Maternal-fetal surgery is not an alternative to abortion care

Every day, pregnant people across the United States get the news that the futures they imagined for their babies are at risk due to a fetal condition. It may be something relatively minor, like a small benign growth on a lung, or something major, like a life-threatening heart or developmental problem.

Some of these problems can be mediated by maternal-fetal surgery. But these procedures are not, as some have claimed, an alternative to abortion care.

Modern maternal-fetal surgery was developed in the 1980s at the University of California San Francisco. Since then, it has been used to repair physical problems and save lives. In this area of prenatal care, a surgeon may make a small incision in the pregnant person’s abdomen and use fiber-optic telescopes and specialized instruments to operate on the fetus or the placenta. When a more invasive approach is required, a larger incision is made to open the womb and expose the fetus’s body. Once the operation is done, the incisions are closed and the pregnancy continues.

Maternal-fetal surgery can be used to treat a range of conditions, from congenital diaphragmatic hernia to spina bifida and rare complications of twin pregnancies.

Since the Supreme Court overturned federal protection for abortion in its Dobbs v. Jackson Women’s Health Organization ruling, anti-abortion legislators have suggested that maternal-fetal surgery has rendered abortion care unnecessary when it comes to fetal conditions. In recent congressional debate on the Women’s Health Protection Act of 2022, for example, U.S. Rep. Cathy McMorris Rodgers (R-Wash.) closed her argument to reject abortion by saying that doctors “can perform a prenatal surgery on 20 different organs,” so abortion “is not following the science. It doesn’t reflect the latest research or modern medicine.”

That is wrong.

As nurses who specialize in the care of pregnant people and families who receive diagnoses of severe fetal conditions, we know firsthand that prenatal surgeries can save lives. But maternal-fetal surgery is not a panacea and should not be considered an alternative to abortion care.

Only about five fetal organ systems are amenable to surgical intervention, and most procedures cannot cure fetal conditions, only mitigate their effects. It has taken decades to develop a handful of these high-risk treatments and the specialty centers needed to implement them. Clinical trials are extremely expensive and limited by small numbers of eligible patients — the clinical trial of maternal-fetal surgery for spina bifida took eight years and cost $22.5 million. It will take years to meaningfully expand surgical approaches for fetal conditions.

Even if prenatal surgery is available for a given diagnosis, those who need it may not meet the fetal and maternal eligibility criteria, or may not be eligible for it due to common problems such as obesity, poorly controlled diabetes, or a history of preterm birth. Pregnant people can also be ineligible for such procedures if they cannot travel and stay close to a specialized care center or arrange for childcare during what can be a months-long recovery process. Eligibility criteria are designed to keep patients safe, but they can also exclude many families and disproportionately affect socioeconomically disadvantaged individuals. These disadvantages are also more likely to burden people of color, which may be why most studies of maternal-fetal surgery have lacked racial and ethnic diversity.

And just because surgery is possible doesn’t mean people want to undergo it. These procedures carry significant risks that include miscarriage, preterm birth, and maternal illness or even death. Although less-invasive approaches, known as fetoscopic surgery, have decreased maternal complications, some procedures still require a large incision into the uterus, which puts the pregnant person at significant risk for complications in all future pregnancies.

In addition, most children who receive prenatal surgery still require further treatments and hospitalizations throughout their lives, exacting a significant medical, psychological, and economic toll.

In other words, it is understandable that many people decide against prenatal surgery because they do not believe that the benefits outweigh the risks to themselves and their families.

Every individual and every family are different. Some people who learn their fetus has absent or non-functioning kidneys choose abortion care in the hope of protecting their baby from suffering after birth. Some choose perinatal palliative care in the hope of a peaceful death in the loving arms of family. And some choose surgery, before and/or after birth, in the hope of giving their baby a chance at a longer life. The important part is that they choose what is best for them and their family.

McMorris Rodgers is not the only anti-abortion leader spreading misinformation about the field of maternal-fetal surgery in order to further their agendas. Lindsey Graham’s national abortion bill makes the false claim that the use of fetal anesthesia during some prenatal procedures proves that a fetus has the capacity to experience pain. Similarly, after the Dobbs decision was made public, the House Energy and Commerce Committee held a hearing in which Rep. Gary Palmer (R-Ala.) tried to use the “Hand of Hope” image from a maternal-fetal surgery case to further a discredited theory that the fetus grasped the surgeon’s finger. However, the surgeon has publicly stated that the fetus was anesthetized, could not move, and did not grasp his finger. A video of the House hearing published by Forbes Breaking News has been liked by nearly 7,000 people whose passionate comments about the “life-saving surgery” show just how misleading the use of these cases can be — prenatal spina bifida repair is not a life-saving surgery.

Other legislators, journalists, and faith-based organizations will continue spreading misinformation about maternal-fetal surgery in their attempts to dismantle abortion care. But the consensus from the experts is clear: the Society for Maternal-Fetal Medicine and the American Academy of Pediatrics released public statements clearly identifying the importance of abortion as part of comprehensive, evidence-based reproductive health care services.

Maternal-fetal surgery is a growing and important field that can provide hope for some people whose pregnancies are complicated by fetal conditions. But it can never replace the option for abortion, despite the misinformation being spread by anti-abortion leaders, and it does not provide supporting evidence for attacks on abortion care. To suggest otherwise is inaccurate, dangerous, and insensitive to those who experience a pregnancy complicated by a severe fetal condition.

Abigail Wilpers is a research assistant professor at the University of Pennsylvania School of Nursing. Kristen Gosnell is the fetal cardiology nurse coordinator at the University of California San Francisco.