While the debate on choice centers on the moral issue of abortion, there are conditions that make it medically necessary to preserve the mother’s health and life.
“Every pregnancy has increased risk of complications” that could lead to maternal death, says Dr. Richard L. Fischer, who is the division head of maternal-fetal medicine at Cooper University Health Care. “Even among low-risk individuals, pregnancy [presents] a higher risk to their life.”
“It’s challenging,” says Dr. Edward Wolf of New Jersey Perinatal Associates in Livingston. “Everybody always thinks about the good and exciting part, and it’s great to have people have good news, but it’s not always good news.” Some severe conditions lead to discussions about whether to terminate the pregnancy.
“From a terminology point of view, it’s the same,” says Fischer. “If you end a pregnancy with [anything] other than a live birth, it’s an abortion, basically.” The terms are often used interchangably, but termination can happen at any point in pregnancy. Elective abortion has legal parameters regarding gestational age. And the reasons behind the decision are not the same.
[RELATED: Where New Jersey Stands on Abortion]
Fischer adds that, although most pregnancies go well, the maternal mortality rate in the United States continues to climb. In 2020, the rate was 23.8 deaths per 100,000 live births, compared to 20.1 in 2019, 17.4 in 2018 and 12.7 in 2007, according to the Centers for Disease Control and Prevention. Factors including worsening racial disparities in health care are to blame, says Fischer. “Patients are heavier, and with that comes a higher risk of diabetes and hypertension.”
Most pregnant women are under the care of a generalized obstetrician. They might only see a maternal-fetal medicine specialist (MFM)—who is specifically trained to gauge fetal health—at their routine 20-week anatomy scan. MFMs are trained to detect birth defects. Obstetricians might also refer a patient to an MFM if the patient has a preexisting condition, such as diabetes, hypertension, lupus, kidney disease or heart defects.
One of the most common threats during pregnancy, preeclampsia, can cause elevated blood pressure that eventually affects every organ in the body, says Wolf. About 1 in 25 pregnancies in the nation results in preeclampsia, according to the CDC. Although there are some known risk factors, such as existing high blood pressure and pregnancy with multiples, “we still don’t know for sure who’s going to get preeclampsia and who won’t,” says Wolf. Other potentially life-threatening maternal conditions include placental abnormalities, excessive bleeding and, if the water breaks early, infection of the uterus.
MFMs help patients understand their conditions and the risks. “There is no situation where we are going to tell a mom she has to terminate,” says Fischer. “That’s not our decision, that’s the patient’s decision,” after extensive counseling about the risks of continuing the pregnancy.
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