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A Missouri bill could make it illegal to treat ectopic pregnancies

An ectopic pregnancy is 100% fatal if untreated, and never, ever results in a baby. Yet it's a common target in anti-abortion legislation.

On Wednesday, Missouri legislators held a public hearing on a bill that would make it a felony to "perform or induce an abortion" to treat an ectopic pregnancy. Ectopic pregnancies never result in a baby and can be fatal if left untreated.

While the Missouri bill is expected to fail, the legislation is an example of how ectopic pregnancy can get mistakenly swept up in efforts to target abortion access.

Republican state Representative Brian Seitz, who introduced House Bill 2810, says the bill is intended to restrict the "trafficking of abortion-inducing devices or drugs." In the hearing, he stated the illegal use of medications that cause an abortion “could actually kill a woman,” despite studies showing abortion medications are safer than penicillin and Tylenol, and 14 times safer than childbirth.

"I'm not a doctor."

state Representative Brian Seitz

When asked if he knew medication abortion is safer than penicillin and Tylenol, Seitz told TODAY Parents he didn't: "No, I don't, because again, I'm not a doctor."

"What I'm just attempting to do is to stop the importation or the trafficking of these types of drugs to be used in an illegal manner," he added. 

The language in Seitz's bill echoes a misunderstanding of what ectopic pregnancy is, and isn't, and that's what has people concerned.

What is an ectopic pregnancy?

Ectopic pregnancies are 100% non-viable, and if allowed or forced to continue would result in organ rupture, severe internal bleeding, possible infertility and even death. They are the leading cause of death for pregnant people in the first trimester.

"An ectopic pregnancy is a pregnancy that is implanted outside the uterine cavity," Dr. Jennifer Lincoln, board-certified OB-GYN in Portland, Oregon and author of "Let’s Talk About Down There: An OBGYN Answers All Your Burning Questions Without Making You Feel Embarrassed for Asking," told TODAY. "These are most commonly found in the fallopian tubes but can also be located in the cervix, on the ovary, or elsewhere in the abdomen."

Related: What is ectopic pregnancy? Signs and symptoms to look out for

Lincoln said ectopic pregnancies "will not survive to a point where a fetus can live" and, if left untreated, "can be fatal to the pregnant person as they will rupture and cause life-threatening bleeding."

"Therefore, they must be treated either with medicine to stop the growth of the pregnancy, called methotrexate, or with surgery to remove the pregnancy," she added. "Each type of treatment has its pros and cons, so it’s a discussion made between the person and their provider to see what is the safest and most acceptable route."

Lincoln also mentioned that under no circumstanced can an ectopic pregnancy be "relocated" to the uterus, a claim made by some Republican legislators. "This is a myth and a narrative that has been put forth mostly by those who oppose abortion and have no medical understanding of what an ectopic is and isn't," she added.

Lincoln has treated ectopic pregnancies, and said "the good news is that our current technology allows us to diagnose pregnancy early and determine the location."

She also said that during her medical training, she was taught the phrase "never let the sun set on an ectopic," meaning they need to be treated right away or can quickly become life-and-death situations.

"I remember one case where my patient went from being very stable when I met her in the Emergency Department and diagnosed her with an ectopic, to it rupturing on the way to the operating room and there being over a liter of blood in her abdomen by the time we started surgery," she explained. "She did fine because of where she was, but in places where access to care is limited or delayed the outcome may not have been as good."

Inside the Missouri legislative hearing

Democratic state Representative Keri Ingle, who was present at the hearing, said there was "some confusion on what ectopic pregnancies are" by her Republican colleague.

"I've had family members and friends who've experienced them, and it led to them not being able to conceive in the future," Ingle told TODAY. "So we were trying to talk that through with the bill sponsor and get to what his actual intent was, and why he was including any language regarding ectopic pregnancies at all."

Related: What moms who provide abortion care think about their jobs

In HB 2810, a doctor would be at risk of being charged with a Class A or Class B felony if “the abortion was performed or induced or was attempted to be performed or induced on a woman who has an ectopic pregnancy.” In Missouri, a Class B felony carries a minimum of 5 years in prison and a maximum of 15. A Class A felony carries a minimum of 10 years in prison, with a max of 10 years or life.

Ingle said Seitz seemed to be "really unclear" as to why he was including the ectopic pregnancy language, instead trying to "focus on sex trafficking victims, and them having potential ectopic pregnancies and being treated outside of a medical facility."

Ingle was a social worker and has worked with sex trafficking victims. In the hearing, she was sitting next to Democratic state Representative Wes Rogers, a former prosecutor who has also worked with sex trafficking victims. Ingle said the hypothetical situations introduced by Seitz were "so far outside of our experiences with victims."

Seitz said his intent with HB 2810 is “not to stop health care providers, doctors and so forth from using these medications to help deal with an ectopic pregnancy.” Instead, he said, “We were talking about totally using these drugs in an illegal manner, including using them for ectopic pregnancies.”

"How do you treat an ectopic pregnancy illegally?" Ingle asked.

Seitz said that he does not know of any instance in which a person has attempted to treat an ectopic pregnancy illegally.

“The only way to know that it’s an ectopic pregnancy would be to go to a hospital, the health care facility, to see your doctor and find out if that’s the case," he added. "And they would prescribe the appropriate methods to take care of that difficulty.”

Related: What to know about the Supreme Court case challenging Roe v. Wade

Ingle said that Republicans on the committee were "also extremely concerned about this language around ectopic pregnancies," because it is so unclear. She also said those from the medical community raised their concerns during the hearing, arguing it would have serious implications on how doctors care for their pregnant patients.

"They do believe that this would perhaps bar them from being able to treat ectopic pregnancies," she added.

While concerned, Ingle said that she does not believe the bill will become a law.

“I actually was just sent a tweet from the Senate majority leader, who said if this bill were to reach the Senate that it would be dead on arrival," she explained.

What HB 2810 may say about future legislative efforts

While seemingly confused about what an ectopic pregnancy is and how it's treated during the hearing, Seitz did tell TODAY he is "fully aware that ectopic pregnancies are not viable."

In the hearing, Seitz said that he did not know the punishment range of either a Class A or Class B felony, but did say that both penalties under this proposed law "are probably not even strict enough."

"So you would even go so far as offering the death penalty as a solution," Rogers asked Seitz. "We'll have to look at that in other legislation," Seitz responded.

"Considering the death penalty for folks providing abortion services was one of the most extreme things I've heard in my time in the house," Ingle said.

Related: On anniversary of Roe v. Wade, adoptees don’t want to be a ‘pawn’ in abortion debates

Ingle said the influx of anti-abortion laws being introduced in the state is a result of the 6-week abortion ban in Texas and the Mississippi 15-week abortion ban being considered by the Supreme Court, which if allowed to stand would effectively overturn Roe v Wade.

And while HB 2810 bill is unlikely to pass, she is concerned about what it signals about future legislation aimed at reproductive health care.

"We're already hearing that any abortion-related bills will have the Texas abortion ban language added on the floor. So, yes, I am very afraid," she explained. "Our State Senate held up the federal reimbursement allowance for Medicaid last year for hospitals up to the deadline, trying to ban Medicaid coverage of birth control and calling oral birth control abortifacients. So the next step is for them to ban birth control. That is the extreme we're dealing with right now."