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Bioscience-Medicine

Why 'heartbeat' doesn't accurately describe what we hear at 6 weeks of pregnancy

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From Texas Standard:

Texas' new law that bans abortions after six weeks of pregnancy comes from legislation known as the "heartbeat bill." The nickname comes from the notion that six weeks is when doctors can detect a fetal heartbeat.

But New York Times health writer Roni Rabin reports that "heartbeat" is misleading. She tells Texas Standard that many medical experts dispute the notion that the electrical current detected at the six-week stage is a true heartbeat. And how a heartbeat is defined has implications not only for the enforcement of the Texas law, but also how the U.S. Supreme Court rules on Mississippi's law that bans abortions after 15 weeks of pregnancy.

Listen to the interview with Rabin in the audio player above or read the transcript below to learn more about what an ultrasound does detect at six weeks of pregnancy, and why doctors are concerned that they are required to misinform their patients.

This interview has been edited lightly for clarity.

Texas Standard: Can you explain how "heartbeat" became the central word in conversations about reproductive liberties?

Roni Caryn Rabin: The Texas law actually enshrines some concepts that are actually medically inaccurate and misleading. The use of the word "heartbeat" implies that there's actually a heart that is beating at six weeks of pregnancy, which is actually only four weeks since fertilization because of the way we count pregnancy; there isn't a formed heart. There is something that doctors call a "cardiac tube" that is composed of cells that are emitting cardiac activity and the tube is pumping blood, but it is not a fully formed heart.

The Texas law actually says that, “The fetal heartbeat" and I'm reading here from the law, "has become a key medical predictor that an unborn child will reach live birth.” Well, first of all, it's not a fetal heartbeat; it's called an "embryo" at this point, and it’s not a key medical indicator that a very early pregnancy is going to actually be viable and lead to a live birth. 

Do you consider the Texas law to state that there has to be an actual heartbeat for it to be enforceable? 

It states that there is a heartbeat and that what is heard on an early ultrasound is a heartbeat. In fact, an ultrasound picks up on waves of activity and it's picking up on this cardiac activity and this movement of a very primitive embryonic tissue.

Is there a consensus about this among most doctors, or is there debate surrounding the definition of a fetal heartbeat? 

I think doctors are partly responsible for the use of the term. When a woman comes in who's very excited about being newly pregnant, they may use the term "heartbeat" in an idiomatic way, in a way to explain that there has been a conception. One doctor compared it to using a "stomach bug" when talking about a gastrointestinal illness. I think they are trying to be more precise in their language.

The vast majority of obstetrician-gynecologists in the United States believe that terminating a pregnancy for various reasons is, part and parcel, an integral part of reproductive care, certainly during the previable stage, and it’s sometimes critical to a woman's health as well. 

You looked at bills across the country seeking to limit abortion access and reported that the majority were not written by someone in the medical field. How is incorrect medical terminology used in informational pamphlets, for example, that doctors are required to hand out?

I looked extensively at that in Texas, and some other groups have looked at it across the country. The Informed Consent Project, which has examined all these pamphlets in the states that require them, which I think is about two dozen, they actually broke it down by the number of statements and how many were accurate and misleading, and they found that almost 1 in 3 statements were inaccurate or misleading.

We hear from doctors, "I'm required to give my patients information I know is wrong." And this is getting even bigger: Right now in Tennessee, there have been medical boards that have been trying to crack down on doctors providing misinformation about COVID and COVID treatments. The Tennessee State Legislature is telling the Medical Board of Tennessee that it cannot do so. 

You reached out to the Texas Health and Human Services Commission to ask about these pamphlets. What happened? 

I asked for an interview about the pamphlets and got back an email saying that they're being reviewed and updated. No further communication. They didn't agree to an interview. Look, they're kind of caught between a rock and a hard place, right? They are, on the one hand, the information that they're required to give women is actually in the state law. State Texas law – and this is not the new law; this has been there for a while – state Texas law says they have to tell women, individuals, seeking an abortion that an abortion can increase their risk of breast cancer, the risk of infertility, and these things are both not true.

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