The Medical Circumstances and Generous Immolation of Saint
Gianna Beretta Molla During Her Last Pregnancy
Rev. Tadeusz Pacholczyk, Ph.D.
Recounting the story of the generous personal
sacrifice made by Saint Gianna Beretta Molla
on behalf of her fourth child often results in
the request for
more medical details regarding her situation. A few of the medical issues surrounding
her pregnancies will be reviewed as the starting point in examining her final
sufferings and immolation.
Pregnancy was always a difficult experience for Gianna. During
each of her pregnancies, she experienced hyperemesis, which means
excessive vomiting. She also experienced intestinal binding and
dysfunction, and other gastric disturbances. These caused her
much pain. Her first pregnancy went 25 days beyond her due date,
had a labor that lasted 36 hours. Because of the large size of
the baby, the delivery was a forceps delivery.
During the course of her second pregnancy, she experienced similar
difficulties, and again went 10 days late with a long and painful
In her third pregnancy she had to be admitted to the hospital due
to acute symptoms similar to her first two pregnancies, with
vomiting but also with acute spasmodic contractions which she thought
she might lose the baby early. In the end her third pregnancy
was also delayed about 10 days, and followed the course of the
ones with a painful delivery.
Gianna never seemed to lose her serenity during her deliveries,
though she sometimes would clamp down on a handkerchief with
her teeth in moments of pain. She appears to have always declined
medication during her deliveries.
In the second month of her last pregnancy, she was diagnosed with
a large fibroid. A fibroid is a benign tumor of the uterus, and
often it is small enough and unobtrusive enough that one can
leave it alone, and allow the course of the pregnancy to continue
Gianna's uterine tumor caused her considerable pain, and based
on medical documents from Italy, it appears that the fibroid
was large enough that it might have threatened the continuation
the pregnancy by compressing the fetus. Such compression, if
not directly disruptive of the pregnancy itself, could nevertheless
result in abnormalities in fetal development. Large fibroids
also be a source of other complications during pregnancy. They
may cause preterm labor. They may cause the uterus to become
trapped in the pelvis under the sacral promontory such that it
to be manually elevated to allow further progress of the pregnancy.
They may occasionally outgrow their blood supply and degenerate
or infarct, causing considerable pain as well as presenting the
risk of becoming infected.
Her husband Pietro recalls that there were three options presented
for Gianna's case:
1. Considering the dangers, she could have chosen to have her
uterus removed (hysterectomy) in order to remove the fibroid
body. This would be a fairly low-risk approach for her situation.
It would result, however, in the death of her 2 month old fetus,
and preclude the possibility of future pregnancies. Based on
the particulars of her case, this option would not have been
problematic; Catholic moralists have analyzed cases of this sort
under the Principle of Double Effect 1. Such an intervention
is directed towards saving the life of the mother by removing
cancerous uterus (which has the undesired effect of ending the
life of the unborn child). Morally, such a case would be properly
considered under the aspect of a hysterectomy, not under the
rubric of elective abortion.
2. A second option in St. Gianna's case would be to have the
fibroid removed as well as terminating the pregnancy, thereby
the possibility of future pregnancies. This option, by requiring
direct abortion, would be morally contraindicated.
3. A third option would be to have the fibroid surgically removed
and risk the continuation of her pregnancy, which is the option
St. Gianna chose. Because she was a physician, Gianna understood
that the risks were several: the surgery on the uterus might
irritate it to the point that the pregnancy would be threatened
spontaneously abort. The blood loss can be difficult to control
in a pregnant uterus. Surgery on the uterus under these circumstances
also presented the danger that during the remainder of the pregnancy,
there might be a re-opening of the scarred wound from the surgery.
A flare-up of this sort could be dangerous from the rapid bleeding
that would ensue.
Gianna followed the recommendation of her advising physician
and had the fibroid removed, but insisted that the maximum care
be used during the surgery so as to avoid interrupting the pregnancy
or harming the developing fetus. The myomectomy was successful,
and her pregnancy continued. The surgery revealed that the tumor
was partially subserous, partially intramural. Although some
of her colleagues had advised her to terminate the pregnancy,
Gianna never considered the possibility of abortion. Being faced
with two morally acceptable options in the early stages of her
pregnancy, she freely chose, with great generosity on her part,
to proceed with a higher risk pregnancy for the benefit of her
child. A typical therapy offered in Gianna's day for a woman
with uterine cancer or a tumor of uncertain type would have been
Prior to her surgery, Gianna's doctors would not have known many
of the details appertaining to the tumor, for example whether
it was cystic or solid, or perhaps even whether it was of the
uterus or the ovaries. It was quite different for Gianna going
into surgery for a tumor in the early 60's in Italy than it would
be today. With ultrasound and other technologies, much more information
would be available to the modern day surgeon. The heroic part
of what Saint Gianna did was to choose life for her child under
these difficult and uncertain circumstances, no matter what the
consequences to herself. It is in this sense that Pope Paul VI
could state that Saint Gianna "was a mother who, in order
to give life to her baby, sacrificed her own life in deliberate
immolation." Towards the end of her pregnancy, when talking
to her brother, she seemed to have a premonition that trouble
lay ahead. She said, "The greater part has yet to come.
You do not understand these things. When the time comes, it will
be either he or I." And again when speaking to her husband
Pietro on another occasion, she said in a firm voice and with
a penetrating gaze, "If you have to decide between me and
the child, do not hesitate; I demand it, the child, save it." Such
was her generous attitude throughout her pregnancy.
At the end of the pregnancy, her physicians attempted to induce
labor with oxytocin, but contractions were not forthcoming. Other
means were attempted, lasting from the afternoon of Good Friday
until the next morning around 10 o'clock, but without success.
Though her water had broken, labor was not proceeding. The decision
was made to deliver the child by Caesarean section.
She underwent general ether anesthesia and a healthy baby girl
weighing nearly 10 pounds was delivered. Gianna's condition began
to decline soon afterwards, with symptoms including an elevated
fever, a rapid, weakened pulse, and exhaustion. She died 7 days
later of septic peritonitis, an infection of the lining of the
abdomen, notwithstanding the fact that antibiotics were utilized
in her treatment. During the painful abdominal sufferings caused
by the septic peritonitis, she declined any narcotic pain medications,
because she felt that such drugs did not allow her to be herself.
In her final sufferings, she once remarked to her sister, "If
you only knew how differently things are judged at the hour of
death! ... How vain certain things appear, to which we gave such
importance in the world!"
The infection she contracted almost certainly occurred consequent
to the Caesarean surgery. The question is occasionally raised
as to whether it would have been helpful to St. Gianna to have
had a hysterectomy after the C- section delivery of her baby,
so as to forestall or stave off the eventuality of infection.
A hysterectomy at such a point would not have likely altered
the pathogenesis of the infection, since it had already arisen
in the abdomen during the C-section. C-sections, it should be
recalled, are not always neat and tidy operations; the surgery,
in effect, opens up a communicating channel between the microenvironments
of the uterus, the cervix, indeed the whole birth canal, and
the abdomen. This can result in unwanted microbial exchange.
However the source of Gianna's infection remains unknown; pathogens
might also have been introduced as a result of improper sterile
technique during the C-section surgery itself.
It is unclear whether the decision for the Caesarean section
was related to the fact that St. Gianna had undergone surgical
intervention previously for the tumor, but there may very well
have been a connection between the two. In the past, obstetricians
were often of the conviction that if a woman had once had a significant
surgical intervention on the uterus (e.g. large tumor removal
or a Caesarean), future deliveries should be by Caesarean, since
there seemed to be a greater risk involved with a normal labor
and delivery after such interventions. Her physicians may have
felt a certain urgency in St. Gianna's case to deliver the child
on-time, since she had a propensity for delayed deliveries, which
presumably stretch an already stressed uterus even further. In
this sense, the death of Saint Gianna may have been an indirect
result of her previous choice to undergo the tumor resection.
In the medical world of today, of the 1990's, it might well have
been possible to save Gianna's life in addition to her daughter's.
Septic peritonitis today is rarely fatal when identified early
and aggressively treated. Physicians often have recourse to a
highly effective triple regimen, three types of antibiotics at
the same time. But in Gianna's day, methods of antibiotic treatment
were not as advanced, and the means available for monitoring
the progress of a pregnancy were also not as sophisticated as
they are today. With ultrasound, highly specific blood tests,
and CAT scans, we are Saint to live in an age where the making
of a life or death between mother or child is becoming progressively
more uncommon and unnecessary
Sadly, though, we live in an age where life and death decisions
against the unborn child are made with an ever greater casualness,
and pregnancies are terminated for reasons that can only be termed
trivial. Saint Glanna's example of heroic commitment to the
life of her own child throws into clear relief the scandal of
the easy-abort mentality of our day. She believed that the privilege
of being a mother, of being a cooperator with God in bringing
forth new life meant always defending and protecting her children,
whether in or out of the womb, even to the point of giving up
her own life on their behalf. Even though it is rarely to the
point of death, every mother is aware of this profound maternal
reality of being immolated and making great silent sacrifices
on behalf of their children.
l Principle of Double Effect - this principle
is utilized to evaluate actions which have two effects, one good
and one evil.
The principle of double effect has been summarized into 4 basic
criteria: 1) the action in itself must be good or indifferent;
2) the good effect cannot be obtained through the bad effect
(because then the end would justify the means); 3) there must
be a proportion between the good and bad effects brought about
(e.g. life against life); 4) the intention of the subject must
be directed towards the good effect, and merely tolerate the
bad effect. Some say there is a fifth requirement - that there
does not exist another possibility or avenue.