The recently enacted Texas Heartbeat Act, a de facto ban on abortions in the Lone Star State, established a system where members of the public can sue abortion providers and enablers for a minimum of $10,000 if an abortion is conducted after a fetal heartbeat can be identified.
The law went into effect on September 1, after the Supreme Court declined to block it.
Now, President Joe Biden is exploring ways to challenge the law, which makes no exception for rape and prohibits abortions even before some women will know they are pregnant.
Right or wrong, The Jerusalem Post sought to explain the “Heartbeat Act,” and what it really means from a medical perspective for women and babies, with the help of two top doctors: Dr. Benny Chayen, director of Women’s Health for Meuhedet Services, and Dr. Ido Solt, director of Maternal and Fetal Medicine at Rambam Health Care Campus.
1 - When can you hear the fetal heartbeat?
The fetal heartbeat can usually be seen at around six weeks. Hearing the fetal heartbeat is a sign of the viability of the pregnancy.
“At six weeks, all we can say is if a baby is viable or not viable,” stressed Chayen.
2 - At six weeks, what does the fetus look like?
According to Chayen, at six weeks the fetus does not have the shape of a human being.
“It looks like a blob of tissue,” he said. “You cannot see a head, a body or any limbs.”
At this stage, the fetus measures at only a few centimeters, Solt said, explaining that the fetus is measured along its longest access to obtain what is known as its crown-rump length or CRL.
3 - How is gestational age calculated and is it really possible that a woman would not even know she is pregnant at six weeks?
The gestational age of a fetus is calculated based on the first day of the last menstrual cycle minus two weeks. So if a woman’s period started eight weeks ago, then the gestational age of the fetus would be six weeks.
Chayen said that if a woman does not have a regular cycle or does not know the date of her previous period then an ultrasound can usually detect the age of the fetus at around six weeks, plus or minus a few days.
Some women, especially those undergoing fertility treatments, are aware of their date of ovulation, which generally occurs about 14 days from the start of one’s period. As such, the gestational age of the period can be calculated from that day.
4 - How early could one know if there is a fetal abnormality? When and how are these evaluated?
The earliest that any fetal abnormalities could be detected is around 11 weeks, said Solt, and this would be done via a nuchal translucency scan that shows a collection of fluid under the skin behind the fetal neck. If this scan reveals that there may be some abnormalities, a woman can then choose to do an amniocentesis test to check if the baby has a genetic or chromosomal condition, such as Down’s syndrome.
Later, around 14 to 17 weeks and then again at around 21 to 24 weeks, the expectant mother can undergo a more detailed ultrasound that can unveil other potential birth defects, such as spina bifida, club feet, cleft lip or even kidney defects.
In Israel, if malformations are discovered, a woman can terminate her pregnancy even in the third trimester, Chayen said.
5 - Medically speaking, when does a fetus become a baby?
Usually around 24 weeks, Chayen said, “because that is the time that if the fetus was born it might stay alive.”
He said that at 24 weeks “already the baby has some chance. He or she would be taken to the neonatal intensive care until and be treated there and the baby could survive.”
However, Solt said that this definition is starting to change and become earlier due to new technologies that improve the viability of babies born prematurely, such as high frequency ventilation.
Nonetheless, there is usually a “price to pay” for saving these babies, he said. Defects can include intraventricular hemorrhage, bleeding inside or around the ventricles in the brain; severe eye problems; or respiratory distress syndrome, Solt said.
6 - And what is an embryo?
The embryo is the state before even the fetus forms - “it is just a few cells,” Chayen said, noting that an embryo is usually called such in the first one to two weeks of the pregnancy.
7 - What abortion methods are available in Israel?
There are two kinds of legal abortions in Israel: surgical and pharmaceutical.
A surgical abortion is usually performed between 11 and 14 weeks and involves “vacuum aspiration,” whereby the doctor will numb a woman’s cervix and then essentially suction the contents of the uterus out, Solt said.
With the pharmaceutical approach, if there is a normal pregnancy and a woman wants to terminate it, the doctor will first administer an anti-progesterone drug that blocks the progesterone hormone, which supports early pregnancy and will usually lead to a miscarriage. After about 48 hours, Solt explained, the woman would then be given a second drug, usually cytotec, which “orders the uterus to evaluate the pregnancy.”
There are four conditions under Israeli law by which a woman is allowed to legally terminate a pregnancy:
1: If a woman is under the legal age to be married (18) or is over the age of 40.
2: If a woman becomes impregnated by someone other than her husband, for example in the case of rape, incest or even adultery or if she is not married.
3: If the baby would be born with a genetic abnormality.
4: If the mother suffers from a physical or psychological condition that would put her life in danger.
8 - Could a woman have medical conditions that would require her to get an abortion?
“A woman could have medical issues like heart or kidney problems and a pregnancy could cause the condition to deteriorate,” Chayen said. “In these cases, a doctor could recommend an abortion.”
Other examples could include women with multiple sclerosis.
“A woman would deteriorate much faster than she would without the pregnancy. But the woman could decide she wants the baby and not terminate the pregnancy even if it endangers her,” he said.
To get an abortion in Israel, a woman has to go before a committee and explain herself. Until week 23, she goes before a standard committee of two doctors and a social worker. According to Solt, more than 99% of abortion requests made in the first trimester are approved.
There are around 40 such committees in hospitals and other medical centers across the country.
Beginning in week 24, a special committee of five members will be convened to discuss the application, Solt said.
“You have to prove that the fetus has a severe abnormality that will cause the child to be more than 30% severely handicapped before the committee will approve termination of the pregnancy after 24 weeks,” he said.
Though he also noted that “we don’t know about all the abortions and some are done without the approval of these committees.”
9 - How many abortions are performed in Israel per year?
In Israel, around 20,000 abortions are performed each year, according to Solt, 10% of the number of deliveries, which holds at around 200,000.
10 - Could the Texas Heartbeat Act ever happen in the Jewish state?
To that question, the doctors had only one answer: Just like in Texas, it is not a question of health but politics.