Essay

Abortions of 'Medical Necessity'

You may have heard someone say, “Sometimes abortion is necessary to save the mother’s life.” It is understandable to wonder what that actually means: If a pregnancy becomes dangerous and has to end early, does saving the mother require intentionally ending the baby’s life? What about severe preeclampsia, infection, ectopic pregnancy, miscarriage, or a baby who is not expected to survive after birth?

For Latter-day Saints, we are speaking about a life that belongs within God’s eternal plan for His children. The Lord’s teaching that “the worth of souls is great in the sight of God” (Doctrine and Covenants 18:10) invites us to approach that life with reverence.

So when a pregnancy becomes dangerous, the faithful and compassionate question is not which of the two lives deserves concern, but how to care for both of them. These are some of the most important questions faithful disciples ask, and they deserve thoughtful answers.

The Most Important Distinction

This one distinction makes the rest of this discussion much easier to understand: Early delivery by induction or C-section or removing an ectopic pregnancy because the mother’s life is in danger are not abortions.

This is why in a world filled with confusion over this question, you will always know an abortion by this: it is the direct and intentional destruction of a human life in the womb.

This distinction is one of the most important things to understand, especially when thinking about when the mother’s life or health is at risk. It helps cut through confusing terminology and focus on what the medical situation actually requires. Instead of hearing “We need to end the pregnancy” and assuming that means abortion, a better question may be: “Do you mean we need to deliver the baby now?”

Why Can the Word “Abortion” Be Confusing?

Part of the difficulty comes from terminology.

In ordinary conversation, abortion means intentionally ending the life of a baby in the womb at any phase of life. But unfortunately, medical terminology has also used the word more broadly. A miscarriage, for example, has often been called a “spontaneous abortion,” and medical coding can still use abortion terminology for pregnancy losses that a woman never chose.

Is Early Delivery the Same Thing as Abortion?

No, when physicians induce labor or perform a C-section with the intention of delivering a baby because continuing the pregnancy has become medically unsafe, they are managing an obstetric delivery.

When severe preeclampsia or another pregnancy complication makes it dangerous for the mother to remain pregnant, the pregnancy may need to end so her condition can be treated and the baby can receive appropriate care. There are two patients, each with medical needs. But ending the pregnancy does not necessarily mean ending the baby’s life. Depending on the circumstances, doctors may induce labor or perform a C-section and then care for mother and child separately.

There really are situations in which a baby must be delivered early to protect the mother, and delivery is the medically necessary action.

If the baby is developed enough, the child may survive and receive NICU care. If the baby is extremely premature, the child may still die despite those efforts. That outcome can be heartbreaking, but the medical goal can still be to end the dangerous pregnancy, treat the mother, and give the baby whatever care is possible.

This is why it is helpful not to assume that “the pregnancy has to end” automatically means “the baby’s life has to be intentionally ended.” Those are different questions, and understanding that distinction can make a difficult medical situation much clearer.

What If the Mother Has Been Told She Will Die If the Pregnancy Continues?

In cases where the mother’s life actually is in danger, this is not the time for an abortion. We can, and do, save the life of the mother through delivery of the baby in a hospital where both the mother and her newborn can receive the care that they need. There is no medical reason to intentionally kill that fetal human being. Perinatal hospice is compassionate and comprehensive health care for women whose fetuses have life-limiting diagnoses.

The important distinction is that ending the pregnancy does not require first intentionally ending the baby’s life in the womb.

When urgent delivery can address the mother’s condition, doctors can deliver the baby alive and then care for mother and child separately. If the baby is developed enough to survive, neonatal specialists can provide treatment. If the baby is too premature or ill to survive, compassionate palliative care can focus on comfort and dignity while allowing the parents to be with their baby.

No outcome can be guaranteed. But when medically appropriate, this is what ending a dangerous pregnancy can look like: deliver the child, treat the mother, and give the baby whatever neonatal care is possible—or compassionate comfort care if survival is not possible.

But What If the Baby Is Too Early to Survive?

This is often the next question. Suppose a mother cannot safely stay pregnant, but the baby is so premature that doctors do not expect the child to survive after birth. If the baby may die anyway, why does it matter whether the baby is delivered alive?

It matters because the baby does not have to die first in order for the pregnancy to end. If the mother needs an early delivery, doctors can deliver the baby and then care for both mother and child. If the baby is strong enough to survive, the child can receive NICU care. If the baby is too premature to survive, the child can receive palliative care focused on comfort and dignity.

That is different from intentionally ending the baby’s life in the womb before delivery. With early delivery, the goal is to treat the mother while still giving the baby whatever chance for life and care is possible.

For parents, that difference can matter deeply. Even if their baby lives only a short time, they can know they did not intentionally cause their child’s death first. They gave their baby the opportunity to be born alive, receive care, and be held and loved for whatever time remained.

What Does Palliative Care for a Baby Mean?

Palliative care is medical care focused on keeping a person comfortable when doctors can no longer cure the condition or prevent death. It does not mean giving up on the patient or doing nothing. It means the kind of care changes from trying to prolong life to relieving pain, easing distress, and surrounding the baby with comfort and love.

For an extremely premature baby, that may include keeping the baby warm, treating pain or breathing discomfort, handling the baby gently, and allowing the child to stay close to his or her parents. A mother or father may be able to hold the baby, talk or sing to the child, pray together, invite siblings or grandparents to meet their grandbaby, no matter how short his or her life.

That is still meaningful medical care. Doctors may not be able to save the baby’s life, but they can make sure the child is comfortable, cared for, and not alone.

This is another reason early delivery can matter when the mother’s life is in danger. If she needs the pregnancy to end, doctors can deliver the baby and then care for both patients. If the child can survive, neonatal specialists can provide treatment. If survival is not possible, the baby can receive compassionate palliative care rather than having his or her life intentionally ended before delivery.

For parents who understand their baby as a child of God, even a few minutes or hours can matter deeply. They may not be able to stop their child from dying, but they can hold, comfort, love, and care for their baby through whatever time remains.

What About Cancer, Infection, or Other Diseases?

Sometimes the pregnancy itself is not the mother’s main medical problem. She may develop cancer, have a serious infection, suffer an injury, or need surgery for another condition.

In those situations, the first question is: What illness or injury actually needs to be treated?

If she has cancer, doctors treat the cancer while also considering the baby. If she has an infection, they treat the infection. If she has been seriously injured, they treat those injuries. Sometimes the pregnancy can continue safely during treatment. In other cases, the mother’s condition may become serious enough that doctors recommend delivering the baby early.

This is where it helps to remember that there are two patients. Modern maternal-fetal medicine can sometimes treat the unborn baby directly while doctors are also caring for the mother. The needs of one patient do not automatically make the other patient irrelevant.

There may still be heartbreaking situations in which doctors cannot save both lives. But the important question is whether treating the mother actually requires intentionally ending the baby’s life, or whether doctors can treat her illness and, if necessary, deliver the baby early and then care for both mother and child.

What About an Ectopic Pregnancy?

Ectopic pregnancy deserves its own explanation because it often comes up in discussions about abortion. To be clear, treating an ectopic pregnancy is a different medical situation from aborting a normal pregnancy.

In an ectopic pregnancy, the pregnancy has implanted outside the uterus, most often in a fallopian tube. It cannot safely continue growing there, and if the tube ruptures, the mother can experience dangerous internal bleeding.

The important point is that a woman should not delay necessary medical care because she is afraid that treating an ectopic pregnancy is the same thing as choosing an elective abortion. Doctors are treating a pregnancy that cannot safely develop where it has implanted and that can become life-threatening to the mother. That is a very different medical circumstance from intentionally ending a normally implanted, otherwise progressing pregnancy.

Why Does Miscarriage Sometimes Get Called an Abortion?

Miscarriage creates a different kind of confusion because of the language used in medical records. A woman may lose a deeply wanted pregnancy and later see the words spontaneous abortion in her chart. Medically, that term has historically been used for miscarriage or early pregnancy loss. But in ordinary conversation, the word abortion usually means intentionally ending a pregnancy, so seeing it on paperwork after a miscarriage can be painful and upsetting.

A miscarriage is an unintended loss of a pregnancy. The mother did not choose for her baby to die. She may already be grieving, and language that sounds as though she chose an abortion can add unnecessary confusion or guilt to an experience that was already heartbreaking.

Sometimes the body completes a miscarriage naturally. Other times, medication or a procedure such as a D&C may be needed to remove pregnancy tissue that remains. A D&C is simply the name of a medical procedure; it does not tell you why the procedure was performed. Similar procedures can be used in very different circumstances, which is why the diagnosis and medical intent matter.

A woman who receives treatment after a miscarriage has not made the same moral choice as someone who intentionally ends an ongoing pregnancy. She experienced the loss of a baby she wanted and then received medical care because of that loss.

This is also why clearer terminology can be helpful. Calling the experience a miscarriage or early pregnancy loss is often much easier for grieving parents to understand than seeing spontaneous abortion written in a chart. The medical terminology may have a technical history, but families deserve language that makes clear what actually happened: the pregnancy was lost naturally, and the mother received care afterward.

What About a Molar Pregnancy?

A molar pregnancy is an abnormal pregnancy in which the tissue that would normally help form the placenta develops abnormally. In a complete molar pregnancy, there is no normally developing baby. In a partial molar pregnancy, some fetal development may occur, but the pregnancy is genetically abnormal and cannot develop normally. Treatment removes the abnormal pregnancy tissue because leaving it in place can threaten the mother’s health.

Treatment may involve a D&C or another form of uterine evacuation to remove the abnormal tissue, but this is not an abortion.

The important point is that a woman with a molar pregnancy is receiving treatment for an abnormal pregnancy that cannot continue normally and may pose risks to her health. That is a different medical circumstance from choosing to end a normally developing pregnancy.

What If Doctors Say the Baby Will Not Survive After Birth?

Parents may walk into an ultrasound expecting an ordinary appointment and suddenly hear that their baby has anencephaly, hydrops, a severe genetic condition, major heart or brain abnormalities, or another condition doctors believe will not allow the child to live long after birth.

Sometimes the diagnosis and prognosis will be correct. Other times, a second opinion, later testing, or what doctors discover after birth may change the picture. Prenatal prognosis is not infallible, which is one reason parents may want another specialist to review a life-changing diagnosis before making an irreversible decision.

There is also a financial reality that can be difficult to talk about. Delivering and caring for an extremely premature or medically fragile baby can require weeks or months in the NICU and can cost a healthcare system a very large amount of money. This is why doctors may be pressured to suggest termination.

Those costs are real, and hospitals and healthcare systems have to think about limited resources. But cost should not quietly become a judgment about whether a particular baby’s life is worth trying to preserve.

Ava’s story gives a personal picture of what facing that decision can look like. She was only nineteen when she received a devastating prognosis about her baby:

For those parents, the question reaches beyond dollars and efficiency. They may want a second opinion. They may want doctors to attempt treatment after delivery. They may choose perinatal hospice if their baby truly cannot survive. And they may simply want the opportunity to carry, meet, hold, and care for their child for whatever time is possible. A compassionate medical conversation should make room for all of those possibilities rather than moving to termination.

What Is Perinatal Hospice?

Perinatal hospice is a form of palliative care for families who learn before birth that their baby has a life-limiting condition.

It allows parents to continue the pregnancy while working with doctors, nurses, neonatal specialists, counselors, chaplains, and others to prepare for what may happen at delivery.

Families can discuss whether any treatment after birth may help, what comfort care will involve if it will not, who they want present, whether siblings or grandparents will meet the child, and what memories they would like to preserve.

For one baby, life after birth may last several days. For another it may last hours or only minutes.

Perinatal hospice does not promise parents that their baby will survive. It gives them a way to continue being their baby’s parents when medicine cannot offer a cure.

That is different from the palliative care discussed earlier only in timing. After an emergency delivery, palliative care may become necessary unexpectedly because the child is simply too premature to survive. With a known life-limiting prenatal diagnosis, perinatal hospice allows the family to prepare for that care before birth.

In both circumstances, the principle is compassionate: when death cannot be prevented, the child can still be cared for.

In this interview clip, Jenet Jacob Erickson talks about parents who learned during pregnancy that their babies had life-limiting conditions and chose to continue the pregnancy. Some of those parents eventually had only a few hours with their children after birth:

Researchers Charlotte Wool, Rana Limbo, and Erin Denny-Koelsch studied parents who continued pregnancies after receiving a life-limiting prenatal diagnosis. 97.5 percent expressed no regret about continuing the pregnancy. Their study was titled “I Would Do It All Over Again”: Cherishing Time and the Absence of Regret in Continuing a Pregnancy after a Life-Limiting Diagnosis.

What parents said afterward helps explain why. They valued the time they had to carry their babies, prepare for them, meet them, hold them, introduce them to family members, take photographs, and simply love them for however long they were given. Their babies were not only a diagnosis; they were sons and daughters and members of their families.

Continuing the pregnancy did not remove the grief of losing a child. But the research shows that, for many parents, a short life was not the same thing as a meaningless life. Even when their time together lasted only minutes or hours, they were grateful for the opportunity to meet and care for their child.

That connects directly to compassionate care after an early delivery. A few hours may sound very small from the outside. To a mother and father holding the baby they have already loved throughout pregnancy, those hours can become some of the most meaningful time they are given.

A Few Questions Worth Thinking About

When I hear “abortion is sometimes necessary to save the mother,” do I understand the difference between early delivery and an abortion, which is the direct and intentional ending of a human life in the womb?
Have I absorbed cultural messages that treat miscarriage, ectopic pregnancy, premature delivery, and abortion as though they are all the same thing? What might I need to understand more clearly?
Do I understand the difference between treating a pregnancy complication and intentionally ending the life of the baby in the womb?
If a baby is very premature or unlikely to survive, have I assumed there is nothing more doctors can do? Have I considered NICU care or compassionate palliative care?
What messages have I heard about babies with disabilities, severe diagnoses, or very short life expectancies? Have those messages led me to assume that a short or medically complicated life has less value?
What does Jenet Erickson’s research teach me about assuming that parents would be better off never meeting a baby who may live only a short time?
If I or someone I loved were told, “The pregnancy has to end,” would I know to ask: Does the baby need to be delivered, or does the baby’s life need to be intentionally ended?

What Can You Do If This Ever Becomes Personal?

If you ever sit in an examination room and hear that your life is in danger or that your baby may not survive, you do not have to understand everything during the first frightening conversation.

Ask your physician to explain the situation in plain language. What exactly is threatening the mother’s life or health? What treatment is needed? Does the pregnancy need to end now? If so, does that mean delivery? Why is a particular method being recommended? What would happen if the baby were delivered? What neonatal treatment could be offered?

If the baby is extremely premature, ask what doctors believe the chances of survival are and what compassionate palliative care would look like if survival is not possible. If your baby has received a severe prenatal diagnosis, ask whether a maternal-fetal medicine specialist or fetal center should review it and whether perinatal hospice is available.

One question may help make a frightening medical conversation much clearer: “Can you help me understand whether my treatment requires my baby to die, or whether my baby can be delivered and cared for?”

Then take what you are learning to Heavenly Father. Pray honestly about what you have been told and what you fear. Seek a priesthood blessing if you desire one. Counsel with your spouse and trusted family members, and seek counsel from your bishop when spiritual guidance would help. Allow family, friends, Relief Society sisters, elders quorum members, and others close to you to carry practical burdens while you deal with appointments, hospitalization, premature birth, or grief.

And if doctors tell you that your baby cannot survive, ask what it would mean to care for your baby anyway. That might mean continuing the pregnancy with perinatal hospice. It might mean an early delivery because your own life has become endangered, followed by NICU treatment if survival is possible or palliative care if it is not.

Jenet Erickson’s research gives us a tender reason not to dismiss that time beforehand. Many parents who continued pregnancies after life-limiting diagnoses were deeply grateful for the opportunity to meet, hold, and love their babies for whatever time they were given.

The restored gospel helps explain why that can matter so much. President Nelson taught us to see unborn life as worthy of protection, and Elder Oaks placed our reverence for life inside the larger truth that God’s children come to mortality as part of an eternal plan. The mother facing a medical crisis is part of that plan. So is the baby she carries.

Jesus Christ knows them both. His Resurrection does not remove every frightening medical decision from mortality, but it does assure us that death is not the end of a baby’s existence or of God’s love for that baby. That gives faithful families reason to seek excellent medical care, ask whether both lives can be preserved, provide compassionate care when death cannot be prevented, and trust the Savior with what remains beyond their control.