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Stacey Abrams abortion row: Is there a fetal heartbeat at six weeks?

Stacey Abrams, the Georgia Democratic gubernatorial candidate and voting rights activist, has upset conservatives by attempting to correct a common misconception about the point in a pregnancy at which a fetal heartbeat can be detected in the womb.

“There is no such thing as a heartbeat at six weeks,” Ms Abrams said during a panel discussion at the Ray Charles Performing Arts Center in Atlanta on 20 September, at which she was appearing as part of her campaign to unseat the Peach State’s Republican incumbent Brian Kemp, against whom she ran unsuccessfully in the 2018 midterm elections.

“It is a manufactured sound designed to convince people that men have the right to take control of a woman’s body away from her.”

A clip of her comments was subsequently shared by the Republican National Committee (RNC) and duly went viral – as was no doubt the RNC’s intention – provoking the obligatory outcry.

Ms Abrams was accused of engaging in a “QAnon-plus level of conspiracy” by Fox News pundit Will Cain, who disingenuously suggested she was arguing that ultrasound machines were routinely manipulated, and labelled “a very sick person” on Twitter by commentator Meghan McCain, who claimed she had heard the heartbeat of her own daughter at precisely that stage in her own pregnancy in 2020.

Kansas senator Dr Roger Marshall, an obstetrician-gynecologist long opposed to abortion, was moved to wonder: “Why do radical Dems hate unborn babies?”

Pro-life activists commonly cite the six-week milestone as a reason for opposing abortion.

However, at that stage, there is no fetus in the womb, only an embryo that has yet to develop the four chambers and valves whose opening and closing create the heartbeat sound when blood is pumped around the body.

Speaking to NBC News earlier this year, Atlanta obstetrician-gynecologist Dr Nisha Verma explained: “Medically speaking, when I put a stethoscope against a patient’s heart, that ‘lub dub’ sound is made by the opening and closing of the cardiac valve. At six weeks, those valves don’t exist.

“It’s an electrical pulse that’s translated into the sound we’re hearing from the ultrasound machine.”

Offering a more detailed explanation, Dr Saima Aftab, medical director of the Fetal Care Center at Nicklaus Children’s Hospital in Miami, Florida, told Live Science the pulse was essentially “a little flutter in the area that will become the future heart of the baby”, which occurs because the group of cells that will one day be the heart’s “pacemaker” gradually gain the capacity to fire electrical signals.

“By no means does it translate to viability of the heart”, Dr Aftab said.

The American College of Obstetrics and Gynecology (ACOG) has also sought to resolve the misunderstanding, stating: “It is clinically inaccurate to use the word ‘heartbeat’ to describe the sound that can be heard on ultrasound in very early pregnancy.

“In fact, there are no chambers of the heart developed at the early stage in pregnancy that this word is used to describe, so there is no recognizable ‘heartbeat’.

“What pregnant people may hear is the ultrasound machine translating electronic impulses that signify fetal cardiac activity into the sound that we recognize as a heartbeat.”

The ACOG says it is not accurate to use the phrase “fetal heartbeat” at all until the heart is fully developed, which it says occurs at between 17 and 20 weeks of gestation.

“Embryonic cardiac activity” is its preferred term until the eight week-mark and “fetal cardiac activity” thereafter, once the growth of what will become the heart muscle has begun.

For Dr Verma, the confusion between the electrical pulse emitted and a heartbeat is entirely understandable, given that expectant parents naturally want to anthropomorphize their pregnancy as soon as possible and because doctors commonly use simplified language to explain complex medical processes to their patients.

“I think it’s OK for people with a desired pregnancy to go in at six weeks and see that flickering and feel connected to that as a heartbeat,” Dr Verma said.

“There’s no issue with using the term ‘heartbeat’ on its own. The issue is using that incorrect term to regulate the practice of medicine and impose these artificial time frames to regulate abortion.”

Dr Jennifer Kerns, an obstetrician-gynecologist and associate professor at the University of California, San Francisco, similarly told NPR in May: “I think this is an example of where we are sometimes trying to translate medical lingo in a way that patients can understand, and this is a really unfortunate side effect of this type of translation.”

Dr Kerns went on to discredit the whole notion of using “heartbeats” as any credible measure of a pregnancy.

“There is nothing specific and meaningful and relevant about the detection of cardiac activity at this gestation that implies anything that’s relevant for women’s health or for pregnancies,” she said.

“It is one indicator – among many indicators – that a pregnancy may or may not be progressing with some expected milestones.”

Georgia introduced a law in 2019 banning abortion in the event that a “detectable human heartbeat” was evident, which recognised the electronic blip as a heartbeat, a move that was struck down by a federal judge as unconstitutional but which a federal appeals court has since ruled can now enter law after the US Supreme Court overturned Roe vs Wade on 24 June.