"D&X" procedures, an abbreviation of "dilate and extract,"
"Intact D&E," or
"Intrauterine Cranial Decompression" procedures.
They are not abortions as defined within medical science. The formal medical
definition of the term "abortion"
means the termination of pregnancy before the fetus is viable. However, it does
fall within the definition of "abortion" which is used by most of the public.
The term "Partial Birth Abortion" was recently created by pro-life groups when the procedure became
actively discussed at a political and religious level. We will generally use the
medical terms in this section.
The procedure is usually performed during the fifth month of gestation or later. The
woman's cervix is dilated, and the fetus is partially removed from the womb,
feet first. The surgeon inserts a sharp object into the back of the fetus' head,
removes the object, and inserts a vacuum tube through which the brain is extracted.
The head of the fetus contracts at this point and allows the fetus to be more
easily removed from the womb, thus minimizing any damage to the woman.
The exact number of D&Xs performed is impossible to estimate with
accuracy. Many states do not have strict reporting regulations.
One often quoted
figure was that over 1000 D&Xs had been performed annually in New Jersey.
From this number, many inflated national totals were estimated. But the New
Jersey figure appears to be an anomaly. A single physician in a single NJ hospital
had allegedly been ignoring the regulations of the state medical association and performing
D&Xs in cases not involving the potential death or serious disability of the
Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers,
estimated (Nightline program, 1997-FEB-26) a total of 3,000 to 4,000 annually
in the US -- about ten a day.
Pro-life groups uncovered an internal memo by Planned Parenthood which estimated that up to 60 (0.24%) of the more than 25,000
abortions performed annually in Virginia were D&Xs. 1 If
this figure is accurate nationally, then there would be up to 2,880
D&X procedures per year in the U.S.
Referring to a Virginia state law, Bennet Greenberg, executive director of Planned Parenthood Advocates of
Virginia said: "I'm not aware of a need for this bill in the first
place, since this procedure is very, very rare, and I'm not aware it's
ever been used [in Virginia]." 4
This is a topic that is almost never discussed during public debates or on
pro-life information sources:
1st Trimester: D&Xs are not performed during the first three
months of pregnancy, because there are better ways to perform abortions.
There is no need to follow a D&X procedure, because the fetus'
head quite small at this stage of gestation and can be quite easily
removed by suction from the woman's uterus.
2nd Trimester: D&Xs are very rarely performed in the late
second trimester at a time in the pregnancy before the fetus is viable.
These, like most abortions, are performed for a variety of reasons,
She is not ready to have a baby for whatever reason and has
delayed her decision to have an abortion into the second trimester. As
mentioned above, 90% of abortions are done in the first trimester.
There are mental or physical health problems related to the
The fetus has been found to be dead, badly malformed, or suffering
from a very serious genetic defect, like Down's Syndrome. This is often only detectable late
in the second trimester.
3rd Trimester: They are also very rarely performed in late pregnancy. The
most common justifications at that time are:
The fetus is dead.
The fetus is alive, but continued pregnancy would place the
woman's life in severe danger.
The fetus is alive, but continued pregnancy would grievously
damage the woman's health and/or disable her.
The fetus is so malformed that it can never gain consciousness and
will die shortly after birth. Many which fall into this category have
developed a very severe form of hydrocephalus.
In addition, some physicians violate their state medical
association's regulations and perform elective D&X procedures -
primarily on women who are suicidally depressed.
There appears to be no reliable data available on how many D&X
procedures are performed for each of the above reasons.
The physician is faced with two main alternatives at this late point in
a hysterotomy, which is similar to a Cesarean section, or
a D&X procedure
A midwifery web site quotes Dr. William F. Harrison, a diplomate of
the American Board of Obstetrics and Gynecology. 2He wrote that "approximately 1 in 2000 fetuses develop
hydrocephalus while in the womb." About 5000 fetuses develop
hydrocephalus each year in the U.S. This is not usually discovered
until late in the second trimester. Some cases are not severe. After
birth, shunts can be installed to relieve the excess fluid on the
newborn's brain. A pre-natal method of removing the excess fluid is
being experimentally evaluated. However, some cases are much more
serious. "It is not unusual for the fetal head to be as large as 50
centimeters (nearly 20 inches) in diameter and may contain...close to
two gallons of cerebrospinal fluid." In comparison, the average
adult skull is about 7 to 8 inches in diameter. A fetus with severe
hydrocephalus is alive, but as a newborn cannot live for long; it
cannot achieve consciousness. The physician may elect to perform a D&X
by draining off the fluid from the brain area, collapsing the fetal
skull and withdrawing the dead fetus. Or, he might elect to perform a
type of caesarian section. The former kills a fetus before birth; the
latter allows the newborn to die after birth, on its own. A caesarian
section is a major operation. It does expose the woman to a greatly
increased chance of infection. It "poses its own dangers to a woman
and any future pregnancies." 2Allowing a woman
to continue in labor with a severely hydrocephalic fetus is not an
option; an attempted vaginal delivery would kill both her and the fetus.
There is evidence that the procedure is sometimes performed for other
reasons: in the case of a very young pregnant woman, or a pregnancy which
resulted from a rape or incest. 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, even in the United States, not all women have access to good
quality pre-natal care. Many pregnant women first seek medical attention
when they are about to deliver.
A committee of the American College of Obstetricians and
Gynecologists (ACOG) thoroughly studied D&X procedures in 1996.
"A select panel convened by ACOG could identify no
circumstances under which this procedure...would be the only option to
save the life or preserve the health of the woman." They also
determined that "an intact D&X, however, 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."
Their statement was approved by the ACOG
executive board on 1997-JAN-12. 3
Abortions in general and D&Xs in particular are extremely emotional
topics for both pro-life and pro-choice activists. Sometimes the truth gets
out of shape:
On 1995-JUL-19, on the radio program Focus on the Family Dr.
Dobson referred to PBAs as a type of "Nazi era experimentation" in which doctors "suck
the brain matter out of a living, viable baby for use in medical experiments".
The incorrect impression given was that this is a procedure requested
by researchers eager to study brain structure. They arbitrarily select
an about-to-be-born fetus at random from the nearest delivery room,
and kill it in order to get more research material. The program
generated a flood of telephone calls which paralyzed Federal
government switchboards. To our knowledge, Dr. Dobson has never
apologized for his misleading statements or corrected his
misrepresentation of the facts.
Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers testified in government hearings that only about 450 D&Xs were
performed annually in the United States. Later, on ABC's Nightline program, he admitted that he had lied about this figure in order to
match the the lies and
rhetoric by the other side in the debate. He now estimates that 3 to 4
thousand per year is a more accurate value.
Senator Rick Santorum, one of the leaders in the Senate of a D&X
ban, said that the procedure is a gruesome form of infanticide. [The
term infanticide refers to the killing of a newborn infant;
it is not really applicable to an unborn fetus during a D&X procedure.]
Senator Santorum also said that it is a lie to argue that a D&X is
sometimes required to protect a woman from a serious health risk.
But, in our opinion, if he truly believed that statement, then he would not have
objected to President Clinton's request that an exemption be added to
the bill in cases of serious health risks to the woman. After all, if
there was no risk of a devastating health problem, then the exemption
would never be exercised, and there would be no harm in including it
in the bill.