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D & X / PBA procedures:

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

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Description of the D&X Procedure:

These are generally called:

bullet "D&X" procedures, an abbreviation of "dilate and extract," or
bullet "Intact D&E," or
bullet "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. 

bullet 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 woman.
 
bullet 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.
 
bullet 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.
bullet 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

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Why Are D&X Procedures Performed?

This is a topic that is almost never discussed during public debates or on pro-life information sources:

bullet 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.

bullet 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, including:

bullet 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.
bullet There are mental or physical health problems related to the pregnancy.

bullet 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.
bullet 3rd Trimester: They are also very rarely performed in late pregnancy. The most common justifications at that time are:

bullet The fetus is dead.
bullet The fetus is alive, but continued pregnancy would place the woman's life in severe danger.
bullet The fetus is alive, but continued pregnancy would grievously damage the woman's health and/or disable her.
bullet 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:

bullet a hysterotomy, which is similar to a Cesarean section, or
bullet 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:

"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

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Disinformation about D&Xs:

Abortions in general and D&Xs in particular are extremely emotional topics for both pro-life and pro-choice activists. Sometimes the truth gets really bent out of shape:

bullet 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.

bullet 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.

bullet 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.

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References:

  1. "Virginia: Pro-life groups work for partial-birth abortion ban," at: http://www.champion.org/
  2. "Information about Hydrocephalus and D&X," at: http://www.gentlebirth.org/
  3. "Statement on So-Called "Partial Birth Abortion" Laws By The American College of Obstetricians and Gynecologists," 2002-FEB-13, at: http://www.acog.org/
  4. Lisa Rein, "Va. Passes Ban on Type Of Abortion: Exception Allowed For Woman's Health," Washington Post, 2002-MAR-8, Page A01, at:  http://www.washingtonpost.com/

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Copyright ©1996 to 2010 by Ontario Consultants on Religious Tolerance.
Last updated: 2010-JUN-27

Author: B.A. Robinson
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