image copyrightCatalina Pizarro
"You feel like you're the executioner."
The phrase is from Catalina Pizarro, a 39-year-old music teacher who accused her doctor of having obstructed her right to abortion in Chile.
She says it to try to explain a feeling that, almost eight years after her daughter Clara died in her womb, she still cannot shake.
"You feel dirty, guilty. You never inhabit your body in the same way again," she says in conversation with BBC Mundo.
Her daughter's heart stopped beating at 20 weeks of gestation, on December 5, 2018.
But, several weeks before, Catalina had asked her medical team to abort due to fetal inviability, one of the three causes legalized in Chile.
On September 3, the Fourth Civil Court of Santiago partially accepted the lawsuit filed against the obstetrician-gynecologist and head of Maternity at the then Tabancura Clinic, Eduardo Carstens Ulloa.
The court established that the doctor breached his contractual and professional obligations, resulting in the obstruction of Catalina's right to benefit from the abortion law, and ordered him to compensate her for 100,275,000 Chilean pesos, equivalent to approximately US$100,000.
End of Most read
If the first instance ruling, which has already been appealed by the doctor, is confirmed, the sentence could set a historical precedent in Chile.
According to Francisca Millán, the plaintiff's lawyer, it would be the first favorable ruling of this nature in the country.
Dr. Carstens, for his part, hopes that this will be reversed. Her defense maintains that her actions were in accordance with the law and good medical practice, and that Clara's condition did not constitute the conditions for an abortion.
"I was confident that they would take care of me"
Catalina and her partner had been trying to conceive for a year and a half when, at the beginning of August 2018, the good news arrived: she was pregnant.
It began to be controlled at the then Tabancura Clinic, now called RedSalud Vitacura Clinic, a private health service located in a wealthy area of Santiago.
His paternal uncle was head of Neonatology there, so the idea of receiving treatment there became natural to him. "I was confident that they were going to take care of me," he says.
Her first check-ups were with the gynecologist Rosana Faúndez. They all came out normal.
Until week 11. It was during that ultrasound that the medical staff realized something was wrong.
"The doctor starts to take a long time, a long time. And he tells me: 'I'm going to bring a colleague.' He brings the colleague and they look. And there he tells me that Clara came with a bilateral cystic hygroma and generalized hydrops," Catalina recalls.
image copyrightGetty Images
According to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), cystic hygroma is a developmental abnormality of the lymphatic system that causes fluid to accumulate, usually in the neck of the fetus.
"This finding increases the risk of chromosomal abnormalities, cardiac and non-cardiac malformations, as well as the probability of fetal death," describes the ISUOG.
The condition is frequently accompanied by generalized hydrops (or fetal hydrops), as occurred in Clara's case. In simple terms, it is an abnormal accumulation of fluid in different parts of the body, including the skin.
A bad prognosis
All the news you need is on BBC World Service
Download it here
End of Ad app
Catalina claims that from the first moment the doctors told her that this diagnosis would prevent her pregnancy from reaching term.
According to her story before the court, after that ultrasound she made an appointment with her gynecologist, Dr. Faúndez, with whom she discussed for the first time the possibility of aborting due to fetal inviability.
The law that regulates abortion, in force in Chile since 2017, allows the termination of pregnancy under this cause, in addition to the risk to the mother's life and rape.
The cause of non-viability is established, according to the law, when the embryo or fetus suffers from "an acquired congenital or genetic pathology, incompatible with independent extrauterine life, in any case of a lethal nature."
To accredit it, the law requires "two diagnoses in the same sense from specialist doctors."
"My gynecologist told me that she didn't see a problem and that I had to discuss it with the Clinic's Ethics Committee, but that she would call me that same afternoon," remembers Catalina.
In those first days they asked her to undergo a genetic test to see if there was any cause at the chromosomal level that would explain her daughter's condition.
That test came back normal, but it did not necessarily imply a better prognosis.
Catalina 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 later stage of pregnancy.
She sought other opinions and arrived at the office of Dr. Waldo Sepúlveda, who examined her on October 26.
According to the court ruling, the doctor detected a significant deterioration in the fetal condition and concluded in his report that, due to the fetal hydrops of an untreatable cause, the case could qualify for the cause of non-viability contemplated in the abortion law.
More exams
With her diagnosis, Catalina only needed to obtain a second favorable report in the same sense.
She sent an email to her gynecologist, with Dr. Sepúlveda's report attached, asking again if they could authorize her abortion.
But Dr. Faúndez contacted her to tell her that the Clinic's Ethics Committee had reviewed her case and requested more tests before making a final decision.
They asked him to have a fetal echocardiography and told him that his case was now in charge of Dr. Carstens.
Catalina had new ultrasounds. A doctor, who worked at another clinic, suspected that Clara might have a complex heart condition.
Then, on November 5, another specialist detected signs that could indicate insufficient development of the left ventricle of his heart.
The professional recommended repeating the studies when the pregnancy was more advanced, after week 20.
But Catalina didn't want to keep waiting. She was tired of what she calls "a pilgrimage" of tests and medical consultations that came to nothing.
Her daughter Clara continued to grow in her womb.
According to her story in court, after having the last ultrasounds, Dr. Carstens summoned her to a meeting on November 12.
Catalina claims that the doctor told her that he had spoken with the doctors she had consulted and that they all agreed on the same thing: she did not meet the conditions to qualify for an abortion due to fetal inviability.
Carstens - says Catalina - also argued that Clara's condition did not appear on the list of pathologies contemplated in the law enforcement regulations.
However, the standard specifies that said list is not exhaustive, that is, it should not be understood as a closed catalog of pathologies.
The doctor instead offered to monitor her pregnancy regularly.
"He offered me to go every Monday, he overbooked me at his office and didn't charge me for the ultrasound to see if the heart was still beating. He told me it would happen at any moment," says Catalina.
It would be another three weeks before Clara died.
"It is a very great torture"
Catalina says that those days were eternal. He was on medical leave, unable to leave his house, where he lived with his partner at the time and his 11-year-old son.
He felt like he was in a spiral. I couldn't stop thinking about it.
"It's like being on the verge of madness, because you really come to question everything... Getting attached, for example. You talk to him and then you say 'no, you can't fool yourself, you can't create a bond because this is not going to last'. And then you feel guilty for that, and it's a loop, a horrible loop. It's very big, very big torture," he maintains.
Listening to her daughter's heart regularly didn't help. Neither does going to the consultation and seeing other pregnant women without complications.
"That intensified everything traumatic a little more," he says. "It was a very dark place to live."
Clara's death occurred on December 5, 2018.
During the routine ultrasound, Dr. Carstens confirmed to Catalina that her heart had stopped beating.
According to Catalina, at that moment, he would have told her: "I preferred it that way because it is more natural. That way you won't have a guilty conscience."
"There I understood everything," says Catalina.
In his defense, Dr. Carstens affirms, however, that the decisions made regarding the pregnancy responded to medical and legal criteria.
In his appeal, the doctor's defense maintains that Clara's condition did not constitute a pathology necessarily incompatible with extrauterine life.
And, therefore, it was necessary to look for its causes and see if it was possible to treat it, before concluding that it was a matter of fetal nonviability.
BBC Mundo contacted the RedSalud Vitacura Clinic and Dr. Carstens to delve into their version of the events, but until the publication of this article there was no response.
Clara's arrival
When Clara's heart stopped beating, Catalina was admitted to an emergency cesarean section.
She says she didn't want them to anesthetize her too much. He wanted to be conscious so he could see his daughter.
"I asked for the epidural so I could have a normal cesarean section in the sense of being able to hug her. But the minute they took Clara out, she burst," he says.
"I asked for them to wrap her in a sheet, something. So they handed her to me and I was able to be with her."
Then she had to wait for the Legal Medical Service to examine her daughter's body to confirm that it had not been an illegal abortion.
"You had to wait for certain procedures to be able to have a funeral for him," remembers Catalina.
She assures that this is another traumatic step that women whose children die in the womb must face. "The whole system is very violent," he says.
The postpartum
Catalina says that the most difficult moment for her was postpartum.
With her daughter's ashes already in her home, she sank into what she describes as "the deepest hole."
The first few days he couldn't get out of bed. He remembers that his 11-year-old son became his main caregiver:
"He would wake me up to give me food. I weighed 47 kilos, I couldn't speak well."
He says that he repeated over and over in his head the phrase that Dr. Carstens would have said to him the day his daughter died.
"I think it was pure paternalism," he says.
"I don't want to believe that it was because he was bad, I don't want to think that it was because he put his religion first. I think it is the paternalism that exists in many aspects of life, like the father who tells you 'this is the best for you'. But they don't know what is best for you, because they are not in your shoes, they have not lived your life, they do not know what it is to be pregnant," she adds.
For Catalina, "these decisions are difficult, but when one decides, one accepts the consequence of that and can process it in peace, one can understand the why and why of that decision. But when there is something that is imposed, it does not help the process."
With the help of his sister, he was able to finance psychological and psychiatric therapy.
And after a while he decided to file a civil lawsuit against Dr. Carstens. "This is not against my doctors, it is not against anyone," says Catalina.
She affirms that what she has always wanted is for her case to serve to make visible the difficulties that women in Chile face in accessing abortion.
Once her complaint became public, she says dozens of women with similar experiences reached out to her.
"Obstacles are not always a 'no'"
The former Minister of Women and Gender Equality of Gabriel Boric's government, Antonia Orellana, assures that during her period in government they detected a series of obstacles that women faced in exercising their right to abortion in the country.
This led to modifications to the regulations on the right of conscientious objection that medical personnel have to avoid interrupting a pregnancy and to the technical standard for the application of the regulations.
"Catalina's case shows that in the right to abortion the obstacles are not always a 'no': they are disguised in delays, one more exam, one more appointment, a second opinion that never arrives," the former minister tells BBC Mundo.
"When there is a clinical discrepancy, what corresponds is to resolve it diligently, not letting the pregnancy progress until the discussion becomes irrelevant. That is paternalism, and it is precisely what the law came to end, the decision is the woman's and the role of the health team is to accompany and inform her," he adds.
Although Chile records the number of cases that meet the legal requirements to terminate a pregnancy due to fetal nonviability and how many interruptions are performed, these statistics do not allow us to establish how many women requested it and were unable to access the procedure.
Nine years after the law came into force, 7,566 cases have been registered in which one of the three causes was proven. Fetal nonviability is the most frequent, with 3,245 cases, according to figures from the Chilean Ministry of Health updated as of July 2026.
Orellana affirms that "we became aware during our management of reported cases of women, especially girls, who had to be transferred to another center, even to another region, because there were no non-objecting professionals available. That is why it was so important to modify the conscientious objection regulations to guarantee provision."
"The objection is legitimate when it is exercised as the law regulates it, it is declared in writing and with the obligation of timely referral. The problem is when someone who has not declared themselves an objector operates as an obstruction. They ask for unnecessary examinations or postpone the second opinion, that is not conscientious objection, it is straight-up obstruction," he adds.
Rebuild
Catalina knows that there is still time to bring a definitive closure to her legal battle.
With Dr. Carstens' appeal, the process could be extended even further.
"I would love for a precedent to be created for other women," she emphasizes.
For now, you have to wait.
She says she knows she is no longer the same and that the grief will be with her forever.
But he also wants to get his life back on track. He returned to playing bass in a tropical music band.
Image source, Courtesy Catalina Pizarro
"Not everything is so dark; you learn to value the things in life, the simplicity, you learn to set priorities...I don't know, knowing that suddenly not everything is work, that family comes first, that life can change the next day, so you have to enjoy it...", he reflects.
When you have a definitive failure you will be able to do something you have wanted to do for a long time.
"I hope, when all this is over, I can free her. I would love to be able to throw her ashes into the sea."
Discover more
Video
End of Video
