Posted on 04/21/2003 4:44:25 PM PDT by RJCogburn
As a ban on a procedure that opponents call partial-birth abortion makes its way through Congress, many of the doctors who provide abortions say they remain confused about what will be banned and fear it will apply to other procedures used in the second trimester of pregnancy.
The procedure at issue — what doctors now call intact dilatation and extraction, or intact D&X — involves pulling the fetus's legs and torso out of the uterus and then crushing its skull before removing it entirely. It is not known how often it is performed in the United States, but its use is limited to the latter weeks of the second trimester. Even then, it is not always the procedure doctors choose.
In fact, it is practiced very rarely. Many doctors who perform abortions say they do not use the technique at all. Yet they agree that in certain situations, it may be the safest way to perform an abortion.
"There are times, quite frankly, when this is the procedure of choice," said Dr. Deborah Oyer, a family practitioner in Seattle who provides abortions, but not late enough in pregnancy to practice the method.
Doctors say they fear that even if they give up this particular procedure, the law will still apply to other techniques that are regularly used to end pregnancies after 16 weeks. The law, many experts say, is vaguely written. It does not spell out the intact D&X procedure.
"The way they define the procedure in the bill, it could easily be attributed to a wide variety of abortion procedures," said Dr. Paul D. Blumenthal, an obstetrician-gynecologist at Johns Hopkins University. Even if doctors begin abortions intending to obey the law, he added, they may be forced by medical circumstances to perform procedures that violate it.
Only one abortion provider interviewed for this article acknowledged regularly practicing intact D&X, and she spoke on the condition that her name not be used. Many others interviewed declined to describe their procedures in detail, for fear of being singled out by anti-abortion protesters.
On March 13, the Senate passed a bill outlawing the procedure. The House of Representatives is expected to follow soon, and President Bush has promised to sign the legislation. President Bill Clinton vetoed similar bills in 1996 and 1997.
Over the years, an important question has remained unanswered: how many partial-birth abortions are actually done?
In 2000, the Alan Guttmacher Institute, a research organization that supports abortion rights, surveyed abortion providers nationwide and estimated that 2,200 such procedures were done that year, by 31 physicians. That would account for less than one-fifth of 1 percent of the estimated 1.31 million abortions performed in the United States that year.
But because not all abortion providers answered the survey, the estimate "could be off by a considerable amount," said Stanley Henshaw, a senior fellow at the institute.
Dr. Warren Hern, director of the Boulder Abortion Clinic in Colorado, questioned whether any doctors in the survey were actually using a so-called partial-birth procedure, because no such technique had ever been described in a medical journal. "We have no idea how this is done or even whether it is done," he said. "Until it's published in a peer-reviewed journal, it's folklore."
One aspect of the debate has changed. When it began, some opponents of the ban said the targeted form of abortion was used only when a fetus had extreme abnormalities or a mother's health was endangered by pregnancy. Now, both sides acknowledge that abortions done late in the second trimester, no matter how they are conducted, are most often performed to end healthy pregnancies because the woman arrived relatively late to her decision to abort.
A Guttmacher study from 1987 indicates that only 2 percent of abortions done after 16 weeks of pregnancy are done because of fetal abnormalities.
A vast majority of second-trimester abortions are done using a technique called dilatation and evacuation, or D&E, in which the cervix is dilated, the fetal sac is punctured and drained, and the fetus's head is crushed. Then the body is dismembered and removed. The procedure typically takes less than 10 minutes.
When a pregnancy has advanced beyond 18 weeks, the process can be more complicated. Because the fetus is larger, it may take three or four days to adequately dilate the cervix. Dr. Hern kills the fetus with an injection of the heart drug digoxin a few days ahead of time. After draining the amniotic fluid, he gives the patient ocytocin to cause contractions of the uterus. This movement aids in expelling the fetus.
Second-trimester abortions can also be done by inducing using labor and delivery alone. Fewer than 2 percent are done this way, however, 1999 statistics from the Centers for Disease Control and Prevention show. Physicians largely abandoned the approach after studies in the 1970's indicated that D&E abortions were safer, said Dr. David Grimes, a former chief of the C.D.C.'s abortion surveillance division.
The studies showed that complications — including bleeding and infections — occurred in 25 of every 1,000 abortions done by induced labor but only 7 of 1,000 abortions done by D&E.
Dr. George R. Tiller of Wichita, Kan., who uses a labor-and-delivery technique, injects the fetus with digoxin one to four days ahead of time. The kind of abortion that would be banned under the new law is a variation of D&E. It was first described by an Ohio doctor in the early 1990's, in a talk to the National Abortion Federation. After his description set off a debate, the American College of Obstetrics and Gynecology described a similar technique, and called it intact D&X.
The technique was designed for abortions done after 18 to 20 weeks, when the fetus's head has grown too large to fit through the cervix easily. By 20 weeks, a fetus is typically about eight inches long.
The physician reaches into the uterus to turn the fetus into a feet-first position. The fetus is pulled through the cervix up to the neck. The doctor then pierces the fetal skull with an instrument and drains some of its contents. This causes the skull to collapse and fit through the opening.
Some doctors do an intact D&X without first adjusting the fetus to a feet-first position, so that it may come out head first.
"From the time I first saw it done, it was clear to me that this procedure was safer and faster and better than the abortions I had been doing before," said the abortion provider who regularly practices intact D&X. The advantage, she said, is that it involves less poking and jabbing inside the uterus.
Rather than mentioning intact D&X, the bill describes a situation in which a doctor "deliberately and intentionally vaginally delivers a living fetus" until either the head or the body up to the navel is "outside the body of the mother" and then intentionally kills it.
Dr. Curtis R. Cook, a maternal fetal medicine specialist at Spectrum Health in Grand Rapids, Mich., who helped write the law, said he avoided the College of Obstetrics and Gynecology's description of intact D&X so that the law would apply to any abortion in which a live fetus is brought partway out of the uterus, not only to those that follow the college's description to the letter.
Abortion providers say that in some classic D&E operations, part of the fetus may pass through the cervix while it is still alive.
"If the cervix is more dilated than you expect, sometimes a large part of the fetus will come out at a variety of gestational ages, from 15 to 22 weeks," explained the physician who practices intact D&X. "If the fetus comes halfway out, and then you do something to complete the abortion, that would be against the law as they've written it. What would you do then? Try to put the fetus back in?" The physician is usually relieved when a large part of the fetus drops into the vagina, she said, because "it means the fetus is coming out in a more gentle and rapid manner."
Because it is hard to know if a fetus is dead or alive, said Dr. Phillip Stubblefield, director of obstetrics and gynecology at Boston Medical Center, "almost any D&E you do from 13 or 14 weeks on, you're going to violate the statute."
But Dr. Cook said the law would not affect D&E abortions. "We used very clear language," he said. "It has to be an overt act, not an unintentional act."
Dr. Nancy Romer, an obstetrician in Dayton, Ohio, who also favors the ban, said abortion providers could comply with the proposed law by killing the fetus with an injection before starting the abortion. "It adds no additional risk, and it gets around the whole issue," she said.
Abortion providers argue that an injection does make the operation riskier because it involves putting drugs in the uterus, and it requires passing a needle through the woman's abdomen.
Dr. Stubblefield noted that the technique was the same one used to perform amniocentesis in pregnancy, in which doctors pass a needle into the amniotic sac to draw fluid for genetic testing. "It can be tricky," he said. "Every now and then one goes through a loop of bowel with the needle. You can carry bacteria in the uterus, and that can lead to severe sepsis."
If this step is routinely added to the standard abortion, he said, "we'd be exposing a whole lot of women to a risk they don't need to be taking."
The ban before Congress includes an exception for saving the life of the mother, but not for preserving her health because, the bill asserts, "a partial-birth abortion is never necessary to preserve the health of a woman."
Most abortion providers disagree. Dr. Tiller of Wichita said intact D&X might be the safest procedure for some physicians.
"It doesn't fit my style of practice," Dr. Tiller said, "but there are good practitioners who develop different styles. If you force those physicians to use my technique, they will not get results as good."
In certain situations related to a mother's dangerously high blood pressure, removing the fetus quickly may be desirable, Dr. Oyer of Seattle said. In such a case, intact D&X might be fastest, she said.
Dr. Cook argued that induced labor would be faster because the patient would not have to wait two days for the cervix to dilate. The so-called partial-birth abortions, he said, can "overdilate" the cervix. "Women who have had this procedure have had problems with cervical incompetence afterward," he added.
When physicians cut into fetal skulls in intact D&X procedures, he added, they risk tearing or cutting the uterus.
Dr. Grimes disagreed with both assertions. "There's not a bit of documentation to establish that intact D&X carries these risks, and I would challenge them to provide a citation anywhere," he said.
A question that often enters the debate is whether the fetus senses pain in an intact D&X abortion.
"We can say with confidence the fetus does not feel pain," Dr. Grimes said. "Neurologically, it is not developed enough to feel pain. A fetal brain in mid-trimester doesn't even look like a human brain. The neural pathways aren't there."
Ultimately, the abortion providers say that they should be able to choose the procedure that is best for each patient.
"The goal of any abortion procedure is the destruction of the fetus," said Dr. Felicia H. Stewart of the University of California at San Francisco. "Given that that is the reality, it doesn't seem to me we ought to have a legislative mandate that likely increases the risk to the woman."
... Likely Ban on Abortion Technique Leaves Doctors Uneasy ...The heart bleeds.
Well, we certainly wouldn't want to outlaw such a harmless pasttime, would we?
Every time I read the description of this horror, I shudder to think that there can even be a DISCUSSION about its utter inhumanity! How can the Almighty hold blameless any nation that allows such depravity!!
God grant. But don't bet rent.
Gee, after reading that description of the procedure, one has to wonder how those zany anti-abortion zealots ever came up with the name "partical-birth abortion."
Absolutely! Four out of five babies agree.
Scientific studies prove womb-bound children are sensing and feeling much earlier than most people think it occurs. [Fetal Psychology, Psychology Today Magazine, Oct'98. http://www.leaderu.com/orgs/tul/psychtoday9809.html ]
A recently delivered woman can tell you they notice movement in their baby, usually around the fifth month from conception, but studies are now confirming that the feelings and sensing of the womb-bound begin around or before the fourth month (14 to 16 week period) from conception, when the brain and body have made the vast majority of nerve connections necessary for hearing, taste, sense of touch.
This is a startling thing which Americans need to know, since current policy allows abortions all the way through to term (40 weeks) and the assaulted child is not even given medication to block the pain! Pain? Yes, excruciating pain.
Can you imagine having an ankle crushed and leg dislocated in pulling your body from a car wreck or from out of a collapsed building?… Second and third trimester abortions accomplishes this quite often, pulling the infant almost all the way from the woman's body before killing for removal, or ripping the little one into pieces for extraction.
There are other excruciating methods used for abortion. A super concentrated saline solution gets injected into the amniotic fluid, which scalds the child to death, causing the kidney's to fail and the heart to eventually stop. There is a long needle with poison, jabbed through the woman's abdomen and into the chest of the prenatal infant. Sadly, Ultrasound technicians often have to watch this as the doomed child struggles to avoid painful jabs.
Most Americans are not aware of the excruciating assaults being made on the womb-bound, sensing, feeling children killed in abortion clinics. Sensing, feeling, conscious children are being murdered in the womb … and it is painful for them. I suppose the serial killers are proud that they can shorten the excruciatingly painful killing to ten minutes worth! Aren't you proud of them, RJCogburn?
No. Why would I be?
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