A surprise, unplanned or unwanted pregnancy can be very challenging for the expectant mother and sometimes also for the father and other family members. In Malta, a country where the preborn baby's right to life is a top priority, gynaecologist Dr Astrid Camilleri describes a number of concrete challenges and how she goes about to offer care and support to women in Malta without abortion.
The Woman Struggling With Mental Health
Dr Astrid distinguishes between her approach with a woman who is in a state of panic and others who have long standing mental disorders. She believes that when a woman is faced with an unplanned pregnancy, she is taken by storm and that her initial reaction is one of rejection. The mother can have the impulsion to do something drastic about the situation.
Dr Astrid believes that the first thing she has to do is to go into a thorough discussion with the person in front of her: “My role is to make the couple or the mother think clearly. Sometimes the mother just needs to see and reason things out by discussing the situation. Most of the time, after one or more sessions, she would realise that her initial reaction was rash and that the situation is not so tragic after all. I have seem many turning points happen when the mother sees the foetus on ultrasound; when the mother feels that there is a living creature within her and she actually bonds with it.”
Dr Astrid continues to say that: “In some cases it is necessary to engage the help of a psychologist to offer more support and help in deciding a way forward. I work closely with several psychologists, both male and female, who can help in this regard. If all these efforts fail, one can offer other options like giving the baby up for adoption. One does all that can be done to steer away from the decision to abort. I am happy to say that besides all the women who after our discussions decided to keep their pregnancy and work their lives around the arrival of a new member of the family, there are about ten women who decided to give the baby up for adoption. Unfortunately, at this stage, you have either convinced the mother to continue with the pregnancy or she disappears, seeking help elsewhere, to abort. Sometimes guilt drives a woman away from the decision to abort. Other women will try to justify abortion and convince themselves that they cannot offer the child a decent life. My question is always ‘are you ready to kill your child instead of giving him/her a life with someone else?’ ”
Dr Astrid believes that if the mother is considering abortion, she must be made aware of the consequences: “The consequences of aborting are usually psychological; rarely medical. Online abortive pills, are unreliable and dangerous, and carry the risk of haemorrhage for the expectant mother. On the other hand, should the mother decide to proceed with the pregnancy it is our duty to offer as much support as possible to this mother who has made an admirable decision and may have chosen to take a much more difficult path.”
In the cases of severe mental health disorders Dr Astrid explains that “even if the pregnancy can be turbulent especially since the mother is on particular medications, these women can still deliver a healthy child.”
The Woman Whose Life Is In Danger
Dr Astrid confirms that the unavailability of abortion in Malta does not impinge in any way on the availability of optimal care for the pregnant mother. She confirms that direct abortion – the purposeful destruction of the preborn baby – is not medically necessary to save the life of the mother: “It is always our top priority to do all that is medically possible to save the mother. Unfortunately this is not always successful, but we are rarely faced with situations where terminating the pregnancy increases the chances of survival for the mother. We must remember that with the excellent rate of survival for preterm babies in Malta, – which is as early as 26 weeks, we can opt to deliver the baby when it is already viable, hence reducing or removing completely the risk of death for the mother. There are other times when the death of the embryo is inevitable such as with ectopic pregnancies, when the embryo gets implanted inside a fallopian tube or somewhere else outside the uterus. In such pregnancies the growing foetus would burst the tube and hence the pregnancy would still be interrupted. Intervening surgically saves the mother without changing the fate of the foetus.
The Woman Whose Baby Has Foetal Abnormality Or Is A Stillborn Child
Dr Astrid describes how parents are well informed and supported in the eventuality of a prenatal diagnosis of abnormalities with the foetus: “Parents who know that they are expecting a child with abnormalities should be made fully aware of the situation as soon as it is confirmed. Then one has to prepare for possible eventualities according to the prognosis, and the likelihood of survival after birth is discussed. Midwives in Malta offer a very sound support system for these parents. This support extends even after birth. Support includes psychological care. Abortion is not offered as an option.”
Dr Astrid adds that, “sometimes, although the diagnosis is made prenatally, it is difficult to predict the extent to which the condition will affect the life of the foetus after birth. In other situations, it is very clear and one would know exactly what the impact on the wellbeing of the child would be. Occasionally, one deals with very rare cases which can prove to be very difficult to manage.”
One particular case Dr Astrid describes is when the ultrasound performed at 20 weeks gestation showed the presence of a large amount of blood in the brain area of the foetus : “It was so extensive that it was obscuring most of the brain. Antenatal brain haemorrhage was diagnosed and the scans were sent to a renowned centre in London for further consultation. The initial advice was to abort. When the parents refused it was suggested to tap the brain to release the blood in utero. This was also refused. I then sent the scans to America for a second opinion. This centre had encountered three such cases whilst we had seen nothing like it before in Malta. They reported back that two of the three mothers had chosen to abort the baby and one had decided to proceed. The mother who continued with the pregnancy experienced something unexpected. Throughout the rest of the pregnancy the blood resolved slowly and until at the time of birth it had cleared up completely. The same happened to my couple client, the baby was born perfectly healthy and today the child suffers no disability and is very intelligent.”
Some women don’t want to carry their baby to term if they know that the child is suffering from a condition that is not compatible with life after birth. “There are times when during the pregnancy we already know that the baby will probably die during or soon after birth because of the problems it has. Trying to deliver a foetus early can also have consequences on the mother’s health so it would not be advisable to intervene prematurely as it could affect the ability of that mother to bear other children in the future. This is very difficult for the parents and family but with adequate psychological support it can be achieved and the chances of medical complications are reduced. Most parents also feel better with this process because they feel that the baby’s death was natural and in no way instigated; in that they were in no way a part of the destiny of this child and its death was natural and in no way brought on.”
Dr Astrid explains how if babies are stillborn, the mother usually gets to know very close to the delivery or during the delivery itself. This situation is very traumatic and requires a lot of compassion and support. Midwives play an important role in these situations and can offer great support.
The Woman Who Believes She Has A Right To Choose Over Her Body
Living within a society carries with it obligations towards others and the taking of responsibility for our actions. Dr Astrid questions those who believe that a woman has every right to do what she pleases with her pregnancy. She asks: “Why does the preborn child have to be the guilty party? Who is going to take responsibility for the termination? Who will be the advocate for this baby?
The embryo should be considered as a human life from conception. Once a male and female cell come together and a foetus starts to form, interruption by medical or surgical means is nothing but murder. The healthy embryo, left in its natural environment will live. It is because it is removed from its place that it doesn’t. The embryo is a particular living entity. It is not the same as having only a sperm which is also a living entity, but can do nothing on its own. Without interruption, the embryo will grow into a baby. The foetus should be protected for this reason and is more vulnerable since it cannot protect itself. It is ironic that it should be killed by the person who gave it life and who is supposed to protect it!!”
She continues to explain how nature provides that, “once a mother is pregnant she has no choice but to deliver. Whether she likes it or not labour will start at some point and that cannot be helped. Her only choice in Malta would be how to deliver; whether vaginally or by caesarean section.”
The Woman Whose Preborn Child Is The Result Of A Casual Relationship
Sometimes a woman finds it hard to accept the pregnancy because it is the fruit of a casual or an extra-marital relationship. Dr Astrid says: “In the case of a pregnancy following a casual or and extra-marital relationship the first thing to establish is whether the mother intends to continue or stop this relationship. If she intends to stop the relationship, the advice would be to come clean with her partner/husband and move forward with the pregnancy. This of course carries the risk of her partner/husband not accepting the situation and even breaking up the relationship or marriage. Should she wish to stop her relationship with her partner it would be important to see the reaction of the baby’s father to the news of the pregnancy. The mother must be aware that she may end up completely alone and unsupported. We are only there to guide and give advice. It is up to the parents to take final decisions on the course of action.”
The Woman Who Has Been Raped
The trauma of unwanted intercourse, because of the lack of consent from the victim’s side, can result in an unplanned pregnancy, which is not easy to accept. Dr Astrid says, “If a woman is sexually assaulted, she has the choice to take emergency contraception if there is the risk of her getting pregnant Yet if emergency contraception is taken when the egg has already been fertilised, it can prevent the embryo from implanting in the uterus, thus terminating its life.
If the woman does get pregnant she will need support if she is to decide not to abort the child. This is an even more difficult decision than if the relationship was consensual because it could bring about strong feelings of rejection of the child by the mother because of the way it was conceived.”
The Young Teen
Findings in a 2010 study reveal that 12.3% of pupils of school-leaving age in Malta, have practiced sexual intercourse. Dr Astrid explains that teaching abstinence is to be encouraged for both the emotional and physical wellbeing of the teenager. For the other teenager who does not want to postpone sex till s/he is in a stable relationship or in marriage, it is important to offer other measures informing the patient about risks and side-effects:
“Teenagers should be offered contraception in this case. Withdrawal and the use of condoms are not reliable. Women who are sexually active outside steady relationships run the risk of acquiring sexually transmitted diseases which can lead to illness and even infertility. Unwanted pregnancies are more common too.”
The Father’s Role During Pregnancy
Dr Astrid highlights the fact that the father’s role during the pregnancy is very important especially to support the mother: "The involvement of the husband/partner is very important. He may not always be available to attend all the prenatal visits but it is imperative that he supports the mother. The couple are also encouraged to attend preparation antenatal classes together and of course the father is encouraged to be present during childbirth.”
Advocating For The Preborn Child
Some argue that although abortion is illegal in Malta some mothers will still go abroad or underground to do it. So why not make it accessible, safe and legal in Malta in the first place?
Dr Astrid replies that: “Most gynaecologists in Malta (if not all) have reservations and do not want to participate in abortions. When the abortion takes place abroad the mother may delay and that gives her time to rethink. Going abroad may also be a deterrent. The embryo is a living human with rights which are to be respected. There is no such thing as a “subhuman human”: a human being/organism with subhuman moral status. Human status is not something one “earns” by reaching some arbitrary level of functional ability. This is also why many centres around the world are moving away from embryo freezing and going for oocyte freezing – vitrification –, a method which gives the same results without the ethical implications of having spare embryos or embryos treated as property if the couple separates.”
Pope Francis On Women’s Needs And Rights
As a society we rarely challenge the causes of so much pain in the life and in the heart of women. Men also need to face their responsibilities. Pope Francis, in his recent letter Christ Is Alive, states that the Church needs to be “attentive to the legitimate claims of those women who seek greater justice and equality,” acknowledging “a fair share of male authoritarianism, domination, various forms of enslavement, abuse and sexist violence.” He speaks of a Church who “can support the call to respect women’s rights, and offer convinced support for greater reciprocity between males and females, while not agreeing with everything some feminist groups propose.”
Pope Francis also renews the Church’s commitment “against all discrimination and violence on sexual grounds” (Par 41). In his 2016 visit to Poland Pope Francis said that “it is the responsibility of the State, the Church and society to accompany and concretely help all those who find themselves in serious difficulty, so that a child will never be seen as a burden but as a gift, and those who are most vulnerable and poor will not be abandoned.”
Article written by Suzanne Vella
Photos of Dr Astrid by Christina Gatt
Published: August 2019
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