A Testing Time Part 2: Modern Pregnancy Tests 

A Testing Time Part 2: Modern Pregnancy Tests 

by Margaret Sparrow

Human Chorionic Gonadotropin (hCG), is a pretty special hormone excreted by the placenta to maintain a pregnancy. It can be detected in blood at low levels and also less sensitively (but more conveniently) in urine, especially that first morning sample when urine is more concentrated. There are two subunits (alpha and beta) and it is the beta subunit which is used in most pregnancy tests.

Immunologic tests are so called because hCG is an antigen which can trigger the production of antibodies. It is these antigen-antibody reactions which are the basis of various tests. Some tests depend on the detection of antigen, others the antibodies.

The door to immunologic pregnancy tests was opened in 1960 when two Swedish researchers (Wide and Gemzell), published the results of a technique called haemagglutination inhibition which detected antibodies to hCG. It was done in a test tube using red blood cells from a sheep which clumped together (agglutinated) in a special pattern when urine containing hCG was added. It took 60-90 minutes to read and was very accurate when taken one week after a missed period. Amazingly, Leif Wide made this discovery when he was a medical student studying under Dr Gemzell. As early as 1961 the method was introduced into Uppsala University Hospital. In 1962 a similar test used a drop of urine on a slide. Instead of red blood cells, latex particles were used to demonstrate the clumping pattern.

Initially tests were done in laboratories, then in doctors’ surgeries, then eventually in the privacy of home.  Organon in Holland was the first to patent a home pregnancy test kit in 1969 and during the 70s these were gradually introduced elsewhere. The first home tests were pretty unreliable and one looked more like a child’s chemistry set with its vial of purified water, an angled mirror, a test tube, an eye dropper and red blood cells taken from a sheep.  It took until 1971 to have home tests available over the counter in Britain, Europe and Canada, until 1977 in USA and later still in NZ in 1980. 

During the 70s and 80s many innovations were marketed with the aim of making the tests more user friendly – simpler, less expensive, more convenient, and more accurate earlier in the pregnancy. A giant leap forward was the use of coloured dyes which bonded to the antigen or antibody and travelled to the test and control zones which appeared like magic as coloured lines. Instead of test tubes or slides we were enticed by elegant test kits or a strip or wand to hold in the stream of urine.

Another significant advance was the introduction of quantitative tests which measure the level of hCG in International Units/ml. Quantitative tests have many other uses but as far as abortion is concerned they are very useful in determining whether the abortion has been successful.  Levels will remain higher than expected if there is an incomplete abortion with pregnancy tissue remaining or if there is a continuing pregnancy. Women are advised to have a post-abortion check in about 2 weeks. At this time a free blood test is available through a laboratory or a low sensitivity test can now be provided to do at home at a reasonable price. This test will only be positive when the level is over 1000 International Units/ml. It is very useful now that early medication abortion can be provided by telemedicine. (Thanks to the law changes!)

Compared to the rapid uptake of rapid antigen tests for Covid, why did it take so long for pregnancy self-testing to become available? The problem was not the tests but judgmental attitudes. Could women really be trusted to carry out instructions? Wasn’t it better to have the diagnosis from a doctor? What about false negatives and false positives? Women would not understand about reliability. What about counselling? What about support if the result was not the desired result? What about privacy? Who should provide the tests – doctors, laboratories, pharmacies, family planning clinics, mail order? And so on….

 It was a coincidence that the introduction of pregnancy testing came at the same time as the sexual revolution of the 60s to 80s.  This was a time of great social change which came to be associated with permissiveness (free love), women’s liberation, abortion law reform, gay rights and the erosion of medical authority. Self-testing gave women greater autonomy and contributed to a realignment of the power dynamics between doctors and patients. The humble pregnancy test sits alongside the birth control pill introduced in NZ in 1961 as a significant agent of change.

Dame Margaret Sparrow was a medical doctor, abortion provider, and president of ALRANZ for many years.

Pro-choice Motherhood

Pro-choice Motherhood

by Julie Fairey

When I first contemplated becoming a mother I worried. I worried about all sorts of things; would I be any good at it, would I hate it, would I be able to get pregnant at all. And I worried that it would change my attitude to abortion.

You see my journey to supporting the right to abortion, that essential medical care that needs to be available to anyone with a uterus, was a bit fraught. I had gone to a Catholic school where my classmates wore the little feet badges on their lapels. It wasn’t until I was about 16 that I learned anti-abortion was not a universally held view. I evolved my position quite slowly from that shocking first time overhearing some other girls talking about abortion as if it wasn’t a Big Bad Thing. By the time I was in my late twenties, looking to become pregnant myself, I had gone through “well I support it but only up to a certain point” to “I guess I support it for others but I could never do that” to “Ok this is a required medical procedure that anyone who needs it should be able to access”.

But the nagging sense from those early years remained, based on being told I’d feel differently once I had children of my own. So I worried, that the experience of pregnancy, childbirth and become a mother would unmoor me from my firmly held pro-choice views.

I could not have been more wrong.

I’ve been pregnant four times. The first ended in an early miscarriage; not physically traumatic luckily for me. When I told a colleague about it they remarked jovially that was just a missed period, and while that was a heartless way to put it, they were correct that what I miscarried did not look or feel to me like a baby at all.

My three subsequent pregnancies have resulted in three live births, three children I parent today as I write this (from Covid isolation!)

And each of those experiences, in particular the pregnancies, have made me more and more pro-choice. All three included bad morning sickness (not just in the morning) and loss of weight in the first trimester. Fair to say I am not one of those people who blooms in pregnancy, even in the second and third trimesters. I find it a great trial; one I’m prepared to undertake because of the likely outcome, but something no one should have to do unless they choose to.

And my final pregnancy produced a particular challenge that reinforced my views, as I went into early labour at 30 weeks (that’s at the three quarters mark for those who don’t think in gestational timeframes). While the outcome was positive for both of us, there was several months of hospital time for my child, which meant a lot of hospital time for me, and the first year was filled with beeping alarms and various tests. I was happy to do all of this because I chose it. I could not imagine going through all of that when I didn’t want to.

If I get pregnant again, I will need an abortion. My last experience, at 38, was much harder than the previous ones, even putting aside the early end. I’m just too old to do it again; others won’t be at this age but for me, for my body, I know that I am. So again, my experience becoming and being a mother, adding to my family, has strengthened my conviction that abortion is absolutely necessary, at the choice of the pregnant person.

Becoming a mother wasn’t the threat to my pro-choice views that I thought it might be. Instead I’ve been a mother speaking up for choice, in case others shared the same illusion I used to that motherhood and supporting abortion rights were incompatible.

Being a parent should be a choice you can make freely and joyfully, not an inevitability you begrudgingly have to accept. Long may we continue towards making that a reality for all.

This blog is part of the #40DaysForFacts campaign. Follow on social media. @alranztweets / https://www.facebook.com/ALRANZ

Missouri Says You Must Die

Missouri Says You Must Die

by Terry Bellamak

The state of Missouri says if you have an ectopic pregnancy you must die.

Missouri House Bill 2810, if it passes, would make aborting an ectopic pregnancy a felony. The health practitioners who do so would be felons after conviction. So would the pregnant person.

An ectopic pregnancy happens when an egg is fertilised outside the uterus, usually in the fallopian tube, and fails to implant in the uterus. The fetus cannot survive there, and it cannot move to the uterus.

If the patient receives treatment, usually surgery, to remove the fetus, they will survive and recover. If not, the fetus will burst the fallopian tube and the patient will haemorrhage and die.

This being Missouri, it is possible that this travesty, this death sentence for unlucky people with ectopic pregnancies, will pass and be signed into law.

Legislators are again attempting to practice medicine without a licence, and also without a clue. In the past, US anti-abortion legislators have demanded that, in case of ectopic pregnancy, doctors move the fetus to the uterus. But there is no such procedure. There is no treatment for ectopic pregnancy that saves the fetus, except in anti-abortion legislators’ imaginations. Either the fetus dies, or both fetus and pregnant person die.

How would this even work in practice? You’d get a diagnosis in Missouri and then … what? Rush to cross state lines to get treatment? That might not be completely impossible if you live near Illinois or Kansas. But what about folks in rural areas far from an interstate highway? Or folks with no car?

This is not normal behaviour for responsible adult legislators. This senseless bill demonstrates how far outside the mainstream these folks are, how the realities of science and medicine just pass them by.

If anyone doubts that the foundation of the anti-abortion movement is misogyny and the patriarchal desire to punish having sex without intending to procreate, look no farther than an anti-choice state that would pass a law requiring pregnant people to die or face prison.

A Testing Time Part 1: Old Fashioned Pregnancy Tests

A Testing Time Part 1: Old Fashioned Pregnancy Tests

by Margaret Sparrow

Last week I helped a friend do her first Rapid Antigen Test for Covid and we marvelled at the scientific progress and the rapid commercial development that made this possible. That got me thinking about the slow progress over the years that led eventually to the development of modern pregnancy tests which are now an essential component of safe abortion services.

Since antiquity the diagnosis of pregnancy has been attempted in a variety of ways. In ancient Egypt women soaked wheat or barley seeds in urine and if they germinated that indicated a pregnancy. A more dubious method was described by Hippocrates. The woman placed a small onion in her vagina overnight and if she was pregnant her breath would still smell sweet in the morning because a pregnancy would somehow stop the odour from spreading through her body. This practice, known as the garlic test was apparently widespread in France until the 18th Century.

Traditionally women have been perfectly capable of diagnosing a pregnancy without the use of any test – a missed menstrual period, a slight elevation of temperature and as the pregnancy progresses feelings of nausea and breast changes.

Pregnancy testing has evolved during the past half century from a time consuming complicated laboratory procedure using expensive test animals into a rapid, relatively inexpensive, reliable and convenient technique.

The basis for most pregnancy tests involves the detection (in either blood or urine) of human chorionic gonadotropin or hCG which is a glycoprotein hormone produced by the placenta during pregnancy. In normal pregnancy the production of hCG begins within 48 hours after implantation, ascends to a peak between 50 and 90 days then falls to a lower level throughout the pregnancy and  ceases soon after delivery.

In 1927 two German gynaecologists introduced the first biological test. They observed that urine from pregnant women injected into several immature female mice caused changes in the ovaries. After 4-5 days of repeated injections the test animals were killed and the ovaries examined for evidence of ovulation. The pregnancy hormones in the urine had stimulated the pituitary gland to produce ovulation hormones. This was even before hCG had been discovered.

Other biological tests were introduced. In 1932 Friedmann did the same thing to rabbits. “The rabbit died” became a euphemism for pregnancy.

In the 1930s and 1940s frogs became the ‘go to’ laboratory animals with the advantage that the reporting time was lessened and the frogs did not have to be killed. In some tests a male frog was injected under the skin with pregnant urine and within 18 hours a positive test was indicated by frog spawn and the presence of sperm under the microscope. In other tests a female frog was used and after an injection of pregnant urine the frog ovulated and the presence of eggs floating in the tank indicated a positive test. A disadvantage was that the woman usually had to be several weeks past the missed period for these tests to be reliable.

A refinement came with the use of toads. A small amount of urine was injected into the dorsal lymph sack of a male toad. Pregnancy hormones would cause the toad to spawn and sperm could be detected under a microscope within 3 hours. The test was not painful and the animal could be used for another test two weeks later.

A disadvantage of using frogs and toads was that they had to be kept in a temperature controlled environment and it was expensive to meet their fastidious requirements. In 1951 an enterprising scientist at the University of Kiel in Germany developed a reliable test using less demanding earthworms but somehow this never caught on. Biological tests were still being used in the 1960s but that was soon to change. And that is another story.

Oh and by the way my friend tested negative.

Dame Margaret Sparrow was a medical doctor, abortion provider, and president of ALRANZ for many years.

Lack of Abortion Care Can Kill

Lack of Abortion Care Can Kill

by Terry Bellamak

One of the most transparently ludicrous claims anti-abortion types have made in recent years is that ‘abortion is never medically necessary.’

Tell that to Savita Halappanavar, who died of sepsis after being denied abortion care in Ireland. Tell it to Valentina Miluzzo, who died of sepsis after being denied abortion care in Italy. Tell it to Agnieska T and the other unnamed woman who died of sepsis after being denied abortion care in Poland.

None of them had to die. All of them had treatable medical conditions. But the treatment required the abortion of their planned, wanted pregnancies.

Restricting abortion care leads inevitably to pregnant people dying. When doctors risk imprisonment for allowing an abortion, they are incentivised to wait until the patient is close to death so that authorities don’t challenge their decision. 

But even less stringent restrictions can put pregnant people in danger when abortion is so stigmatised that no one dares talk about it.

Few people know about it, but New Zealand has had its own experience with unnecessary death for lack of a termination.

Back in 2006, before our abortion law was reformed, the Health and Disability Commissioner (‘HDC’) commenced an investigation into the death of Ms B in 2004.

Ms B had a heart condition called aortic stenosis. This means her blood flow from her heart to her body’s main artery, the aorta, was partially blocked. She had an aortic valve replacement in 1997, and recovered. In 1999 Ms B gave birth to a son.

In 2004, after seeking advice from her cardiologist and receiving the all clear, Ms B again became pregnant.

Twenty weeks into her pregnancy, Ms B’s aortic stenosis returned. When she heard the news, Ms B became tearful and said she wished she could terminate the pregnancy, but didn’t think it was possible so late in her pregnancy.

In reality, termination of Ms B’s pregnancy would have been approved almost instantly had she been able to put the question to certifying consultants. Under the Crimes Act 1961 in force at the time, termination after 20 weeks was legal to ‘save the life of the woman or girl or to prevent serious permanent injury to her physical or mental health.’

But none of the doctors involved with Ms B’s care, nor her midwife, were prepared to discuss abortion with her. The HDC report refers to their actions as ‘delicately side-stepping an awkward issue.’ Given the clarity with which Ms B expressed her desire that medical staff not ‘ me be a baby incubator and then letting me die,’ it could also be characterised as obstruction.

Ms B was hospitalised. A termination followed by valve replacement surgery could have saved her life, even at this point. But her medical team insisted she continue the pregnancy. In the end, her condition deteriorated rapidly, and both she and her baby died during emergency surgery.

What killed Ms B?

Was it the silence around abortion that made ignorance of the law (and how certifying consultants applied it) so typical? Was it a kind of preciousness on the part of Ms B’s cardiologist, obstetrician, and midwife that would not let them acknowledge Ms B’s concerns for her own life? Were they full-blown conscientious objectors? Or did their moral or professional arrogance obscure the enormity of letting a woman die in the hope of saving a foetus?

It seems clear that the reason Ms B’s medical team did not listen to her was that she was talking about abortion. If abortion had been treated as normal health care, not covered in arcane legal restrictions and sexist shame, then Ms B and her family could have pushed back more effectively. Her medical team’s indifference to Ms B’s wishes could have received appropriate condemnation well before it turned up in an HDC report.

It seems clear to me that what killed Ms B was abortion stigma.

Nowadays, after law reform, a case like this is unlikely to happen. This is not only because we have a new law, but also because the debate around law reform put a big dent in abortion stigma, and established abortion as health care that people have a right to. But as long as abortion remains ‘controversial’, the battle is not over.

The Challenge

The Challenge

by Terry Bellamak

At the second reading for the Contraception, Sterilisation, and Abortion (Safe Areas) Bill, Kieran McAnulty issued a challenge. At the end of his call, he laid it down:

“If you’re going to vote against it – fine. Get up and tell us why.”

I wonder if any will rise to the challenge.

Opposing people being able to go to work or get health care without being harassed by anti-abortion protesters is a hard position to defend.

The MPs in question might go the route of many submitters to the Health Select Committee, who ignored the bill’s obvious boundaries and used the opportunity to attack abortion itself. Not unexpected, but not a very useful strategy, considering the fight for abortion as health care has been decisively won.

The work of the Health Select Committee has left them without even the fig leaf of hand-wringing over freedom of expression. The Attorney-General has made it clear he considers the current version of the bill limits freedom of expression only to an extent that is justified in a free and democratic society.

The new definitions of ‘protected person’ and the sorts of activities that the bill prohibits are narrowly defined. All areas will be bespoke, so that they will be as small as possible to achieve their objective.

(It will take months for the Ministry of Health to finely handcraft each one, which is not ideal. The process needs to be abbreviated. But that is a rant for another day. Soon.)

It seems probable that MPs who oppose the bill will do as they did at the third reading of the Conversion Practices Prohibition Legislation Bill and not make a speech, figuratively slinking through the ‘no’ door wearing a disguise.

In a way, this is good news. It is a signal of how the frame has shifted over the past 2 years. Abortion has taken its rightful place in the mainstream. Attacking pregnant people and abortion providers is now fringe.

The ‘no’ MPs will be explaining this vote for the rest of their careers. Will they come up with some reasons? Or will they take the path of least resistance and keep schtum?

Only time will tell.