What Six Weeks Pregnant Actually Means

It's *not* six weeks after conception.
Pregnancy test with two lines
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Welcome to Down to Find Out, a column in which Nona Willis Aronowitz addresses your biggest questions about sex, dating, relationships, and all the gray areas in between. Have a question for Nona? Send it to downtofindout@gmail.com or fill out this Google form. (It’s anonymous!)

This new Texas “heartbeat law” has me worried and confused, including about what it means for someone who’s actually pregnant. What exactly does it mean to be “six weeks pregnant”? Is there really a “heartbeat” at this stage?*

You’re not the only one who’s worried. Besides being blatantly unconstitutional, Texas’s new law that bans abortions at about six weeks — once an ultrasound shows fetal cardiac activity — is insidious precisely because it is confusing. So let’s break down what it really means.

First, a quick lesson in the menstrual cycle itself: The first phase of your cycle is when you’re actively bleeding. The second phase is known as the follicular phase, when your body prepares to ovulate. Depending on how regular your periods are, the length of this part of the cycle can vary a lot, but in a 28-day cycle, it lasts about a week. Then comes ovulation, when an egg is released from one of your ovaries; in a regular cycle, it happens at around the midpoint. This is the time when you’re most likely to become pregnant. After ovulation is the luteal phase, which lasts about 14 days.

Weeks of pregnancy are measured by the first day of your last periodnot from the day of your missed period. That means that you’re considered about four weeks pregnant by the time you miss your period. Texas governor Greg Abbott was being wildly misleading (or just showing his ignorance) when he said that the new law allows “at least six weeks for a person to be able to get an abortion.” An abortion cutoff at six weeks pregnant as defined by law means that even if someone notices they’re pregnant right away (which many people, especially teens, do not), they have only two weeks to confirm the pregnancy; schedule and perhaps travel for their abortion; fulfill the state-mandated counseling, 24-hour waiting period, and ultrasound; and then have their procedure. If the pregnant person is a teen who wants to get an abortion without parental approval, the legal avenue called a judicial bypass is essentially unavailable to them, given the time crunch.

Some clinics won't administer an abortion until they can visually confirm a pregnancy through an ultrasound. Which means there's sometimes such a thing as showing up too early for an abortion. I know this from personal experience: I knew I was pregnant literally one day after my missed period, but when I went to the clinic I was told there was nothing visible in my uterus. To be sure my pregnancy wasn’t growing in the wrong place (a rare and dangerous condition called ectopic pregnancy, when a fertilized egg implants outside the uterus, that requires a different kind of care than abortion), I had to wait for visual confirmation — so my abortion didn’t happen until 6.5 weeks along.

On to your next question: Is there really a “heartbeat” at this stage? Not in the literal sense. “What is meant by a ‘heartbeat’ is cardiac activity or a ‘flicker’ that is noted on ultrasound around six weeks,” says Meera Shah, MD, MPH, MS, Chief Medical Officer at Planned Parenthood Hudson Peconic. “The developing fetus does not have an anatomical heart [like] some people think.” Still, supporters of the Texas law have used the term and imagery of “heartbeat” to rally people around the near-total abortion ban.

“Cardiac activity is a milestone in development that may or may not be significant to the person carrying the pregnancy,” says Dr. Shah. And doctors do often use this term with their patients. But overall Dr. Shah sees this language as “a way to distract people from the actual issue at hand — an individual has the right to choose the outcome of a pregnancy they are carrying.”

I recently started birth control pills and missed one day. What are the consequences for my menstrual cycle and fertility? What should I do? Go back as if nothing happened or wait for my period to start taking it again? What precautions should I have with my sex life?

—Ana, 20, she/her

There’s probably not one birth control pill-taker on this Earth who hasn’t forgotten a pill here and there. The good news is that one missed pill is not the end of the world! All three gynecologists I consulted about your question — Meera Shah, ob/gyn and cofounder of Girlology Melisa Holmes, and Sherry Ross, ob/gyn and author of she-ology — assured me that it is very unlikely that you’d get pregnant after skipping just one pill. (Of course, if you’re nervous, you can always use condoms as a backup.) The more common consequence you might experience is breakthrough bleeding or spotting.

The first thing to do if you miss one pill is “take it as soon as you remember,” says Ross. You can also take “two pills or ‘double-up’ the next day.” If you miss two pills, she says, “double up” the next day and the following day, then use a backup contraception or condom the rest of the cycle. “If you miss three or more pills it gets more complicated,” Ross says. “You will need to “double up” for three days in a row and use a backup contraception or condom until the end of the pill pack. You may want to call your healthcare provider for further instructions.”

To help prevent future missed pills, Holmes recommends “pairing your pill-taking with another daily habit, like brushing your teeth. Then have an alarm or reminder set on your phone to serve as your ‘back-up reminder.’ You can also have a birth control app remind you.” And again, if birth control pills are new to you, and you’re struggling to get in the habit, it wouldn’t hurt to use a condom or another barrier method until taking your pill is burnished in your mind. Better safe than sorry.

*This question came from Teen Vogue editors.

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