Under More Grace: Will You Die for a Cause, or Will You Live for It? Ectopic Pregnancy and Ideas about Honoring Life

A Response to the Invited Speaker List for Vision Forum’s 2010 Baby Conference

Note: In the summer of 2008, Vision Form started a campaign to advance their idea that pre-emptive surgery for a woman with a tubal pregnancy constitutes murder of the unborn as an elective abortion. Individuals who were outspoken or quoted in that discussion have been included as invited speakers at VF’s July Baby Conference (which will also host the famed Duggars of the TLC/Discovery Channel). I believe that VF will use this vehicle to further advance what I find to be their very dangerous and distorted position concerning tubal pregnancy.

My Personal Perspective

I no longer work as a nurse in intensive care, but I did so for many years. While my husband was still in graduate school and on a meager stipend, we lived in a very depressed community with a high indigent population in the heart of the Bible belt. Even after 25 years of experience as a nurse, I have yet to see such physically sick, fragile people as I did in that town. The hospital was at a medical school, and the medical director of the ICU where I worked piloted and tested experimental equipment in clinical trials. Dying people were sent to us for enrollment in these trials as the last possible measures that might save their lives. Between the poor health of the population we served and the numbers of people that were flown in from outside the state – from places like Baylor and big city hospitals in Dallas – we saw the sickest of the sick. Doctors who could do no more for their dying patients would send them to us. So my experiences there at this hospital are not typical, and I saw conditions and did procedures there that many critical care nurses only read about in books. I saw the worst of the worst of the worst-case scenarios. That must be noted. But, regardless, I still saw them. And we saw many good outcomes that I consider miraculous. That definitely should also be noted. But the bad outcomes haunt me still.

I didn’t work in obstetrics (OB), but we received so many OB cases while I worked there, the hospital decided to open their own OB ICU. I even helped to train those nurses in the care of critical patients. To some extent, a predictable number of things tend to happen to critically ill pregnant women, just because of the nature of things. We generally saw hypertensive patients, commonly called toxemia. And we saw some other more terrible things resulting from sepsis, infection in the blood stream, something that occurs with the peritonitis that follows a ruptured fallopian tube resulting from ectopic pregnancy. We saw other pregnant women for other critical conditions, and I cared for patients and families as they worked through the decision-making process about what to do and what was ethically right to do. These decisions do not come as light matters for either patient or doctor, and the outcomes are not always good, even when the most virtuous decisions are made. Care is often delayed while people try to make the best decisions, and the women often suffer the consequences. I recall vividly in images that I wish I could wipe from my mind of two different husbands, weeping at the foot of the bed of their wives who were comatose after valiant efforts were made to save their babies. In both these cases, the babies died and the mothers would likely never regain consciousness.

Though I have fought with everything inside me to help save some of these OB patients and witnessed a couple of miraculous outcomes, I have also cared for a great many women who did not survive their pregnancies. Sometimes, neither baby nor mother lived. Some women suffered peritonitis. Others chose to be valiant and Pro-Life by refusing surgery for conditions other than ectopic pregnancy, and I would have done the same as they did in many cases. But in the case of those who refused surgery because of a tubal pregnancy, their unborn child had absolutely no chance of survival, and such deaths were not virtuous.

We have no technology to enable us to remove a baby and placenta from a fallopian tube to place it on more suitable tissue so that the life that has already begun has the opportunity to grow normally. There is just no way to do it. Even if we could, the confinement created by the tube deprives the baby of nourishment to such a degree that those babies do not grow and are not healthy enough to survive such a procedure, even if one could be done. When the baby’s tissue is examined after surgery (as is done with anything that is removed from the body during surgery), pathologists/histologists find that there is little to no placenta because it cannot develop normally. The baby is not normal but is more often trophoblastic, something more like the tissue of a tumor because it was deprived of so much nourishment. For other ectopic pregnancies, this is not always true, but the predominant number of all ectopics are tubal implantations. There are TWO sets of rules and ethical considerations for these very different types of ectopic pregnancy. Tubal pregnancies are different in terms of ethics.

Peritonitis and sepsis (infection that jumps from the pelvis into the blood stream in such cases) can be very deadly. Severe peritonitis can have as high as a 30% mortality rate, even given the best available and possible medical intervention. People who experience sepsis also face a 20-40% mortality rate. Roughly, one out of every three people who gets this sick dies. (And nurses count them, I can assure you.) The bacteria produces toxins that cause deadly low blood pressure. The infection alters the body’s ability to balance acids which drastically affects the heart and kidney. The toxins can destroy the surface coating inside the lungs, making it nearly impossible to get oxygen into the blood. (This is complicated when the pregnant woman also suffers pneumonia along with sepsis.) Cellular debris from the bacteria itself can independently induce kidney failure. More rarely, the sepsis causes a blood clotting disorder. Small blood vessels clot causing strokes and tiny heart attacks while, at the same time, the patient is also bleeding to death from their uterine wall where the placenta was once attached. (The mortality rate for this rarer condition ranges from 20 – 50%.) I have seen all of these things happen to pregnant and post-partum women, and I have cared for them. The final act of nursing care that I provided for most of these women was to wrap them in shrouds and place toe tags on them before they were taken to the morgue. Yet I have another uncommon perspective about this as well.

When my husband first started working in post-mortem forensics as a toxicologist, we moved around a bit while he worked his way up into a lab director position. We’ve lived in two states that had a high population of people who follow a cultic Evangelical Christian group called the “Church of the First Born.”

Like those in many circles of patriarchy today, this particular group sees home births as a religious rite, and they often refuse traditional medical care, particularly during pregnancy. Good medical examiner offices preserve the dignity of decedents, and I have always been impressed by the great sense of holy honor that the profession shows in their care of the dead. They are saddened and disturbed when they see people who have died who could have and should have lived instead.

It is often a hard job, and people often use humor to cope with this pain and grief that is not a show of disrespect but of frustration. In some of these offices, because of the heartache of compassion that results from seeing otherwise healthy young women lying dead on cold metal tables in the morgue, this religious group was given the unofficial name of “The Church of the Stillborn.” It was not a show of disrespect for the dead but an expression of disdain over what was often a needless death, the ultimate price that was paid because some ideologue told them such measures were necessary as a show of their faith and convictions. And there is my very devout Christian husband, feeling a flood of intense mixed emotion including a sense of shame over the behavior of some within Evangelical Christianity and the tragic results of that behavior. The world and other Christians do not see this as virtue but as ignorance and needless death – a waste of God’s gift of life. It was never an easy thing as he attended morning rounds, as the whole team gathered around each body to discuss each death and the circumstances of each soul, a precious and marvelous creation of God. (I have asked him to consider writing more of his own perspective on this subject himself, something that I hope can become a new blog post at some point.)

The Baby Conference from Douglas Phillips on Vimeo.

The Use of Utilitarianism to Prove Special Status before God at a Woman’s Expense

During the Summer of 2008, Vision Forum declared that any pre-emptive surgical intervention for tubal pregnancies constitutes murder, if the surgery takes place before a confirmed fetal death. Tubal pregnancies present a definite problem in this way, because the medical profession does not specifically confirm fetal death -- because there is only one option for a woman with a tubal pregnancy. Life-saving surgery provides the only ethical option for the medical profession. Because no baby from a tubal pregnancy has ever survived, the doctor must save the life of the mother, and it would be drastically unethical to do otherwise. The pathology of the condition ends the pregnancy and risks the mother’s life, not the doctor who acts to rescue the woman. In this case, Vision Forum fails to honor the life of the woman in favor of death. By the time a woman knows that she is pregnant with a tubal pregnancy, the life of the unborn baby has already been critically compromised because of the conditions that have adversely affected its growth. Yet Vision Forum recommends “Watchful Waiting” in ALL cases of ALL ectopic pregnancy types. In cases where the baby stands a chance of survival outside the womb, even with a poor prognosis, I completely agree with “Watchful Waiting.” In cases of tubal pregnancy, however, I believe such behavior dishonors life and makes a mockery of wisdom in the very Name of Wisdom itself.

But why would Vision Forum make such a declaration? Doug Phillips, an Attorney by training, defines any medical intervention in the case of any ectopic pregnancy as a utilitarian measure that places the life of the mother ahead of the life of the baby. That is often true in other types of obstetric (OB) care such as extreme hypertension, for example, but it is not the case in tubal pregnancy for those reasons stated above. As is so typical of Vision Forum, all cases are drawn out to be all-or-nothing cases and all decisions to be clear cut “black and white” ones, part of their “grand sweeps of revelation” that do not allow for exceptions on any ambiguous and unusual matters concerning any topic. On one hand, the group argues that surgery which ends the life of the baby during tubal pregnancy constitutes murder because they define it as a utilitarian decision of pragmatics, something that they define as cold and humanistic. Yet on the other hand, the group states statistics about what they determine to be an insignificant and exaggerated risk of harm regarding tubal pregnancy. They quote real death and incident rates concerning ectopic pregnancy, apparently claiming that such numbers don’t really warrant all of the concern displayed by those outside of their group. Somehow, their quoting of numbers and diminishing the significance of them does not seem remotely pragmatic and utilitarian to them.

Their ethical argument should be sufficient, so what purpose do these statistics show? They employ this as a propaganda technique to manipulate their followers into dismissing or denying dispassionate fact. “It’s really not that many…” They also fail to recognize that the statistics they quote regarding maternal death in tubal pregnancies reflects the standard of medical care that demands surgical treatment or other medical intervention which averts those deaths! Those women who die as a result of declining or refusing treatment are not properly captured or reflected in these statistics which artificially decreases the significance of not receiving the recommended and life-saving surgical intervention. To make meaningful statements about these statistics in the way Vision Forum has attempted, the researcher would have to eliminate from consideration all women who had pre-emptive surgical intervention from consideration! Death rates are low because it is unethical to allow a woman with a tubal pregnancy to die when the baby never survives.

Both the morbidity and mortality related to ectopic pregnancy, tubal pregnancy in particular, are painted (by people who are not physicians or nurses) to be some myth concocted by abortion minded people who love death and can’t wait to evangelize others into their culture of death. And these supposed evangelists for death exaggerate the numbers and claims and such in order to hurt good, fervent, and dedicated Christians, tempting them to act in an unethical and ungodly manner. But then, Doug Phillips is noted to state that “He who defines, wins.” (Perhaps I will explore this topic in another post about the Doctrine of the Double Effect

to explain why I believe that the ideologues at Vision Forum are unethically and ignorantly abusing matters themselves. They employ a philosophy of pragmatism favorable to their self-centered and personally aggrandizing views, carelessly jerking faithful and trusting women of God around as if they are nothing more than disobedient dogs on a choke chain. By doing so, they prove to themselves that Vision Forum holds a greater position of honor in the eyes of God and that their following is more special to God than any other Christian group.)

At this point, I have to ask how their arguments about the rarity of tubal pregnancy corresponds with the Good Shepherd who left ninety-nine sheep to rescue the one? I find that their pragmatic arguments stand in complete opposition to the principle taught by Jesus in His parable found in Matthew Chapter 18

and Luke Chapter 15.

*[What men are they, having an hundred sheep (women with healthy pregnancies), if they lose one of them (through tubal pregnancy), does not leave the ninety and nine in the wilderness, and go after that insignificant minority which is lost, until they find them?]* But patriarchy does admit to the legitimate existence of exceptions to any rule. Exceptions are labeled “non-normative” and therefore statistics can be discounted, giving no deference or consideration to that one non-normative sheep. Rather than embrace them as perhaps more deserving of attention, care and encouragement, those messy people who do not conveniently fit the preferred mold are cursed as pariahs. That one sheep is a messy one, and patriarchy doesn’t like the mess because they are consumed with keeping themselves free of the “contamination” (phrase used by Kevin Swanson

) by means of “normative” living. How inconvenient the messy, fallen world is for them.

In August of 2008, I contacted a whole host of Pro-Life and Christian medical ethics organizations regarding these teachings concerning tubal pregnancy advanced by Vision Forum, and only a few responded to me. None would make any kind of formal statements, repeating to me the common sense about things I already knew and embraced about the Doctrine of Double Effect. I am grateful for those who made an effort to respond, but they are all hesitant to make any formal statements because they fear that doing so might possibly be misunderstood as their organization taking a stand that might possibly be misunderstood as the support of abortion in some remote way. Privately, however, everyone expressed concern and grief over the idea that a ministry encourages women to put themselves in harms way concerning tubal pregnancies. It is unethical to ask a mother to crawl up on the altar of an ideologue for a lofty idea when the price required may be her own life – all without any possibility of saving another life which is true of all tubal pregnancies. These men are not telling women to wear head coverings or dresses as a means to and demonstration of their holiness. Ideologues are telling women that they must put their lives at risk when there is no wisdom in doing so – that they must spill their own blood in order to demonstrate their holiness.

My Challenge to the Reader

Please note again that I cared for an unusual population of people when I dealt with obstetric (OB) cases in ICU. I would imagine that only those nurses at that facility have seen the broad population of people in an underserved region of the country with the high acuity that the population that I reference. It is not typical. But I must ask myself, according to my causality and my faith, why did I have these experiences and what is my responsibility to the women who suffered and died? What is my duty to those who lived due to miracles? What is my responsibility to the husbands of the women I mention here who wept so sadly at their wives’ bedsides over the loss of both spouse and child? What is my responsibility to the profession of nursing, something that is a holy calling for me? What is my responsibility to all women?

I believe that I have been put in a very unique place to bear witness to the truth that some women die from peritonitis and sepsis if they don’t first hemorrhage to death following ruptured tubal pregnancies. The medical profession respects their rights and is sometimes encouraged that people are willing to stand by their convictions, but the profession does not see them as martyrs. I am here to bear witness about the pregnant women for whom I’ve cared as they struggled against sepsis.

They were real people! I talked to them gently and encouraged them to keep fighting to live as I washed their faces which were distorted with tubes. I swabbed their parched tongues with cool water. My own heart raced for them as I soberly raced to help to save them, these very real women for whom I had the honor to know in some way, rendering care to them. I remember staying after my shift to wash clumps of blood from their hair so they could look and smell clean when their grief stricken families came in to visit them, these real women. (Their acuity made these concerns of hygiene a luxury, because the nurse on duty was so consumed with immediate concerns of the woman’s survival.) I watched the grief in the eyes of my coworkers as women slipped away from us, and the joy they displayed when we were able to help these very real women. I stood at besides with their families as they came to see their dead daughters, not always managing to contain my own tears, trying to comfort the family and to help them not be alone in that moment. I wept as I wrapped these young mothers in death shrouds to be taken to the morgue. And my eyes swelled with tears every time I heard my husband talk about another case of the “Church of the Stillborn.” We do what we do because we hate death and love life, and I bear witness to the Church about these women whom so many seem to think don’t really exist or don’t really suffer very much. And I still weep.

Vision Forum has announced “The Baby Conference,” and those who were outspoken during this discussion in 2008 have been invited as speakers at this event in July 2010. I believe that they will capitalize upon the fame of the Duggar Family to again convince themselves that they are more special to God than other “Canaanite” Christians like me, using this conference as a vehicle to advance this disturbing thesis regarding tubal pregnancy. While their critics are characterized as Mengeles and Sangers, the humble mother can feel transcendent and connected to something critically important in a culture of death through her stand upon the sensationalism of what has been taught to her as the highest virtue. It appears to followers that “no group does what Vision Forum does,” though cultic groups like the “Church of the Firstborn” boast a much longer history of doing the same thing in this case. Their activities have been recorded as far back as the 18th Century.

When I was younger, I used to idealize the idea of martyrdom for the cause of Christ to the point that I would dream about it. I felt great worth and transcendence, at one with my Creator, when I thought of sacrificing myself for a cause, particularly through serving others. I could imagine no greater honor and thought of it as wisdom. Then I got a little older and much more tired, and I realized that there is such a thing as “throwing your life away.” (Not all situations are always “do or die,” and definitely not so all of the time.) I began to realize that it is much wiser to be balanced and that zeal and drama without balance can be very fruitless, even though it made ME FEEL better. That drama was just a drug that I used, and that the idea that any action at any cost was often a tactic used by manipulative ministers to get more money or more of a devoted following. Those things became like a carrot before the horse for me, because I never got much reward for the big dramas. Not that I’ve mastered the art of deciding what risks to take… Yet, I pray that I may never stop learning.

I hesitate to use Scriptures here because so many modern day Pharisees have trite answers to explain competing meanings away, and I do not want to be numbered among those who suggest that they have a Scripture verse with a static answer for every contingency which absolves people from thinking and responsibility. So in closing, I will offer this food for thought for women who will do anything to help their children live. I challenge you to consider that you have to show yourself accountable before God for the value of your own life, the talent He has placed in your care for His honor and glory. In a tubal pregnancy, your baby cannot survive, and you can die, despite what “In a Shoe” has to tell you. You don’t always have the option for “Watchful Waiting.” I hope that you will consider this:

To be brave one short instant is an easy matter;
it is easier to die for a cause than to live for it.
Madame La Comtesse Diane de Vobrillac,
a confidante to King Louis XVI and friend of Ben Franklin

If you have a tubal pregnancy, and knowing that those small percentages do represent real women, I challenge you to consider that God may want you to honor your own life and to live for the cause of that life He has given you. Live to be a helpmeet to your husband and the other children that God has also given you. I think that you have become that one sheep that Jesus challenges us to go out to rescue, leaving ninety-nine behind in the wilderness because His heart breaks over your distress. I challenge you to think of your duty to Him, and I respectfully ask you to think about it for yourself.

No Longer Quivering’s Response to “The Baby Conference”