HOW ARE LATE-TERM ABORTIONS PERFORMED?

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Warning:

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 be distressing.

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Terminology:

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 conception.

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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:

	Through medication Using Methotrexate & Misoprostol or RU-486
	By manual vacuum aspiration
	By a surgical procedure

This essay continues below.

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Second trimester abortions:

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 these conditions.

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. ₁
	"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 delivered—either dead or soon to die—medical 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." ₄

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 effect.

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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 pregnancy:

	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 to deliver.

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Related essay:

Why are late-term abortions performed?

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References:

"Dilation and Evacuation Abortion (D&E) of a 23 week old fetus," Priests for Life, at: http://www.priestsforlife.org/
"Partial Birth Abortion," Priests for Life, at: http://www.priestsforlife.org/
Suzanne Batchelor, "Abortion Procedures Ban Limits Endings for Doomed Pregnancies," Women's Enews, 2003-SEP-29, at: http://www.now.org/
"Statement on So-Called "Partial Birth Abortion" Laws By The American College of Obstetricians and Gynecologists," 2002-FEB-13, at: http://www.acog.org/