As a midwife noted: Women arriving in their beds are surrounded by other women with babies in arms. The United Nations Committee on Economic, Social and Cultural Rights has asked states to remove all barriers to the full realization of sexual and reproductive rights.30 Abortion bans make women unequal, with impacts that differ depending on economic, social, and cultural factors, including the health care available to them. quality of life even with optimal medical therapy, and 4 was incompatible with life. Concluding Observations on Chile. The abortion ban exposes women to otherwise avoidable risks, and medical practitioners distinguish between obstetric and mental health consequences. We asked them when, by whom, and how affected women were told; what overall medical treatment was provided; what the women’s reactions were; whether the women requested pregnancy interruption; and what course of action was followed for women who sought abortions. And for these traumas, this is a very delicate matter. Concluding Observations on Chile. As a group of female midwives noted, feelings of guilt, incompetence, and shame are all channeled toward family and partners: “‘Why wasn’t I able to carry a healthy baby? C. Astete and B. Román, “Aspectos éticos del aborto (o interrupción voluntaria del embarazo) por malformaciones incompatibles con la vida extrauterina,” in S. Salas, F. Zegers, and R. Figueroa (eds). The oligohydramnios in the first and second trimester was associated with an This person is often hidden behind terms such as "fetal anomaly" and "incompatible with life." Caring staff will usually draw a curtain around the bed or otherwise provide some privacy, but this depends both on the particular staffers and on physical capacity. Our findings match other studies of pregnant women with a fetal anomaly diagnosis in that the primary feelings are shock and disbelief.19 Forced motherhood in a fetal impairment context is an undue hardship on women and their partners and often leads to breakups. Providing appropriate and desirable care to this group of women and their families plays an important role in the process of coping with this crisis. Pregnancy termination due to fetal anomalies has many psychological consequences for women. Depending on protocols, women may also be referred to secondary care facilities for confirmation by a geneticist and an opinion on fetal survival. When faced with a difficult situation, he asks colleagues for a second opinion, but there is no comprehensive approach. Committee on the Elimination of Discrimination against Women. A midwife said that the law prevents her from providing care that is consistent with women’s sexual and reproductive rights. These interviews starkly illustrate the plight facing women carrying nonviable fetuses, including women's shock upon receiving the diagnosis, their feelings of bereavement and loss, and the clinical practices used in an attempt to ease their suffering under the weight of exceedingly difficult legal restrictions. Reprod Health Matters. Hydrops fetalis is a serious, life-threatening condition in which a fetus or newborn has an abnormal buildup of fluids in the tissue around the lungs, heart, or abdomen, or under the skin. E/C.12/GC/22 (2016). After the woman underwent an emergency early induction of labor, Chile’s main conservative newspaper ran a front-page headline stressing that this was pregnancy termination, not abortion.27 In 2017, the former health minister who had reminded the affected woman that abortion was illegal signed and sponsored a paid ad opposing Bachelet’s bill in the same newspaper. except in cases of serious fetal anomalies incompatible with life" (Epner 1998). Please enable it to take advantage of the complete set of features! Respondents reported that some maternity care facilities provide areas for women and relatives to practice their beliefs, and even allow them to see or touch the baby if they wish. USA.gov. In the private sector, cases continue to be handled on an individual basis. She said that despite the pain of coming home to an empty baby room, it was a great relief knowing that it no longer suffered. Concluding Observations on Chile. Ironically, in Sweden, which allows abortion prior to 18 weeks, abortion after 21 weeks is seldom approved.26. Among the disadvantaged, most choose termination.”. So from a purely financial standpoint, insurers will press for termination. There is merely creativity and instinct by the multidisciplinary team responsible … We have no specially trained people to follow up on cases. 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While some of the women in our sample (the women we directly interviewed and patients of the people we interviewed) sought to get pregnant again, fear led most to shun a future pregnancy. Pamela Eguiguren et al. Children with trisomy 18 have many physical problems — heart defects are common — as well as neurological deficits and profound developmental delays. These interviews confirmed that compelling women to carry nonviable fetuses to term violates their human rights. We also queried them on their views on liberalization of the law and its potential effects on clinical practice. Her colleagues agreed that after an experience like this, many couples break up. Another doctor said that obstetric risk protocols are followed “until [the pregnancy] is considered viable, at 35 or 36 weeks, approximately. Fetal abnormalities make up approximately 3% of pregnancies. Risk to life is considered rare. However, this abortion procedure may minimize the trauma to the woman’s uterus, cervix, and other organs (Epner 1998). Locating women who had had nonviable pregnancies and were willing to talk was not an easy proposition. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The medical community, including midwives, has presented its views for and against, especially on how the law may affect clinical practices; in addition, women, many of whom have experienced a fatal congenital malformation diagnosis, have weighed in. Email: lidia.casas@udp.cl. One private sector obstetrician-gynecologist said that dealing with these cases is a very personal affair. Committee on the Elimination of Discrimination against Women. And it would allow abortions after 24 weeks if there is a “lethal fetal anomaly,” or if the fetus is incompatible with sustained life outside the uterus. Fetal Diagn Ther. In simple terms, congenital refers to the existence at or before birth. In these circumstances a woman needs support from her family and doctor to make a decision to continue with her pregnancy or end it before term. This qualitative study draws on 22 semi-structured interviews with nine certified nurse-midwives, one neonatologist, nine obstetrician-gynecologists, one psychiatrist, one psychologist, and one sociologist who provide care during gestation, pregnancy, delivery, and post-delivery in the public and private sectors, plus three interviews with two women and the former partner of a woman who underwent the experience. COVID-19 is an emerging, rapidly evolving situation. In the Chilean public health system, women who seek to terminate a pregnancy after 22 weeks are dependent on medical discretion. It’s a relief. Since 1999, Chile has been prompted numerous times by United Nations human rights bodies to improve its abortion laws.1, This article documents the experience of carrying and delivering fetuses with congenital anomalies incompatible with life and reviews the actions of providers who care for these women during gestation, pregnancy, delivery, and post-delivery. E/C.12/1/Add.105. General Recommendation No. In practical terms, it is the start of a lengthy, uncertain process in which many practitioners interact with varying degrees of coordination. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Chan School of Public Health. Another said, “We gave this woman a misoprostol prescription. How and when a diagnosis is reported is key. I recall making an appointment for a test; they took some amniotic fluid and we got the results three weeks later. 2004 paras. It helps to think a little bit like a mom, what type of life my baby would even have. We also interviewed two women and the former partner of a woman who lived through the experience. Accordingly, given the limitations of science and of the health care system, requiring a rock-solid diagnosis could become a barrier. There was consensus among medical respondents that most affected women experience shock and disbelief. She chose not to see it. Gawron and Watson (see note 3), p. 177; Lotto et al. Immediate care after delivery ; A woman seeing a doctor in private practice said that he suggested a safe out-of-country abortion, an option she declined. CONTRA-INDICATIONS • Uterine contractions • Uterine bleeding • Chorioamnionitis • Premature rupture of membranes. report that 20% of 23,446 infant deaths in Chile in 2013 involved fetal anomalies.10 Overall, Chilean infant mortality has fallen, while the number of malformations has remained constant, perhaps due to late and teen pregnancies and alcohol and drug abuse.11 For 2012, Chile’s National Statistics Institute noted a total of 8.6 fetal anomalies per 1,000 live births.12. -. The women were identified with assistance from health care providers and personal contacts. Whether it's fetal anomaly incompatible with life or congenital malformation resulting in little or no life expectancy, all Chilean women are expected to carry their pregnancies to term. Advertisement. This article tries to provide a nuanced portrait of women’s suffering and of the difficulties confronted by clinicians dealing with fetal malformation diagnoses in a country with an absolute abortion ban. The pro-life Perinatal Hospice Bill, HB 2685, was approved by the Health Committee to address that. The key task of the fetal MRI examination is, in fact, the early detection of congenital anomalies incompatible with life, which require the termination of pregnancy, or the discovery of life-compatible anomalies in developed countries due to fetal surgery whenever possible. My belief is that once you have the opportunity to meet these babies with fetal anomalies you will have a hard time telling them their imperfections are not worthy of life. As abortion was illegal: 10.1016/S0968-8080 ( 14 ) 44811-0 that, OK, the... Uncertainty as a coping mechanism fourth weeks of pregnancy through that,,..., UN Doc a single primitive ventricle s for the financial support provided by the Diego Portales, a. Not get the chance to meet was incompatible with life. do so because they are unable have. To continue their pregnancy, others don ’ t deliver proper care risks for majority! 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