Abortion and the grey space

We hear this word used in everyday life – abortion. We can all formulate an idea of what abortion is….someone choosing to end the life of their baby. But this isn’t a wholly accurate or fair description and is certainly not what medical professionals use the word ‘abortion’ for.

According to Wikipedia, the term ‘abortion’ can be defined as:

“The ending of a pregnancy by removing a fetus or embryo from the womb before it can survive on its own.”

The unintentional expulsion of an embryo or fetus before the 24th week of gestation is called a ‘spontaneous abortion’. This is the clinical term that is used by medical practitioners in their notes to describe what most lay people would understand to be ‘miscarriage’.

The intentional expulsion of an embryo or fetus is called an induced abortion. Reasons for intentionally inducing abortion are either therapeutic or elective:

  • Therapeutic abortion is performed to save the life of the pregnant woman; prevent harm to the woman’s physical or mental health; where indications are that the child will have a significantly increased chance of premature morbidity or mortality or otherwise disabled.
  • Elective abortion is voluntary when it is performed at the request of the woman for non-medical reasons.

And then there are the methods of abortion, including medical abortion and surgical abortion:  Medical abortion (sometimes also called chemical abortion) is induced by drugs or pharmaceuticals.  Where as surgical abortion includes procedures such as vacuum aspiration, Dilation and Curettage (D&C), Dilation & Evacuation (D&E) and hysterotomy.

The use of methotrexate to terminate my pregnancy of unknown location or ‘ectopic’ pregnancy is described as a medical abortion and can also be described as therapeutic abortion. Clinically, I did not miscarry.  Although I am sure I had started the process of miscarrying before I took the methotrexate, and would consider it to be a spontaneous abortion – or – miscarriage – or – early pregnancy loss. However you want to ice it, in my medical notes it will be described using the word abortion.

For those who are not aware that this is actually a clinical term it can come as quite a shock to see those words on their medical records.  For example, here is a link to a news article: “Mom to be shocked when miscarriage called ‘abortion’ in medical records” that shows how easy it is mis-perceive the term abortion.

But definitions of abortion vary across and within countries as well as among different institutions. Language used to refer to abortion often also reflects societal and political opinions and not only scientific knowledge. Popular use of the word abortion implies a deliberate pregnancy termination, whereas a miscarriage is used to refer to spontaneous fetal loss when the fetus is not viable (i.e. not yet unable to survive independently outside the womb).

Paul Freeling and Linda Gask* explain the problem well:

“As children many of us learnt the old rhyme “Sticks and stones may break my bones but words can never hurt me”. As we grew older we discovered that the adage was untrue. For most of us whose profession involved interacting with other people it became obvious that clumsy or inapposite use of language could cause pain. An attempt to avoid such pain has provoked…to suggest that distress in women who have miscarried would be reduced if changes were made in the language used by professional carers…the word “abortion” should be avoided because the lay public interprets it as applying to a termination of pregnancy.”

And then there is the grey space in between all of this. This is where in the US definitions and clinical descriptions are all important for insurance companies.

I recently read about a lady who fell right in between this grey space….

At a 13 week scan several doctors told her that her baby had a heartbeat, but the organs were not inside its body, the hands and feet are curled, one limb was missing, the neck was not right. Overall, the baby was unlikely to survive and should be removed as soon as possible before it could cause serious health issues. By definition, in Ohio, this situation was considered by the insurance company as an optional abortion because there was still a heartbeat, therefore, they would not cover the cost of the $10000 operation at the hospital. Planned Parenthood would be able to perform the surgery at a cost of $800.

Eventually, after the doctors re-worded the case, the insurance company agreed to cover the costs. But it came at a cost. You should read the whole article to fully appreciate what this poor woman went through: http://www.huffingtonpost.com/tamara-mann/heartbeat-involuntary-miscarriage-and-voluntary-abortion-in-ohio_b_2050888.html

This blog post is not about pro-life or pro-choice. It is merely a brief peek into the complexities of the use and definition of the term ‘abortion’.

For me personally, the insurance company did not initially cover the cost of my methotrexate treatment because it was being used as an abortion drug. Eventually we managed to claim the cost back directly via our European insurance provider.

I don’t have a solution to propose, I just know that abortion – whether it is spontaneous, elective, optional, surgical, medical – is a confusing grey mess of an area in the US.

* Freeling, P. & Gask, L., Changing terminology is no substitute for good consultations skills BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7165.1028 (Published 17 October 1998)

NaBloPoMo November 2015

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8 thoughts on “Abortion and the grey space

  1. My Perfect Breakdown says:

    I have no idea how I missed this post. I’m as you know, aborion and miscarriage and termination for medical reasons are all very close to my heart. Having had multiple miscarriage that required medication and/or surgery to remove “products of conception” (I still hate that term) and being sent to an abortion clinic to have a potentially life saving procedure have made this messy and confusing term an intimate part of my life. And I suspect it will always be close to my heart because I will never be able to forget my experiences. I guess what I’m saying, very poorly, is that I live in that grey area on a daily basis. An you my friend, you are right, the terminology is complicated and confusing at best. And the emotions around it make it impossible to have a real conversation about it. Kudos for you to venturing into it, I wish more people would.

    Liked by 1 person

    • thegreatpuddingclubhunt says:

      That is just an awful word ‘product’ 😦 Like the woman I mentioned in this post, she could have gone to ‘Planned Parenthood’ but there is so much negative stigma attached to that place. I know you had absolutely no choice where you could go to have the procedure, but the pro-lifers have turned these clinics into ‘hell holes’ for everyone. All because they don’t understand or don’t want to try to understand this grey area. I truly wish you didn’t feel like you were living in this grey area.
      I thought about sharing this post on my personal facebook for awareness amongst more of my friends and family, but as my other post suggests I’m just a bit of a chicken. I know it’s pretty neutral. May be I’ll pluck up the courage later today 🙂

      Like

  2. ourgreatestdesire says:

    I also somehow missed this post. I think it is very well written and yes, in the US, this is a very tough subject. I also didn’t realize a miscarriage could be written as an abortion in medical records. Now I’m curious to look mine up and see what it says.

    Like

  3. thelongestjourneyoregon says:

    I hate that the medical community stills refers to miscarriages as spontaneous abortions and medical abortions. I really think that they need to change the wording to spontaneous miscarriage and medical miscarriage. On 4 of my miscarriages I needed medical assistance and each time I saw the word medical abortion clearly across the paperwork and it made my heart drop, because I didn’t think that encompassed what was really going on. Thanks for bringing light to the situation. xo

    Like

  4. audreylain says:

    To medical professionals there’s very little distinction. The distinction is all complicated and messy due to politics. So when an ER doctor casually called my predicament a “threatened spontaneous abortion”, the words were shocking until I understood that abortion doesn’t mean what we think it means. It carries no connotation of aborting a live fetus with a procedure. It’s any process – natural or otherwise – which expells the fetus outside the uterus – whether that fetus is alive at the time or not.

    If you have an ectopic pregnancy, that is in fact an abortion procedure. If the fetus dies in the womb but doesn’t expel from the body, an abortion may be required. It’s basically the medical codes for the procedure.

    There is a huge gray area but to some people there is almost none. there’s a large and vocal part of the population who believe that yes, you should be forced to give birth to a stillborn rather than abort even a fetus that has no heart beat, and yes, you should risk all sorts of things even for a fetus with 0% viability. This is terrifying.

    Liked by 1 person

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