Julia Pulver: Abortion 101: Because our lawmakers need a refresher

A pro-choice demonstration outside the U.S. Supreme Court, 2016 | jordanuhl7, Wikimedia Commons

Perhaps it’s been a long time since some had a high school health class or even basic studies in anatomy and physiology. Because there are several male-dominated legislatures that are proposing wildly inaccurate and breathtakingly inappropriate prescriptions for women’s reproductive health care across the country.

This is true in Michigan, as the state House and Senate appeased anti-choice lobbyists by passing bills Tuesday outlawing a rare, but safe, abortion procedure, dilation and evacuation.

As a registered nurse who has worked in newborn intensive care units (NICUs) at three Michigan hospitals and recently took on President Trump over his abortion lies, I thought I would set the record straight about these restrictions, too.

President Donald J. Trump, Monday, January 14, 2019, at the New Orleans Ernest N. Morial Convention Center, in New Orleans, Louisiana. | Official White House Photo by Tia Dufour, Flickr

The Michigan bills seem tame compared to the draconian bills being passed and signed into law in states like Georgia and Ohio, where they have banned abortions after six weeks and are threatening people with prison.

All of these laws are blatantly unconstitutional, and these lawmakers know that. They are teeing these cases up to be appealed to the U.S. Supreme Court in hopes they will finally be able to overturn the Roe v. Wade decision that legalized safe, medically sound abortion nationwide. They are hopeful that the conservative majority on the bench will finally do their dirty work for them, and send the message that women are essentially government-owned chattel.

This debate isn’t a new one. The same arguments are being made today against choice that have always been made. The difference seems to be now that those who are the most ignorant of the actual substance of reproduction, and who are willing to be the most intellectually dishonest about the merits of these issues, are widely in control of our fates.

While we plead and appeal with our own personal stories of abortion, miscarriage, fatal fetal diagnosis or neonatal hospice, they show photoshopped pictures of mangled fetal parts and claim there is new holocaust happening.

While we use medically accurate terms (dilation & evacuation procedure), they use incorrect words (dismemberment) meant to stir up as many negative emotions as possible.

Michigan Capitol | Susan J. Demas

We correctly point out that the best way to avoid unwanted pregnancy is comprehensive sex education, which includes education about consent and rape culture, and increased accessibility to birth control and sterilization procedures. They plot to outlaw birth control and sterilization, as well, while lecturing us about abstinence and ignoring rape culture.

Reproduction 101

So, in an effort to set the record straight, and bring back some common sense to the evergreen debate on birth control and abortion in America, I would like to give you all a refresher on Reproduction 101.

In order for fertilization to occur, two cells must meet and combine, the sperm and the ovum (egg). Men make millions of sperm throughout their entire lives, from puberty until death, and can cause pregnancy at any time in between. Women are born with a finite number of ovum and can’t, despite popular opinion, “get themselves pregnant.”

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Starting at puberty, generally on a monthly cycle (although it can vary widely) an ovum will “ripen” and be released from the ovary and float down the fallopian tube. When this exactly happens is unknown, and once this happens, the ovum remains viable for roughly 24 hours. Sperm, on the other hand, can live for up to a week in the female reproductive tract, just waiting to run into an ovum. This makes the “rhythm method” of avoiding pregnancy based on the timing of intercourse extremely unreliable.

If a sperm doesn’t successfully find and combine with an ovum during that time, the uterus gets rid of the uterine lining that was starting to thicken up in preparation for a possible implantation. This phenomenon is known as menstruation or a “period.” And the whole cycle starts all over again.

If a sperm does successfully find an ovum in that 24 hour time frame from ovulation, it will burrow inside the ovum (blocking other sperm from also getting inside) and the two cells will start exchanging their DNA and creating new strands.

This is a tricky process that must happen just right, or it won’t be viable. It happens in the fallopian tube, and the newly formed combined genetic material is called a zygote. This zygote will keep traveling down the fallopian tube for about three days.

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Once it enters the uterus, it is now called a blastocyst and will then burrow into the side of the uterus in a process called implantation, which can also take another three days or so to complete. Once this happens, it is now called an embryo.

The body starts kicking out a hormone called human chorionic gonadotropin (hCG), a.k.a. the pregnancy hormone, to signal the body to start making changes to support the pregnancy. This level starts out at around five or lower in non-pregnant bodies, but starts doubling every 48 to 72 hours. Once this level gets to 50 to 100, it can be picked up by home pregnancy tests.

Here’s an important reminder: Pregnancy is measured from the first day of your last period.

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That’s right, since it is almost impossible to pinpoint exactly when fertilization occurred (outside of in-vitro fertilization) this is the agreed-upon date to begin assessing fetal development. So week one and two is your period, week three is fertilization, week four is implantation and week five is when the hCG starts increasing to detectable levels.

And that’s if everything goes according to plan. So the idea that states are starting to ban abortions at six weeks is, I believe, a complete and total ban on abortion. There’s no way around it.

Miscarriage and abortion

The embryo continues to develop, and is considered a fetus at 11 weeks of pregnancy (nine weeks of gestational age). Many pregnancies that are ended during this time happen either because something went wrong in the myriad of steps that needed to happen (fertilization, cell division,  implantation or embryonic development) and the pregnancy ends in a spontaneous abortion (or miscarriage).

An incomplete miscarriage | Wikimedia Commons

Many times, this happens prior to someone realizing she had, in fact, been pregnant. She may have had a later cycle and heavier-than-normal bleeding, but was unaware of the presence of an embryo at any time.

When pregnancy is known, but is “lost” in these early weeks, it is generally believed to be a failure of the embryo to progress normally because of a genetic malformation or incorrect implantation occurred that couldn’t sustain the needed blood flow for ongoing development.

Sometimes “nature takes its course” in a miscarriage and the embryo and uterine lining are fully expelled. But sometimes it doesn’t, and intervention is necessary. A “D&C” or “dilation and curettage” procedure is often performed to fully remove the contents of the uterus to avoid infection, which could jeopardize future fertility and even be fatal in cases of an “incomplete abortion” or ‘missed abortion.”

There are times when something in this process goes incredibly wrong, like the blastocyst implanting not into the uterus, but into the fallopian tube. This is called an “ectopic pregnancy” and it’s life-threatening.

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As the embryo continues to develop and grow, the fallopian tube is not designed to stretch, and at a certain point will rupture, along with the blood vessels feeding it. This can lead to fatal hemorrhage and death.

The only cure is emergency surgery and removal of the embryo, and attempt to stop the bleeding, thus preserving the mother’s life and future fertility. Despite an Ohio politician’s opinion, the embryo is not able to be transplanted into the uterus. And it is a grotesque fantasy to propose doing so over performing life-saving surgery on the mother.

Pregnancies during this time are also ended by elective abortion for a number of valid, moral and ethical reasons known only to the individual. Elective abortions done during this early embryonic phase (which account for almost all elective abortions) are completed using either medications that essentially restart your period to expel uterine contents, or a D&C to manually remove all the uterine contents.

Both methods are incredibly safe, preserve future fertility and are widely accepted as best practices in the medical community for early pregnancy termination.

Dilation & evacuation

So what about the controversial “dilation & evacuation” procedures that was voted on by the Michigan Legislature? These incredibly rare procedures are generally done when there are no good outcomes left. They are surgical abortions in the second trimester (12 to 28 weeks) done for reasons beyond deciding not to carry a pregnancy to term.

They are done because there is a severe fetal anomaly that is incompatible with life and either choice —termination or delivery — will have the same outcome in the end. These were wanted pregnancies with devastated parents, who deserve our compassion and understanding, not our disdain and cruelty.

Sen. Mallory McMorrow talks about an Oakland County couple who sought the D&E procedure.

In extremely rare cases, second trimester abortions are done when someone was barred from terminating a pregnancy in the first trimester, or they were unable to come to terms with their pregnancy due to abuse, rape and/or incest. All of these cases are extremely rare, and are not an epidemic in need of arbitrary legislative restriction.

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Forcing anyone to carry a pregnancy to term against her will is immoral. Limiting the scope of accepted medical practice due to legislators’ personal or religious beliefs is unacceptable. None of these procedures are done as a means of “birth control.” They are expensive and unpleasant.

No one chooses to go through one of the worst days of their lives. These are thoughtful decisions made under the worst of circumstances. Likening it to a form of birth control is not only factually wrong, but incredibly insulting.

What would be a better form of birth control … is birth control. If there is truly a desire to reduce the number of abortions needed (which is frankly everyone’s goal), why isn’t every anti-choice bill accompanied by bills that provide abundant birth control, a state-funded information campaign about using birth control effectively to avoid pregnancy and requirements to teach consent as part of sex education in the state?

The answer is because the issue at hand isn’t about avoiding the need for elective abortion. It’s about a puritanical desire to impose religious beliefs onto the state, which includes a refusal to accept sex as a normal, healthy part of the human condition. This is theocratic behavior, not behavior that adheres to our founding principles for the separation of church and state.

Pro-choice rally | Zhu photo, Flickr

The continued debate around abortion remains purely religious and philosophical. From a public health, medical or even ethical standpoint, there are no reasons to put arbitrary limits on safe, evidence-based procedures.

I highly suggest that any politicians who want to prescribe medical treatments to the people of Michigan be, in fact, licensed to do so. Otherwise they would be attempting to practice medicine without a license, which is in itself, immoral, unethical and illegal. And that is an actual problem rising to epidemic proportions around the country, including here at home in Michigan.

Julia Pulver
Julia A. Pulver, RN, BSN, CCM has been a leader in the field of health care, patient advocacy and public health for over a decade. In 2016, she founded Women Organize Michigan and ran for the state Senate in 2018.

1 COMMENT

  1. At this point, the evangelical right is a single-issue party: control of women’s reproductive rights in which the only legally allowable sex is unprotected monogamous sex in the missionary position between a man and wife for no purpose other than procreation.
    How do we know this? They’ve introduced laws for the past 100+ years attempting to criminalize almost every variation from that theme.
    The evangelical right dresses themselves up in a Bible they’ve never fully read and claims they’re enforcing the morals of a God they barely believe in while ignoring the obvious messages of the scripture every day all for the endless — and ultimately doomed — crusade of trying establish a patriarchal breeding state.
    It’s why we see such disingenuous defenses of moral repugnance (like trying to convince people Donald Trump was somehow worthy of the office) simply to try and manipulate a judicial end-state that won’t survive the century.

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