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Abortion pill reversal: a chance for a change of mind

Mon, 2019-09-02 11:51

How many of us have ever made a really big decision in life and then changed our mind? I suspect quite a few of us.  And if there was any ambivalence in the initial decision, then a subsequent change of mind is even more possible.

In which case, decisions on abortion, especially if made with some ambivalence or doubt, can also be subject to change.  With surgical abortions, once a woman is in the operating theatre there is little to no opportunity to reverse her initial decision. However, the situation is different with medical abortions.

Unknown to most women, it is possible to reverse a ‘medical’ abortion, after it has started. So if a woman does change her mind about going through with the abortion, she could reverse her initial decision. After all, it should be her choice to be able to if she wants.

Some background is needed.

‘Medical’ abortions are carried out at any stage from early pregnancy and generally up to fourteen weeks gestation. But they can take place up to 24 weeks gestation. As I’ve explained in this paper, a woman is given an oral dose of Mifegyne (mifepristone, also known as RU-486) at a clinic/hospital to kill the fetus. Following a short wait to ensure that the drug has absorbed properly, women leave the hospital or clinic. The second stage of the abortion involves taking misoprostol up to 48 hours later, either orally or vaginally. This causes uterine cramping to expel the dead fetus.

Mifepristone is a progesterone receptor blocker, and by blocking progesterone, it blocks the effects of progesterone. Progesterone is crucial to the health of the pregnancy, so when the effects of progesterone are blocked by mifepristone the placenta separates from the wall of the uterus, leading to the death of the fetus. Misoprostol causes the uterus to contract and expel the fetus.

The window of opportunity to change her mind comes after the woman has taken the first medicine, the mifepristone, but before she has taken the second drug.

An abortion ‘reversal’ (although it is not strictly a reversal) works by utilising the hormone progesterone to out-compete the ingested mifepristone and swamp its action. One of the developed protocols involves injecting 200 mg of progesterone intramuscularly as soon as possible after the woman has taken mifepristone. This dosage is repeated for two more days, then every other day until the 14th day since the mifepristone ingestion. The same progesterone dosage is administered twice a week until the end of the first trimester.  Another protocol involves high-dose oral ingestion of progesterone.

The process is remarkably effective (64-68 per cent effective) and safe. There is no increased risk of birth defects compared to the general population and the preterm birth rate is actually lower than the general population.

If a woman changes her mind and decides not to take the second pill, misoprostol, but does not use the progesterone protocol, there is a less than 25 per cent chance that the baby will survive.  However if she does use the progesterone therapy, the chance of the baby surviving is 68 per cent overall, rising to  77 per cent if the pregnancy is 9 weeks or over. It is most effective for later stages of pregnancy so if the abortion pill is taken at an early stage of less than 5 weeks gestation the chance of foetal survival is 25 per cent, even with progesterone therapy.

In recent years, the Catholic Medical Association (UK) and other pro-life organisations have received calls from women in distress in this situation. These women are desperately seeking advice and assistance to help them save the lives of their babies and preserve their pregnancies.

If women are to make informed choices, they need all available information in order to ensure having an abortion is an informed decision, and they need to be free to change their minds.  Abortion advocates place emphasis on a woman’s right to choose: to choose what happens to her body, her baby and her life. But what if her choice changes after she starts an abortion?

The number of medical abortions has been steadily rising year by year over the last decade and that trend will continue. 77 per cent of women now have a medical abortion so the option of abortion reversal is now open to many women. Doctors, nurses, midwives, pharmacists and the general public need to be aware that this treatment is available, that it is safe and, in many cases, that it allows a woman to change her mind and keep her unborn child.

Women have the right to know that they have a second chance at choice. So she should be well informed about, first of all, all the risks of medical abortion, but also that if she happens to change her mind and no longer wants an abortion, there is an avenue for reversal.

After all, it should be her choice.

See: Delgado G, Condly S, Davenport M, Tinnakornsrisuphap Mack J, Khauv V, Zhou P. A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine. 33(1):3-14, 2018

Also a medical abortion briefing paper here

Categories: Discussion

About time! Australian doctors to investigate transgender treatments for kids

Fri, 2019-08-23 10:49

It’s about time. A national inquiry into the safety and ethics of transgender medicine in Australia will be conducted by the Royal Australasian College of Physicians with the backing of Federal Health Minister Greg Hunt.

At the moment there are no nationally agreed standards, although guidelines issued by Melbourne’s Royal Children’s Hospital gender clinic have been referred to as the ‘Australian standards’. However, this document, which has been described as the ‘most progressive’ in the world by Victoria’s Minister for Health, has not been approved by the National Health and Medical Research Council.

The RCH model commits doctors to the controversial policy of reducing ‘mental illness in trans and gender diverse children by affirming and protecting their identity in a world where many judge and hurt them‘.

According to an exclusive article in The Australian about the inquiry, ‘Critics say the 2018 standards encourage risky medical treatment without properly considering safer therapies such as counselling for problems such as depression, anxiety, autism spectrum disorder, bullying and family conflict. The RCH standards overplay evidence for medical treatment and downplay risks, say “dissident’ clinicians”.’

The opposing sides of the debate over transgender Australian youth could not have more different attitudes.

On the one hand, Michelle Telfer, director of the Royal Children’s Hospital Gender Service in Melbourne, told The Australian that commencing medical intervention for children as young as 13 or 14 years old was ‘not at all controversial within those with expertise because we all know that we have been doing this for years‘.

On the other hand, critics of medical intervention for children and teenagers – which includes puberty blockers and cross-sex hormones – question whether the gender dysphoria epidemic is real.

Far be it from anybody to say that there are absolutely no people in the world who are genuinely gender dysphoric and who find it impossible to live in their biological sex,’ says Dr Dianna Kenny, a psychologist. ‘What I’m saying is it’s been massively and irresponsibly over-diagnosed … (these children and teens) are going to be irrevocably damaged by the treatment they received.’

She believes that gender dysphoria is in part ‘a social construct … propagated through the processes of groupthink and social contagion’.

And the ethics of irreversible medical treatment have not been settled. ‘Who gave ethics approval for this treatment (at children’s hospitals) when it lacks any scientific basis and therefore is an experiment?‘ asks Prof John Whitehall, of Western Sydney University. ‘We should give the psychiatry and psychology a full run before we start castrating children.

Australia’s inquiry comes at a good time. Gender ideology is becoming the conventional wisdom amongst some politicians, even though a growing number of doctors, psychologists and sociologists are clamouring that ‘the emperor has no clothes’.

A collection of essays to be released next month in the UK, Inventing Transgender Children and Young People, questions the transgender narrative of a serene journey from gender dysphoria to life as a transperson.

We are collectively arguing that this unquestioning acceptance poses a serious threat to children’s well-being and safety,’ co-editor Heather Brunskell-Evans, a former research fellow at King’s College London, told the Daily Mail. ‘We hope through this book to bring the world’s attention to the public scandal of transgendering children.

The contributors warn that :

  • Doctors do not tell young people they are ‘sacrificing’ their chance to have children
  • Psychologists are wary of questioning transgender ideology;
  • Clinicians who are reluctant to diagnose children as transgender are being accused of transphobia
  • Gender experts fail to acknowledge that there are other explanations for discomfort with gender, like autism

The ‘Australian standards’ of care for transgender children appear impressively comprehensive – but they rest on very shaky foundations. The Royal Children’s Hospital Melbourne acknowledges that ‘the recommendations made in this document are based primarily on clinician consensus’. What constitutes a ‘consensus’ in this context? At its best, it is the shrewd opinions of doctors who have extensive experience and want to back up their hunches with evidence-based studies. At its worst, a ‘consensus’ is just the groupthink of bubble-dwelling ideologues.

And in this case, it’s more likely to be the latter. Even the document acknowledges that the evidence is thin. The consensus is supported by ‘a limited number of non-randomised clinical studies and observational studies’. A drug to cure cancer would not be approved on such flimsy evidence; why should drugs to cure gender dysphoria be treated differently?

The Australian inquiry cannot come soon enough – although everything depends on the composition of the task force.

 

Michael Cook is the editor of MercatorNet

This blog was originally posted on MercatorNet on August 19 2019

Categories: Discussion

Surrogacy: asking the questions no-one wants to ask (or answer)

Wed, 2019-08-21 11:19

In June, the Law Commission published a consultation document on surrogacy, which is still open for submissions. The premise of the consultation – and indeed of the Government – is that surrogacy is a positive, family-building, option but the current law is too restrictive and needs to be ‘reformed’.

The Consultation paper could hardly be clearer with its title: ‘Building Families through Surrogacy: a new law.’ This is backed up by Government support: ‘The Government supports surrogacy as part of the range of assisted conception options.’

The Law Commission, along with other proponents for change, argues strongly that the current law is out of date and in urgent need of reform: ‘We think that there is a strong case for reform to the law. We believe that the current law is out of date, unclear and not fit for purpose.’ Or, as Sir James Mumby, former President of the Family Division puts it: ‘Our legislation is elderly by any standards. Large-scale legislative reform is essential.

Two of the main issues that the Law Commission is looking at are payments to surrogates and who are the legal parents of the baby. For the latter, they propose that in principle the ‘intended parents’ will become the legal parents at birth, (rather than after six weeks as at present), thus transferring parental rights immediately to the ‘intended parents’, and away from the surrogate mother.

A helpful CMF blog covers some of the practical and ethical issues in more detail. I want to take a step back however and question the basic assumption that surrogacy is a positive family-building option, to be supported and encouraged.

I have some simple questions about surrogacy which the Law Commission avoids even asking, let alone answering:

Q: Is surrogacy a commercial transaction or not? (A. It is almost always a commercial transaction and there should be no pretence that it is not).

Q: Who takes care of the short- and long-term health needs of surrogate women once they have ‘produced’? (A. No-one)

Q: Who is concerned about the effects on children from being cut off from their gestational mother and from their biological heritage and identity? (A. Very few (see p19-21) See here too (p22)

Q: Who will answer the sibling pleading with his mother (see p18): ‘We don’t need the money; can we just keep my brother?’‘ (A. Who can answer this?)

Q: Who are parents nowadays? The biological? The social? The gestational? (A. All of them, including this surrogate mother, eight years after giving birth)

Q: Why do no wealthy women become surrogate mothers? (A. They don’t want to!)

Q: Who has done the research showing that surrogates are not impacted physically and psychologically in the long-term? (A. Very few, and on very few women. There are personal stories though.)

Q: Why do wealthy Westerners go abroad for surrogates? (A. To pay less, avoid restrictions and exercise more control.

Q: Why do Indian women really become surrogates, in a country where it is highly stigmatised? (A. For the money, rarely for altruism or to make other lives ‘whole’)

Q: Why are surrogate mothers so often called ‘gestational carriers?’ (A. It conveniently de-personalises mothers and what they are doing)

Q: Who really cares about the mothers and children? (A. A few people, but not enough. Anyone with the illusion that mothers are not impacted by carrying a child for ‘just’ 9 months should read this letter by a surrogate, or this report on international surrogacy)

Q: What and who is really driving the global industry of surrogacy? (A.MONEY, same-sex couples and some heterosexual couples – and not necessarily infertility)

In reality, surrogacy is an exploitative global industry, driven by money and the demands of commissioning ‘parents’. It requires women to become ‘breeders’ and it treats children as commodities. Indeed, I would go so far as to say that in many cases, commercial surrogacy is not too far off buying and selling children.

To read more on the biblical and ethical perspectives surrounding the use of surrogacy, have a look at this CMF briefing paper.

This warning by CS Lewis back in 1943 was highly prescient: ‘What we call man’s power over nature turns out to be a power exercised by some men over other men with nature as its instrument…’

Lewis was right, because the truth is, with surrogacy, one woman’s (or man’s) gain is almost always another one’s loss.

Categories: Discussion