In the 1990's, much of routine obstetrics and gynecology is contrary to Catholic teaching in medical ethics. Many allege that practicing OB-GYN in accord with the Vatican would be unworkable and impossible. Catholic hospitals and medical schools sometimes tolerate or engage in practices which are, from a Catholic moral perspective, unethical.

The fact that Catholic hospitals and medical schools engage in these practices does not go unnoticed. Many decent non-Catholics look to them for guidance but they are confused. They assume that if some practice or procedure occurs in a Catholic institution, it must be ethical. Others conclude the Churchs position on medical ethics must indeed be unworkable, otherwise Catholic institutions would adhere to it. Teaching of error undermines the truth.

The lack of an acceptable Catholic alternative is harmful to many. Patients who seek treatment in accord with Church teaching are too often unable to find it. A few students attend Catholic medical schools to avoid participation in practices they know are wrong. Non-Catholic physicians might embrace Catholic medical care, but they are unaware of its existence. Western society as a whole is widely perceived to be undergoing a broad and profound moral decay. Society needs the examples and leadership that should come from Catholic institutions practicing medicine in a Catholic way.

Patients, medical students, and other have related to me incidents wherein Catholic institutions are doing things considered immoral by the church. Medical students at Catholic medical schools have told me that some patients with maternal disorders were advised to have abortions. Some fetuses with birth defects were delivered early so as to end the pregnancy-a fetal form of euthanasia. Some students were drawn into tubal ligations or other forms of contraception even though they tried to avoid them. Newspaper reports suggest that assisted reproduction techniques are being used at catholic m edical schools and hospitals. On the other hand, I formerly worked at the Pope Paul VI Institute in Omaha, NE. All aspects of obstetrics and gynecology were practiced in accord with the church. It is not only practical and workable, but in my estimation, is superior medical care. Other examples of the superiority of Catholic medical care can be found in Catholic foreign countries. Dublin, Ireland is a world famous center for obstetrics. Practicing according to Catholic principles because nearly all patients and doctors there are Catholic, they have become famous by demonstrating that in practice Catholic principles not alone work, but give superior results.

Abortion for maternal indication was said by some to be obsolete by the early 1950's. A study by Cosgrove and Carter (1944) reported on 67,000 deliveries from 1931 to 1943 at the Margaret Hague Maternity Hospital in Jersey City. Only 4/67,000 were thought to require abortion for maternal indication. Cosgrove delivered a subsequent 70,000 babies with no therapeutic or maternally indicated abortions.nnHefferman and Lynch (1953) conducted a postal survey of maternal deaths at hospitals which did or did not permit abortion for maternal indication. The causes of death were very similar, suggesting that death rates were not biased by referral patterns. At hospitals which did not permit abortions, there were 1469 deaths and 1,680,989 deliveries for a maternal death rate of 0.87/1000. At hospitals which did permit abortions, there were 1558 maternal deaths and 1,574,717 deliveries, yielding a maternal death rate of 0.98/1000. Maternal death was lower (0.87/1000) at institutions which did not allow abortions than at those (0.98/1000) that did.

Most studies become less credible and less impressive as they become obsolete and more out of date. These studies, however, make a stronger argument since they date from the 1950's than if they were published in the 1990's.

Technological advances in medicine make it ever more difficult to make a reasonable argument for maternally indicated abortion. Exceeding rare conditions must be cited, as there are no common conditions for which a credible argument could be made. Valvular and structural cardiac defects can usually be managed. Mention is usually made of cardiac conditions such as Marfan syndrome, cardiomyopathy, and Eisenmenger complex Experts in this area, such as Oakley (1990), consider only Eisenmenger complex as an "absolute" indication for termination, the others being at most "discretionary". It is thus refreshing that Avila and co-workers (1995) reported a maternal survival of 77% when 13 mothers with Eisenmenger complex were treated with bed rest, oxygen therapy, hospitalization, and heparinization.

Focusing on the rare situations distracts from the obvious. The usual case is a discredited indication, such as depression. The more one examines these situations critically, the more one finds that the evidence is usually trumped up, an obvious therapy has been ignored, risks are often overestimated. This author is not aware of any maternal indication for which a randomized, controlled trial has shown abortion to be better than non-abortive therapy. nnIf doctors of the 1950's did not need abortions to manage pregnancies, surely we dont need them in the 1990's. Providing and developing alternatives to abortion for maternal indication should be an important mission for OB/GYN departments at Catholic medical schools.

Abortion for fetal indication is not beneficial for the fetus. Abortion for fetal indication often causes spiritual, psychological and or physical harm to the mother. Having a baby with many birth defects, and having that baby die, is a profound and unforgettable tragedy for a mother. To add abortion makes a bad situation worse.

A few of my patients have had babies with lethal anomalies. Delivery at term, with supportive family in attendance, and holding and loving the baby till it dies naturally in its mother arms, can be an incredibly positive and healing experience. It can generate an unforgettable explosion of love. An unforgettably tragic experience is then forever linked with an unforgettably loving and healing event.

This way of management for severe and/or lethal anomalies seems to be widely overlooked. In my training, I only discovered it by accident when refusing to participate in abortions. Patients should have this option provide d to them, and Catholic medical schools should provide, teach and promote it.

At the Pope Paul VI Institute received contraception, and all are encouraged to use natural family planning. It is safe and effective. In addition, the beneficial effects of natural family planning on couples are obvious. The natural family planning husbands seemed much more supportive to their wives than were the men I met in my previous experiences in obstetrics.

Many Catholics do not realize that assisted reproduction techniques are immoral in the catholic church. One patient (not at a Catholic institution) was shocked to find, after her birth of her twins that she had 24 human embryos stored in a freezer. Another patient (not at a Catholic institution) told me that as a pre-requisite to in vitro fertilization, she had to sign an agreement promising to undergo fetal reduction if too many embryos implanted. This practice is commonplace. These examples illustrate just a few of the many reasons why in-vitro fertilization and most assisted reproduction technologies should not be allowed in Catholic institutions.

At the Pope Paul VI Institute, Dr. Thomas Hilgers has developed many treatments for infertility which are consistent with the Catholic church. These treatments are far less expensive than conventional fertility treatments, and at least as effective. Anyone can easily demonstrate this for him self/herself. Ask any previously infertile couple what they were doing when they got pregnant. They usually answer that they had abandoned fertility treatments at the time they got pregnant. In contrast, Dr. Hilgers patients are usually following his advice when they get pregnant.

When Catholic medical schools duplicate secular practices, they undermine church teaching and Catholic medical ethics. Patients who want and/or need Catholic medical care cant find it. Pro-life medical students avoid OB-GYN residency training because they feel they will be subjected to "academic apartheid." Even students at Catholic medical schools feel they would be persecuted for their pro-life beliefs. NnEven otherwise faithful Catholic physicians go along with fetally- or maternally-indicated abortions, in vitro fertilization and contraception. Societys medical ethics; as embodied by contraception (60's), abortion (70's), in vitro fertilization (80's) and euthanasia (90's) continues to degenerate. Cloning has only just come up and it already seems inevitable. The problem of Catholic medical education in OB-GYN is important for society as a whole.

Catholic medical care in Obstetrics and Gynecology needs to be a top priority for every Catholic teaching hospital, and especially for Catholic medical schools. There is a crucial need for obstetric departments which see Evangelium Vitae, Humanae Vitae, and Donum Vitae as their primary mission. In the words of one nun who was mission director for her hospital, if they dont see this as their mission, they donít have a mission..nnPro-Life means different things to different people. Many doctors practicing contraception, in-vitro fertilization and/or fetal euthanasia might consider themselves pro-life. The most rigorous pro-life approach is that of the natural-family-planning-only (NFP-only) OB/GYNs.

The OB/GYN faculty at Catholic teaching hospitals should be NFP-only OB/GYNs. This is especially true of department heads. NFP-only OB/GYNs can be found in Steve Koobs One More Soul directory. As of this writing (April, 1999) the directory does not contain any OB/GYNs who are on the faculty of a Catholic medical school.

Contracepting OB/GYNs at Catholic institutions should be gently and lovingly evangelized by their patients. Patients attempting to convert their OB/GYNs should may initially encounter humiliation, hostility, condescension and resistance (so I have been told by patients who tried to convert their doctors).

Turning the other cheek could be very effective. Evangelists should realize that NFP and some aspects of pro-life OB/GYN may go against everything their doctor has been taught. Fewer than 1/1000 OB/GYNs are NFP-only. OB/GYNs are frequently taught that NFP is ineffective. Studies that I am now aware of, showing that NFP is 99% effective, were never mentioned any time during my medical education. Since much of medical education is funded by drug companies, this should not be surprising.nnDonors and philanthropists could have a significant impact. They should encourage the institutions to determine if Catholic medical care is provided. They should ask if fetal euthanasia, abortion referrals for maternal disorders, in-vitro fertilization, and contraception are available. The Catholic institutions should gently and charitably be encouraged to do better. Those few institutes which provide truly Catholic OB/GYN medical care (among them the Pope Paul VI Institute) desperately need financial support.

A fund and a program should be established to support a truly Catholic OB/GYN residency (medical training program). Such a project would require time, money and prayer. It could generate many new therapies. This would enable doctors to practice medicine the way Jesus wants. Patients could find alternative treatments when abortion, contraception, or in vitro fertilization are recommended. Medical students would be exposed to doctors practicing medicine in accord with church teaching. Residents could learn how to be pro-life, NFP-only OB-GYNs. Faculty could develop new therapeutic alternatives to the culture of death. Where all these were gathered together in His name, the Holy Spirits presence would be felt by all.

We live in a time of moral decay, just as the early Christians did. The sacrament and institution of marriage in our society is under attack from Planned Parenthood, the media, movies and television. Divorce and broken homes are common, as are teenage pregnancy, juvenile delinquency, and drug abuse. Meanwhile we cant build prisons fast enough to hold all the criminals who should have been our hope for the future.

The promotion of sex for pleasure and profit, and the production and/or destruction of babies according to prevailing market conditions means that our civilization is self destructing. The early Christians infused the dying Roman Empire with the Gospel of Love and converted it. We can do it again. We must.

The assistance of Suzanne Baggot is gratefully recognized.
Part of this work was done at the Pope Paul VI Institute in Omaha NE, which is directed by Dr. Thomas Hilgers.

Avila WS, Grinberg M, Snitcowsky R, Faccioli R, Da Luz PL, Bellotti G, Pileggi F (1995).
Maternal and fetal outcome in pregnant women with Eisenmengers syndrome.
European Heart J. 16:460-464.

Cosgrove, SA and Carter, PA (1944).
A consideration of therapeutic abortion.
Am. J Obstet & Gynecol. 48(3):299-314.

Hefferman, RJ and Lynch, WA (1953).
What is the status of therapeutic abortion in modern obstetric?
Am J Obstet-Gynecol. 66(2):335-345.

Oakley CM (1990).
Cardiovascular disease in pregnancy.
Can J. Cardiology 6, supplement B, 3b-6B.