Adjusting the medical record for a pro-life practice

In this editorial, we propose the use of the term baby instead of fetus and embryo for radiological and medical reports. The latter terms put the culture of life in a defensive position. Pro-life practices can use the term baby as a matter of choice to remind the culture of medicine's fundamental premise to preserve life. We suggest the use of pro-life terminology be disseminated in medical notes of all kinds as a matter of conscience of the practitioner.

The terms embryo and fetus are defined as the young of animals in the womb or an egg. Although their primary use is for the young of viviparous (i.e., not from an egg) animals, the term embryo is even used for plants. The transition from embryo to fetus is species dependent. For the human species, according to the American Heritage Medical Dictionary and American Heritage Scientific Dictionary, this transition is eight weeks. From a purely scientific point of view, these terms must be qualified by the species type. Abnormalities of chromosome number, and the thirteen thousand single-gene traits listed in the 2006 edition of Online Mendelian Inheritance in Man are largely species specific. The obstetric ultrasound screens for abnormalities that are largely species specific. Since medicine is a field for the human species, the term human is implicit and therefore redundant. Yet there is no definition of embryo or fetus that defines them exclusively for humans. We would not venture to use the qualifier term human before the words embryo or fetus as a reminder that medicine is a field of study of and for the human species, even though this would be a more precise use of terms. Baby would suffice. Since the age of gestation is always qualified in medical records anyway, it would be an easy transition to say six-week baby in lieu of six-week embryo and thirty-week baby for thirty-week fetus. Alternatively, the word gestation could be used when documenting age. For those who prefer more technical medical terminology, the word infant could be used in place of baby, but this is more often used after delivery. Another idea is to use the English translation of the medical terms (e.g., fetus = little one; embryo = young one).

In Blessed John Paul II's Evangelium Vitae, there is a recognition of the power of ambiguous terminology:

But today, in many people's consciences, the perception of its gravity has become progressively obscured. The acceptance of abortion in the popular mind, in behavior and even in law itself, is a telling sign of an extremely dangerous crisis of the moral sense, which is becoming more and more incapable of distinguishing between good and evil, even when the fundamental right to life is at stake. Given such a grave situation, we need now more than ever to have the courage to look the truth in the eye and to call things by their proper name, without yielding to convenient compromises or to the temptation of self-deception. In this regard the reproach of the Prophet is extremely straightforward: “Woe to those who call evil good and good evil, who put darkness for light and light for darkness” (Is 5:20). Especially in the case of abortion there is a widespread use of ambiguous terminology, such as “interruption of pregnancy,” which tends to hide abortion's true nature and to attenuate its seriousness in public opinion. Perhaps this linguistic phenomenon is itself a symptom of an uneasiness of conscience. But no word has the power to change the reality of things.” (n. 58)

The terms fetus and embryo are legitimate, but the practitioner who recognizes the seriousness of the culture of the death can take the some steps in clarifying terms to influence the conscience of the culture back toward reality.

Another argument for the use of baby in medical terminology, is the statistical fact that most pregnancies in the world are desired or accepted, with the minority ending in abortions (Brind et al. 1996; Finer and Zolna 2011). Families have access to their records. Why would they not want to keep a copy of an obstetric report in a photo album as they would an ultrasound image of their baby in utero? So from a purely business point of view, an obstetric report that uses the term baby instead of fetus is a good idea. To do otherwise may impose ambivalence in the medical record, if not derision, to the parents. Most people simply consider their pregnancy to be about a baby and not an embryo or fetus. There are multiple commercial enterprises and hospital marketing schemes that center on the baby in gestation, never a fetus. The practices of midwives may also prefer this terminology. Why produce a medical document at variance with families and with businesses that center on procreativity? Could a like-minded philosophy of medical records actually result in more business for hospitals and practitioners? In addition, the next generation of babies will likely seek pediatricians and doctors recommended by their parents.

One could, at this point, say that for those pregnancies that are unwelcomed, the use of the term baby would be unwelcomed also. This may be so, but we are not suggesting imposing this terminology, but simply proposing it as a matter of choice. We do not advocate the regulation of this terminology via accreditation and CME organizations, peer-review publications, or government-mandated medical insurance reimbursement regulations, despite the logic we present for its use. This would be a form of medical tyranny and far removed from the freedom of conscience rooted in the medical profession.

There are more arguments for this pro-life terminology. The detrimental effects of abortion on women have been well documented (Sykes et al. 1993; Ring-Cassidy and Gentiles 2002, 255; Jones and Kooistra 2011). These are physical and emotional. Regardless of any controversy on the existence of the detrimental effects, a practitioner who believes they exist may want to incorporate a pro-health message into their medical records with a pro-life tone. We would like to remind these practitioners that there is a real choice in how they document a pregnancy.

Finally, many practitioners use the terms male and female in their medical notes. One of these authors has preferred the use of man or woman and boy or girl. It is not unusual for some adult-care practitioners to use phrases such as “40-year-old pleasant gentleman/lady well known to me” in their medical history. This personal and informal nature of the medical record does not in any way take away from the professional and scientific nature of the medical record. Many obstetricians, neonatologists, and perinatologists consider themselves as doctor of both mother and baby-in-utero. In discussing the pregnancy with a mother, it is not uncommon to refer to the fetus as your baby or child. Why not then in the report?

Sample Ultrasound Templates

The following are obstetric ultrasound report templates used in our practice. They are intended as an example or practical suggestion of the choices that can be made by practitioners in this field who see the value in this approach and not intended to be written in stone. For example, the use of the accustomed abbreviation FHM for fetal heart motion instead for the baby heart rate used may be more appropriate for familiarity. These are available for reference or download at http://www.tepeyacfamilycenter.com/ultrasound.htm.

First trimester ultrasound report

FINDINGS:

There is a __week and __ day intrauterine gestation based on an averaged __ cm CRL (Hadlock). There is baby heart motion at __ BPM (Alternate: Cardiac activity is at __ BPM). Based on today's measurement, the EDD is ______. Based on the LMP, the gestational age is __weeks and __ days and the EDD is ______.

The uterus measures __ cm x __ cm x __ cm. The cervix measures __ cm and is closed. There is no bleed. There are no fibroids, free fluid, or adnexal masses. The right ovary measures __ cm x __cm x __ cm. The left ovary measures __ cm x __cm x __ cm. Both are normal.

IMPRESSION: Normal __ week and __ day intrauterine gestation.

Second trimester ultrasound report

SUMMARY

Presentation: Vertex, single baby. Movement present.

Placenta: Anterior, Grade

Amniotic Fluid Volume: Normal Index cm

Baby Heart Rate: BPM, regular

Table

Baby measurements (Hadlock) (cm)	Age (weeks)	Pctl
Biparietal diameter:	d ± d
Head circumference:	d ± d
Abdominal circ:	d ± d
Femur length:	d ± d

Ratios

Table

FL/AC	% (20–24%, >21 weeks)
FL/BPD	% (71–87%, >23 weeks)
FL/HC	% ( - %, weeks d)
HC/AC	( -, weeks d)

GESTATIONAL AGE

Table

From today's measurements:	weeks d	EDD
From the LMP:	weeks d	EDD
Weight: (Hadlock)	grams	lb oz percentile ( )

BABY ANATOMY

Table

Lateral ventricular level:	Normal	Cerebellum:	Normal
BPD level:	Normal	Spine:	Normal
4 extremities:	Normal	Stomach:	Normal
Heart-4 chambers:	Normal	Outflow tract:	Normal
Profile:	Normal	Nose/lips:	Normal
Diaphragm:	Normal	Abdominal wall:	Normal
3-Vessel cord:	Normal	Cord insertion:	Normal
Bladder:	Normal	Kidneys:	Normal

MATERNAL ANATOMY

Cervical Length: cm.

COMMENTS: Normal obstetrical ultrasound with normal anatomical screen and concordant dates.

Conclusion

The bias against the culture of life may be effectively countered with use of the term baby in lieu of fetus and embryo. The use of the term is legitimate and within the constraints of medical standards and should be used as a matter of conscience. It is also more accurate, more pro-life, more pro-health, and more pro-family. It can promote a practice. We encourage its use or other pro-life terminology for the medical record, particularly before the terms fetus and embryo become embedded and even unchangeable in electronic medical record products.

Additional information

Notes on contributors

Azar P. Dagher

Azar P. Dagher is a pro bono radiology consultant for Tepeyac Family Center, LLC in Fairfax Virginia, a non-profit pro-life Obstetrics and Gynecological medical practice that provides state-of-the-art medical care to women with and without medical insurance.

Marie A. Anderson

Karen Cassidy and Marie A. Anderson are full-time employees of the same clinic and also affiliated with the fund raising organization, Divine Mercy Care, a 501(c)(3), not-for-profit, faith-based organization also located in Fairfax.