Tag: Obstetricians

An 18th-Century Hoax

Things have been a bit heavy lately. Not heavier than usual as regards all things adoption but even so, I’m going for a bit of light-hearted-ness today – or is it, really ? My soul and psyche need it but this one may not soothe, as it is one those historical oddities. Never-the-less . . . here goes.

Courtesy of The Guardian story by Melissa Harrison. It is a review of LINK>Mary and the Rabbit Dream. In 1726, the medical establishment believed that a poor woman had given birth to rabbits. That woman was Mary Toft of Godalming, who was a seasonal field laborer. paid only a penny a day. Her husband Joshua was a cloth worker. They were impoverished almost to the point of destitution. It wasn’t all that rare in a time of gross economic inequality. She was illiterate and healthy but her doctors described her as having “a stupid and sullen temper”. 

The first “rabbit birth” occurred not long after Mary had suffered a miscarriage. Her mother-in-law, Ann Toft, was her midwife. A doctor from Guildford, John Howard, was enlisted for her case. She was moved into John Howard’s house but he lost control of the situation, as the sideshow snowballed with more and more rabbit parts issuing from Mary. So, she was taken to London, where she attracted the interest of the press and the king, was examined by rival surgeons and, eventually, the eminent obstetrician Sir Richard Manningham. 

There was a myth at the time that that anything a woman saw or even imagined while pregnant could impress itself upon the developing fetus. What was known as maternal impression. Indignity and suffering were visited upon this powerless woman by people in thrall either to their own egos or their own schemes. In this historical hoax story, there was a lack of any clear, central motive presented to explain Mary’s supposed condition (though hunger could have driven her to the fabrications). At the time, rabbit farming was popular on Godalming’s sandy soils, but only for the rich. To poach a rabbit was to risk severe punishment – even in the face of starvation.

The “rabbit births” could have been an act of desperation on Mary’s part. Like many stories lost in the mists of time, all of the facts will never be known. So okay, maybe not a fun story for today. More so, a sad tale – as too oft is the truth.

Which Was It ?

Recently, more than one woman, as the nuances are parsed out, has come to realize that what they thought of as a miscarriage was actually a type of abortion. Truth is the definition means that both result in a similar outcome.

Medically, an abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to a viability allowing it to continue living. Many doctors now prefer to refer to this event as a termination rather than an abortion (for obvious reasons). This can happen either spontaneously or it can be induced. Generally, the more spontaneous is referred to as a miscarriage and this can occur even rather late in a pregnancy. When the event is induced, it is referred to as an abortion. Often, when a D&C is performed, medical personnel don’t really know for certain, if an embryo is present. I remember having to have a D&C when I was receiving reproductive assistance between the births of my two sons due to my lining not developing well enough and being asked directly if I was or could be pregnant. Since I was experiencing secondary infertility due to age and had not had any embryos transferred, I could be confident in my answer. With recent laws at some state’s level, this kind of situation could risk legal ramifications for the medical personnel and the woman.

During in vitro fertilization, it is common to fertilize more eggs than will be needed as the goal is to increase the woman’s chances of a successful pregnancy. Those excess fertilized eggs are commonly frozen, disposed of or donated for scientific research (which will then cause their destruction) – none of those choices are thought of as abortion. Some couples, as we did, will donate their frozen embryos to another couple – though in our case – the couple whose effort initially was successful and joyous, ultimately failed to develop after that point. All reproductive assistance patients want their pregnancy to be successful. In my mom’s group, only about half of the woman who started off in the group with us ended up with a pregnancy and ultimately, a child or children (we had quite a few twins and even a set of triplets in our group).

Often tens of thousands of dollars have been invested in the effort. Though this effort may initially appear successful, the pregnancy can still end and a decision must be made to remove those cells and the lining. Technically, this would be defined as an abortion. I read today about one case where a patient was carrying triplets. The pregnancies created by through in vitro fertilization, each implanted but stopped developing at different stages: one at six weeks, one at seven and one at eight. Therefore, none of these embryos were going to be successful in producing a child. Her doctor had to remove that tissue. It is not healthy and serves no purpose in remaining.

There is a kind of miscarriage that will be referred to as a missed abortion. The pregnancy actually ended, even though no symptoms of that had occurred. The contents of the uterus have not been naturally expelled. Sometimes, there may be some brownish discharge. The fact that the embryo has died is often discovered during a routine scan by her OB. The patient will be given Oxytocin, antibiotics and a D&C (a complete uterine evacuation – abortion). This is a situation where new laws could become problematic, especially if this occurs after 6 weeks and a positive indication of pregnancy.