Tuesday, May 4, 2010

The Pill as an Abortifacient: Science Meets Morality


To many, this debate may seem trivial – a tired argument from right-wing conservatives that like to split hairs over abortion. I once shared this view, to be honest. It was a convenient stance to take, but at the end of the day it was not grounded in science or logic, but in fear and naivete.

Starting on the Pill was liberating. I was young (younger than I care to admit), in love and having sex, but the agonizing wait for my monthly reassurance was wearing on both our nerves. The Pill was a simple solution to a serious potential “problem”. Within a month’s time I was finally able to put that pesky issue of fertility behind me, and go on enjoying my sexual freedom without a care.

While I have quite a bit more to say about the Pill – the recklessness with which it is distributed, the defeminization that it imposes upon unsuspecting young women, and the cavalier disregard for its concomitant health risks perpetrated by health care professionals (check out my guest post on Laura’s blog, on my journey from the Pill to Natural Family Planning) – this post will focus on an issue even closer to my own heart than any of these. Closer to my own heart because it made a liar out of me, and I will never know the extent of my own guilt.

I will never know how many conceptions I unknowingly aborted in my seven years on the Pill. I will never know the fruit of those conceptions – never count their tiny fingers and toes, never hear their precious giggles, never feel the warmth and weight of their bodies on my chest. Granted, I was never ready to be a mother in those seven years. But had my chosen behavior resulted in a pregnancy, I certainly would have kept the baby and become a mom. More importantly, had I known that my chosen method of birth control was an abortifacient, I would have thrown it out long ago.

Not unlike many other young women in my situation, I was provided very little “education” surrounding the Pill when it was prescribed. I was told to take it at the same time every day, and to be extra cautious if I missed a pill or two in a row. That was about it. No one explained how the Pill works. I was aware of the general gist of the story – that the Pill “prevents” ovulation by regulating the level of circulating estrogen such that it

(a)    suppresses secretion of Follicle Stimulating Hormone (FSH) – which would fuel the maturation of an egg-containing ovarian follicle

and

(b)   never reaches the threshold level at which it would trigger a monthly surge in Leuteinizing Hormone (LH) – the hormonal event that triggers ovulation.

Seemed logical and effective enough to me! No ovulation, no egg, no pregnancy. Got it.

The next logical question, which apparently never occurred to me, is “How on Earth do women get pregnant on the Pill, then?” Good question.

The answer? They ovulate.

I suppose I always assumed that women who got pregnant on the Pill must have screwed up somehow. They missed a few pills, they took antibiotics that interfered with its efficacy… who knows. Certainly that is often the case. It really is tough to get pregnant on the Pill though, even under such confounding circumstances. This difficulty arises from the fact that the Pill also acts to thin the lining of the uterus so dramatically that it becomes very difficult for a fertilized egg to implant. In addition, its progesterone component thickens the cervical fluid such that it significantly reduces the survival time of sperm, and hinders the ability of sperm to enter the cervix at all, much less “swim” to the fallopian tubes where fertilization occurs.  Yet somehow, 1 woman in 1,000 who use the Pill “perfectly” still gets pregnant.

Now, let’s take that statistic a step further. Given the considerable obstacle to implantation presented by the thinned uterine lining, statistically speaking most successful fertilizations will not result in successful pregnancies. This implies, then, that there is a lot more fertilization going on in the background that simply isn’t resulting in successful implantation and pregnancy (which in turn implies a lot of ovulation).

What’s more, let’s take into account the fact that a woman is only fertile for a few days per month (assuming that she has ovulated), surrounding ovulation. That fertility window is even smaller in a woman on the Pill, because the pre-ovulatory window of fertility assumes survival of sperm for several days in fertile cervical fluid while they await the arrival of an egg. We have already established that sperm cannot survive in the thick, sticky cervical fluid produced by women on the Pill. If we allow for a generous window of survival, say 48 hours, then intercourse must occur 48 hours prior to ovulation at most, and within 24 hours after (the lifespan of the average ovulated egg). 

This gives a 3-day window that a woman who has had a so-called “breakthrough ovulation” on the Pill could physically get pregnant. What are the odds that (a) intercourse occurred during the appropriate 3-day window, (b) the sperm penetrated the thick, sticky cervical fluid barrier within the cervix to enter the uterus and “swam” to the fallopian tubes, (c) fertilization was successful, and (d) that fertilized egg managed to successfully implant in the harsh uterine environment, resulting in a pregnancy?

After considering all of these obstacles, it becomes clear that each breakthrough ovulation on the Pill practically requires an “alignment of the stars”, so to speak, to result in a pregnancy. This simple fact implies that, statistically, there must be an awful lot of breakthrough ovulation occurring in women taking the Pill, just to result in one pregnancy in 1,000.

Great, Jenna. But what does it all mean? Well, the most important point in all this (in my humble opinion) is that breakthrough ovulation on the Pill is not the extraordinary event that women are led to believe. It happens. For many women this phenomenon is of no consequence, so long as it does not result in a pregnancy. A problem arises, however, if you happen to be a woman who is firmly opposed to abortion and who fundamentally defines life as beginning at fertilization. The Pill is designed with a back-up plan – if fertilization occurs, it ensures that the uterine environment is as hostile as possible to the embryo as it attempts to implant, so that it will most likely be rejected and flushed out with menstruation. Call it splitting hairs if you want to, but the reality is that so long as a woman is taking the Pill, she is passively facilitating the possibility of aborting a conception.

No one ever told me. As a naïve young woman, I took the advice and guidance of my healthcare providers at face value, just like so many other young Christian women have done and will continue to do. None of this absolves me of responsibility – ignorance is no defense in the information age – but it speaks to a disturbing and disheartening trend in women’s healthcare. The Pill is dispensed like candy, with complete disregard for the religious and ethical ramifications of its use and with very little (if any) emphasis on patient education.

As a patient, I feel betrayed. I will never know how many breakthrough ovulations I experienced or how many unborn children my chemicalized body rejected. How many times was my integrity undermined? The truth is, I was undermining my own integrity for seven years – every night before bed when I popped that tiny little pill. Chances are, I may have had a few breakthrough ovulations in that time. Chances are none of them were fertilized successfully. But I’ll never know, and whether or not a conception ever occurred is neither here nor there. The point is that I unwittingly failed my own moral values by allowing that process to occur within my own body.

Take home message: The Pill made a liar out of me. Don’t let it make a liar out of you.


***A Note to IUD Users: Please see the Appendix on IUDs for more information on how all this applies to you. I assure you, it does, but in a slightly different way.


Sunday, May 2, 2010

My iPod's Got the Holy Spirit!

Five minutes after finishing that last "poor pitiful me" post, I hopped in the shower after setting my iPod to shuffle a random mix of Christian music. This is what I got.

Song #1: Let The Waters Rise by Mikeschair

Don't know where to begin
Its like my world's caving in
And I try but I can't control my fear
Where do I go from here?

Sometimes its so hard to pray
When You feel so far away
But I am willing to go
Where you want me to
God, I trust You

[Chorus]
There's a raging sea
Right in front of me
Wants to pull me in
Bring me to my knees
So let the waters rise
If You want them to
I will follow You

I will follow You

I will swim in the deep
'Cuz You'll be next to me
You're in the eye of the storm
And the calm of the sea
You're never out of reach

God, You know where I've been
You were there with me then
You were faithful before
You'll be faithful again
I'm holding Your hand

[Chorus]

God Your love is enough
You will pull me through
I'm holding onto You
God Your love is enough
I will follow You
I will follow You

[Chorus]

Song #2: You Never Let Go by Matt Redman

Even though I walk through the valley of the shadow of death
Your perfect love is casting out fear
And even when I’m caught in the middle of the storms of this life
I won’t turn back
I know You are near

And I will fear no evil
For my God is with me
And if my God is with me
Whom then shall I fear?
Whom then shall I fear?

[Chorus]
Oh no, You never let go
Through the calm and through the storm
Oh no, You never let go
In every high and every low
Oh no, You never let go
Lord, You never let go of me

And I can see a light that is coming for the heart that holds on
A glorious light beyond all compare
And there will be an end to these troubles
But until that day comes
We’ll live to know You here on the earth

[Chorus]

Yes, I can see a light that is coming for the heart that holds on
And there will be an end to these troubles
But until that day comes
Still I will praise You, still I will praise You

[Chorus]

It was a quick shower (time is exam points, people!). But the point is, God is faithful even in the smallest ways... encouraging me with some lyrics that I REALLY needed to hear in these particular moments. He is always faithful, always near, always guiding, always listening, always casting out fear, always holding tight to His children. 

So "Let The Waters Rise", Neuroscience. BRING IT. "If our God is for us, then who could ever stop us? And if our God is with us, then what could stand against?" (Yeah. That song just came on. Thanks, Chris Tomlin.)


And now, I will join Philips, Craig and Dean in a chorus of "Revelation Song" ...because God knew I'd be ready to belt out some serious praise right about now ;]

Poor Pitiful Me...

I would just like to take a moment to complain. So consider yourself warned...

I HATE THIS CLASS. I HATE NEUROSCIENCE. NEUROANATOMY IS IMPOSSIBLE. SCHOOL IS RUINING MY LIFE. (oohhhhhhhhhh the drama!)

I MISS MY HUSBAND. When I have an exam on a Monday (and they are almost without exception ALWAYS on Mondays), I encourage him to go spend time with his friends and our family for the weekend, since I'm stuck in the house and (a) am no fun to be around, and (b) study better when he's not here. But I miss him :'( Our quality time is reduced to kisses goodbye and kisses goodnight. Then all my friends at school wonder why I don't go out to the "post-exam party" on Monday night... I haven't seen my husband in four days, that's why! And being the hard-working, faithful provider that he is, he isn't going out partying with me on a Monday night, because SOMEONE's gotta get up at 6am and go to work around here. 

MY HEAD IS POUNDING. It has been pounding for two days. There is a biological reason for this, apart from the three-day study marathon (I'll spare you, but you ladies get it), but it makes focusing on a bright computer screen for hours on end QUITE unpleasant. I tried Excedrin. I tried a nap. I tried a Starbucks triple. Nuthin'. Faaaaaaaantastic.

I'm clearly feeling very sorry for myself. Sorry enough that I felt it necessary to take a break from studying JUST to complain into cyberspace. But I know that "this too shall pass"... in less than 24 hours in fact, this exam will be behind me, and I'll be at the salon enjoying a MUCH-needed haircut :] And then I'll be enjoying a nice dinner out with my long-lost husband, my dad and my grandmother. Ahhhh... normalcy. 

And in just 18 short days, I'll be taking my last exam of the semester and kissing medical school GOODBYE FOREVER!!! Or maybe just for the summer. Definitely just for the summer. Unless I decide to quit and become a professional blogger. HA! THAT will surely pay off my student loans. Riiiiiiiiiight. 

Alright, enough chit-chat. I'd better get back to it. But before I go, just FYI... once this exam is over I've got a great idea for my next "real" post: The Pill as an Abortifacient. Stay tuned... and thanks for listening ;]


Friday, April 30, 2010

More on the science of fetal pain

I'd like to add an interesting addendum to yesterday's post on Nebraska's Fetal Pain Law. A little more geared toward the science, this time. Dr. Anand asserts that the anatomical capacity for feeling pain begins to develop at about 7 weeks gestation, with the appearance of pain receptors around the mouth which then spread throughout the body, having completely populated the surface by week 20. Preceding the emergence of these pain receptors at the surface is the migration of the nerve fibers necessary to transmit impulses back to the spinal cord, where sensory information is integrated and directed to the appropriate brain structure for processing. In short, the presence of the surface pain receptor implies the presence of the appropriate neural circuitry to relay the sensory information that it collects back to the spinal cord. I'll spare you the fancy anatomical jargon of the brainstem nuclei and cortical connections that collect and relay sensory information collected by the spinal cord, but suffice it to say that the basic brainstem-level processing circuitry, relay circuitry, subcortical and cortical structures of the brain that are necessary for pain sensation and perception, including reflex responses to painful stimuli, all seem to be present and accounted for by the 20 week mark - if not sooner.

The major puzzle piece that is missing, however, is the modulatory circuitry responsible for inhibiting pain impulses, which doesn't even begin to develop until 32-34 weeks gestation. In practical terms, what this means is that the body's ability to deaden, numb, or mute pain signals is missing until late in the third trimester. Anyone who has endured any kind of acutely painful injury, say a broken bone for instance, has experienced this "numbing" effect. When our pain threshold is reached, our bodies begin to compensate for the shock to the nervous system by inhibiting the transmission of pain signals at various levels of the neural circuitry, effectively muting our perception of the painful stimulus, like turning down a dimmer switch. The absence of this inhibitory system in the fetus implies that not only can a 20-week-old fetus perceive pain, but that it most likely feels it far more intensely than a newborn or small child can. The system has developed the capacity to relay excitatory information (pain), but lacks the ability to transmit inhibitory information to restrain that excitation.

The science also demonstrates that the typical anesthetic doses given to mothers during abortion procedures are not even remotely sufficient to appropriately anesthetize the fetus. Typical nerve block methods (such as epidural anesthesia) confer no pain relief to the fetus whatsoever, because they only block maternal nerves below a certain spinal level. And general anesthetics, while they can cross the placenta and fetal blood-brain barrier to provide some level of relief, have been shown time and time again to require significantly higher doses to achieve the same effect in the fetus as in the adult. Levels of anesthetic high enough to realistically ensure that a sufficient amount successfully escapes breakdown by the maternal liver, crosses the placenta and anesthetizes the fetus would be toxic to the mother.

Further evidence for the ability of the fetus to feel pain is provided by hormonal studies carried out on fetuses that required intrauterine blood transfusion, accomplished by piercing the fetal abdominal cavity with a needle and placing it in the intrahepatic vein (in the liver). Stress hormone levels (cortisol, catecholamines and beta-endorphin) as well as heart rate rapidly increased in these subjects following insertion of the needle, but the magnitude of the response was greatly reduced following administration of the opiate pain-killer fentanyl. Furthermore, fetuses transfused through the umbilical cord (which is not innervated) showed no change in stress hormone levels at all, indicating that the response was not induced by the transfusion itself, but specifically by the perception of pain.

Most of this information was gleaned from one review article (http://www.nrlc.org/abortion/fetal_Pain/AnandPainReport.pdf), but like I said, search PubMed and you will find that Dr. Anand is not the only scientist that is doing this work and reaching these disturbing conclusions. It's time to accept the fact that a developing fetus is more than just a human-shaped lump of tissue - it's a feeling, perceiving, reacting, experiencing human child. A child who deserves a chance, and needs someone to step up and fight for his or her rights too.

Thursday, April 29, 2010

Nebraska's Fetal Pain Law


If we’re gonna do this, let’s do it right, shall we? Why not start off with something nice and contentious, a real juicy issue, like, say… abortion? I’ll probably lose some friends tonight – especially those whom I’ve duped into believing that I am a staunch liberal ;] I may harbor many classically “liberal” views, but this ain’t one of ‘em.

First things first – let me clarify my general position on the issue. Abortion is absolutely wrong, all the time, in every circumstance, without exception. Utterly tragic as rape and incest are, they do not justify the murder of an innocent child. Life begins at conception. Conception means fertilization – the merging of egg and sperm. These foundational points are not arguable for me – I’ve thought them through and I stand firmly on them. I will add the disclaimer that I do not consider every individual who has ever had or considered an abortion to be a morally bankrupt person. Circumstances are powerful, and we are all human. I will, however, often challenge the morality of certain justifications and lines of reasoning employed by pro-choice advocates.

Now, on to the issue at hand. I’d like to address a recent legislative move by Nebraska Governor Dave Heineman – you may have heard the buzz, since the news is already two weeks old. Governor Heineman recently signed into law the “Pain Capable Unborn Child Protection Act”, which reduces the threshold for legal abortion to 20 weeks gestational age. The change comes in response to mounting scientific evidence suggesting that unborn fetuses may develop the capacity for sensing pain as early as 17 weeks. The legislation was enacted as a defensive measure when Dr. LeRoy Carhart, friend and colleague of the murdered late-term abortionist Dr. George Tiller, vowed to carry on Tiller’s work in his Nebraska clinic. In an attempt to avoid becoming “the country’s late-term abortion capital”, the Nebraska legislature voted 44-5 in favor of the Act.

Pro-choice activists have already leapt at the collective throat of the Nebraska legislature with accusations of ideological agenda-pushing, and claims that the science is shaky at best. Of course, they do have good reason to rally the troops and put on their defensive hats – the Act challenges the very foundation of Roe v. Wade, in that it shifts the criteria for establishing legislative guidelines from viability (the point at which a fetus can survive outside the womb) to the ability to feel pain. Viability is not a set point determined by law – though 22-24 weeks is the generally accepted threshold range, the final determination is left up to the discretion of individual physicians. The ability to feel pain on the other hand, being so heavily dependent upon scientific inquiry into the complex neural circuitry of the developing fetus, really requires a mutually agreed upon set point in order to be practically applied as a criterion.

This shift signals not only the lowering of a long-standing threshold for legal abortion, but also the enforcement of a true absolute. Absolutes, unfortunately, are no friends of the pro-choice movement. Being a future physician myself doesn’t disconnect me from the reality that there may exist a pro-choice OB/GYN or two that will fudge the limit in the absence of an absolute, “for the benefit of the patient” of course ;]

The pro-choicers also bemoan the bill’s failure to include an exception for the risk of injury to the mental or psychological health of the mother. [Stunned pause]. Seriously?! Now making a woman cry is sufficient justification for infanticide? I suppose we should start seeking the death penalty for every mean kid who pushes a little girl down on the playground. I jest, of course, but talk about avoiding absolutes – that’s about as broad a grey area as I can imagine. Just how “upset” do you have to appear, as an expectant mother, to qualify for a later-term abortion on these grounds? Allow me let you in on the real bottom line here: What really upsets the pro-choicers is the fact that this omission leaves no loop hole for murdering handicapped babies beyond 20 weeks. If the expectant mother’s psychological fortitude is just so fragile that it couldn’t possibly withstand the hassle of dealing with a disabled child, shouldn’t she have the right to spare herself the trouble? Ugh. And here we meet our true foe in the abortion debate – moral relativism. I can’t even make an argument for the INSANITY of the statement that I just made, because doing so would assume a common moral compass that just doesn’t exist anymore. The concept that a woman’s “psychological health” should trump a baby’s right to life is just about as morally bankrupt as the Holocaust. You may disagree, but there’s just no way to truly argue that point in itself. We are at an impasse, my friend.

The truest danger of this piece of legislation lies in the fact that it broaches the subject of fetal rights in a big way, and comes down on the side of the child. It not only introduces the concept of fetal pain, but it also assumes that an entity that feels pain should have a right to be spared of that pain. It humanizes the fetus in a way that seriously endangers the core of the pro-choice platform – namely that a fetus is not in fact a life that is due any rights or protection.

It’s easy to draw arbitrary lines in the sand concerning the definition of “life”. The very fact that these lines are broadly defined (i.e. “22 to 24” weeks for viability), to me, highlights their arbitrariness. If it could be 22 or 24, then maybe it could be 21, or maybe 20 and a half… how far does it go? Or for others who define life at implantation, what makes it any less “alive” the previous day? ARBITRARY DEFINITIONS.

The definition of life as “viability” also begs the question, should what constitutes “life” be defined by the limits of technology? There was a time when 28 weeks was the lower limit of realistic viability for premature babies, but technological advances have brought us to 22 weeks. 50 years from now, when that limit is even lower, will 18-week-old fetuses suddenly be more “alive” than they are today? Should our ability to sustain life outside the womb determine whether or not an entity is in fact “alive” inside the womb? The idea that something is somehow less alive within the confines of an amniotic sac than outside it just boggles my mind in and of itself. If we had to somehow technologically “breathe life” into the fetus as it emerged, I’d understand. But it already has “life” – our technologies only sustain what it already has, in the case that its organ systems are underdeveloped. If the ability of certain organ systems to sustain life is what defines life, then God help the poor patients on transplant lists.

And as for the science (check out my follow-up post on the science), I’ll leave you to search PubMed for “fetal pain” and observe the “dearth of scientific evidence to back up the fetal pain issue” that the pro-choicers claim. Please. Of particular note is a review article by famed veteran fetal pain researcher and pediatrician Dr. Kanwaljeet Anand, one of the giants of the field: http://www.nrlc.org/abortion/fetal_Pain/AnandPainReport.pdf. The science is there. I’m sure that there are lots of researchers who make opposing claims (News flash: MOST of what you hear on the news about “scientific breakthroughs” is still heavily contested within its field – the media simply relies on the fact that most of us are either too lazy or too busy to look into it), but that doesn’t erase the work of Dr. Anand and many others. And I for one am just fine with erring on the side of caution in the case of causing pain to innocent unborn children – if there’s any indication that the last sensation an aborted baby feels is agonizing pain, we as a society ought to proceed carefully in how we handle that information. To ignore it, again, would be about as morally bankrupt as the Holocaust.


For more information, feel free to consult a few of my sources:

http://www.washingtonpost.com/wp-dyn/content/article/2010/04/19/AR2010041902082.html



Wednesday, April 28, 2010

A Whole New Bloooooooooggggg


Are you bored with my blog? I'm bored with my blog.

Quite honestly, my life is simply not interesting enough to be blogged about. At least not very often. It was quasi-interesting when I was simultaneously planning a wedding and applying to medical school, and it may recover "interesting" status one day when I finally become "Mommy, MD". But for now, all I do is study all day. And no one wants to listen to me bitch about studying all day. That's just a downer.

So, I've decided to take this whole blogging thing in a new direction. Inspired by a Blogger-extraordinaire friend of mine (*cough* Laura Cooke *cough* *cough*), I've decided to use this space as an outlet to express my opinions and my perspective on "issues" that interest me. This could cover a very broad range of topics - who knows where we'll end up - but quite frankly, I need it. I NEED to think about things beyond the scope of the day's medical lecture topics. I really love to write (as you may have noticed), and everyone needs a hobby (even medical students who "don't really have time" for such trivial personal indulgences), so I'm converting this blog into a more structured "hobby". I don't expect to develop a large and devoted following - I might even lose readers if I get boring enough (though really, what could be more boring that what I've been writing about? And YOU'RE still here. I'm talking to no one, aren't I. Faaabulous). But I think this will be a healthy outlet, and I hope that I stick with it.

That said, I've got some ideas and I hope to start composing some "structured rants" very soon. I hope to be stepping up the quality of my writing, and including research and links to support my views and promote active interest. I'll emphasize again that these posts will be heavily opinion-based, but being a scientist at heart (and by trade, I suppose) I usually don't assert strong opinions without having some sort of concrete basis for them, so hopefully I won't make a complete ass of myself.

And fear not - I won't completely shut down the "personal update" portion of my blogging. Those of you who actually enjoy listening to me bitch about studying all day will still get your fix, maybe once every week or two - I haven't quite decided on frequency. But rest assured, I got ya covered ;]


Ye Be Warned...

Major blog overhaul in progress. Possibly involving a title change. Just didn't want anyone to be confused when they couldn't find "My Better Half". Like lots of people follow me ;]