by John T. Bruchalski, MD, FACOG
How can OBGYNs and Pregnancy Resource Centers (PRCs) collaborate to build a healthier community where abortions are unwanted? This is the purpose of this presentation. Seeing the benefits of what we have accomplished has been inspiring, but we can do more. Based on Tepeyac Family Center’s work of serving regional pregnancy centers in Northern Virginia for the past two decades, we have a few ideas on how to make abortion unwantable.
Individually, our purpose on Earth is to love God and love our neighbors with all of our heart, mind and soul. Faith and charity go hand in hand. As Tepeyac physicians, we see medicine as an act of mercy where we care for and have compassion for the sick and vulnerable, the “least of our brothers and sisters.” There is no better way to live this vocation as an OBGYN than by serving the local PRCs in our neighborhood, community, and beyond.
Compassion means to suffer with, and we can suffer with our clients and patients and love enough by working together. Practicing merciful medicine removes the reasons for abortion and does so much more than save a baby. We are working toward Transforming Hearts Through Healthcare™ and mercy shows God’s grace.
Let us elucidate the problems that OBGYNs face today, so we can suggest some practical answers to make abortion unwantable.
Everywhere we turn, the world seems to be in crisis. With massive changes to the United States (U.S.) healthcare system, physicians today are more cynical, pessimistic, fearful and tired than I have seen in three decades of practicing medicine. The present government solution to fix healthcare decreases reimbursements to doctors and increases paperwork and overhead costs with complex regulations.
Moreover, the Affordable Care Act (ACA) has ignored the entire issue of malpractice resulting in increases in liability insurance costs. Under the rhetoric of “reproductive rights” and “women’s healthcare”, the current administration has enshrined abortion and contraception as mainstream medical practices despite the stigma, the paucity of providers, and split in public opinion.
Further, the ACA dismisses personal consciences and violates religious freedoms. The American Congress of Obstetricians and Gynecologists (ACOG) has assaulted conscience rights of future doctors and is demanding that their member doctors either refer or perform abortions. ACOG knows that most physicians refuse to perform the procedures because of its barbaric nature and the number of abortionists is dwindling.
Below are my observed problems that OBGYNs face in building relationships with crisis pregnancy centers and making abortion unwantable.
The first problem is lukewarmness. Lukewarm is a problem for physicians on both sides of the abortion issue. Sadly, I know this from first hand experience. I spent the first two years of my career as an abortion provider. Thankfully, my faith and prayer life led me to a place where I am no longer forced or required to violate my conscience. By faith and sacrifice, my wife and I founded Tepeyac Family Center in Northern Virginia in 1994, and its parent company Divine Mercy Care (DMC) in 2000.
My Tepeyac colleagues and I have worked alongside and inside pregnancy resource centers as volunteer counselors, advisors, and board members. Despite many excuses, the primary, honest reason most doctors do not perform abortions is the brutality of the procedure. Over one million abortions are performed in the U.S. annually and most doctors are simply not that passionate about abortion to actually perform them. It is easier for doctors to refer abortions out to the local abortionist.
On the pro-life side, most doctors, even those identified in a Christian faith tradition, are really not that passionate about the dignity of human life to take on the added malpractice risk of seeing women with crisis pregnancies, or accept the financial burden of caring for people without insurance. Providing life-taking or life-affirming care is too much of a burden to physicians with so many other problems and responsibilities to deal with on a day to day basis.
Lukewarmness among doctors is a problem for both sides of the abortion issue.
The second problem is chasing idols. My profession has placed idols before the source of happiness and joy. Idols include making money and increasing prestige; believing abortion is an answer to social and medical problems yet being lukewarm in its practice; not searching for the root cause of unplanned pregnancies; accepting rampant promiscuity and the resultant diseases that follow; treating fertility as a disease and children as sexually transmitted infections; pitting mothers and fathers against their unborn children; and working with suffering without seeing the redemptive nature when suffering cannot be relieved.
As doctors who have taken a vow to “do no harm” and care for all who come before us, physicians have moved away from His light and became instruments of evil in the world, subject to the worst of tyrannies. As OBGYNs, we are being asked to hold back from God and to hesitate to answer His call. Because we are fearful of the cost, the pain, the unknown, we no longer trust the Divine Physician nor do we care or serve our neighbors in need. This is the malice found in our soul.
We have become hollow, filled with emptiness and fear. Rather than turn to Christ, we grasp for more of the same: more abortion, more contraception, more sterilization and more secular, sexual education. When we attempt to follow ways other than willed by God, we find loneliness and sadness. We chase idols.
Physicians have stopped treating two patients; OBGYNs are being taught to treat a patient with a disease in her womb. No mercy and no care. Faith and love have gotten a divorce from each other and from ourselves, yet, we are called to care for women in crisis pregnancies and show her how to care for her unborn child. This is Tepeyac’s model of practicing excellent and merciful medicine. As a consequence of doctors being lukewarm and chasing idols, Heartbeat and your ministries heroically and sacrificially give of your time and expertise in meeting the needs of the woman with an unwanted pregnancy.
You are present at the time of crisis and need. But this is not enough. PRCs have to provide ultrasounds because doctors in your communities cannot meet this need.
The medical model of a pregnancy resource center was born out of necessity because we in the medical profession, for the most part, have turned our backs on caring for two patients by eliminating the humanity of the fetus and violating the dignity of the woman. Most doctors, even those of Christian faiths, only see the poor on sabbaticals and not during their daily work, when in truth, there are poor people living in our very own community that need our help. We allowed abortion to become a valid medical practice in the Affordable Care Act because we did not uniformly stand together voicing our outrage.
We abdicated the intellectual and scientific truth of when life begins.
With almost twenty years of experience, Divine Mercy Care (DMC) and Tepeyac Family Center offer a solution.
Abortion and healthcare are NOT political footballs at Divine Mercy Care and Tepeyac Family Center. DMC’s solution has seven practical principles resting on a solid three-pillar foundation of serving, inspiring and unifying when collaborating with PRCs. Nearly two decades of being on the front lines has taught Tepeyac doctors much about combating “lukewarmness” and “idols”.
Tepeyac’s doctors have found a method through sacrifice, hard work and tithing for medical practices to see all patients; those insured and those not insured or under-insured by outreaching to all pregnancy resource centers in our region. Charity, not entitlement, is at the heart of serving our community. Every PRC is different, so we do not force anything on anyone. We offer our obstetrical expertise to care for the woman and the child in the hopes of helping her see the blessing of the child. We introduce her to resources intended to build a stable and strong family and/or support system. Our fiscal approach is called the MERCY Program where we financially cover medical services that the patient cannot afford. We want to be able to do more than save a baby; we introduce them to community services for a continuum of support; we work toward turning around a life and transforming hearts.
We recognize the great work many PRCs do with their medical model of providing ultrasounds to women in crisis pregnancies. Further, Tepeyac provides immediate ultrasounds and doctor visits for PRC patients. We are applying to open Tepeyac School of Sonography (TSS) Certification Program. If approved by the Commonwealth of Virginia, State Council of Higher Education, TSS will offer a 13-week curriculum designed to train your ultrasound technicians and ready them for the American Registry for Diagnostic Medical Sonography testing.
Medical care is more than a technical skill. Ultrasound technicians must meet the rigorous professional and safety standards while loving the patients, both mother and baby. This can be taught. Tepeyac shows students how to love and treat patients while fully complying with radiology standards. Additionally, Tepeyac’s standard of providing high quality ultrasound services in a supportive, life-affirming environment ensures that staff respond lovingly to patients who have an abnormal scan.
Our Kristen Anderson Perinatal Hospice Program is Tepeyac’s medical, spiritual and community approach to a woman carrying a terminally sick child. The hospice approach maximizes the time a mother spends with her preborn child and enhances the love available for the family as a whole.
By having a pro-life radiologist and OBGYNs at Tepeyac, we are able to electronically connect PRCs to a medical expert to read and interpret sonographic information. With the internet and open hearts, no distance is too far to provide excellent medicine and excellent resources.
Leading by example, DMC, through Tepeyac, can help doctors in your area realize the critical importance of not simply sitting on boards, or counseling, but actually seeing the client in need as a patient and building relationships. To transform hearts and minds, we actively attract men and women who are pursuing healthcare degrees and help them understand the importance of working with PRCs once they enter private practice. This is not on top of what we do, this is what we do. Collaborating with PRCs is a way to give back to the community in your own neighborhood.
This is not a “zero sum” game. We cannot continue to the “turf wars.” We serve a generous God. DMC can speak at annual banquets to help inspire those in the audience to give generously to this most urgent of causes. When donors and financially savvy people see the cooperative nature of PRC with a medical practice and other services, they are apt to give more generously knowing that they are not duplicating life-affirming services.
It is clear the prolife community needs to be more unified. This is easier said than done. Thankfully, Tepeyac’s approach seems to bring together doctors, PRCs, emergency rooms, maternity homes, social services, specialists, and even churches of various faith traditions. There is a way to live by example the axiom that we can love enough together to make abortion unwantable, children welcomed and families stronger.
Faith and charity is the goal of living. We can overcome the “lukewarmness” and the “idols” by working more closely together. OBGYNs and PRCs need to collaborate. The great work that Heartbeat International and Tepeyac Family Center have accomplished can be improved on, building on what we have done and making abortion unwantable. The above steps are the practical ways this can happen.
Please contact us for a conversation that can lead to the continuing transformation of hearts for our patients, clients and ourselves.
by Susan Dammann, Medical Specialist, LAS
On April 9, the U.S. Food and Drug Administration approved the morning sickness drug Diclegis, 30 years after it was pulled from the market due to concerns that it caused birth defects.
Diclegis is a delayed-release tablet, a combination of doxylamine succinate, an antihistamine, and pyridoxine hydrochloride, a form of vitamin B6, and is used to treat pregnant women who have not responded well to other means of dealing with morning sickness.
Although both substances have been prescribed separately for several years, this combination is an extended release formula, intended to stop the morning sickness before it begins. Sometimes the conservative treatment of eating smaller meals, eating low fat or bland foods which are easier to digest, and avoiding smells that can trigger nausea are not adequate in controlling the symptoms of morning sickness.
According to the FDA’s press release announcing its approval, the recommended starting dosage of Diclegis is two tablets at bedtime. However, “[if] symptoms are not adequately controlled, the dose can be increased to a maximum recommended dose of four tablets daily (one in the morning, one mid-afternoon and two at bedtime).”
An article printed in Medscape from WebMD tracks the history of Diclegis, particularly why it was first pulled from the market 30 years ago and what has changed to allow the drug to hit the market again, which is expected to take place in May.
Diclegis was previously sold in the United States under the brand name Bendectin between 1956 and 1983, but it was pulled from the market because of litigation about birth defects. Although ongoing research has shown that the concerns were unsupported, the drug's previous maker, Merrell Dow Pharmaceuticals, declined to keep making the drug because of the high costs of defending it.
Edward McCabe, MD, medical director for the March of Dimes, told the Associated Press that the birth defect rate was the same among women who used the drug as in those in the general population, creating the false impression that the drug caused the birth defects. "Nothing better has come along" to treat morning sickness in the 30 years since it was taken off the market, Dr. McCabe said. The FDA at the time continued to call the drug safe.
Though Diclegis has been researched, the fact remains that we do not know what effects this drug may have once it hits the general population. Therefore, it should probably be reserved for more severe cases.
Heartbeat recommends that you research and discuss this medication with your medical director, and develop your center’s policy for advising and assisting clients who experience severe morning sickness symptoms.
by Susan Dammann, Medical Specialist
As we stand aghast at the radically pro-abortion Reproductive Health Act recently proposed in New York, we wonder how this could ever happen in our nation. We also have to wonder if this legislation will eventually become a model for laws in other states—or even the nation.
Thankfully, many New York medical professionals have gathered to speak out against the proposed legislation, and they are making their voices heard, striving to turn the hearts and decisions of the lawmakers toward righteous laws.
God has divinely placed many medical professionals within the pregnancy help movement, with unique gifts, callings and expertise that are critically needed in the medical setting. But our influence should not end there. We are also called to inform those who are determining the future of medicine and the lives of our fellow citizens through the laws and legislations that affect medical practice.
We must not be silent in the face of evil, which strives to change the laws of our land, advance the pro-abortion agenda, and eliminate our religious or civil freedom. As Edmund Burke so aptly admonished, “All that is necessary for the triumph of evil is that good men do nothing.”
The honor, respect, integrity, and trust placed in medical professionals must not be wasted, but maximized to create a voice of influence. We have both the right and the duty to be a voice to our local and state community. This is an issue of faith, courage, and principle.
What is at stake? Nothing less than the right to practice medicine according to our conscience and faith. To live in freedom. To save women and children from the devastation of abortion. Even to be free from the coercive power of government.
How are we to implement our precious First Amendment right? As so beautifully exemplified by Dr. John W. Volk in his letter to the editor of the Greeley (Colo.) Tribune, writing articles for publication is one way to get involved.
We can also get involved by participating in local city councils, school boards, testifying during city legislation, introducing pro-life measures to elected officials, and by befriending those in authority and speaking truth to them. Talk radio, op-ed pieces, and more, can also leave a powerful footprint on our world.
Some would ask if we should be vocal in government. Did Jesus call us to sit out the culture war when He said the following?
You are the salt of the earth, but if salt has lost its taste (its quality), how can its saltiness be restored? It is not good for anything any longer but to be thrown out and trodden underfoot by men. You are the light of the world. A city set on a hill cannot be hidden. Nor do men light a lamp and put it under a peck measure, but on a lampstand, and it gives light to all in the house. Let your light so shine before men that they may see your moral excellence and your praiseworthy, noble, and good deeds and recognize and honor and praise and glorify your Father Who is in heaven? (Matthew 5:13-16, Amplified Bible)
Salt acts as a preservative, preventing decay. It is clear that Jesus, in referring to us as salt, is profoundly issuing the command for us to penetrate society, while at the same time keeping evil from penetrating us. Light penetrates darkness. For us to know wisdom and truth, yet hide it is as absurd as lighting a light and hiding it under a basket.
This same mandate is also expressed in Proverbs 1:20-21:
Wisdom cries aloud in the street, she raises her voice in the markets; She cries at the head of the noisy intersections (in the chief gathering places); at the entrance of the city gates she speaks. (Amplified Bible)
Tom Minnery, in his book, Why You Can’t Stay Silent: A Biblical Mandate to Shape Our Culture, brings the biblical truth of Christian citizenship to bear on our everyday lives with the following paragraph:
The proper role for the Christian citizen is to participate in government as fully as his calling and skill can take him, whether it be limited to voting or as an active government leader. When the sparks fly over moral issues in the councils of government, how much more effective it is (and honoring to Christ) to have skilled Christian people at the center of the debate, in full possession of the facts and a record of public trust. Sometimes, of course, this isn’t enough, and the moral position is defeated. But many times the impact of Christian leaders on difficult moral issues has been astounding.1 (Emphasis added)
If we do not speak up and do what we can to influence our culture for righteousness, who will bear responsibility for the results?
As we remember the millions of innocent babies who have lost their lives through abortion, we can take inspiration from the words of Abraham Lincoln in his Gettysburg Address:
It is for us the living, rather, to be dedicated here to the unfinished work … that from these honored dead we take increased devotion to that cause … that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.
Though the challenge may seem daunting and the forces arrayed against us to be great, let us take courage in the fact that after a long hard battle, one president, with the stroke of a pen freed millions of slaves.
This can happen again if we do not ignore our First Amendment rights, and speak out. Whether we are victorious or not, we have been called to be faithful.
Let us take the wisdom, diligence and faithfulness so beautifully displayed within our pregnancy medical clinics and bring it outside the PMC to influence the influential.
1. Tom Minnery, Why You Can’t Stay Silent: A Biblical Mandate to Shape Our Culture (Carol Stream, IL: Tyndale House, 2002), 58.
While this is not an exhaustive list, listed below are some references you may want to investigate as possible resources for your center to offer clients with a poor prenatal diagnosis.
Samuel Armas -- 21 weeks in utero (FoxNews.com)
Samuel Armas -- 9 years old(FoxNews.com)
The First Annual Conference on Medical Advances in Prenatal Diagnoses was hosted by the Council on Poor Prenatal Diagnoses & Therapeutic Intervention in January of 2012.
The conference brought together professionals from many different specialty areas, including genetic researchers, ob-gyn physicians, developmental pediatricians, hospital nursing staff, medical genetic counselors, and medical students. Other participants and guests included peer ministry providers, social service support professionals, advocates for persons with disabilities and public policy specialists.
Julie Armas and her son, Samuel, both spoke at the conference, testifying to the wonderful life Samuel has lived, even with a prenatal diagnosis of spina bifida. The unforgettable 1999 picture of Samuel’s tiny finger reaching out of the womb and grasping his surgeon’s finger was printed in several newspapers worldwide, including USA Today. Samuel turned 13 in December of 2012.
You can view this full-day conference free of charge here.
The following information is found at the CDC site:
Not all birth defects can be prevented. But a woman can increase her own chances of having a healthy baby by managing health conditions and adopting healthy behaviors before becoming pregnant. This is important because many birth defects happen very early during pregnancy, sometimes before a woman even knows she is pregnant.
Awareness and education are the first steps to preventing birth defects. The immediate step following awareness and education is taking action. There are a number of things you can do to increase the probability of having a healthy pregnancy and a healthy baby. Some are more challenging than others because they require that you break habits, but it is worth your effort.
Here are a variety of tips you can use to prevent birth defects as you contemplate starting or adding to your family:
Tip 1. The first and foremost tip is maintaining preconception health; eating well balanced and nutritional meals, and taking a multivitamin daily that includes the recommended 400 mcg of folic acid.
Tip 2. If you are sexually active and pregnancy is a possibility, make sure you take a multivitamin daily which includes the recommended 400 mcg of folic acid and other essential B vitamins.
Tip 3. Avoid all activities that could potentially lead to birth defects including alcohol, tobacco, illicit drugs, and caffeine.
Tip 4. Seek an annual gynecological and wellness exam.
Tip 5. Obtain genetic counseling and birth defect screening, particularly if you have any family history of birth defects or if you are 35 years of age or older.
Tip 6. Help your family or friends who might be considering parenthood by informing them that January is Birth Defects Prevention Month. You can send an e-mail and link to this page to everyone in your address book.”
Premature Birth: Important growth and development occur throughout pregnancy – all the way through the final months and weeks. Babies born three or more weeks earlier than their due date have greater risk of serious disability or even death. Learn the warning signs and how to prevent a premature birth.
Folic Acid: Folic acid is a B vitamin that can help prevent major birth defects. Take a vitamin with 400 micrograms (mcg) of folic acid every day, before and during pregnancy.
While there are thousands of different birth defects, the most common are heart defects, cleft lip and cleft palate, Down syndrome and spina bifida. Approximately 150,000 children are born every year in the United States affected by one or more birth defects, according to the American Pregnancy Association.
The CDC reports that one in every 33 babies (about 3 percent) is born with a birth defect, and that birth defects are one of the leading causes of infant deaths, accounting for more than 20 percent of all infant deaths. Causes vary, including the use of alcohol, street drugs, and prescription drugs, being exposed to various infections such as cytomegalovirus or sexually transmitted infections. Genetic conditions can also be passed from parent to child.
The CDC has great information on many birth defects which you may find useful in your center at the following links:
The following information is also found at the CDC site:
CMV is the most common congenital (present at birth) viral infection in the U.S. Each year, about 5,500 (1 in 750) children in this country are born with or develop disabilities that result from congenital CMV infection. More children have disabilities due to this disease than other well-known congenital infections and syndromes, including Down syndrome, fetal alcohol syndrome, spina bifida, and pediatric HIV/AIDS.
CMV is spread from person to person by close contact with body fluids, such as blood, urine, saliva, semen, vaginal fluids, and breast milk. Once CMV is in a person's body, it stays there for life. Most people who become infected with CMV have mild, flu-like symptoms or no symptoms at all; the exceptions are infants with congenital infection or people who have weakened immune systems.
For pregnant women, sexual contact is a common source of CMV infection. Limiting sexual partners and practicing safe sex may reduce the risk of catching CMV.
Another common source of infection for pregnant women is contact with the urine or saliva of young children who are infected with CMV and are shedding the virus.
Prenatal diagnosis is now much easier and safer than ever before. But, these advances also exist within a mix of conflicting and sometimes hidden agendas. January is Birth Defects Prevention Month, so there's no better time to examine the topic and focus on the critical role PHC/PMC’s play in preventing birth defects.
The education we provide to our clients may be the determining factor in preventing a child from being born with birth defects, but this fact raises a great dichotomy to the surface: On one hand, we desire all mothers and babies to be healthy, and we should proactively educate them on how to achieve this. On the other hand, however, we must carefully construct our instruction in a way that avoids negatively influencing a client to seek an abortion if she should learn of a negative diagnosis regarding her baby.
Fetal problems are a serious rationale for considering abortion in our current culture, spurred in part by diagnosis of these abnormalities with the increased use of ultrasound, amniocentesis, and other tests in pregnancy. Ultrasound studies to determine fetal anatomy are often done at 18-20 weeks, so abortions done as a result of these scans are late abortions. But ultrasound is imperfect and analysis of the images can result in inaccurate interpretations.
Pregnant women who have declined abortion for fetuses diagnosed by ultrasound with fatal birth defects have sometimes ended up giving birth to normal babies. Other parents have resisted recommended abortions for serious anatomical problems, and had their babies undergo surgical repair after birth.
A great example of this truth comes from, Is Late-Term Abortion Ever Necessary?, an article by Mary Davenport, M.D., published on the American Association of Pro-life Obstetricians and Gynecologists website:
C. Everett Koop, M.D., the former surgeon general and renowned pediatric surgeon, was asked during the partial-birth abortion hearings if he had treated children “born with organs outside of their bodies” (omphalocele). Dr. Koop replied, “Oh, yes indeed. I’ve done that many times. The prognosis usually is good….the first child I ever did, with a huge omphalocele much bigger than her head, went on to develop well and become the head nurse in my intensive care unit many years later.”
For fatal birth defects, abortion is sometimes presented as the only option. But a better alternative is perinatal hospice. This involves continuing the pregnancy until labor begins and giving birth normally, in a setting of comfort and support until natural death occurs. It is similar to what is done for families with terminally ill children and adults. Karen Santorum, a nurse and the wife of former Senator Rick Santorum, was faced with the prospect of her own son, Gabriel, being born with a fatal birth defect. She describes how Gabriel lived only two hours, but how in those two hours “we experienced a lifetime of emotions. Love, sorrow, regret, joy—-all were packed into that brief span. To have rejected that experience would have been to reject life itself.” The sense of peace and closure felt by families experiencing neonatal death in a hospice setting contrasts markedly with the experience of families undergoing abortion for fetal anomalies. Couples who have had abortions for birth defects may suffer from adverse long-term psychological effects and prolonged grief reactions. Children who learn that their mothers aborted their siblings can suffer feelings of worthlessness, guilt, distrust and rage.
Non-fatal birth defects can be more challenging. The most common prenatal diagnosis resulting in mid-trimester abortion is Down syndrome. There has been an aggressive campaign by the American College of Obstetrics and Gynecology to use new technologies to detect Down syndrome in younger women through measurement of fetal neck-fold thickness and first trimester blood tests, now that prenatal diagnosis and abortion have succeeded in eliminating 90 percent of Down babies in women over 35. After diagnosis of Down syndrome, families are often not presented with an honest discussion of parenting their Down syndrome child, or the possibility of their Down syndrome child attending school and leading a semi-independent life. There are couples who are willing to adopt children with Down syndrome or other birth defects, but genetic counselors frequently do not give patients this information. Diagnosis of a child with a fetal anomaly is life-changing and a major stress, but many families rise to the occasion and are able to cope with a disabled child. Although parents choosing abortion may allege that the disabled child is better off not existing, disabled adults would contest that assertion. When surveyed in numerous studies, no differences have been found between disabled and “able-bodied” people as to their satisfaction with life.
A sad depiction of the haste to abort children with birth defects is captured in the following story, from LifeSiteNews.com:
GIA LAI PROVINCE, VIETNAM (May 16, 2012) --- A family is in grief after aborting a child erroneously reported to have congenital defects. The child died shortly after being born following a failed abortion. The mother, Nguyen Thi Thu T., had undergone two ultrasounds that falsely reported birth defects – one in her native Chu Se District and another in Ho Chi Minh City. She chose to abort the baby in the seventh month of her pregnancy. However, as the family gathered to bury the child, they found the baby was still alive and had no such defects. Although they rushed the child to Gia Lai Province General Hospital at 9:30 Sunday morning, it was too late.”
Dr. Gerard Nadal offers some hopeful encouragement to this discussion. He says that, while some are fearful that the newer diagnostic tests for Down syndrome will lead to a higher number of abortions, the already-staggering number of 90-93 percent of unborn Down syndrome babies being aborted can also offer a glimmer of hope.
The regrettably high number of Down syndrome babies being aborted means "there is not much room for (those numbers) skyrocketing", Dr. Nadal points out, and the advances in amniocentesis, which can diagnose Down syndrome as early as the 10th week, may actually offer parents more time to come to terms with the diagnosis and seek alternative advice earlier in the pregnancy than previously available.
Helping the parents come to terms with the reality of their child’s special needs ahead of time is critical for bonding. As those called to serve these parents, it is essential for pregnancy help medical personnel and peer counselors to understand just how devastating a negative diagnosis can be, so that we can provide help during a difficult time. The earlier the diagnosis, the more time we have to help them.
Still, there is a disturbing eugenic flavor to the fact that the American College of Obstetricians and Gynecologists (ACOG) and other groups are now recommending Down syndrome screening to all pregnant women. Many physicians are beginning to recommend that clients undergo non-invasive prenatal screening for fetal abnormalities, with a particular emphasis on Down syndrome.
As Steve Calvin, M.D., said in an article posted at AAPLOG.org January 11, 2007, “Women are reporting both subtle and overt pressure to undergo prenatal screening and to have an abortion if DS is found.”
This problem is further seen in the fact that most genetic conditions can be identified in the womb—including Down syndrome—yet, there are no available cures or therapies that can be administered before the child is born. Thus, a predominant purpose of prenatal screening is to offer parents the option of aborting “defective” babies. An estimated 70 percent of pregnant U.S. women will choose to have prenatal screening tests. A certain combination of screening results, though not definitive, can predict DS with up to 90 percent sensitivity.
Let us remind ourselves of the dignity and value of every person, who are all made in the image and likeness of God. Remember too that perfect health and a normal IQ are not required for happiness, friendship, and love of life. Rather than offering parents ways to eliminate their unborn child, we can provide them with more resources and support.
In her article found at PhysiciansForLife.org, Down Syndrome and Abortion, Susan W. Enouen, PE, wrote:
A Harvard study found that mothers who chose to continue their pregnancy after a prenatal diagnosis of Down syndrome did so for personal reasons such as conscience and religion, but also because they had gotten information about Down syndrome, either in printed materials or from talking to a parent of a child with DS. However, most of the mothers felt that their doctors did not explain DS adequately and in a balanced fashion.
This is where we can have a dramatic impact with a client who is facing a negative diagnosis. Let us become knowledgeable about the issues, develop resources for the client and extend to her the love, compassion, and prayerful support she so desperately needs.
by Ellen Foell, Heartbeat International Legal Counsel
“A patient-physician relationship is generally formed when a physician affirmatively acts in a patient’s case by examining, diagnosing, treating, or agreeing to do so.
"Once the physician consensually enters into a relationship with a patient in any of these ways, a legal contract is formed in which the physician owes a duty to that patient to continue to treat or properly terminate the relationship.”
- Valarie Blake
This sounds like a trick question a Pharisee might ask to entrap Jesus.
The answer seems fairly straightforward. The patient is anyone who receives medical services from a physician. But then, there is a follow-up question: "When is my patient no longer my patient?" In other words, when does the legal obligation to the patient end?
The physician and the clients who walk through the center’s doors are indispensable to its existence as a medical pregnancy clinic. Without the client-patients, there would be no need for the medical center to exist. Without the medical director, the center has no legal authority to provide any of its critical life-changing medical services, including ultrasounds and sexually transmitted infection and disease testing.
The medical director’s presence in name, policy-setting, procedure, and writing standing orders creates a patient-physician relationship. It runs between the physician and every client who walks through your doors to receive medical service.
However, much like ambulatory care clinics, the relationship between the physician in a medical pregnancy center and patient is limited in time and treatment, so the center must set distinct parameters to avoid confusion for the patient and liability for the center. Failure of the center to be clear in setting and communicating those parameters to the patient can create liability-laden situations.
The best way for centers to avoid liability issues is to be up-front in communicating the parameters of the patient-physician relationship with each client. In the eyes of the law, the physician-patient relationship continues if the following three factors are present, with the third factor posing the most relevance for pregnancy help centers:
It is easy to see how a client-patient could leave a center with the impression that she and the medical director have now established a continuous patient-physician relationship. Treatment and care for a pregnant woman typically involves multiple doctor visits, additional ultrasounds, and can include additional procedures as well.
Further, since many of the women coming to a medical pregnancy clinic may not have an existing relationship with a physician, a client-patient might naturally conclude that the relationship would continue beyond the parameters of that place (the center) and time (the appointment).
That is, the client-patient might have a reasonable expectation of continued services because she clearly requires continued treatment. The question is, “From whom?” That question can and must be addressed in the context of clear and explicit communication to the client that the patient-physician relationship is terminated upon her leaving the pregnancy medical clinic, and—if needed—receipt of referrals for obstetrician-gynecologists, in keeping with standard pregnancy medical center practice.
If the client is clearly and explicitly informed—verbally and in writing—that no continuing patient-physician relationship continues after the verification of pregnancy and/or ultrasound, then the center and its medical director will have fulfilled their legal duty to the client. In fact, most pregnancy medical centers have a Consent and Release Form for the client to sign, indicating this agreement.
Heartbeat International was recently asked whether giving a regimen of prenatal vitamins or prescribing prenatal vitamins constituted a continuation of the patient-physician relationship, possibly exposing the center to liability. The question was raised for obvious reasons: Prenatal vitamins tend to be something pregnant women take throughout the course of their pregnancy, implying continuing treatment.
Arguably, prescribing the vitamins could be interpreted to constitute action taken pursuant to the patient-physician relationship. Thus, a center will want to ensure that its Consent and Release Form is broad enough to encompass the prescription for vitamins.
Pregnancy help medical clinics daily provide excellent and caring life-saving services. In the event that a client-patient is pregnant, she should be given referrals for other service providers.
Centers should have an attorney draft a Consent and Release Form, which should be given and explained to the client-patient. This paperwork should clearly state that no follow-up care will be provided, and that the patient-physician relationship is terminated.
That form must be signed by both center staff and the client-patient, with a signed copy given to the client-patient and a copy kept in the client-patient’s medical file. In following these guidelines, a center will have fulfilled its obligation to the client-patient, and to the law.
Go and do likewise!
What would you do if a client contacted you and said she had taken the first dose of the RU-486 regimen and now regretted it?
There is help!
Because of the critical time factor involved in attempting a reversal, Dr. George Delgado and Culture of Life Family Services have launched AbortionPillReversal.com.
This website and its associated hotline (877-558-0333) will serve as a means to rapidly connect women who have taken mifepristone (brand name Mifeprex, a.k.a. RU-486) to a nationwide network of medical providers who can attempt reversal of the drug with progesterone.
In a recent presentation to the American Association of Prolife Obstetricians and Gynecologists (AAPLOG), Dr. George Delgado described a series of seven patients where a reversal of RU-486 was attempted. The majority of the babies survived, and were born full-term with no apparent anomalies.
Mifepristone causes abortion because it is a progesterone receptor blocker. Progesterone is an essential hormone during pregnancy, which allows the placenta to grow, flourish, and nourish the baby. Blocking the action of progesterone (as mifepristone does) causes placental failure, which in turn, leads to the death of the unborn baby.
Supplemental progesterone, if given early enough, can out-compete the mifepristone and prevent the progesterone receptor-blocking action. By out-competing the mifepristone on a molecular and receptor level, the progesterone serves as an antidote to the mifepristone.
Since Ella and other “morning after pills” are also progesterone blockers like mifepristone, they also have the potential to be reversed by an emergency progesterone intervention.
The fact is that many women regret their choice to abort their babies. After a surgical abortion, of course, there is no going back. But, when a woman begins the process of a medical abortion and changes her mind, there is a window of opportunity to reverse the effects of an abortion-causing agent.
Please take a look at this website, and keep this information handy, should one of your clients come looking for help.
By Kimela Hardy, MA, RT(R), RDMS
Available literature states the fetal heart beat begins its lifelong work at approximately six weeks, and depending on the sonographer’s skills, ultrasound system, and maternal body habitus, the heart beating may be visualized at this time. There are several factors that can be used to not only see this little miracle at work, but also improve general images.
Thermal Index is the heating of tissue as ultrasound is absorbed by tissue, measured by ratio of power used to produce a temperature increase of 1°C. This is measured in soft tissue (TIS), bone (TIB), and in the cranium (TIC).
The Mechanical Index is an ultrasound measurement used as estimation of the risk of non thermal effects and the degree of bio-effects a given set of ultrasound parameters will induce; Higher MI means a larger bio-effect. These can include cavitation, the formation of transient or stable bubbles, which can damage tissues. The current Federal Drug Administration has set the maximum MI at 1.9
MI = PNP Peak Negative Pressure of the ultrasound wave √Fc The Center Frequency of the ultrasound wave (MHz)
Before a specific organ, for example the fetal heart, image can be improved on, first obtain the best image possible. To begin any ultrasound study, but especially in Obstetrical scanning, the correct manufacturer’s Preset must be selected. Presets are essentially a “recipe” set for the ultrasound system. These parameters may include depth, gain, frequency, and focus among other factors. Using the OB Preset sets the Thermal Index (TI) and Mechanical Index (MI) which are generally lower for obstetric ultrasound examinations. In general, the TI and MI are not deliberately manipulated during routine ultrasound examinations.
Which Knobs Can Improve Your Picture?
Once the Preset is selected, consider the overall gain in the image on the monitor. Is it all black, all white, or a combination with many grays? Adjust the overall gain, often a large dial easily accessible, so it is easiest to identify the landmarks and in general is appealing to one’s eye and interpretation. This may differ somewhat with each sonographer, but not to an extreme.
The importance of correctly interpreting the landmarks cannot be over stressed, know the anatomy well.
Be sure the size of your image, or depth, allow demonstration of the area of interest. On some machines, this is either a dial knob or toggle switch labeled Depth, Size, or a combination of these. There is a scale on either side of the image that registers this depth in either centimeters or millimeters, and changes as the dial/toggle is adjusted.
Most transducers/probes are multi-herz, which means they offer more than one frequency, usually 2, 4, and 6 MHz. Once the landmarks have been identified and the overall gain is satisfactory, try each frequency with a simple adjustment and determine which provides the best penetration and resolution.
This means images of a patient with Large Maternal Body Habitus (LMBH) most often improves with the lowest frequency, and our smaller, more athletic patients can use the higher frequency for better resolution images. The frequency is often displayed at the top of the image where the TI and MI are located.
The optimal area of the ultrasound beam is the focus, demonstrated by a triangle or karat along the depth scale. Place this at the area of interest at the correct depth. On some systems, the focus makes a significant difference in clarity, but in other systems, there does not appear to be much change.
After the above have been set to optimize the image, the slide pods or TGC/STC can be used to fine tune the image even more. These are a step alteration in the gain, with the slides on the top affecting the top of the image and vice versa. Most often the “slope” is a gradual downward slope to the right.
Manufacturers frequently have specific image enhancing features under proprietary names which reduce haze, clutter, and artifacts allowing for improved clarity of images. These harmonic features may allow for increased penetration without details lost. Simply turning this feature on and determining its benefit (or not) is required.
Looking at the Heart
Once the optimal image has been achieved by using the features discussed above, there are additional tips to see that small fetal heart. Some systems have a Field of View (FOV) which has the effect of “coning down” and creating a smaller field visible and increases image clarification. This is the consequence of taking only a portion of the available area to scan instead of the entire area seen prior to using this option. Often, a pie-shaped icon is on the image top to illustrate and highlight the FOV area.
Using the Zoom option will increase the image size, which also can make it easier to visualize the fetal heart. In addition, most of the Zoom also has a feature which allows the size of the area, or box, to be increased/decreased. Another key to using a zoom option is to be certain the item of interest is directly in the center of the box.
When viewing the small fetal heart, another gain adjustment making the image brighter aids in recognizing the wave form during Motion-mode (M-mode). This gain is sometimes located by turning the M-mode dial. The brighter the image, the more likely the wave form is visualized. Also, the wave form will be in direct relationship to the location of the heart in the 2 Dimensional (2 D) image. For example, if the heart is in the center, the q, r, s, etc. waves will be in the center of the strip. If the heart is at the bottom of the image, the wave form will be at the bottom of the strip.
Oftentimes, maternal respirations interfere with achieving a well demonstrated strip. To overcome this, ask the patient/client to suspend breathing or hold her breath. Be aware, if she takes in a deep breath, the fetal heart may move out of the image, and you will need to make the necessary adjustments.
All of these discussed options to improve ultrasound images pertain to both Transabdominal and Transvaginal imaging. However, it is reasonable to anticipate that Transvaginal images will be larger and therefore improve the ability to obtain a fetal heart rate.
Using these tips should increase the skill set and confidence for the nurse sonographer and show this little miracle to his or her maximum potential. The tips prior to the “M-mode” can be used for general imaging as well.
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