(from an actual doctor)

With all the abortion news going on in America and around the world, one news story was cropping up all over the internet and social media. An American woman in Malta was allegedly being denied an abortion when she started having symptoms of miscarriage.

Dr. Calum Miller took to social media and provided some insight on the situation from a doctor’s perspective. He gave HDI permission to use his post. We thought it would be important to provide our readers some information from a different point of view on an abortion issue outside the United States. Hopefully his thoughtful and measured response can push back against some the very clear-cut claims pro-choice organizations have been making concerning Andrea Prudente’s situation. His account, with only slight edits, is below:

There has been a lot of media attention – and dare I say misinformation – given to a current situation in Malta where, it is claimed, a woman was denied an abortion which would save her life. What is the reality?

1) This is very difficult to know because all we have are a few public reports with minimal clinical detail. Anyone who claims to know with certainty what treatment this lady needs, other than those with direct access to her full clinical record, simply cannot be trusted. 

These clinical situations are complex and cannot be speculated about on the basis of one or two details reported in the media, mainly by abortion activist groups with a vested interest. Any judicious and conscientious clinician (or reporter) would refrain from commenting in detail about what is needed in the specific case.

2) Maltese law and medical practice clearly allow premature delivery of the child where the woman’s life is at risk – regardless of whether the baby is alive, has a heartbeat, and regardless of whether they are viable. 

Maltese doctors have for years, in many cases (though these cases are still very rare) delivered the child early, in some cases with the child subsequently passing away, in order to save the mother’s life. None of them have ever needed to worry about legal repercussions. Pro-life obstetricians do this in every country around the world.

3) This has been made abundantly clear by Malta’s leading judges, including Giovanni Bonello, formerly a judge at the European Court of Human Rights.

4) Hence whatever the true clinical picture, it is simply false to claim that the law is to blame. The law is absolutely clear: where a woman’s life is at risk, premature delivery is permitted, regardless of any other factors.

5) It is in part for this reason that Malta has the lowest maternal mortality ratio in the world, far lower than in pro-abortion countries like the UK or France. In fact, there has been not a single maternal death in Malta in the last 10 years. This is astonishing.

6) The likelihood is, therefore, that in this case, the clinical scenario does not warrant a delivery, because the mother’s life is not at risk. This needs some explanation – an explanation that the patient deserves.

7) Preterm premature rupture of membranes (PPROM) is a clinical condition where the gestational membranes break early, before 37 weeks. In itself it is not life-threatening, but it can lead to an infection, which will become life-threatening. Once there is evidence of an infection, the child should be immediately delivered to save the woman’s life.

Until there is sign of an infection, the standard approach after viability is not to deliver the baby as soon as the membranes rupture – it is to manage expectantly (i.e. not intervene) for as long as possible to give the baby the best possible chance of survival.

9) Before viability, the chances of the baby surviving are significantly lower, but they are not zero. It is possible to keep a pre-viable baby alive in this situation until viability, and babies have been born alive as a result, even though the chances are slim.

10) Hence there is no specific need to deliver as soon as the membranes rupture. In pregnancies of viable gestation, the “watch and wait” approach is routinely taken, and does not put women’s lives seriously at risk. The woman needs careful monitoring for signs of infection, and if there is a sign of chorioamnionitis she should be delivered immediately – but until then it is not necessary.

11) Other complications, such as placental abruption, may be present in cases of PPROM, and may also warrant early delivery. But again, this depends on the specific clinical details: it cannot be asserted to be warranted simply on the basis of a vague line in a report by abortion activist groups. The full clinical details are necessary.

12) A much more remote possibility is that the doctors have misunderstood the law, or have misunderstood the seriousness of the clinical situation, and a premature delivery really is clinically necessary. This is less likely, but it is possible. 

In that case, it is not the law which is to blame, but the doctors’ understanding of the law and the clinical situation. If there is any ambiguity among the doctors involved in her care on these issues, I would strongly urge them to seek outside expert legal and medical counsel, which is available and which could resolve their indecision. 

However, the likely possibility remains that a premature delivery is simply not clinically indicated. On the basis of press reports without the full clinical details, it is obviously impossible to know the truth here, and I am making no accusations either way. All I am saying is that if the doctors really do not understand the law or the clinical situation, there is external advice available, and they should use it.

13) Likewise, if the patient and her advisers are convinced that her life is at risk and that she would be entitled to a delivery to save her life, I urge them to make contact with people who may be in a position to help. I am more than willing to do everything I can to make sure that this patient gets a premature delivery if she really needs one. My help is available, and I encourage you to make use of it if the clinical situation really is as is being suggested. 

If your life is really at risk, you are entitled to a premature delivery under Maltese law. I will do my utmost to help ensure that you receive that treatment if it is medically necessary.

14) Hence, the law is clear, and medical practice is usually clear, even if in some rare cases doctors make mistakes. To blame this situation on the law in Malta is utterly misleading, and even more so given the very sparse clinical details available to the public.

15) Malta has a maternal health record to be proud of. It has had not a single maternal death from any cause in the last 10 years, and consequently has the lowest maternal mortality ratio in the entire world, along with Poland, where unborn children also have legal protection. Attempts by pro-abortion countries and advocates to smear this record are grossly hypocritical, given the far poorer maternal mortality records in more affluent pro-abortion countries like the UK and France. Malta should be proud.

16) The likelihood is that this is a misinformation campaign being perpetrated by groups which frequently post misinformation on social media, like the radical fringe extremist group Doctors for Choice Malta. I encourage anyone interested in this story, or reporting on it, to see also the mainstream responses provided by Professor of Obstetrics George Buttigieg, or Doctors for Life Malta, which boasts many hundreds of members across Malta (compared to the handful at Doctors for Choice).

Update: this woman was flown to Spain where it is said, “Only in Spain were they able to deliver their daughter, hold her and say goodbye.” As Dr. Calum Miller pointed out, in Malta she legally would have been able to deliver her child if her life was at risk. This outcome complicates an already complex situation, but without full clinical details, no one can definitively say whether the Maltese doctors were mistaken about the severity of her condition or not, only that the Maltese law would have allowed her an opportunity to be delivered early if her life was at risk.

Photo by Mike Nahlii on Unsplash

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Medical doctor, ethicist, and philosopher

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I love science and teaching. I am passionate about using those interests to speak for those who can't.

The views and opinions expressed in these articles are those of the author and do not necessarily reflect the official position of Human Defense Initiative.