by Dr. Lloyd Holm, retired OB/GYN, Executive Director

It seems all things – at least those things pertaining to women and pregnancy – are now temporally linked to Roe v Wade. We frequently hear, “Since Roe v Wade…” or “Before Roe v Wade…” women did this or that.

In this context, does a woman, upon learning she is pregnant, ever wonder when life really begins? I can’t recall ever being asked this question in all of my 40 years of providing obstetrical care. That, of course, doesn’t mean the issue wasn’t or isn’t ever pondered by a woman. But why then, is there so much written about the topic as if it’s the number one issue confronting every woman with a newly discovered pregnancy?

Prior to 1973, “when life began” was never an issue because everyone intuitively knew it was at the time of conception. Granted, prior to ultrasounds and the ability to visualize a developing baby, it was not definitely known when the heart started to beat. Without ultrasounds, obstetricians were unable to hear a fetal heartbeat until at least the 18th week, about the time a woman would feel fetal movement for the first time (quickening).

But I believe the onset-of-life dilemma arose when the frequency of abortions began to increase and the abortion industry, in an attempt to quell the guilt women were expressing at the time of an abortion created this narrative: “You aren’t actually killing your baby because life really doesn’t begin until X number of weeks. Afterall, it’s just a clump of cells.” In fact, as the gestational age of terminations began to go beyond 12-14 weeks, ACOG (the American College of Obstetricians and Gynecologists) released a policy statement (1) that read in part, “…Until the chambers of the heart have been developed and can be detected via ultrasound (roughly 17-20 weeks of gestation), it is not accurate to characterize the embryo’s or fetus’s cardiac development as a heartbeat.” Therefore, if there’s no “heartbeat,” there isn’t any life, and if there isn’t any life, having an abortion, isn’t taking a life.

So, when does life really begin?

Life begins when a male gamete (sperm cell) encounters or joins a female gamete (egg or ova) and fertilization then takes place. From this fundamental union, a cascade of events take place, all resulting in the development of a baby.

Once fertilization takes place, a single cell is formed and from this one cell or zygote, subsequent cell divisions result in the formation of a blastocyst. This blastocyst contains the beginning of the three distinct types of cells that go on the form the skin and skeletal system, the internal structures and all the vital organs.

Formation of a blastocyst

It isn’t until about 6-7 weeks before anything resembling a life form we would recognize emerges. By this gestational age, the formation of all the major organs has commenced, all that is required is a continuous flow of maternal blood and nutrients, growth and development.

Seven week embryo

By six weeks the fetal heart is formed, and blood flow has been established thereby perfusing the developing organs and tissues. Further, this pumping of the fetal heart and subsequent flow of blood can be detected ultrasonographically by six weeks.

How can anyone possibly argue the early visualization of a fetal heartbeat does not represent life?


Dr. Lloyd Holm is a licensed physician and OB/GYN. He started his career as a general practitioner in rural Iowa where he practiced for 7 years. Subsequent to this, he completed a residency in obstetrics and gynecology at the University of Nebraska Medical Center in Omaha. After practicing as a board certified OB/GYN for nearly 30 years, he retired in 2018. During his career he served as President of the Iowa State Board of Health, chairman of the College of Medicine Curriculum Committee at the University of Nebraska College of Medicine and OB/GYN Student Clerkship Director at the University of Nebraska College of Medicine. In addition, he is the author of two novels and a children’s book about the birth of Jesus. His writings have appeared in The Omaha World-Herald, Iowa Medicine, Obstetrics and Gynecology, the American Journal of Obstetrics and Gynecology, The Female Patient, and the medical website, Doximity. As the Executive Director of Options for Women/River Falls, Dr. Holm has continued his commitment to women’s well-being and is a steadfast supporter of its ministry and mission.


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