“There is no such thing as a heartbeat at six weeks,” Stacey Abrams, the Democratic nominee for governor in Georgia, said this week while speaking on a panel in Atlanta. “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 human life is more than a heartbeat, and a “heartbeat” is insufficient to produce a human.
Abrams is being attacked by far-right media for this comment. One Fox News analyst called it an “outright lie,” stating, “So really the heart starts beating at three weeks” (sic). Another conservative commentator took issue on the grounds that “Hearing my babies heartbeats” was “one of the most exciting, liberating and most beautiful moments of my entire life” (irrelevant).
This kind of soft-on-the-facts-strong-on-the-emotional-overlay milieu nurtures policies that are both dangerous and ludicrous — for example, abortion bans that begin before many women could possibly even know they are pregnant, or bills that prohibit ending an ectopic pregnancy, which can be immediately life-threatening to the pregnant woman. The latter includes an infamous Ohio bill that proposed “reimplanting” an ectopic into a uterus, a medically impossible procedure.
Going on attack underscores a fear of the accurate, for Abrams’ remarks are difficult to assail. At six weeks of pregnancy, there is no heart. There is no sound. If this were a “Saturday Night Live” episode of “Coffee Talk,” the host would say, “An embryonic heartbeat is neither a heart, nor a beat: Discuss.”
Historically, the heart was seen as the repository of the soul, intellect and emotion. Despite tremendous advances in our understanding of human anatomy and physiology, we retain an inclination to imbue even the whisper of a heart’s presence with outsize emotional significance. But a human life is more than a heartbeat, and a “heartbeat” is insufficient to produce a human, not least when it only reflects periodic electrical activity produced by a clump of precursor cells.
What we call a “heartbeat” can carry special meaning for many people at an early pregnancy appointment, particularly if the pregnancy is desired. Even if the pregnancy has already been revealed by other means, the “heartbeat” seems more concrete than a line on a test stick. But that meaning, as Abrams stated, is a social construct that has more to do with the anticipation of future outcomes and little to do with what is actually present in the uterus at that point.
As with much language in medicine, the term carries unintended implications. It’s reasonable to expect that a “heartbeat” refers to the movement or sound coming from an organ called the heart. Yet at six weeks of pregnancy (which is actually four weeks after fertilization, because of the confusing way we date pregnancies), it merely reflects electrical activity produced by a tiny, amorphous clump of cells. Within the less than half-an-inch mass, there is not yet any structure recognizable as a heart, no pumping of blood, no circulatory system within which it could be pumped, and no developed end organs to pump it to.
We retain an inclination to imbue even the whisper of a heart’s presence with outsize emotional significance. The cells generate electrical activity because that is the nature of those cells. Heart tissue grown in a lab will also pulsate, as will cells dissolved down from a heart and no longer organized into the structure of the original organ. And the ultrasound machine, in turn, translates such activity into a low audible whir that is a product of the machine itself, rather than amplification of any existing sound. Detecting this “heartbeat” in clinical practice is helpful in a number of ways. It can confirm the diagnosis of a pregnancy, as it is condition-specific; it allows us to estimate gestational age; and when there are concerns about pregnancy loss, the presence, absence or change of the “heartbeat” can be informative about viability (a term that means nothing more than that the pregnancy is likely to continue). When I had a miscarriage, I knew it in an instant at my second ultrasound, when what I’d heard earlier as a brisk whoosh had become ploddingly slow. The final report read, “nonviable pregnancy.” I’d been grateful that technology allowed me to know early on that I’d lost my pregnancy. But I would have felt differently if that same technology was used off-label, to measure things it was not designed to measure — for example, the personhood of the embryo or the viability or nonviability of my personal autonomy.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
