By Tom Perille MD
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December 13, 2023
The pregnancy of Kate Cox, the Dallas-area women who sought an abortion in Texas because her fetus was diagnosed with Trisomy 18, raises numerous emotionally charged issues. She is 31 years old and has had two previous C-section deliveries and two healthy children. Texas has enacted abortion restrictions which prompted her to sue the state to procure an abortion after 20 weeks gestation. This is a tragedy for Ms. Cox and her family. it is incredibly painful when a family first learns that their dreams for a healthy child are dashed. However, it doesn’t mean that their pain is diminished by access to abortion. And it doesn’t mean that their lives won’t be enriched by their child -even if their child’s life is abbreviated. It is worth reviewing some of the more prominent media distortions pertaining to the Cox pregnancy/baby that prejudice the public’s response to this tragedy: 1) Trisomy 18 has a poor prognosis. It is true that there is a high probability for a fetus with Trisomy 18 to be stillborn. However, the prognosis is not as bad as portrayed in the media. According to a recent systematic review, a baby born with Trisomy 18 in 2020 has a 13% 10-year survival rate. 2) A Trisomy 18 baby may face challenges, but their lives can be a source of great strength and inspiration for a family. Senator Risk Santorum’s baby, Bella , is a case in point. 3) For those families who choose comfort care (perinatal palliative care and/or perinatal hospice ) for their baby with Trisomy 18, the experience is described by many families as deeply moving and life-affirming. These families don’t try to extinguish the memory of their child, but instead, celebrate their short life. A team of professionals walks with the family during the pregnancy, at birth, and post-partum. They provide support to the mother and baby and ensure that when the baby dies it is without discomfort and surrounded by loving family. This can contribute tremendously to healing for the grieving family. The healing is impeded for those families that choose abortion since they will never forget their complicity in their child’s violent death. 4) At 21 weeks, the D&E procedure that was recommended to the Cox family is associated with substantial risk to the mother. This is omitted from mainstream media stories. The risk of dying from an abortion increases by 38% for each week of gestation after 8 weeks. Even without factoring in her increased risk for uterine rupture by virtue of her previous C-sections, the risk for an induced abortion is substantially greater than the risk of natural childbirth based on evidence from national record linkage studies. If the Cox baby needs a C-section rather than vaginal delivery, the risks are higher, but C-section is not an inevitability. If Ms. Cox had two previous low-transverse cesarean deliveries, she would be a candidate for a trial of labor after C-section (TOLAC). 5) The recommended D&E abortion procedure is often performed without administering a feticide- a chemical/drug that kills the fetus prior to the surgical abortion. One review reported that only 52% of abortion providers inject a feticide before proceeding with a second trimester D&E abortion. The D&E entails the systematic dismemberment of the living fetus which is pain capable by the gestational age of the Cox baby. Imagine for a moment the excruciating suffering elicited in the living fetus as its limbs are literally torn off. Some abortion advocates mistakenly view this as the “compassionate” choice. 6) Even in those cases where an abortionist chooses to administer a feticide prior to the procedure, the fetus will endure incredible suffering. The most common feticide, digoxin, takes up to 4 hours to kill the fetus if it is injected directly into the fetus and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. Digoxin overdose is associated with intense nausea, vomiting, abdominal pain, and delirium before it slows the heart and induces death. This can aptly be described as fetal torture. 7) The media suggests that Kate Cox’s life is in jeopardy if she continues the pregnancy. However, there is nothing in the lawsuit that corroborates this assertion. Ms. Cox visited the Emergency Department for cramps and diarrhea, but this is not a concerning symptom for her health or life. During a second Emergency Department visit she was reported to have some unidentified fluid from her vagina – suggesting the possibility of leaking amniotic fluid. This would be a more significant concern, but the Emergency Department commonly visualizes the cervix to make this diagnosis. They can also perform ultrasounds and several forms of tests on the vaginal fluid to establish this diagnosis (including pH-based tests, a fern test, and placenta alpha-1 globulin protein). The fact that none of this was mentioned in the lawsuit leads one to believe that Ms. Cox was not manifesting Premature Rupture of Membranes (PROM) and leaking amniotic fluid. The lawsuit mentions an elevated prenatal blood sugar, but gestational diabetes can be managed with a very low risk of morbidity/mortality. Translation - there was nothing in the lawsuit suggesting her life was at risk. 8) The media uncritically reports that future fertility is at risk if she continues her pregnancy. In the lawsuit, Ms. Cox indicates that she would like to have another child. It is true that if she had a C-section to deliver her child with Trisomy 18, there would be increased risk from a 4th C-section with a future child. The risk of uterine dehiscence (which means the partial opening of the uterus at the previous C-section scar) goes from 6.6% with her third C-section to 10.3% with her fourth C-section. This is a concern, but the absolute risk remains low. Furthermore, she is at increased risk with a future child regardless of her abortion decision by virtue of her C-section history. As indicated previously, it is not certain that a repeat C-section would be required and if she has a vaginal delivery of her Trisomy 18 child, there is little additional risk incurred with her future pregnancy. 9) Surgical abortions in general, and late abortions in particular, are associated with premature birth in subsequent pregnancies. Induced abortions are associated with cervical damage . This means that if Kate Cox obtains a late abortion, she may be putting her own and her future baby’s life at risk. Preterm delivery is associated with long term mortality for the mother and is the biggest driver of infant mortality for the child. 10) If any of the facts reviewed above miss some of the salient clinical features omitted from the lawsuit or if Kate Cox’s condition deteriorates, the Texas Supreme Court has made it clear that abortion is an option if her bodily functions or life are at risk. Furthermore, the court explicitly stated that her life does not need to be in “imminent” danger to pursue abortion in those circumstances. Her attending physicians simply need to make that determination based on reasonable medical judgement and the Texas Supreme court says it does not need to be reviewed by the judiciary. The Cox family have our sympathy and we all wish them well. However, their decision should be based on all the facts and not the selective narrative of abortion providers. It is unfortunate that families with life-threatening fetal anomalies are often given no hope and coerced into pursuing an abortion that they later regret.