Introduction: Description; why are they
done; disinformation about the procedure

	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 pregnancy:

	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. ₂ He 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. They reported: