"I see something on the ultrasound that we need to talk about." The very words immediately alter an atmosphere filled with elation and expectation to one of fear and anxiety. All couples yearn for and even expect to deliver a "perfect" baby, yet in reality approximately 2% of all babies will be born with some type of birth defect. Most are non-life threatening and if need be, can be corrected after the baby is born. Others, however, can result in the growing baby's death if not corrected.
Decades ago it was not unusual for the obstetrician and parents to be surprised at delivering a previously unknown twin. Today, given developments in modern medicine, we can see and count the number of heartbeats 28 days after conception. Today's ultrasounds are safe for mom and baby, and have opened a window into the womb thought to be impossible just 10 years ago. We all remember seeing ultrasound images of a friend's baby and having trouble differentiating a head from a foot. Today's three-dimensional images more closely resemble portraits and elicit comments such as, "Oh my goodness, he has his daddy's nose."
With the development of new laparoscopic tools and techniques, surgeries such as gallbladder removal have changed from a ten-inch abdominal incision and a prolonged recovery period, to same-day surgery and four small bandages on the abdomen. Abdominal surgery, joint repair, and even cardiac bypass procedures are now routinely being performed through tiny incisions. As amazing as these techniques are, we have now added another new tool, fetoscopy, allowing us to have real-time video of the baby in the womb.
New instruments are giving us unprecedented views of the developing baby. The images are so clear and full of vibrant color that even my three-year-old daughter can see a video of a pregnancy 5 weeks after conception and say, "Daddy, look at the baby." Arms, legs, fingers and toes come to life in the ultimate "womb with a view." As fascinating as the images are, this is not only a diagnostic tool. Advanced centers across the country are now using this technology to correct problems in developing babies before they are even able to survive outside the womb.
Maternal Fetal Medicine specialists are treating both mother and baby as individual patients in amazing ways. While dependent on the mother for nutrition, oxygenation, and waste elimination, the developing baby has his or her own blood supply and circulatory system. Communication with the mother is accomplished via the placenta. The pediatrician is no longer the baby's first physician. The obstetrician is.
Blood tests and ultrasounds evaluate the health of both the mother and the baby. If the mother is diagnosed with hypertension or diabetes, therapy is initiated and the condition is controlled.
There are several conditions that cause the baby's blood count to become very low (anemia). If this is not corrected, the baby, just like an adult, will go into heart failure and die. Using ultrasound as a guide, a long, fine needle is passed through the mother's abdomen, uterus, and directly into the vein of the baby's umbilical cord. A tiny blood sample is obtained and tested, and the appropriate amount of donated adult blood is transfused to the baby. This process often needs to be repeated several times during a pregnancy. The reward for such efforts is a healthy, well-developed baby with no long-term consequences.
More recent advances now go far beyond mere blood transfusions.
Spina bifida is a condition affecting approximately one in every thousand babies. During the earliest stages of development, the bones and tissues of the spine fail to fully cover the delicate nerves of the spinal cord. The exposure of these delicate nerves to the amniotic fluid can result in paralysis from that point, downward. This defect is traditionally treated shortly after birth, with mixed results.
Surgeons at Vanderbilt University and elsewhere, have developed a technique for performing a type of Cesarean section that allows for exposure of the affected portion of the baby's spine. The defect can then be surgically corrected, amniotic fluid returned, and the incision on the uterus closed. The baby is then allowed to continue gestation and is delivered months later. The outcomes have been promising, and randomized trials are now comparing outcomes of surgeries in the womb and those performed after delivery. These surgeries have been performed as early as 19 weeks' gestation, less than halfway through a normal pregnancy. This is well before a baby can generally be expected to survive on the outside.
Many of us recall the photo of the hand of Samuel Armas, extending through the uterine incision as he was having this surgery performed four years ago. Samuel was 21 weeks' gestation at the time. On September 25, 2003, three-year-old Samuel testified before the U.S. Senate Commerce Subcommittee on Science, Technology, and Space. Samuel, who is healthy and walks with the assistance of leg braces, stole the show with his testimony: "They fixed my boo-boo."
Many other conditions are now being treated surgically in the womb. Blocked bladders (obstructive uropathy) prevent the normal flow of urine from the kidneys and out through the urethra. The resulting backpressure on the kidneys causes renal failure. If this is not corrected, the baby will die shortly after birth. But a shunt can now be surgically placed in the bladder, allowing it to drain normally, and a healthy baby is born months later. Shunts can also be inserted to drain excess fluid from around the brain, a potentially lethal condition known as hydrocephalus.
Sacrococcygeal Teratoma is the most common tumor found in newborns. Although usually benign, it can be large and cause the baby to go into heart failure. Using a technique similar to that used to repair spina bifida, the tumor can be removed at a gestational age of only 26 weeks.
A diaphragmatic hernia is a defect in the muscle that separates the lungs from the abdomen. It can result in the bowel and/or the liver protruding into the chest cavity. The lungs never have enough room to develop. University of California San Francisco surgeons surgically place a balloon into the windpipe of the developing baby. Normal fluids build up in the lungs, thus pushing the bowel and liver back into the abdomen where they belong. At birth the balloon and fluid are removed, the lungs function, and the baby can undergo corrective surgery. While still in its infancy, fetal surgery is rapidly changing how we treat these tiny patients. Yet despite the advances in both equipment and technique, there are still conditions, diseases, and injuries in both adults and children that we just can't fix. Should we confront parents and inform them that they or their child have suffered an injury or have developed a condition that we can't fix, and advise them that life is no longer worth living? Because Christopher Reeve is now paralyzed from the neck down, does he have less right to life or less human dignity than before he was thrown from his horse? God forbid.
The psalmist David writes in Psalm 139:13, 14, "You formed my inmost being; you knit me in my mother's womb. I praise you, so wonderfully you made me; wonderful are your works! My very self you knew..." Life is a gift from God. It is He that weaves us in the womb. To stop that life is an act of defiance against God and His will.
We still have very little insight into how, in a span of forty weeks, a single cell can grow into a precious baby of many trillions of cells. Any surgical corrections that we attempt are primitive compared to the normal development that takes place every day.
Do these unborn babies qualify as human lives? We have just described how we can give the unborn blood transfusions, excise tumors, and repair defects to the bladder, spine, and diaphragm in the womb. If they are not human lives, what are they? Does God see a difference between born and unborn babies?
Medical liability law recognizes the value of unborn life. Medical liability law deals with morbidity and mortality of human life, not property. A physician is held liable if he or she had a duty, breached that duty, and caused harm to an individual. Failure of a physician or hospital system to diagnose and appropriately manage an ailing unborn child can result in the awarding of damages to the family in the tens of millions of dollars, even if no damage or injury occurred to the mother. Our courts have even recognized the inherent value of the earliest of pregnancies, when errors result in a miscarriage secondary to a procedure or medication. Does this inherent worth of the unborn baby disappear merely because the mother "chooses" not to continue her pregnancy?
In Luke 1:44 God uses the Greek word "brephos" to describe how the as-yet unborn John the Baptist "leaped in the womb for joy" while in the presence of the unborn Christ. In the very next chapter the same word "brephos" is used to describe the already born baby Jesus (Luke 2:12). God sees them as babies, whether born or unborn, with all the God-given human dignity and the same right to life afforded to adults.
Part of my personal ministry is speaking to groups around the country and allowing them to see the amazing detail of the human being present within the womb. Ultrasound and fetoscopic images allow the unborn to communicate to the audience with minimal narration from me. We see and hear a heart beating 28 days after conception, and my eldest daughter jumping and sliding in my wife's womb 6 weeks later. The goal is not merely to demonstrate that there is life in the womb, but to allow the personalities of the unborn to dramatize their personhood.
After the audience realizes the personhood present within the womb, we then demonstrate the tools of abortion used in all three trimesters. The realization then is that a person has been lost.
Without exception, abortion is fatal. A genetically unique person with his or her own heartbeat, blood supply and personality is now dead. Until we realize that abortion is always fatal to the most innocent and defenseless of patients, we will not be able to win the battle for these children. If we can develop surgical techniques that correct physical ailments of the unborn, surely we can ban surgical techniques that always result in the deaths of these same unborn children.
Location does not confer or deny one's God-given rights. During my residency, I remember a case of a patient with twins visiting the Pensacola area. She presented to our hospital in pre-term labor, and rapidly progressed and delivered the first twin, who was admitted to the intensive care nursery. The second twin remained intact and her labor stopped. We then had two babies, conceived at the same moment, in the same womb, being cared for in two very different ways: The first in an intensive care nursery with ventilatory support, IV fluids, and all the rights that any of us would expect if we were in an adult intensive care unit. The second twin remained in the womb, with none of the rights guaranteed to his sibling. He could have been legally aborted based solely on the "choice" of his mother. A partial-birth abortion could have been used to terminate this second twin's life.
So what do we do when we diagnose abnormalities that we can't correct? The same thing we do for adults or children who develop incurable conditions, or suffer severe injury – we treat them with love, compassion, and dignity. That is what makes us human. Unless there is another condition that poses a direct threat to the life of the mother, an abnormality is never an indication for terminating a pregnancy. Our duty as physicians and parents is to preserve life when we can, and provide compassion and comfort when we can't.
The lives of the most innocent lie in the balance, and are relying on our faithfulness to continue to defend them. Now that we can see their personalities, and heal their afflictions in the womb, we must continue our quest to protect their lives.
We have all heard the public service announcements that heart disease is the number one killer of both men and women in the United States. I agree. Only a disease of the heart would allow for over a million babies to be aborted in this country every year. Until the hearts of the nation are changed, abortion will continue. We need to tell the truth to our friends, vote for those who value life, and hear about God's gift of life from our pulpits. The tens of millions of women who have had an abortion need to know that we serve a loving and forgiving God, and through that forgiveness true healing begins.
"I have set before you life and death, the blessing and the curse. Choose life, then, that you and your descendants may live" (Deuteronomy 30:19).