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The Medical Circumstances and Generous Immolation of Saint Gianna Beretta Molla During Her Last Pregnancy

Rev. Tadeusz Pacholczyk, Ph.D.

Recounting the story of the generous personal sacrifice made by Saint Gianna Beretta Molla on behalf of her fourth child often results in the request for more medical details regarding her situation. A few of the medical issues surrounding her pregnancies will be reviewed as the starting point in examining her final sufferings and immolation.

Pregnancy was always a difficult experience for Gianna. During each of her pregnancies, she experienced hyperemesis, which means excessive vomiting. She also experienced intestinal binding and dysfunction, and other gastric disturbances. These caused her much pain. Her first pregnancy went 25 days beyond her due date, and had a labor that lasted 36 hours. Because of the large size of the baby, the delivery was a forceps delivery.

During the course of her second pregnancy, she experienced similar difficulties, and again went 10 days late with a long and painful delivery.

In her third pregnancy she had to be admitted to the hospital due to acute symptoms similar to her first two pregnancies, with vomiting but also with acute spasmodic contractions which she thought meant she might lose the baby early. In the end her third pregnancy was also delayed about 10 days, and followed the course of the earlier ones with a painful delivery.

Gianna never seemed to lose her serenity during her deliveries, though she sometimes would clamp down on a handkerchief with her teeth in moments of pain. She appears to have always declined pain medication during her deliveries.

In the second month of her last pregnancy, she was diagnosed with a large fibroid. A fibroid is a benign tumor of the uterus, and often it is small enough and unobtrusive enough that one can leave it alone, and allow the course of the pregnancy to continue normally. Gianna's uterine tumor caused her considerable pain, and based on medical documents from Italy, it appears that the fibroid was large enough that it might have threatened the continuation of the pregnancy by compressing the fetus. Such compression, if not directly disruptive of the pregnancy itself, could nevertheless result in abnormalities in fetal development. Large fibroids can also be a source of other complications during pregnancy. They may cause preterm labor. They may cause the uterus to become trapped in the pelvis under the sacral promontory such that it would need to be manually elevated to allow further progress of the pregnancy. They may occasionally outgrow their blood supply and degenerate or infarct, causing considerable pain as well as presenting the risk of becoming infected.

Her husband Pietro recalls that there were three options presented for Gianna's case:

1. Considering the dangers, she could have chosen to have her uterus removed (hysterectomy) in order to remove the fibroid from her body. This would be a fairly low-risk approach for her situation. It would result, however, in the death of her 2 month old fetus, and preclude the possibility of future pregnancies. Based on the particulars of her case, this option would not have been morally problematic; Catholic moralists have analyzed cases of this sort under the Principle of Double Effect 1. Such an intervention is directed towards saving the life of the mother by removing the cancerous uterus (which has the undesired effect of ending the life of the unborn child). Morally, such a case would be properly considered under the aspect of a hysterectomy, not under the rubric of elective abortion.

2. A second option in St. Gianna's case would be to have the fibroid removed as well as terminating the pregnancy, thereby still retaining the possibility of future pregnancies. This option, by requiring direct abortion, would be morally contraindicated.

3. A third option would be to have the fibroid surgically removed and risk the continuation of her pregnancy, which is the option St. Gianna chose. Because she was a physician, Gianna understood that the risks were several: the surgery on the uterus might irritate it to the point that the pregnancy would be threatened and would spontaneously abort. The blood loss can be difficult to control in a pregnant uterus. Surgery on the uterus under these circumstances also presented the danger that during the remainder of the pregnancy, there might be a re-opening of the scarred wound from the surgery. A flare-up of this sort could be dangerous from the rapid bleeding that would ensue.

Gianna followed the recommendation of her advising physician and had the fibroid removed, but insisted that the maximum care be used during the surgery so as to avoid interrupting the pregnancy or harming the developing fetus. The myomectomy was successful, and her pregnancy continued. The surgery revealed that the tumor was partially subserous, partially intramural. Although some of her colleagues had advised her to terminate the pregnancy, Gianna never considered the possibility of abortion. Being faced with two morally acceptable options in the early stages of her pregnancy, she freely chose, with great generosity on her part, to proceed with a higher risk pregnancy for the benefit of her child. A typical therapy offered in Gianna's day for a woman with uterine cancer or a tumor of uncertain type would have been hysterectomy.

Prior to her surgery, Gianna's doctors would not have known many of the details appertaining to the tumor, for example whether it was cystic or solid, or perhaps even whether it was of the uterus or the ovaries. It was quite different for Gianna going into surgery for a tumor in the early 60's in Italy than it would be today. With ultrasound and other technologies, much more information would be available to the modern day surgeon. The heroic part of what Saint Gianna did was to choose life for her child under these difficult and uncertain circumstances, no matter what the consequences to herself. It is in this sense that Pope Paul VI could state that Saint Gianna "was a mother who, in order to give life to her baby, sacrificed her own life in deliberate immolation." Towards the end of her pregnancy, when talking to her brother, she seemed to have a premonition that trouble lay ahead. She said, "The greater part has yet to come. You do not understand these things. When the time comes, it will be either he or I." And again when speaking to her husband Pietro on another occasion, she said in a firm voice and with a penetrating gaze, "If you have to decide between me and the child, do not hesitate; I demand it, the child, save it." Such was her generous attitude throughout her pregnancy.

At the end of the pregnancy, her physicians attempted to induce labor with oxytocin, but contractions were not forthcoming. Other means were attempted, lasting from the afternoon of Good Friday until the next morning around 10 o'clock, but without success. Though her water had broken, labor was not proceeding. The decision was made to deliver the child by Caesarean section.

She underwent general ether anesthesia and a healthy baby girl weighing nearly 10 pounds was delivered. Gianna's condition began to decline soon afterwards, with symptoms including an elevated fever, a rapid, weakened pulse, and exhaustion. She died 7 days later of septic peritonitis, an infection of the lining of the abdomen, notwithstanding the fact that antibiotics were utilized in her treatment. During the painful abdominal sufferings caused by the septic peritonitis, she declined any narcotic pain medications, because she felt that such drugs did not allow her to be herself. In her final sufferings, she once remarked to her sister, "If you only knew how differently things are judged at the hour of death! ... How vain certain things appear, to which we gave such importance in the world!"

The infection she contracted almost certainly occurred consequent to the Caesarean surgery. The question is occasionally raised as to whether it would have been helpful to St. Gianna to have had a hysterectomy after the C- section delivery of her baby, so as to forestall or stave off the eventuality of infection. A hysterectomy at such a point would not have likely altered the pathogenesis of the infection, since it had already arisen in the abdomen during the C-section. C-sections, it should be recalled, are not always neat and tidy operations; the surgery, in effect, opens up a communicating channel between the microenvironments of the uterus, the cervix, indeed the whole birth canal, and the abdomen. This can result in unwanted microbial exchange. However the source of Gianna's infection remains unknown; pathogens might also have been introduced as a result of improper sterile technique during the C-section surgery itself.

It is unclear whether the decision for the Caesarean section was related to the fact that St. Gianna had undergone surgical intervention previously for the tumor, but there may very well have been a connection between the two. In the past, obstetricians were often of the conviction that if a woman had once had a significant surgical intervention on the uterus (e.g. large tumor removal or a Caesarean), future deliveries should be by Caesarean, since there seemed to be a greater risk involved with a normal labor and delivery after such interventions. Her physicians may have felt a certain urgency in St. Gianna's case to deliver the child on-time, since she had a propensity for delayed deliveries, which presumably stretch an already stressed uterus even further. In this sense, the death of Saint Gianna may have been an indirect result of her previous choice to undergo the tumor resection.

In the medical world of today, of the 1990's, it might well have been possible to save Gianna's life in addition to her daughter's. Septic peritonitis today is rarely fatal when identified early and aggressively treated. Physicians often have recourse to a highly effective triple regimen, three types of antibiotics at the same time. But in Gianna's day, methods of antibiotic treatment were not as advanced, and the means available for monitoring the progress of a pregnancy were also not as sophisticated as they are today. With ultrasound, highly specific blood tests, and CAT scans, we are blessed to live in an age where the making of a life or death between mother or child is becoming progressively more uncommon and unnecessary

Sadly, though, we live in an age where life and death decisions against the unborn child are made with an ever greater casualness, and pregnancies are terminated for reasons that can only be termed trivial. Saint Glanna's example of heroic commitment to the life of her own child throws into clear relief the scandal of the easy-abort mentality of our day. She believed that the privilege of being a mother, of being a cooperator with God in bringing forth new life meant always defending and protecting her children, whether in or out of the womb, even to the point of giving up her own life on their behalf. Even though it is rarely to the point of death, every mother is aware of this profound maternal reality of being immolated and making great silent sacrifices on behalf of their children.

l Principle of Double Effect - this principle is utilized to evaluate actions which have two effects, one good and one evil. The principle of double effect has been summarized into 4 basic criteria: 1) the action in itself must be good or indifferent; 2) the good effect cannot be obtained through the bad effect (because then the end would justify the means); 3) there must be a proportion between the good and bad effects brought about (e.g. life against life); 4) the intention of the subject must be directed towards the good effect, and merely tolerate the bad effect. Some say there is a fifth requirement - that there does not exist another possibility or avenue.

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