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Two posts by Dr. Jen Gunter (pregnant people, not just cis women):

Georgia passes an abortion bill filled with bad medicine and a 1st year med student mistake

The Georgia legislature passed a new abortion bill (HB 954). Yet another law (it’s only a matter of time before it’s signed) governing the practice of medicine based on nothing resembling science.

The issues:

  1. Fetal pain. The law will make Georgia the seventh state to enact a gestational age limit based on the false belief that a “20 week” fetus can feel pain. The lack of cortical connections as well as the absence of connections between the thalamus and the subplate before 23 weeks means that a 20 week fetus does not have the neural ability to feel pain.
  2. No rape or mental health exception. Abortions are only allowed after 20 weeks for a congenital or chromosomal anomaly incompatible with life and to preserve the life/prevent irreversible physical impairment of the mother).
  3. Any abortions after 20 weeks must be done so the fetus has “the best opportunity…to survive” There are 2 ways to perform a 20+ week abortion: a dilation and evacuation (D&E), which is a surgical procedure where the cervix is dilated and the fetus is removed in parts, and an induction of labor, whichcan take several days in the hospital. What this law means is if a woman has an abortion for genetic reasons she must have her labor induced. The life of the mother clause does allow doctors to offer a D and E in specific situations. A fetus can’t survive before viability, so this “best opportunity” seems moot and just another way to make the experience more challenging and expensive, although if you read further it is clearly a set up for…
  4. Any baby born alive that is capable of sustained life must get medical aid.” Meaning if you have an induction at 22 weeks for a severe congenital anomaly, a pro-life doctor or nurse can swoop in and resuscitate your baby against your wishes. Of course, nowhere does it say the government will pay for this medical care. This medical aid against the parents’ wishes could also be applied to situations where parents have made the difficult decision not to resuscitate their premature baby. 

And finally the mistake? Well, I’m not going to disclose it until after it’s signed into law. I had to read the bill multiple times to make sure I was reading, well, what I was reading. This error makes it crystal clear that no one with any basic medical knowledge read the bill.

But hey, it’s only women’s health care we’re talking about.

Pro-choice is pro-facts: the error in the Georgia anti-abortion bill

The Georgia abortion bill HB 954 has been widely promoted in the press as another “20 week” bill, but it isn’t (and this is the mistake in the bill’s wording that I was referring to in yesterday’s post). I think it wants to be a 20 week bill given it’s aimed at “fetal pain”, but if you read the exact wording it appears as if the lawmakers passed a bill that legalizes abortion (outside of life/health of mother issues) up to 22 weeks gestational age.

The Georgia lawmakers go to great lengths to describe how at 20 weeks post fertilization they think a fetus can feel pain (it can’t, BTW). In fact, the definition of a 20 week fetus in Georgia HB 954 is 20 weeks post fertilization, which is inaccurate medical terminology (and why I wrote yesterday that it was clear no doctor read the bill). At 20 weeks after fertilization a fetus is actually 22 weeks gestational age in medical terms.

This is the exact wording from the bill:

“At least by 20 weeks after fertilization” (in reference to fetal pain). This phrase appears 4 times in the 1st section.

Probable gestational age is an estimate made to assume the closest time to which the fertilization of a human ovum occurred…” also in the 1st section.

And then specifically in Code Section 31-9B-1 gestational age is defined as follows: “the postfertilization age of the unborn child at the time the abortion is planned to be performed or induced, as dated from the time of fertilization of the human ovum.”

Let’s be very clear. Pregnancy is dated from the 1st day of the last menstrual period (LMP) not from fertilization. Even when an ultrasound is performed, the additional 2 weeks pre-conception (if you will) are built into the dating. It’s even on a pregnancy calendar I downloaded and on every single prenatal wheel that OBs use to date pregnancies.

Think of gestational age dated from the LMP/by ultrasound as metric and correct, and think of the post fertilization age in the Georgia bill as an out of date Imperial system that has no scientific meaning (you sure won’t find it in any medical textbook).

Other states, such as Arizona, actually use the correct medical terminology of LMP/ultrasound in their laws. So, in Arizona when HB 2036 reads “Gestational age means the age of the unborn child as calculated first day of the last menstrual period of the pregnant woman,” it means what doctors everywhere call 20 weeks. As much as I disagree with the bill, at least they have their terminology correct.

According to the Guttmacher Institutewhich I assume uses the correct medical terminology (i.e. 20 weeks = 20 weeks by LMP/ultrasound), as of April 1, 2012 there are 7 states with a 20 week gestational age limit: Alabama, Idaho, Indiana, Kansas, Nebraska, North Carolina, and Oklahoma. Arizona will be the 8th. Despite reports to the contrary, it is clear that Arizona is not imposing the most restrictive gestational age and given the wording in Georgia the Peach State will not be joining Arizona among the 20-week fetal elite.

Imposing gestational age limits is wrong. There are unfortunate circumstances where lethal or very severe anomalies are not detected until the 3rd trimester. I don’t think it’s anyone’s place to tell a woman who is pregnant with a baby who has no brain and a single eye like a cyclops that she has to go to term. I heard one woman in such a devastating situation say, “It was as if a little bit of me died inside every time some stranger asked when I was due to deliver.” Women don’t ever have late-term abortions out of convenience or on some kind of whim, they have them because of horrible, terrible, genetic calamities. Fortunately, with modern prenatal testing these later diagnosis are becoming rare, but they still happen.

I personally think the lawmakers in Georgia were aiming for a “real” 20 week bill, but were so deer-in-the-headlights about fetal pain!and 20 weeks! and life at fertilization!  that they forgot to do any basic research. And that’s exactly who you want writing bills, not scholarly lawmakers who have thoughtfully researched a subject and consulted the experts, but douchebags competing to pass the most misogynistic, evidence-baseless legislation in a bizarre game of one-upmanship. It’s even more concerning because lawmakers are encroaching in the practice of medicine with this misinformation.

With states like Georgia using inaccurate terminology discussions can get confusing. But it is essential to make sure we are using the accurate medical terminology so we can all compare apples with apples, because for me pro-choice is pro facts.

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