Family Planning Post #4: Concerning Ectopic Pregnancy

(For those of you visiting from Amber's blog, thanks for stopping in! You'll want to read Post #3 below before you read this one. #3 is the foundation for so much that we believe, and you won't likely get the full meaning of this post without reading it first.)

There was a question raised regarding ectopic pregnancy as a result of the last post. I will admit that I have no personal experience and very little knowledge regarding ectopic pregnancy, though I have known friends who have gone through them (it was AWFUL). With that in mind, I did some limited reading. One article I found to be helpful is written by the American Academy of Family Physicians. It provides some detail about rates of ectopic pregnancies, where they land, how they are resolved, etc. You can read it yourself at http://www.aafp.org/afp/20000215/1080.html if you're interested.

I deduced/reasoned several things from this article, but I'm up for correction if any of you know more or have other experiences...

1. There is a good percentage of ectopic pregnancies that resolve themselves without treatment (and sometimes without the mother even knowing they existed).
2. It seems like ectopic pregnancies are difficult to diagnose clearly, which is why a woman can so easily find herself in an emergency situation.
3. When they are diagnosed early, if there is no immediate danger to the mother, it seems as though there are many doctors who monitor the situation VERY closely to see if it resolves itself... either by re-implanting itself (which is VERY uncommon, but may be possible) or by dying and being removed naturally. If it's resolved, then no action is necessary.
4. There are some cases where the location of implantation and size of the life (and apparent impossibility of re-implantation) cause the doctors to make decisions to recommend removal of the life. There are also some cases in which the organ where the life has implanted begins to rupture or tear, making it impossible for the life to continue and creating an emergency situation for the mother.

Another helpful story to make things even more complicated... One of my friends just told me about a woman who had an ectopic pregnancy where the life had implanted in her fallopian tube and then moved and re-implanted in her intestine. Because there was significant blood-flow in the intestine, the baby was able to survive, be delivered, and was just fine. The pregnancy was very high-risk, but both mother and baby survived.

My thoughts in response to all of this... I would say that, because there is significant evidence stating that many ectopic pregnancies resolve themselves (either by being naturally removed or, in the rare case, by re-implanting), one should not necessarily jump to remove the pregnancy automatically. AND AT THE SAME TIME, the mother should be closely monitored to see if things are digressing.

If a mother has a motivation to do everything to preserve her pregnancy, is closely monitored, and her doctor comes to the conclusion that it is really, truly impossible for the life to continue and that she is in grave and immediate danger... or if she begins to rupture (thereby making it impossible that the life will continue)... it would seem like it's not imprudent to take the advice of her doctor. Maybe???

And yet, if a baby was developing in the uterus, and a doctor determined that the baby and the mother were in grave danger, I would not suggest that the life of the child be terminated. In fact, I would suggest that it should NOT be terminated. Instead, I would recommend that the mother and baby be closely monitored so that if rupture or something else happened, the doctors were nearby to help preserve both the life of the child and the mother if possible.

I'm not sure if there is a discrepancy here (between my thoughts on the ectopic or correctly implanted pregnancy), so I'm totally open for help on this one. I don't think there's an easy answer from a human perspective, and yet I know that there's a right (as in acceptable and without error) answer according to the Lord. I just don't know what it is. Help me out here, those of you who have expertise or thinking minds. I'd also like to know if any of you have thoughts about how all of this plays out in less-developed countries where they lack the same technology we have.

Additional Thoughts

One way to help filter through whether or not your doctor is giving you advice that is out to preserve life at every stage is to interview him/her at the outset--as in, before you decide to employ this person as your physician--to determine these things. Then, if and when a tragic situation like an ectopic pregnancy occurs, you will still need to think for yourself, but will be able to trust your doctor's recommendation with a bit more confidence, even if he/she says that medical intervention is necessary.

I read several articles discussing the details of ectopic pregnancy. Here are a few of them (in addition to the one listed above):
KidsHealth: Ectopic Pregnancy
American Pregnancy Association: Ectopic Pregnancy
Mayo Clinic: Ectopic Pregnancy

If you read these articles, you'll notice that in each article, there is a list of things that contribute to an increase in the chance for ectopic pregnancy. These lists have inevitably included a set of information regarding birth control methods (temporary and permanent) that increase the risk for ectopic pregnancy (you can deduce this information from the paragraphs in the KidsHealth article even though specific methods aren't listed).

You'll also notice that the APA and Mayo Clinic articles list the IUD as one method of birth control that increases the risk of ectopic pregnancy. However, the American Association of Family Physicians article describes that the IUD does not likely contribute to an "increased risk" of ectopic pregnancy simply because, when a woman has an IUD in place, IUDs are more effective at preventing the life from implanting in the uterus, and because of this, the life is more likely to implant in another (ectopic... "out of place") location or not at all. I think that this is a helpful thing to think about, because it demonstrates to us the complexities of the issues at hand. Basically, what they're saying is that the rate of ectopic pregnancies as compared to successful intrauterine implantations is higher, not because the rate of actual ectopic pregnancy goes up in IUD users as compared to non-IUD users... but because the rate of successful intrauterine implantations goes down in IUD users as compared to non-IUD users.

It seems to me that this is just one more confirmation that there are a good number of "breakthrough" fertilizations with the IUD, and it gives us a good picture that, when the IUD is functioning properly, it does indeed create a hostile environment for implantation in the case of breakthrough fertilization. If it did not create a hostile environment for implantation, then it would not be nearly as effective at "preventing" pregnancy. Why? If the first function of the IUD--which is supposed to be that it prevents fertilization by making it harder for the sperm to reach the egg--were effective, then it would seem that the number of ectopic pregnancies would actually DECREASE among IUD users... because there would be fewer breakthrough fertilizations of any kind that needed a place to implant. The fact that there are at least as many ectopic pregnancies among IUD users than there are among non-IUD users should be a helpful piece of information in helping us decide that there is serious cause for alarm when it comes to this method of birth control. I hope I just made sense there.

Further, I have been convicted during the research for this series that, if a choice I'm making regarding family planning increases the chance for ectopic pregnancy, then that method should be excluded from my list of options. After all, in the end, doing something to my body to cause an increase in the chance that a life would implant in the WRONG place is not different than doing something that would cause the life to fail to implant at all... because it's my job to do everything I can to prevent myself from adding to the chance that my child would not survive. I told Amber and Chet the other day that this was a new aspect to my line of thinking that I hadn't really thought about before... and when the ectopic pregnancy question was raised in comment to my last post, I realized even more that this is a very important ethical issue. Basically, I had not really considered the risk of ectopic pregnancy as an issue related to birth control methods prior to about a week ago even though it makes total sense... it's just evidence that I didn't know a lot about some things and needed to research in order to find out that there is indeed a significant connection.

One more thing just came to mind... I think that the story above about the woman whose baby implanted in the fallopian tube and then re-implanted itself in her intestine and went on to survive is a demonstration of my point that it doesn't necessarily take implantation in the uterus to deem this a human life that we're talking about.

These are certainly weighty issues we're discussing, and we should not handle them flippantly without due consideration. After all, this ectopic pregnancy discussion could help us to think through so many aspects of family planning that we might not have otherwise considered. I know it has done just that for me. I haven't obviously come to any clear conclusions about what should be done in all the various situations regarding an existing ectopic pregnancy, but I have concluded that I do not want to do anything that would increase the risk of being put in that situation or increase the chance that it would be impossible for my child to survive. This topic will come up again when I finally get around to posting about where I am right now with this whole issue as it applies to our family.

On that note, I would LOVE to hear some of your thoughts, experiences, etc. on this issue. Have any of you had ectopic pregnancies that you feel comfortable discussing? If so, did your doctors give you any information about the process of deciding when it was time to remove the baby from its incorrect location? Or did they resolve themselves either by re-implantation or natural miscarriage? Are any of you actual doctors who can speak to any of these issues? I realize that these are VERY sensitive subjects, so I want to emphasize that I am humbly asking for your thoughts because I just don't know exactly how it all works.