Reproductive Surgery · Definitive and Ablative Procedures

Further Evaluation of Uterine Isolation

Hilgers TW

Published February 1994 The Linacre Quarterly, 61(1), 82-88
DOI 10.1080/20508549.1999.11878244
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RRM Academy Synopsis

A 1994 essay argues uterine isolation at cesarean is sterilization

A 1994 opinion essay covers uterine isolation. Surgeons divide the tubes and leave the uterus in place, a practice defended for a uterus said to be weakened by repeat cesareans. The author argues it is sterilization. At one hospital he watched, 47 out of 487 cesarean sections in 1990 included it.

Key Findings

  • At one hospital the author observed, 47 out of 487 cesarean sections in 1990 included uterine isolation, an incidence of 9.6 percent.
  • In the first nine months of 1991, the incidence at that hospital had increased to 11.5 percent.
  • The author writes that rupture appears to have become less common over 20 years (0.04%) as cesareans increased, and nearly 80 percent of ruptures were not linked to an earlier cesarean.
  • The author states that after a low transverse scar, the chance of rupture in a later pregnancy is extremely rare (about 0.3 percent).

Interpretation

The essay is one physician's opinion. It mixes clinical reasoning with Catholic moral theology. The hospital counts come from the author's own observation, with no described method or comparison group. The rupture figures and the 0.3 percent scar figure are the author's statements, with one citation for the first. The sterilization conclusion is the author's judgment. The essay addresses Catholic hospital policies and notes that cesarean and rupture risks were much greater in the 1940s and 1950s than in the 1990s.

RRM Context

Restorative Reproductive Medicine works with the body and keeps fertility intact where tissue can be repaired. The essay applies that idea to a scarred uterus. The author argues that repairing a ruptured or separated scar at cesarean can leave the uterus able to carry a later pregnancy. The essay reports no outcome data for that repair beyond the rupture figures it cites.

Abstract

"Uterine Isolation" has been discussed, in one form or another, since the early 1940's by such notable American theologians as Fr. John C. Ford, SJ, Fr. Gerald Kelly, SJ; Fr. Francis J. Connell, C.SS.R.; Fr. L. Bender; Fr. John R. Connery; SJ, Fr. Edwin F. Healy, SJ; and Fr. Thomas J. O'Donnell, SJ.l The term "uterine isolation" originated with Fr. O'Donnell. O'Donnell, who is personally convinced of the validity of the arguments for the solid probability of the "uterine isolation" view, was also responsible for having this deleted from the "Ethical and Religious Directives for Catholic Health Facilities" which were published and approved by the bishops in 1971." 'Isolation of the uterus' or 'uterine isolation' " he says, "had taken root in the medical-moral community and, either through misunderstanding or deception, was being used as a presumably morally acceptable semantic for various forms of clearly contraceptive sterilization."l O'Donnell states that the following three points need to be understood by Catholic hospital administration and staff with regard to the term "uterine isolation procedure": 1. Hysterectomy in the presence of a uterus which has been so damaged or weakened by multiple cesarean sections that it is judged to be incapable (because of the damage within the uterus itself) of safely supporting another pregnancy is, with solid probability, not a contraceptive sterilization and is permitted . . . 2. In this case, and only in this case, the isolation of such a uterus at its tubal adnexa, instead of its extirpation, if clinically indicated, is, with solid probability, not a contraceptive sterilization and thus may be permitted and practiced; unless, of course, this is disapproVed by the bishop of the diocese who might well foresee greater harm in the danger of misunderstanding and morally unwarranted extension of the procedure as a semantic to conceal directly contraceptive sterilizations. 3. If, after further study and investigation, there would be a sufficient consensus of theological opinion or a decision by the Congregation for the Doctrine of the Faith that either of the procedures described above (either the hysterectomy in this case or the isolation procedure) is indeed a direct sterilization (such as to discount the solid probability that it is not), then neither of the procedures could be done within the context of Catholic teaching. The sale moral defense of either procedure is the solid probability of the moral opinion that it is not a directly contraceptive sterilization (emphasis applied). I wish to emphasize the need for further study and investigation of this issue because the experience with "uterine isolation" is compelling and proves that the practice is nothing but direct contraceptive sterilization. It is also a practice with inappropriate medical justification . . . a practice which, in the 1990's, cannot be justified on medical moral grounds. One of the most important questions that needs to be asked with regard to "uterine isolation" is "What are we isolating the uterus from?" It is clear that the uterus is not being isolated from either the sperm or the ovum since they present no potential of risk. It is equally clear that the isolation of the uterus, so proposed, is not isolating the uterus from any known disease condition. the only possible thing that this procedure could be isolating the uterus from is a pregnancy . Thus, it seems equally clear that the primary intent of such a "uterine isolation" is contraceptive sterilization. Furthermore, the actual application of "uterine isolation" policies in Catholic hospitals suggests that it is direct contraceptive sterilization.

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Related research

Reproductive Surgery › Definitive and Ablative Procedures › Hysterectomy · Ethics and Policy › Reproductive Ethics › Conscience Protections
Thomas W Hilgers
Tom Hilgers, T Hilgers
DOI 10.1080/20508549.1999.11878244 10.1080/20508549.1999.11878244 Hilgers et al. 1994, Hilgers 1994

Cite this article

Hilgers, T. W. (1994). Further Evaluation of Uterine Isolation. The Linacre Quarterly, 61(1), 82-88. https://doi.org/10.1080/20508549.1999.11878244