Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

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What To Do For Oxygen-Deprived Newborns? Cool Them Down

Nate Lawrence underwent induced pediatric hypothermia at birth. Here he is, at 1, with his parents, Elizabeth and TJ.

By Fran Cronin
Guest Blogger

Nate Lawrence was born in Winchester Hospital in Massachusetts, December 16, 2010, in severe distress. He was limp, purple and not breathing. Both his lungs had collapsed.

As his parents and grandparents began to descend into panic, the neonatology staff at Winchester went into action.

They took x-rays of Nate’s chest, put a breathing tube down his throat, wrapped a turban around his head and placed him in a clear acrylic transportation box. Children’s Hospital Boston, 13 miles to the east, had been alerted that Nate was on his way. The ambulance team was instructed not to turn on warmers or swaddle Nate. He was to arrive at Children’s a cool 92.3 degrees, more than six degrees below normal.

Nate was born hypoxic, which means that because of his collapsed lungs, insufficient oxygen was flowing through his blood and into his brain. Lack of oxygen, like Nate’s, can lead to cell injury or cell death and ultimately to irreversible brain damage. To halt this potential deterioration, Nate’s body needed to slow down. Cell metabolism had to be lessened and his demand for oxygen reduced. He needed to operate on less energy and to rest.

Since lab trials began almost a decade ago, so-called “cooling” has demonstrated that for every degree a baby’s body temperature is lowered, its body functions and demand for energy slow down by 10 to 15 percent. Continue reading

Study: Newborns With Jaundice Have Higher Risk Of Autism

New research finds an association between newborn jaundice and autism

Neonatologists and some new mothers have suspected it for years.

But a new study by Danish researchers of more than 700,000 babies found that jaundiced newborns are 67% more likely than others to be later diagnosed with autism.

Newborn jaundice is a fairly common condition in which the baby’s skin turns yellowish due to the buildup of a substance called bilirubin, derived from the breakdown of hemoglobin in red blood cells.

Rikke Damkjaer Maimburg, lead author of the study published in the medical journal Pediatrics, told USA Today that while “doctors have long known that premature babies have a higher risk of autism, this study found a link between jaundice and autism among full-term infants.”

The new research offers “no smoking gun” evidence that baby jaundice leads inevitably to a diagnosis of autism, says Vinod Bhutani, a Stanford neonatologist and an expert on the diagnosis and treatment of bilirubin-related disorders, who was not involved in the study. “But there’s a strong enough association that we have to take a prospective look at this. We can’t dismiss it. And I think we may find that bilirubin plays an important role in the development of autism.”

Of course, he said, it’s important not to panic. Continue reading