Reviews |  Why fetal heart rate is a risky social construct

Reviews | Why fetal heart rate is a risky social construct

“There is no heartbeat at six weeks,” Stacey Abrams, the Democratic candidate for governor of Georgia, said at a panel in Atlanta this week. “It’s a manufactured sound designed to convince people that men have the right to take control of a woman’s body away from her.”

A human life is more than a heartbeat, and a “heartbeat” is insufficient to produce a human being.

Abrams is being attacked by far-right media for this comment. A Fox News analyst called it an “outright lie”, saying, “So really, the heart starts beating at three weeks” (sic). Another conservative commentator challenged on the grounds that “Hearing my baby’s heartbeat” was “one of the most exciting, freeing and beautiful moments of my entire life” (irrelevant).

This kind of soft-on-fact, hard-on-emotional layering milieu fuels policies that are both dangerous and ridiculous – for example, abortion bans that begin before many women even know they’re pregnant, or bills that prohibit the termination of an ectopic pregnancy, which can be immediately fatal for the pregnant woman. The latter includes an infamous Ohio bill that proposed to “re-implant” an ectopic into a uterus, a medically impossible procedure.

Going on the attack underscores a fear of accuracy, as Abrams’ remarks are difficult to attack. At six weeks pregnant, there is no heart. There is no sound. If this were a “Saturday Night Live” episode of “Coffee Talk,” the host would say, “An embryonic heartbeat isn’t a heart or a beat: chat.”

Historically, the heart was considered the repository of the soul, intellect and emotion. Despite tremendous advances in our understanding of human anatomy and physiology, we retain a tendency to imbue even the whisper of the presence of a heart with outsized emotional significance. But a human life is more than a heartbeat, and a “heartbeat” is insufficient to produce a human being, especially when it only reflects the periodic electrical activity produced by a cluster of precursor cells.

What we call a “heartbeat” can have special meaning for many people during an early pregnancy appointment, especially if pregnancy is desired. Even if the pregnancy has already been revealed by other means, the “heartbeat” seems more concrete than a line on a test stick. But this meaning, as Abrams stated, is a social construct that has more to do with anticipating future outcomes and little to do with what is actually present in the womb at that time.

As with much language in medicine, the term has unintended implications. It is reasonable to expect that a “heartbeat” refers to the movement or sound coming from an organ called the heart. Yet at six weeks pregnant (which is actually four weeks after fertilization, due to the confusing way of dating pregnancies), this simply reflects the electrical activity produced by a tiny, amorphous clump of cells. Within the mass less than half an inch there is as yet no structure recognizable as a heart, no pumping blood, no circulatory system into which it could be pumped, and no developed end-organs to which pump it.

We retain a tendency to imbue even the whisper of a heart’s presence with an outsized emotional significance.

Cells generate electrical activity because that is the nature of these cells. Heart tissue grown in the lab will also vibrate, as will cells dissolved from a heart that are no longer organized into the structure of the original organ. And the ultrasound machine, in turn, translates such activity into a faint audible hum that is a product of the machine itself, rather than an amplification of any existing sound.

Detecting this “heartbeat” in clinical practice is useful in several ways. It can confirm the diagnosis of a pregnancy, as it is condition-specific; it allows us to estimate the gestational age; and when there are concerns about pregnancy loss, the presence, absence, or change of “heartbeat” can be informative about viability (a term that means no more than that the pregnancy is likely to continue).

When I had a miscarriage, I knew it in an instant during my second ultrasound, when what I had heard earlier as a rapid breath became extremely slow. The final report said “unviable pregnancy”.

I had been grateful that technology let me know early on that I had lost my pregnancy. But I would have felt differently if this same technology had been used off-label, to measure things it was not designed to measure – for example, the personality of the embryo or the viability or non-viability of my personal autonomy.

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