Perinatal Hospice

Mothers of Congenitally Ill Babies Deserve Better than Abortion | Opinion

John Bruchalski, M.D. , Founder and President, Divine Mercy Care
On 10/19/22 at 7:00 AM EDT, NEWSWEEK Opinion

When a mother learns that her unborn child has a severe, life-limiting diagnosis, the news is devastating.

Regretfully, I followed the standard medical recommendation and aborted babies with hydrocephalus, spina bifida, and genetic abnormalities during my residency in the late 1980s. But now I am convinced that elective abortions are never merciful or medically necessary. Mothers and their unborn children deserve a better treatment option.

For many, perinatal hospice with palliative care is that better treatment option. It provides tender, compassionate, and holistic care to mom and baby after she receives the news that her child's life will likely be short.

Even though perinatal hospice is now considered standard care, there are still only about 300 programs worldwide. Many of these programs assist with family bereavement but are not committed to life until natural death for the baby. What's more, only a little over one third (37 percent) of genetic counselors even mention perinatal hospice as an option. There's a lot of work to do to normalize and improve perinatal hospice programs, and it's far from the norm. Elective abortion remains the norm.

The suffering of pregnancy—especially when a woman is carrying a congenitally sick child—is very real. It's understandable that the doctor and mother would want to do everything in their power to limit her suffering and grief. But elective abortion is not a shortcut through grief, and it is far from the "act of mercy" many claim it is.

First of all, diagnoses made in utero can be incorrect. When genetic blood tests turn up positive, they're usually wrong (85 percent of the time). In almost one in five cases, ultrasound imaging also fails to properly diagnose defects, according to a 2014 study. Over 8 percent of congenital defect diagnoses were totally incorrect and over 9 percent were misclassified. In many cases, the full extent of the child's condition is better assessed after birth.

When it comes to a mother's mental and emotional health, almost all women who carry their congenitally ill babies to term say they do not regret the experience. Data from a 2018 study and others suggest that mothers who have had abortions, by contrast, regret not spending more time with their child, even in the womb. I have found this to be true in my experience. Moms want to spend time with their suffering babies—especially if they know that once the umbilical cord is cut, their time together may be counted in minutes.

Women who have been through my practice, Tepeyac OB/GYN's perinatal hospice program, which was inspired by Dr. Byron Calhoun's model, often tell me the experience of getting to say hello and goodbye to their baby, while heartbreaking, is healing. Anyone with a dying loved one wants the opportunity to spend more time with him or her and to say goodbye. The same should go for our children. One mom recently asked me, "How could I abandon my child without providing her with my loving gaze, caresses, and comfort for whatever amount of minutes I had the privilege of accompanying and being there for my suffering baby?" Moms are intertwined with their unborn children through the millimeter-thick lining between placenta and womb. They are connected heart to heart and soul to soul.

Ending the life of a sick baby doesn't end the mother's emotional suffering. It simply trades the mother's physical suffering in continuing the pregnancy for psychological suffering. That is a clinical reality with which the physician must come to terms. Doctors are expected to relieve suffering for a living, but we can't end this kind of emotional suffering with a surgical procedure.

OB/GYNs are often guilty of igniting fear in mothers and pitting them against their own flesh and blood. Ending that life without so much as suggesting perinatal hospice misplaces compassion and robs mothers of the chance for courage. It robs them of an opportunity to fulfill their role as a loving mother and care for their children.

Rather than telling mothers that their babies have no chance or will never live fulfilling lives, what if we physicians gave them hope? What if instead of instilling fear, we gave them a chance to be courageous? What if we treated the womb as a hospice home to give mothers more time to love and say goodbye to their sick babies? In that sense, medicine can truly be an act of mercy.

Mothers deserve compassion, encouragement, and the truth that elective abortion is neither merciful nor medically necessary. Moms and congenitally ill babies deserve perinatal hospice and palliative care—a higher and more dignified standard of care than what the medical status quo offers them today, even in this post-Roe world.

John Bruchalski, M.D., is the Founder and President of Divine Mercy Care and the Founder of Tepeyac OB/GYN in Fairfax, Virginia. He is the author of Two Patients: My Conversion from Abortion to Life-Affirming Medicine. You can follow him on Twitter at @JohnBruchalski.