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The Health 202
The Health 202

A newsletter briefing on the health-care policy debate in Washington.

The fight over ‘heartbeat’ further inflames tensions in abortion battle

Analysis by

with research by McKenzie Beard

September 26, 2022 at 8:08 a.m. EDT
The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good Monday morning, readers! Today's edition is coming to you from the Cunningham household, where I'm pleased to report an 18 percent reduction since school started again in the time needed to get three kids out the door. Rachel Roubein will be back in your inbox tomorrow.

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Below: Abortion ranks second among issues more important to voters in a new Washington Post-ABC News poll and Moderna has asked federal regulators for emergency use authorization of its omicron-targeting coronavirus booster shot for kids and teens. But first:

Newly-pregnant women hear the word “heartbeat” all the time

A “heartbeat” doesn’t exist early in pregnancy, abortion rights advocates and some Democrats argue as they combat a spate of abortion bans pegged to embryonic cardiac activity.

The heated debate was reignited last week, when Stacey Abrams told an audience “there is no such thing as a heartbeat at six weeks.”

“It is a manufactured sound designed to convince people that men have the right to take control of a woman's body,” said Abrams, a Democrat who is running for governor of Georgia.

Antiabortion lawmakers and groups quickly denounced Abrams and the furious back and forth highlighted how in the aftermath of the Supreme Court overturning Roe v. Wade, the battle over abortion will be fought word for word with precise definitions squaring off against popular understanding. Doctors say the sound heard during an early pregnancy ultrasound is a precursor to a heartbeat, not a heartbeat itself, whose sound is created by the cardiac valves opening and closing — something that can't be heard until closer to 10 weeks.

But for women going through pregnancy, that’s not the message they get on popular pregnancy websites or even in their own doctor's office. It’s common for OB/GYNs to check for a “heartbeat” on the first prenatal visit — and for women to experience an immense feeling of relief when a fluttering sound is heard. Consider this language from leading pregnancy websites describing embryonic development at six weeks:

  • TheBump.com: “Baby’s heart is typically beating away by six weeks.”
  • Whattoexpect.com: “Your baby’s heart has started to beat sometime between week 5 and now.”
  • BabyCenter.com: “Your baby’s heart isn’t fully developed, but cells in the heart tube have started beating fast, around 160 times a minute. You may hear the sound this week if you have an early ultrasound.”
  • Johns Hopkins places it even earlier, saying on its website that “the heart is beating” by the end of four weeks.

Government-backed websites in other countries also refer to a heartbeat by six weeks:

  • The U.K.’s National Health Service: “The heart can sometimes be seen beating on a vaginal ultrasound scan at this stage.”
  • Pregnancy, Birth and Baby, a website backed by the Australian government: “If you have an ultrasound in the sixth week, you may be able to see the baby’s heart beating.”
  • Public Health Agency of Canada: “The tissues that will form the heart begin to beat. The heartbeat can be detected with ultrasound at around 6 weeks of pregnancy.”

Even Planned Parenthood’s website until recently described a six-week embryo as having “a very basic beating heart and circulatory system develop.” 

As National Review’s John McCormack recently noted, the organization has since changed the language, which now reads: “A part of the embryo starts to show cardiac activity. It sounds like a heartbeat on an ultrasound, but it’s not a fully-formed heart — it’s the earliest stage of the heart developing.”

Web archives indicate the edits took place sometime after July 25 — a time of intense national focus on conservative states banning abortions, sometimes as soon as a “heartbeat” is detected.

Planned Parenthood tacitly acknowledged it made the edits, saying “fetal heartbeat” is a term being used to stigmatize abortion and justify early bans.

  • “As anti-abortion lawmakers and activists seeking to control people’s health care decisions continue to peddle misinformation and even codify medical inaccuracies into law, it’s critical that people get unbiased information from actual experts, like health care providers and educators.” Julia Bennett, digital education and learning strategy at Planned Parenthood Federation of America, said in a statement in response to questions from The Health 202.
  • Bennett also said Planned Parenthood's website is regularly updated “to ensure that information is medically accurate, reflects the latest science and is accessible to learners.”
The science

So does a 6-week-old embryo have a heartbeat? Medical professionals note a distinction between the sound heard early in pregnancy compared with later further development of the heart.

Nisha Verma, a member of the American College of Obstetricians and Gynecologists (ACOG), which supports abortion rights, puts it this way:

A heartbeat is the sound created by the opening and closing of cardiac valves. But what people think of as a heartbeat in early pregnancy is actually created by electric impulses that are captured by an ultrasound machine and translated by the machine into the sound of a heartbeat — there are no cardiac valves, so there is no sound of them opening and closing.

Some journalists have also made this point, including The Post’s Fact Checker Glenn Kessler:

The debate

But the widespread dismissal of the word “heartbeat” has drawn an angry response from the antiabortion side. Writers of the original “heartbeat” bills intentionally deployed the word to evoke an emotional response and help humanize an embryo or fetus early in development, as a way of trying to persuade more Americans to oppose abortion.

They contend the technicalities miss their broader point: Cardiac activity in an embryo indicates it’s on its way to becoming a fully formed baby. They want to force abortion rights supporters to acknowledge that an abortion, even one that takes place very early in pregnancy, means ending that fluttering evidence of life.

And, as some noted, doctors don’t use such technical language when they’re talking to patients — when the word “heartbeat” is used in the context of early pregnancy, most women understand what it’s referring to.

Marjorie Dannenfelser, president of SBA Pro-Life America:

Alexandra DeSanctis Marr, a fellow with the Ethics and Public Policy Center:

ACOG’s Verma acknowledged that she and other physicians use the word “heartbeat” with their newly pregnant patients — and believes it’s perfectly fine to do so. She compared it to using the word “stomach bug” to refer to what is medically known as gastroenteritis.

“That is language they connect with, they understand,” Verma said. “It doesn’t have to be medically precise.”

Verma said even if abortion bans used more medically precise language — perhaps if they said “cardiac activity” instead of “heartbeat” — that wouldn’t change ACOG’s opposition to such bans. But she takes umbrage with how abortion foes have used the term “heartbeat” in the heated debate.

“Politicians are using this language to elicit an emotional response in people,” she said.

Readers help us

We want to hear from you: What does aging mean to you?  The Post is working on a special section next month on “aging well,” but how do you define that phrase? What qualifies as aging well vs. aging poorly? Tell us here.

Poll check

Voters divided amid intense fight for control of Congress, poll finds

With just six weeks to go until the midterm elections, Republicans and Democrats are in a neck-and-neck race for control over Congress this November, our colleagues Dan Balz, Emily Guskin and Scott Clement report.

Two-thirds of voters see this election as more important than past midterm campaigns as the divided nation continues to grapple with soaring consumer prices, sky-high interest rates and the Supreme Court decision overturning Roe v. Wade, a new Washington Post-ABC News poll found.

Where they stand: Americans say the economy, inflation and abortion are three of the most important issues in their vote. When asked which party they trust to handle specific issues, voters gave Republicans a 17-point and 18-point lead on managing the economy and inflation respectively, and gave Democrats a 17-point advantage on handling abortion.

Speaking of abortion … when the positions of the two parties are weighed on the issue, 50 percent of Americans said Republicans favor too many restrictions, while 29 percent said the GOP’s posture is about right and 10 percent said Republicans favor too much access to abortion. About 3 in 10 said Democrats favor too much access, while 45 percent said Democrats’ positions are about right and 13 percent said Democrats favor too many restrictions.

Check out more about what's important to voters this November:

In the courts

Democrats weigh in on upcoming patients' rights case

First in The Health 202: More than a dozen House and Senate leaders submitted an amicus brief with the Supreme Court on Friday in support of the plaintiffs of Health and Hospital Corp. of Marion County v. Talevski.

In the brief, the Democratic lawmakers argue that beneficiaries of federal spending programs like Medicaid should be able to continue using a private enforcement mechanism granted under Section 1983 of the U.S. code to sue government-funded facilities if their civil rights have been violated.

Should that mechanism be eliminated, the lawmakers contend that federal-state programs would be left with “limited oversight” due to insufficient resources and individuals without recourse should states neglect their care.

Catch up quick: The case concerns Gorgi Talevski, a now-deceased dementia patient whose family alleges was abused while living at a nursing home operated by the Health and Hospital Corp. of Marion County, Ind. Because the adult care home was publicly owned, the patient’s family argued it could sue the corporation for allegedly violating Talevski’s rights under the Federal Nursing Home Reform Act — but the corporation behind the nursing home disagreed, appealing several lower court rulings that sided with the Talevskis. The high court will hear oral arguments in the case in November.

Daybook

The House and Senate are both in this week. Here’s what we’re watching over the next few days:

Tuesday: The House Rules Committee will meet to discuss the Mental Health Matters Act and other pieces of legislation.

Thursday: The House Committee on Oversight and Reform will hold a hearing to examine the threat of a national abortion ban to patients; the House Veterans’ Affairs Committee will discuss innovative approaches to veteran suicide prevention.

In other health news

  • Rep. Val Demings (D-Fla.), chair of the House Homeland Security Subcommittee on Emergency Preparedness, Response, and Recovery, led a congressional delegation to Puerto Rico to oversee the Federal Emergency Management Agency’s response to Hurricane Fiona.
  • On Friday an Arizona judge revived a ban on abortion that dates back to the mid-19th century, lifting a decades-old injunction that means the procedure is effectively illegal in the state at all times except when a pregnant woman’s life is at risk, our colleague Andrew Jeong writes.
  • Moderna has asked federal regulators for emergency use authorization of its omicron-targeting coronavirus booster shot for children age 6 to 11 and adolescents age 12 to 17 years, Reuters reports.

Health reads

Seniors are stuck home alone as health aides flee for higher-paying jobs (By Christopher Rowland | The Washington Post)

Is the pandemic over? Pre-covid activities Americans are (and are not) resuming. (By Marc Fisher and Taylor Telford | The Washington Post)

‘Other Places in the Country Didn’t Do This’: How One California Town Survived Covid Better Than the Rest (By Victoria Colliver | Politico)

Sugar rush

Thanks for reading! See y'all tomorrow.

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