hydatidiform moles produce disordered growths, indicating they are not limited by environment, but rather by their own intrinsic nature; a nature that does not rise to the level of an organism...If the necessary structures (molecules, genes etc.) required for development (i.e., an organismal level of organization) do not exist in an entity from the beginning, the entity is intrinsically incapable of being an organism and is therefore not a human being. Such entities are undergoing a cellular process that is fundamentally different from human development and are not human embryos.

(Maurine Condic, "A Biological Definition of the Human Embryo," Persons, Moral Worth, and Embryos: A Critical Analysis of Pro-Choice Arguments, as quoted by Jay Watts in his article Condic on the Difference Between Embryonic Humans and Hydatidiform Moles, emphasis Condic's.) 

(Q6b) A partial mole on the other hand is when a normal ovum is fertilized by two sperm or by one sperm that replicates itself, creating a triploidy or tetraploidy cell. In this case, an embryo/fetus can develop. Rarely is this embryo viable; partial moles usually miscarry and even when they do not the embryo is often overtaken and destroyed by the abnormal placental tissue. However there have been extraordinarily rare cases of triploid human organisms surviving until infancy. These are human organisms with severe and fatal genetic abnormalities.

We have written on molar pregnancies before. Some people use hydatidiform moles as an example to argue that fertilization is not necessarily the beginning of a human being, or that because fertilization can result in these moles, then it's wrong to say a fertilized egg is a human being.

In one sense, they're right. They're correct to say that not all fertilizations result in human beings. Clearly, some result in complete moles. Fertilization is a necessary but not sufficient condition for the formation of a human organism.

However in the vast majority of cases, a fertilized egg is a human organism (human being). The exception really does prove the rule. As the previous blog post pointed out, pro-lifers tend to take shortcuts here and say that fertilization is the beginning of a new human life. Most of the time, that's true. Perhaps it would be better to just say "a zygote is a human being," or something similar.  

Read more: Hydatidiform moles and molar pregnancies

Q7. Miscarriages

According to the NIH, half of all fertilized eggs die spontaneously, and 15-20% of pregnancies (post-implantation) will miscarry.

Q7a) People may cite the high number of miscarriages to imply that abortion is not morally problematic or the zygote is not a human being.

However, there's a clear distinction between natural death and intentional killing. Every human being will die. Some die of cancer (natural death) and some die of gunshot wound (intentional killing). If lots of people die of cancer, would that make shooting them morally acceptable? No. Just because people die naturally, whether in old age or pre-implantation, doesn't mean it's acceptable to kill them, whether by gun or by chemical.

If lots of people die naturally of cancer, does that mean they were not human beings to begin with? Clearly not. Likewise a high rate of natural death in the preborn does not mean they were not human beings. As stated above, a zygote is a human being, whether it dies naturally in a day or in 100 years.

(Q7b) People may also cite the high number of miscarriages to question why pro-lifers don't appear as concerned with the high number of deaths there. 

Why do people speak out more passionately and perhaps more frequently about shootings than they do about cancer? Does it mean that people who die naturally, from cancer, don't matter? Does it imply that they don't really care about people dying in general? Of course not. It makes sense to be more upset by a human being intentionally killing another human being than it does to be upset by a natural cause of death. Furthermore, stopping this type of killing is more likely within our grasp than finding a cure to cancer.

Likewise with abortion: we are far more equipped to stop the intentional killing of young human beings than we are equipped to stop natural miscarriages. And it's understandable that an egregious harm being perpetrated by an intelligent human being (capable of moral contemplation) is more upsetting than harm perpetrated by non-moral agents.

Read more: Nearly half of all fertilized eggs fail to implant. 

Q8. Skin cells are human!

The skin cells on my arm are human, too. Is it murder if I scratch my arm? Sperm are also human, is masturbation murder? 

This objection conflates "human" the adjective and "human" the noun. Epithelial cells and sperm are human cells, but they are not human organisms. There is a difference between components that make up an organism (epithelial, endothelial, renal, pulmonary, hepatic cells, etc) and the organism itself. Human organisms (human beings) are what pro-lifers are concerned with, which includes the zygote.