Some of the following text is graphic in nature and might upset some
readers. Some of the references listed at the bottom of this essay include drawings of surgical procedures that may also
Dialog about abortion is very difficult because different groups assign
conflicting meanings to important terms:
We will use the term "abortion" to refer to any intentional medical
intervention which terminates a pregnancy at any stage. This is the definition
used most commonly by the public. The medical definition of the term is more
restrictive; it only applies to ending pregnancies before viability.
We will define the start of "pregnancy" as occurring when the the
pre-embryo becomes implanted in the uterine wall. This the
definition used by the medical profession and by most of the public. Many
pro-lifers define pregnancy as beginning at
First trimester abortions:
As noted elsewhere on this web site, about 90%
of abortions are performed early in pregnancy. These are primarily elective
abortions sought by women who simply do not wish to be pregnant. Abortions
are performed using a variety of techniques:
About 9% of abortions are performed in mid-pregnancy. Some of these
are elective abortions. For example, a young woman may be in denial
and delay seeking an abortion until she can no
longer hide her pregnancy. Another
main reason for an abortion at this stage of pregnancy is that an
ultrasound examination or an amniocenteses procedure has revealed that
the fetus has a serious genetic defect, like Down's syndrome or spinal
bifida. Essentially all pregnant women elect to have an abortion under
As of 2003-OCT-9, there are four techniques which can be employed
to terminate the pregnancy:
Induced labor: Medication is administered to the pregnant
woman which triggers labor. The woman eventually gives birth to the
partly developed fetus.
"D&E" (dilation and evacuation). The physician inserts a long
toothed clamp through the woman's vagina into the uterus. She/he grabs
body parts of the fetus at random, breaks them from the body and pulls
them out. Finally, the head is crushed and extracted. Finally, the placenta and
any remaining parts of the fetus are suctioned from the uterus.
"D&X" (dilation and extraction) The woman's cervix is
dilated. If necessary, the fetus is rotated until it is facing feet
downwards. The surgeon reaches into the uterus and pulls the fetus' body,
with the exception of its head, out of the woman's body. Surgical
scissors are inserted into the base of the fetal skull, and withdrawn. A
suction tube is inserted and the fetus' brains are removed through
aspiration. This partially collapses the fetal skull. The fetus is then
fully removed from the woman's body. 2
Some comments about the relative worth of these methods:
Dr. Katharine O'Connell from New York's Columbia-Presbyterian
Hospital and a a member of the pro-choice group Physicians for
Reproductive Choice and Health, explained that while induced labor
can be done as early as 16 weeks, it is normally not done until 19 or 20
weeks of pregnancy. It puts the woman under particular stress. In the
second trimester, she said, induced labor requires medication doses much
higher than those used at the normal end. The labor "takes
two-to-three days." She said that: "Many studies have shown the
'D&E' or 'D&X' is preferable." 3
Pro-life obstetrician Dr. Steve Calvin, from Minneapolis, MN, a
member of Pro-Life Obstetricians and Gynecologists believes that
either induced labor or carrying the fetus to term are the only
appropriate options. He said: "Induced labor leads to the fetus dying
on its own, often in the arms of its parents." He said that after a
fetus is deliveredeither dead or soon to diemedical staff support the
family in an important viewing and grieving process. 3
In a 1997 Statement of Policy, The American College of
Obstetricians and Gynecologists (ACOG) opposes any legislation that
"would supersede the medical judgment of a trained physician, in
consultation with a patient, as to what is the safest and most
appropriate medical procedure for that particular patient." The
College's 1997 statement states that anti-D&X laws are "inappropriate,
ill advised, and dangerous....The policy statement noted that although a
select panel convened by ACOG could identify no circumstances under
which intact D&X would be the only option to protect the life or health
of a woman, intact D&X 'may be the best or most appropriate procedure in
a particular circumstance to save the life or preserve the health of a
woman, and only the doctor, in consultation with the patient, based upon
the woman's particular circumstances, can make this decision."
D&X procedures are often popularly called "Partial
Birth Abortion" although the latter is a vague term which lacks a
definitive medical definition. President Bush signed a federal
bill into law on 2003-NOV-5 which criminalizes the D&X procedures
unless the fetus is dead or the woman's life is in danger. A number of court injunctions have been obtained to prevent the law from taking
Third trimester abortions:
Fewer than 1% of all abortions are performed in late pregnancy.
They are prohibited by state and provincial medical associations,
unless the fetus is dead, the abortion is required to save the life of the woman, or
it is needed to avoid
very serious health complications.
There appears to be no reliable data available on how many D&X
procedures are performed for each of the above reasons. There is some
evidence that, in the past, a physician in a hospital in New Jersey
violated his medical association's regulations by performing late
elective abortions -- procedures for non-medical reasons. Some groups opposed to abortion
access extrapolated the New Jersey data to create an artificial
national figure for third trimester abortions.
There is evidence that late abortions are sometimes performed for
other reasons: in the case of a very young pregnant woman, or a
pregnancy which resulted from a rape or incest.
The physician is faced with two main alternatives at this late point in
A hysterotomy, which is similar to a Cesarean section.
The woman is given a local anesthetic. A cut is made into her
abdomen which extends into the uterus. The fetus is removed. The
placenta is then removed. Finally, the incision is stitched.
A D&X procedure (as described above).
As noted above, D&X procedures may eventually be criminalized by a
federal law, leaving physicians with only one option.
Former Surgeon General C. Everett Koop has stated that no competent
physician with state-of-the-art skill in the management of high-risk
pregnancies needs to perform a D&X. Of course, many physicians lack
this level of skill, and so need to resort to the D&X procedure. And
some women in the U.S. have no access to good quality pre-natal care.
Some pregnant women first seek medical attention when they are about