Friday, January 07, 2005

You Are Your Uterine Lining

Note: If the comment is true, Christie from Del. Cosgrove's office is misinformed about the number of babies [...] abandoned and found dead in 2003 alone. It's not 11. It is 1.

Anne alerts us to this Metafilter post: Miscarry in Virginia? Call the police or go to jail.

Democracy for Virginia has the story:

You are at home alone at 8:00 on a Friday night. You are 8 weeks pregnant. You are excited about the pregnancy, but being cautious, you haven't told anyone about it yet except your partner, your best friend, your parents, and your doctor.

All of a sudden, you begin to experience heavy cramping. Bleeding ensues. You realize with shock and sadness that you are probably experiencing a miscarriage. You leave a message with your doctor's service. The on-call doctor calls back, offers sympathies, and advises taking pain medication or going to the hospital if the bleeding gets worse. She offers you the next available appointment for a follow-up exam - Monday at 3PM. You accept. You are overwhelmed with grief and surprised by the intensity of physical pain involved. You call your partner and ask him to come home from his "boys night out", sparing him the reason over the phone. You call your best friend. She offers to come over immediately and make you cocoa. You cry.

You decide not to tell your parents yet; let them sleep through the night before delivering the terrible news. Your partner comes home and you break the sad news to him. He holds you on the couch and you both cry together. Your best friend comes over with cocoa. You cry some more. Over the next few hours, you suffer pain, cramping, and intermittent bleeding. Exhausted, you finally fall asleep in your partner's arms around 4 AM. You sleep until noon, and then gird yourself for the difficult call to your parents, who were so eagerly anticipating their first grandchild.

Guess what? You just earned yourself up to 12 months in jail and a $2,500 fine. Why? Because you failed to call the cops and report your miscarriage within 12 hours.

Please read her entire post, including the comments.

Spontaneous abortion (miscarriage) = when abortion occurs without medical or mechanical means to empty the uterus.

More than 80% occur in the first 12 weeks. Chromosomal anomalies cause at least 50% of these early abs. A majority of fertilized eggs do not implant. Moreover, of those that implant, 22% are aborted before pregnancy is clinically recognized. The frequency of clinically recognized abortion is 12% to 26% [Williams 21 ed, p 856].

There are 4 types of spontaneous abortions:

1. Threatened ab: vaginal spotting/bleeding and abdominal cramping/low backache; cervix closed

Extremely common, approximately 50% will abort [can't predict in advance]. No established treatment (?bed rest, avoid intercourse, etc.).

2. Inevitable ab: membranes ruptured, uterine contractions; cervix opened [dilated]

3. Incomplete ab: products of conception (POC) partially expelled, steady/heavy vaginal bleeding; cervix opened

If the placenta (afterbirth) has been expelled, the management is expectant. In other words, nothing needs to be done. In one study, spontaneous resolution of the pregnancy occurred within 3 days in 80% of women. If POC are retained, the treatment is curettage.

4. Missed ab: this is more of a definition of the POC (retention of dead POC), than of the mechanism of ab (same as the other types).

In nearly *all* cases of spontaneous abortion, the expulsion of the POC is preceded by the death of the embryo or fetus in utero (inside the uterus).

A lot of you might be wondering what is the point of this proposed legislation. According to one of the comments I read:

Del. Cosgrove wrote an email to one of the DailyKos commenters about an email she sent him today. Here is what he said was his reason:

"This bill, which was requested by the Chesapeake Police Department, is an attempt to reduce the number of "trashcan" babies that are born and then abandoned in trashcans, toilets, or elsewhere to die from exposure or worse. There are numerous examples of these tragic deaths in Virginia, many in Northern Virginia and also in Hampton Roads. Once the body of a child is found, if the death of that child is undetermined by a coroner, the person abandoning that child can only be charged with "the improper disposal of a human body".

That is the intent of the bill."

I've never heard of Del. Cosgrove, so I can't comment on his intentions. I can, however, offer you an informed opinion.

Once abortion is illegal, the number of "spontaneous abortions" increases dramatically. [In this context, "spontaneous ab" means an elective ab documented as a spontaneous one.] It's impractical for the state to verify that an abortion is in fact spontaneous at the end point, in the doctor's office. [There are ways to do it, but I'd rather not give anybody any ideas.] So the state needs to institute an early warning and tracking system, if you will. Mandatory pregnancy testing, and miscarriage reporting by the pregnant woman are proven methods; they've been used in other countries and they work.

I have to run now, but allow me to offer you a related piece of advice. Ladies, you better start being extra, super nice to your neighbors. Because if we're headed where it appears we are, regular police reports about your activities, from your neighbors, will be the norm. Also, don't forget to bond with your doctor/nurse. You will so need them to risk their license and freedom for you in the near future.

[I must say this: I've reached new levels of stunnedness.]


  • The definition of fetal death in Virginia (emphasis added):

    2. "Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, regardless of the duration of pregnancy; death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

  • The Bill (proposed amendment in italics):

    D. When a fetal death occurs without medical attendance upon the mother womanat or after the delivery or abortion or when inquiry or investigation by a medical examiner is required, the medical examiner shall investigate the cause of fetal death and shall complete and sign the medical certification portion of the fetal death report within twenty-four 24 hours after being notified of a fetal death.

    When a fetal death occurs without medical attendance, it shall be the woman's responsibility to report the death to the law-enforcement agency in the jurisdiction of which the delivery occurs within 12 hours after the delivery. A violation of this section shall be punishable as a Class 1 misdemeanor.

  • According to a commenter at Democracy for Virginia (emphasis mine):

    I just had the nicest phone conversation with Christie from Mr. Cosgrove's office. VA HB1677 does not, in fact have anything at all to do with miscarriages. The revision to the law currently on the books has been proposed in an effort to deter people from dumping babies and leaving them to die. Eleven babies were abandoned and found dead in 2003 alone.

    Since death prior to the complete expulsion or extraction from its mother of a POC excludes d[eath] from exposure or worse, it appears Del. Cosgrove's office staff contention that [t]he revision to the law currently on the books has been proposed in an effort to deter people from dumping babies and leaving them to die is a red herring.


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