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Cases of Life, Death and Decision

“Any country that accepts abortion is not teaching its people love, but to use violence to get what they want. This is why the greatest destroyer of love and peace is abortion.” Mother Teresa to the National Prayer Break-fast in Washington, D.C., February 3, 1994.

In October 1999, the world’s population reached 6 billion. The United Nations estimates that population is increasing annually by more than 90 million. Though often presented as a medical necessity to preserve the life or health of the mother, abortion is the primary means used to control the world’s population growth. There are over 50 million abortions performed worldwide each year. In order to achieve this large number, 4,000 babies must be aborted every day at a rate of 1 child every 20 seconds! The overwhelming majority of all abortions (95%) are performed as birth control. Only 1% are done because of rape or incest and 1% because of fetal abnormalities. A mere 3% are performed because of maternal health problems. This is an essay about the choices that people make. The cases presented here represent different responses to a variety of problems, all of which present abortion as one of the available options. Since 1973, over 40 million abortions have been recorded in the United States. Over the last five years, the Center for Disease Control has recorded between 1.3 and 1.4 million each year. Some of cases that follow made a contribution to that number; others chose not to do so.

Congenital Deformity

S.T. is a 25 year old beautiful woman who was quite anxious and excited about being pregnant for the first time. She worked as a secretary and her husband is a landscaper. When she came to her eighteen-week ultrasound we discovered the baby was somewhat small, had a cleft lip and palate, and congenital heart disease. To be better prepared for the baby’s arrival, amniocentesis was suggested and done and the chromo-somes returned Trisomy 13 or Edward’s syndrome. This is a condition characterized by severe mental retardation, congenital heart disease in 77% of cases, cerebral malformations (especially aplasia of the olfactory bulbs—making the baby deaf), eye defects, low set ears, cleft lip and palate, low birth weight and a characteristic dermatoglyphic pattern (characteristic ridges in the fingers, palms, toes and soles).

Most Edward’s syndrome babies either die at birth or shortly after birth. Knowing all of this the couple chose to deliver the baby. When the day arrived, the pediatrician and priest were by the bedside with the parents ready for the baby girl’s arrival with tears and the fear of her likely demise. To everyone’s surprise, she lived, thrived and brought joy to this couple for over a year. They loved this baby as much as any couple could love a child and are grateful to this day for the opportunity to have known her.

J.K. is a 33 year old mother of two girls. Her risk of having a baby with Down syndrome is 1 in 625 and her risk of having a baby with any congenital anomaly is 1 in 317. These risks are not large. The risk of an amniocentesis, however, is a 1 in 200 chance of hitting the baby, causing an infection, or rupturing the maternal membranes. It is not prudent to risk an amniocentesis when the probable risk exceeds the likelihood of finding an anomalous baby. But she insisted on knowing. Given the lack of any family his-tory to that effect, my feeling was that she had an inordinate fear of having an abnormal baby. Nonetheless, the amniocentesis was performed against my better wishes. Subsequently I learned that the reason this woman wanted to know the baby’s chromosomes was to find out the sex. When she discovered it was another girl (46XX), she aborted the baby.

L.M. is a 37 year old mother of four absolutely stunning children. She and her husband are devout Christians in the Church of the Nazarene and are a joy and delight to all they meet. At their eighteen-week ultrasound, the baby was found to have a shortened thigh bone, some increased nuchal fold thickness and to be small for her gestational age. Amniocentesis was offered; parents have a right to prepare for a potentially abnormal baby. They chose not to do the amniocentesis because it would not change what they planned to do. At the birth of their fifth child, they discovered that she had Down syndrome-Trisomy 21. This is characterized by mental retardation, brachycephaly (having a short head with a cephalic index of 81.0 to 85.4cm), prominent epicanthal folds, poor nasal bridge development, congenital heart disease, hypotonia, hypermobility of the joints, characteristic dermatoglyphics (simian creases in palms). Sarah today is mainstreamed into first grade and her mother continues to fight for understanding from the child’s classmates.

Troubled Women

J.L. is a 13 year old eighth grader. Recently the local school board incorporated the eighth grade into the high school—a regretful trend that mixes ages in an effort to best utilize available teachers and classrooms. J.L. is quite pretty and much older looking than her years, but she still thinks with the mind of an eighth grader. A senior took advantage of her and she became pregnant. In Massachusetts, once a teenager becomes pregnant, she is an “emancipated minor.” This means the state accords her the rights of an adult because the assumption is that if she is old enough to conceive and take responsibility for a family she is old enough to make her own decisions. She did just that. J.L. chose to keep the baby, despite ostracism from her parents and friends who insisted that she have an abortion.

T.K., 27 years old, calls the office panic stricken. Last night she had unprotected intercourse at midcycle and she asks for emergency contraception. My partner fills a special package of four birth control pills to be taken two at a time twelve hours apart. She accompanies this with anti-nausea medication. Is this flooding the system with hormones to prevent ovulation or fertilization? Or is this creating a hostile environment so that it is impossible for the fertilized egg to implant? The research is not clear and slow to give an answer. Soon RU-486 will be available, along with methotrexate, so that medical abortions will occur more and more frequently in the physician’s office rather than in the abortion clinic. Then the 1.4 million abortions that occur each year will be augmented by a number no longer recorded, since an office procedure is performed behind closed doors.

R.M. is a 43 year old who is twelve weeks pregnant. This is her husband’s second marriage. He has two other children. This is her second pregnancy. The couple has a beautiful four year old. The woman has conceived with the help of ovulatory inducing agents and medication to lower her prolactin. This has been a conscious well-planned and concerted effort at conception. After she conceives, she and her husband realize that it is very difficult to raise four children and that they really cannot afford this child. At 43 years old she admits that she really did not believe she could still conceive. She makes and cancels three appointments to terminate the pregnancy. She chooses to carry the baby, but has cried every day of her pregnancy.

“Selective Reduction”

N.S. is a 35 year old woman with primary infertility. After many frustrating years of unprotected intercourse, she has failed to conceive. She has undergone basal body temperature chartings, ovulatory predictor kits, post-coital tests, hormone studies, hysterosalgingograms (injecting the tubes with dye under fluoroscopy to prove tubal patency) and a diagnostic laparoscopy (looking through the umbilicus with a camera to ensure that the tubes are free and that ovulation is occurring and that no pelvic factor is interfering with her ability to conceive). Her husband has had numerous semen analyses. Everything is perfect, yet she has not conceived. She has had ovulation induction to ensure ovulation at the right time and timed intercourse. She has undergone intrauterine insemination with her husband’s sperm to help greater numbers of eggs reach greater numbers of sperm. Yet the couple has not had a pregnancy.

They then choose to undergo in vitro fertilization. She is placed on daily shots of follicle stimulating hormones, has daily ultrasounds to watch the growth of the developing follicles (many are forced to form so that a greater number of eggs can be recovered and fertilized), daily estriols (blood tests checking on her estrogen level) and transvaginal recovery of the follicles under ultra-sound guidance. Eight are retrieved. Her husband’s sperm is then cleaned and spun. Fertilization occurs under direct vision. All four fertilized eggs are implanted in her uterus. All four survive. She now has quadruplets! After years of infertility, she is pregnant with four.

She is advised that the survivability and risk of prematurity is so great that she should have “selective reduction.” After years of waiting to see if she gets pregnant, she is forced to consider aborting two of the four to significantly improve the chances of the remaining two. She proceeds with selective reduction and delivers two healthy, beautiful children. Selective reduction is reluctantly chosen by many couples, but could you abort two of your children if you were faced with the likelihood that all four would potentially do poorly if born prematurely? Fertility clinics try to avoid this problem by implanting fewer embryos and freezing the remainder for later use. But what are we to do with these remaining tiny humans?

Each day over 4,000 women in the United States make the choice to abort a baby. When we understand the immensity of the numbers we are awestruck. How is this morally conscionable? “Now the word of the Lord came to me saying: Before I formed you in the womb I knew you, before you were born, I consecrated you; a prophet to the nations I appointed you” (Jeremiah 1:5).

January 2000

Michael J.F. Iannessa, M.D.
Obstetrician-Gynecologist
Director Women’s Healthcare Associates
Hingham, Massachusetts