abortion rights

New Law Would Force Abortion Doctors to Do the Impossible — or Face Charges

Photo: Oscar Gutierrez/Getty Images/iStockphoto

A 700-page anti-abortion bill proposed by Ohio state legislators includes a strange side provision that would require doctors to “reimplant an ectopic pregnancy” into a woman’s uterus or face charges of “abortion murder.” But ectopic pregnancy is the term for a pregnancy that grows outside the uterus and thus will never produce a baby.

Doctors (as well as anyone familiar with the ins and outs of pregnancy) say such a procedure is medically impossible, and not for the first time — when the bill was first introduced in May, OB/GYN and researcher Daniel Grossman called the idea “pure science fiction” on Twitter. Given that the bill’s author has pointed to a case study from 1917, he’s barely exaggerating.

The Ohio bill is one of the most extreme in a wave of anti-abortion legislation (sometimes called “heartbeat bills”) introduced across the country, with conservative Republicans aiming to force a Supreme Court reversal of Roe v. Wade. Given that this is obviously the goal, some experts say the ectopic-pregnancy provision is a distraction: It’s not that Ohio legislators know this little about how women’s bodies work but that they don’t care, and drumming up outrage over this relatively tiny part of the bill might allow the core anti-abortion legislation to quietly pass. Regardless of its intention, this provision has been perplexing and painful for many people who’ve experienced their own ectopic pregnancies.

Below, Colleen Denny, a clinical assistant professor of obstetrics and gynecology at NYU Langone Health, explains why the Ohio bill doesn’t make medical sense and who it harms.

What is an ectopic pregnancy?

An ectopic pregnancy literally means that a pregnancy is growing in the wrong place. Most normal, healthy pregnancies implant and then grow in the uterus. Those are the pregnancies that can turn into full-term babies. But every so often, about 2 percent of the time, the pregnancy implants and starts to grow in a place that just can’t support it. Most of the time it’s the fallopian tubes, but it can also be in the ovaries, and different parts of the abdomen, but the tubes are the most common place. So the pregnancy is trying to embed itself in tissue that just can’t support it. You need a pretty strong blood supply, like the uterus has, to support a healthy growing pregnancy.

Is anyone more or less likely to have an ectopic pregnancy?

Ectopic pregnancies can happen in anybody. There are risk factors, but the majority of people who have an ectopic pregnancy don’t have any risk factors that we know of at all. Ectopic pregnancies are no more likely to grow in people who do want their pregnancies or don’t want their pregnancies. Any pregnancy can become ectopic.

Why is it incorrect to equate an ectopic pregnancy with abortion?

An ectopic pregnancy cannot turn into a baby. It just cannot. It doesn’t matter how the woman feels about the pregnancy, it’s simply not an option. Once a pregnancy has implanted in some kind of tissue, you can’t move it or put it into a different place. You can’t cut off its blood supply and then put it where you want it to be. It just doesn’t work. You can’t stop it from growing and then restart it again. Once a pregnancy is trying to grow in the tubes, or the ovaries, or somewhere that can’t support it, it will either die by itself, or it continues to grow until it bursts through the tissue that contains it, and starts to bleed into the woman’s abdomen, which is an emergency.

An ectopic pregnancy is in a totally different category than abortion. Abortion is removing a pregnancy that is early but growing in the right place. All of our techniques and medicine and surgery related to abortion are to deal with an in-uterine pregnancy.

What are the treatment options if someone has an ectopic pregnancy?

First, we always tell our patients that there is no way this pregnancy can turn into a baby, which is sometimes a really sad conversation, especially for people who want to be pregnant. But it’s an urgent medical issue. The two options we have are to give a medicine that stops the pregnancy from growing, which is a shot. That’s possible for smaller ectopic pregnancies. But if it’s a bigger ectopic pregnancy, or it’s already started to burst through and bleed, then the only real treatment is surgery to remove the pregnancy and any damaged tissue nearby. The most common thing, then, is taking out the tube where the pregnancy has tried to grow.

Can you tell me a little more about how people typically react to news their pregnancy is ectopic?

For people who are trying to become pregnant, and they’re excited because they have a positive pregnancy test, and then we find out that unfortunately it’s growing in their fallopian tube, that’s a really sad conversation. There’s nothing we can offer beyond standard care. It can never become a baby, which is what these families often want. It’s a bad feeling. I think one of the things that’s particularly sad about this bill is that it’s very confusing for patients who wanted to be pregnant, had an ectopic pregnancy, had the right treatment, and then they’re getting this message that there’s some way their pregnancy could have turned into a baby, and that’s just not true. It’s not fair, and it’s kind of cruel.

Why do you think there are continued efforts to pass this legislation?

I think looking into it more deeply, the guy who’s writing it has these two case studies, one of which is from 1917, about someone who once saw somebody else do what they thought was reimplanting a tubal pregnancy into the uterus. But it’s not like that’s something that’s cutting edge. That does not exist. It’s not a possible procedure. It’s sort of buried in this overall law that is talking about “abortion murder” and banning abortion at any gestational age, and I think that’s part of the general trend we’re seeing in many states of passing these extremely restrictive laws that are just designed to get in front of the Supreme Court and threaten Roe v. Wade. My friends who are lawyers and into reproductive-health law say that’s the only goal. It’s disappointing, and these bills occasionally have these crazy little side notes, like this ectopic-pregnancy thing, that just reveal that they’re not written by doctors.

It might be that it’s a distraction to get people fired up while the overall trend is marching toward more and more restrictions on abortion. We’re huffy about this thing, which is totally wrong, and shouldn’t be in there, but it’s also not the main point of the bill at all. It’s disheartening for those of us who are trying to provide evidence-based, safe care for our patients.

New Law Would Force Abortion Doctors to Do the Impossible