Credit, Catalina Pizarro
"You feel like you're an executioner."
The phrase is from music teacher Catalina Pizarro, 39 years old. She accused her doctor of obstructing her right to an abortion in Chile.
Pizarro tries to explain a feeling that she still cannot overcome, almost eight years after her daughter Clara died in her womb.
"You feel dirty, guilty. You never return to inhabit your body in the same way," she tells BBC News Mundo, the BBC's Spanish-language service.
His daughter's heart stopped beating at 20 weeks of gestation, on December 5, 2018. But, several weeks earlier, Pizarro had asked his medical team to perform an abortion due to fetal non-viability, one of the three legal causes in Chile.
On September 3, the Fourth Civil Court of the Chilean capital, Santiago, partially accepted the action presented by her against the gynecologist and obstetrician Eduardo Carstens Ulloa, head of the maternity ward at the then-called Clínica Tabancura.
The court ruled that the doctor did not comply with his contractual and professional obligations, which created obstacles to Pizarro's right to make use of the country's abortion law.
Therefore, the payment of compensation worth 100.275 million Chilean pesos (around US$100,000, or R$548,000) was ordered.
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The doctor appealed the decision taken at first instance. But if confirmed, it could set a historic precedent in Chile. For Francisca Millán, Pizarro's lawyer, it would be the first favorable ruling of this nature in the country.
Carstens hopes that the decision will be reversed. His defense states that his actions followed legislation, good medical practice and that Pizarro's condition did not constitute the necessary conditions for abortion.
'I had confidence that they would take care of me'
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Catalina Pizarro and her husband had been trying to conceive for a year and a half. And, at the beginning of August 2018, the good news arrived: she was pregnant.
She started prenatal care at what was then called Clínica Tabancura, a private health service located in an affluent region of Santiago. Today, it is called Clínica RedSalud Vitacura.
His uncle on his father's side was head of neonatology at the clinic. Therefore, the decision to look for the location was natural for her.
“I had confidence that they would take care of me,” she says.
His first control exams were carried out by gynecologist Rosana Faúndez. Everyone had normal results until the 11th week, when the ultrasound showed the doctors that something was not going well.
“The doctor starts to take a long time, a long time,” recalls Pizarro. "He tells me, 'I'm going to bring a colleague.' He brings his colleague and they look."
"He then tells me that Clara had a bilateral cystic hygroma with generalized hydrops."
Credit, Getty Images
According to the International Society of Ultrasound in Gynecology and Obstetrics (ISUOG), cystic hygroma is an anomaly in the development of the lymphatic system that causes fluid to accumulate, usually in the fetal neck.
"This discovery increases the risk of chromosomal abnormalities, cardiac and non-cardiac malformations, as well as the likelihood of fetal death," describes the ISUOG.
The condition is often accompanied by generalized hydrops (or hydrops fetalis), as occurred in Clara's case. Basically, it is an abnormal accumulation of fluid in different parts of the body, including the skin.
Bad prognosis
Pizarro states that, from the first moment, doctors told her that this diagnosis would prevent the pregnancy from reaching term.
According to her report to the Chilean Court, after this ultrasound, she requested an appointment with her gynecologist and discussed with Faúndez, for the first time, the possibility of aborting due to fetal unviability.
The law regulating abortion in Chile has been in force since 2017. It allows the termination of pregnancy for this reason. The other authorized causes are rape and risk of death for the mother.
According to the law, unviability occurs when the fetus or embryo suffers from "an acquired congenital or genetic pathology, incompatible with independent extrauterine life, in all cases, of a lethal nature".
To certify this disease, the law requires "two identical diagnoses from specialist doctors".
"My gynecologist told me that she didn't see any problems and would need to talk to the clinic's ethics committee, but she would call me that same afternoon", recalls Pizarro.
In the first few days, she was asked to undergo a genetic test, to check if there was any cause at a chromosomal level that could explain her daughter's condition. The exam had normal results, but did not necessarily represent a better prognosis.
Pizarro had already made the decision to terminate her pregnancy. She did not want to wait for her daughter to die in her womb, at a more advanced stage of pregnancy.
She sought other opinions and arrived at the office of doctor Waldo Sepúlveda, who examined her on October 26th.
According to the court decision, the doctor detected considerable deterioration in the condition of the fetus and concluded in a report that, due to fetal hydrops for an untreatable reason, the case could be classified as a cause of unviability, as contemplated in the Chilean law that regulates abortion.
New exams
With his diagnosis, Pizarro only needed to obtain a second, similar favorable opinion.
She sent a message to her gynecologist, asking again for authorization of the abortion, with Sepúlveda's opinion attached.
But Faúndez contacted her, informing her that the clinic's ethics committee had analyzed her case and requested new tests before making the final decision. They requested a fetal echocardiography and said that her case was now being handled by doctor Eduardo Carstens Ulloa.
Pizarro performed new ultrasounds and a doctor from another clinic suspected that Clara might suffer from a complex heart disease.
On November 5, another specialist detected signs that could indicate insufficient development of his left ventricle. He recommended repeating the tests when the pregnancy was more advanced, after the 20th week.
But Pizarro didn't want to keep waiting. She was tired of what she calls the "pilgrimage" of exams and medical appointments, which led nowhere.
Meanwhile, her daughter Clara continued to grow in her womb.
Pizarro told the court that, after the last ultrasounds, Carstens called her for a meeting on November 12th.
She states that the doctor said he had spoken to the doctors she had consulted and that they all agreed on the same point: her case did not meet the necessary conditions for an abortion due to fetal non-viability.
Carsten also argued, according to Pizarro, that Clara's condition did not appear in the list of pathologies included in the law enforcement regulations. But the standard specifies that that list is not exhaustive, that is, it should not be interpreted as a closed catalog of pathologies.
As an alternative, the doctor offered regular monitoring of her pregnancy.
“He offered me to go every Monday,” says Pizarro.
"He made me fit in his appointments and didn't charge me for an ultrasound, to see if my heart was still beating. He said that would happen at any moment."
Within three weeks, Clara died.
'It's very strong torture'
Pizarro remembers that those days seemed eternal.
She was on medical leave, unable to leave her home, where she lived with her then partner and her 11-year-old son.
She felt like she was in a whirlwind and couldn't stop thinking about it.
"It's like being on the verge of madness, because, in fact, you end up questioning everything...", she laments.
"Creating affection, for example. You talk and then say 'no, you can't deceive yourself, you can't create bonds because it won't last'."
"And then you feel guilty about it, it's a loop, a horrible loop. It's a very strong, very strong torture," according to her.
Listening to her daughter's heartbeat regularly didn't help, nor did going to appointments and seeing other pregnant women without complications.
“This amplified what was already traumatic a little more,” says Pizarro. "It was a very dark place to live."
Clara died on December 5, 2018. In a routine ultrasound, Carstens confirmed to Pizarro that her heart had stopped beating.
At that moment, according to her, the doctor said: "I preferred it to be like this because it's more natural. This way, you won't have a burden on your conscience."
“There, I understood everything,” says Pizarro.
In his defense, Carsten declared that the decisions made about the pregnancy respected medical and legal criteria.
In his appeal, the doctor's defense argues that Clara's condition did not constitute a pathology necessarily incompatible with extrauterine life. Therefore, it was necessary to look for its causes and check if it was possible to treat it, before concluding that this was a case of fetal unviability.
BBC News Mundo contacted Clínica RedSalud Vitacura and Carstens to deepen their version of the facts, but there was no response until the publication of this report.
Clara's arrival
When Clara's heart stopped beating, Pizarro underwent an urgent cesarean section. She says she didn't want to be completely anesthetized, as she wanted to stay conscious so she could see her daughter.
"I asked for the epidural so I could have a normal cesarean section, in the sense of being able to hug her," she says. "But the minute they were taking Clara away from me, her body broke."
"I asked them to wrap her in a sheet, in something. With that, they passed her to me and I could keep her."
She had to wait for the Legal Medical Service to examine her daughter's body to confirm that it was not an illegal abortion. “We had to wait for some procedures to be able to hold the funeral,” he recalls.
Pizarro says that this is yet another traumatic step that women whose children die in the womb need to face.
“The whole system is very violent,” she laments.
The postpartum
Catalina Pizarro says that postpartum was the most difficult time for her. With her daughter's ashes at home, she has sunk into what she describes as "the deepest hole."
For the first few days, she couldn't get out of bed. Pizarro recalls that her 11-year-old son became her main caregiver.
“He would wake me up to give me food,” she recalls. "I weighed 47 kg, I couldn't speak properly."
She says that she repeated in her head several times the phrase that Carstens said on the day of her daughter's death.
“I believe it was pure paternalism,” according to her. "I don't want to believe it was because of evil, I don't want to think it was because he put his religion first."
"I believe it's the paternalism that exists in many aspects of life, like the father who says 'this is what's best for you'. But they don't know what's best for someone, because they don't wear their shoes, they haven't lived their life, they don't know what it's like to be pregnant."
For her, "these decisions are difficult, but when we decide, we accept the consequences and we can process them in peace, we can understand the why and the objective of this decision."
"But something that is imposed doesn't help the process", according to her.
With the help of his sister, Pizarro was able to pay for psychological and psychiatric therapy. And, after a while, she decided to file a civil lawsuit against Carstens.
"It's not against my doctors, it's not against anyone," she explains.
Pizarro states that she always wanted her case to serve to expose the difficulties faced by Chilean women in accessing abortion. And she says that, after her complaint became public, dozens of women with similar experiences contacted her.
'Obstacles are not always a 'no''
The former Minister of Women and Gender Equality in the government of former Chilean President Gabriel Boric (2022-2026), Antonia Orellana, states that, during her period in government, several obstacles faced by women in exercising their right to abortion in the country were detected.
This finding led to changes in the regulation of medical professionals' right to conscientious objection not to terminate a pregnancy and in the technical standard for applying the regulation.
"Catalina's case shows that, in the right to abortion, obstacles are not always a 'no'", explains the former minister to the BBC. "They disguise themselves as delays, another exam, another consultation, a second opinion that never arrives."
"When there is a clinical discrepancy, it is necessary to resolve it diligently, not letting the pregnancy progress until the discussion becomes irrelevant", argues the former minister.
"This is paternalism, it is exactly what the law came to eliminate. It is the woman's decision and the role of the medical team is to accompany and inform her."
Chile keeps records of the number of cases that meet the legal requirements to terminate pregnancies due to fetal unviability and how many terminations were carried out, but statistics do not allow determining how many women requested the procedure without success.
After nine years of the legislation being in effect, 7,566 cases of proof of one of the three legal causes were registered. Fetal nonviability is the most common, with 3,245 cases, according to figures from the Chilean Ministry of Health, updated until July 2026.
Orellana states that "during our management, we became aware of reported cases of women, especially girls, who needed to be transferred to another center, even to another region, because there was no availability of non-objectionable professionals. That is why it was so important to change the conscientious objection regulations to guarantee the provision of the service."
"Objection is legitimate when exercised in accordance with legal regulations, declared in writing and with the obligation of timely referral. The problem occurs when someone who has not declared themselves as an objector operates as an obstructor."
"They ask for unnecessary tests or postpone the second opinion. This is not conscientious objection, it is direct obstruction", highlights the former minister.
The reconstruction
Catalina Pizarro knows that there is still time to conclude her legal battle. E, com o recurso de Carstens, o processo poderá se estender ainda mais.
“I would love for him to set a precedent for other women,” she highlights. But for now, all that’s left is to wait.
She says she knows she is no longer the same person and that the grief will stay with her forever. Mas também quer retomar sua vida e voltou a tocar baixo em uma banda de música tropical.
Credit, Personal collection
“Not everything is so dark,” according to her. "Nós aprendemos a valorizar as coisas da vida, a simplicidade, aprendemos a definir prioridades."
"I don't know, knowing that, suddenly, not everything is work, that family comes first, that life can change from one day to the next and, therefore, you have to make the most of it", she reflects.
When the final sentence comes out, she will be able to do something she has wanted to do for a long time.
"When this is all over, I hope I can release her. I would love to be able to release her ashes into the sea."
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