League of Women Voters of Milwaukee County

Public Issues Form November 13, 2023

Fact or Fiction:  Dispelling Abortion Care Myths 

Resource List

Presentations:
Tia Reiner PDF

Dr. Allie Linton PDF

Prochoice Washington PowerPoint outlines preferred terms when discussing a topic. 

The First Six Weeks of Pregnancy

 

By Alisha Haridasani Gupta

Published April 30, 2024 in the New York Times

Updated May 1, 2024, 10:49 a.m. ET

By the time a woman is considered six weeks pregnant, she would have had two weeks, at most, to realize it.

That’s because the gestational age of a fetus is counted not from the moment that sperm fertilizes an egg or from the moment you have a positive pregnancy test, but weeks earlier, on the first day of the previous menstrual cycle. This means that just two weeks after a missed period, a woman is six weeks pregnant, said Dr. Dawnette Lewis, director of Northwell Health’s Center for Maternal Health in New York and a maternal fetal medicine specialist.

That’s if someone has a typical menstrual cycle, which lasts about four weeks. But several factors — including stress, perimenopause and certain health conditions — can make the menstrual cycle so unpredictable that it could take longer than six weeks for someone to realize they might be pregnant.

“People come in and they’re like, ‘I’ve always had irregular periods and I just thought I was gaining weight’ and lo and behold, they are pregnant,” said Dr. Shruthi Mahalingaiah, a fertility doctor at Massachusetts General Hospital and professor of environmental and reproductive health at Harvard T.H. Chan School of Public Health.

 

The question of how soon it’s possible to detect and confirm a pregnancy has come into focus as new abortion restrictions have been enacted in 21 states, including in Florida, where a ban on most abortions after six weeks took effect May 1. Florida is the third state to ban abortions at this point in pregnancy.

We asked experts to explain how the first six weeks of pregnancy unfold, and what factors might make a pregnancy hard to detect.

Weeks 1 to 2:

If an egg isn’t fertilized, the uterus sheds its lining. The first day of bleeding is considered Day 1 of a menstrual cycle. Typically, this bleeding lasts between three and seven days, Dr. Lewis said.

 

As the bleeding subsides, estrogen and another hormone, called follicle stimulating hormone or F.S.H., begin to rise. Together, they nudge the ovaries to produce a mature egg and create a fresh uterine lining for a potential fertilized egg.

At or around Day 14 of a cycle, the ovary would typically release an egg. If an egg is released and sperm is present, fertilization can occur in the fallopian tube a day or two after ovulation.

 

Weeks 3 to 4:

If an egg has been fertilized, it becomes an embryo, which typically travels into the uterus and implants itself on the lining. This can take around a week or more, said Dr. Michael Belmonte, an obstetrician-gynecologist and fellow at the American College of Obstetricians and Gynecologists.

Once this happens, the body begins producing a hormone called human chorionic gonadotropin, also known as the pregnancy hormone. This tells the ovaries to hold off producing another egg.

At implantation, a woman would technically be considered about four weeks pregnant, based on how gestational age is calculated. But she would likely not have any physical symptoms of pregnancy, like nausea or fatigue. HCG levels may also be too low to be detected by an at-home pregnancy test; it is only detectable about a week after implantation, Dr. Belmonte said.

It is impossible to know if the embryo will keep developing normally or whether it even implanted in the uterus, said Dr. Mahalingaiah. About half of fertilized embryos do not end up implanting at all. In an estimated 2 percent of pregnancies, the embryo implants elsewhere, like the fallopian tube. This is known as an ectopic pregnancy and can be life-threatening, requiring medical or surgical intervention.

Week 5:

If you are pregnant, this is, roughly speaking, the earliest that you might be able to detect a pregnancy at home. If you have a regular four-week cycle, have missed your period and think you might be pregnant, you might take a urine test at home at the tail end of this week, which would pick up elevated hCG levels.

 

But there are several reasons to expect a period to be irregular and not think to take a pregnancy test at this point. Polycystic ovarian syndrome, which affects as many as five million women in the United States, can disrupt ovulation and cause irregular menstrual cycles, as can other endocrine disorders like thyroid disease. Significant amounts of stress in the first two weeks of your cycle can delay ovulation or menstruation, said Dr. Mahalingaiah, as can a bad case of the flu. Those who are in perimenopause, the transition to menopause, experience increasingly irregular ovulation as they approach the end of their reproductive years. This means that their menstrual cycles can change in length every month, often by several weeks.

Even if you did suspect you were pregnant around week 5, a health care provider would not be able use an ultrasound to confirm that a pregnancy is viable, because there would be no fetal cardiac activity yet. The pregnancy may also turn out to have been what is known as a biochemical pregnancy, Dr. Mahalingaiah said. When this happens, someone might test positive on an early home pregnancy test, but the fetus doesn’t develop further. This results in a pregnancy loss that simply looks like a late period. Some research suggests an estimated 22 percent of pregnancies end this way.

Week 6:

This is approximately when an ultrasound could pick up fetal cardiac activity, which can sound like a heartbeat. Some states require an ultrasound before a woman can obtain an abortion, including a medication abortion. Florida requires two in-person visits, 24 hours apart, including an ultrasound. The new law also prohibits telehealth providers from prescribing medication to end a pregnancy.

That timing, Dr. Belmonte said, leaves women with “a very small window” in which to confirm a pregnancy and obtain an abortion.

 

Background Information 

CDC Pregnancy National Center for Health Statistics 2010-19: 
During the data collection time period US pregnancy data showed significant decrease in unintended pregnancies (by 15%) and abortions (by 17%). Slight increase in pregnancies resulting in live births and loss (both increased by 3%). Released April 2023.

CDC Reproductive Health Abortion Surveillance Data 2020: 
Provides data on number, rate and ratio of abortions during 2020. Compares number, rate and ratio data to 2019 and provides trends on this data since 2011.  From 2011 to 2020, the number, rate, and ratio of reported abortions decreased 15%, 18%, and 9%, respectively. This page also provides the percentage of abortions completed by gestational age, < 13 weeks (93.1%), 14-20 weeks (5.8%), and > 21 weeks (0.9%).  Early medication abortions, prior to 9 weeks accounted for 51% of abortions.  Increase of 22% from 2019 and 154% since 2011.  

      American Congress of Obstetrics and Gynecology (ACOG):  Pregnancy Information Sheet:
Provides overview of fetal development by the weeks of pregnancy. 

ACOG Fact sheet on Gestational Age Fetus can feel and process pain: 24-25 weeks: 
ACOG review of evidence based literature on this topic. 

ACOG Fact Sheet Dispelling Abortion Myths: 
Review by the ACOG on common abortion care misinformation.

National Institute of Health and Child Development Premature Calculator: 
Provides survival data and associated health consequences for extreme premature infants, born between 22-25 weeks of pregnancy.  Data collected from National Neonatal Research network, nurseries that provided standardized assessment and best practice care.  Please note Antenatal steroids, given to mother hopefully 24 hours prior to delivery in order to mature organs and improve survival and decrease negative long term health outcomes.   

Guttamacher Institute:
Since 1968 has supported the integration of nonpartisan social science research, public policy analysis and public education to create evidence-based reproductive health care and rights policies.  Topics covered in US: Abortion, Contraception, Pregnancy, Sexually Transmitted Infections & HIV and Teens.  It is considered the most comprehensive data site for abortion data and research information in US. 

Resources for Discussing Abortion Care

Planned Parenthood Workshop Handout

Pregnancy Advisory Center, Government of South Australia: 
Brochure reviews common Abortion Myths 

Reproductive Coalition for Reproductive Choice Brochure:
Interview with the Rev. Carlton Veazey, president of the Religious Coalition for Reproductive Choice based in Washington, D.C. It is a coalition that advocates for reproductive choice and religious freedom on behalf of 40 religious groups and organizations. He was the pastor at Zion Baptist Church in Washington, D.C. for 33 years before taking this position.

CARAFEM: Brochure, US Not for profit that provides reproductive health care in select US cities. 

Organizations Supporting Pregnant Women and Abortion Care

Planned Parenthood Wisconsin:
Website offers ability to scheduledirect Reproductive Health Care services.  In addition you can check out their extensive library via the Education tab. 

P.O.W.E.R.S, 
Pregnancy Options Wisconsin:  Education, Resources and Support information for pregnant women. 

Women's Medical Fund, 
Founded in 1972, it is a 501c foundation that helps Wisconsin women pay for abortions. 

Legislature Contact

Wisconsin Legislature Contact

US House of Representative: 
Web page will identify your Representative and then go to your Representative’s web page for their specific contact information. 

US Senate, Wisconsin Senators: 
Web page will provide Washington DC office and telephone. Email address one needs to go to each Senator’s web page.