The Straight Dope on "partial birth abortions" (U.S. issue)

[Philster]

It's difficult to get the facts about this issue when two camps rally around it with the drive that only politics and religion can possibly generate.

(U.S. issue, btw)

First, is "partial birth abortion" legal - the abortion in the last trimester ?

If the partial birth abortion is legal, are the gruesome descriptions of how the "brain is sucked out" accurate?

I'll qualify my innocence by saying that I am actually in tune with debunking rumors, and scare tactics, but trying to learn anything from searching on this topic is futile. Every group hollering their point of view might as well be named something like "biased liberals for choice", or "biased viewpoint of religious lunatic fringe".

Set aside feelings about what is 'right' and 'wrong', and give me the dope on this topic.

I just want facts so that I can form my own opinions.

Thanks, Dopers.

[Whack-a-Mole]

Yes, partial borth abortions are gruesome. Then again, IMHO, most medical procedures are gruesome.

The deal with a partial birth abortion is that the fetus/infant/pick your term cannot be born alive. If it is born and then killed after the fact that is basically murder by most definitions of murder I can think of. So, the 'simplest' way to kill the unborn is the brain sucking method (it also makes it 100% certain the unborn is truly dead).

What gets lost in the cries of horror over this is that it is not done lightly or often. Such a procedure is an extreme measure in extreme circumstances that usually involve the life of the mother (i.e. she will die if the procedure isn't performed). PBA's are not done merely because a woman decides to have an abortion late in the game.

[Enola Straight]

The doctor reaches into the mother and grasps the baby by the feet, pulling the baby out...leaving the head inside.

A pair of scissors is inserted into the juncture between the head and neck, puncturing the skull.

A vaccuum aspirator is inserted in the hole and the "cranial contents" are sucked out. At this point the skul collapses.

The baby is then pulled out.



Nice, huh?

[tiny ham]

I think I'm going to puke.

[Philster]

So....Partial Birth Abortion (PBA)- the gist of it is this:

- sucking the brains out of the unborn
- it is legal
- the intended result is the termination of a pregnancy that would jeopardize the life of the woman, if she were to carry the unborn to term.

So, to keep in the legal spirit of things, I'm avoiding the use of the words such as "mother", "baby" and "child" (that's not where I was going with this thread, but we might as well stick with the 'facts').

Is this account accurate, based on the posts so far? Anyone else have knowledge on what happens and when in this procedure (PBA facts).

[bibliophage]

This thread has the potential to turn ugly, so as a preventive measure I will say now let's all be extra careful about sticking to the facts. Just the medical and legal facts.

bibliophage
moderator GQ

[pravnik]

Guys, please. All abortive procedures can be gruesomely detailed. It's an issue that raises a lot of passions, but try to save the passions for GD.

To pass Constitutional muster, a law concerning abortion cant' place an undue burden on a woman's right to have an abortion before fetal viability, and must have a provision allowing for abortion to protect the health of the mother after fetal viability. Usually, in the second trimester, this is performed by a method called Dilation & Extraction,(D&E) involving diltaion, removal of fetal tissue using non-vacuum surgical instruments and (after the 15th week) potential dismemberment of the fetus or collapse of fetal parts to facilitate evacuaton from the uterus. This is the standard abortion procedure.

A variation of D&E, Intact D&E, is used after 17 weeks. It involves removing the fetus "intact" from the uterus in one "pass", rather than several passes. This is accomplished either one of two ways: head first or feet first. The feet first method is known as "Dialation & Extraction (D&E). D&E is what we commonly think of as partial-birth abortion. D&X is superior to and safer for the mother afetr a certain period.

All this is from a SCOTUS opinion, Carhart v. Nebraska, that struck down a Nebraska statute for lacking the all-important "health of the mother" provision. Nebraska argued that this provision was uneccessary, as safe alternatives to D&X were available. The lower court founds, and SCOTUS upheld, that because D&X was safer to the mother during certain pre-viability periods of gestation than D&E, Nebraska could not ban it altogether. What's more, the law was overbroad, and could be read as criminalizing certain D&E procedures that were clearly Constitutional. I'm massively oversimplifying a very long opinion and technical opinion here, but you get the general idea.

[Mars Horizon]

Originally posted by Whack-a-Mole
What gets lost in the cries of horror over this is that it is not done lightly or often. Such a procedure is an extreme measure in extreme circumstances that usually involve the life of the mother (i.e. she will die if the procedure isn't performed). PBA's are not done merely because a woman decides to have an abortion late in the game. I would love - really love - to find a cite for this from a source that could - as much as is possible when dealing with abortion - be called impartial and honest. Anyone have one?

[pravnik]

A variation of D&E, Intact D&E, is used after 17 weeks. It involves removing the fetus "intact" from the uterus in one "pass", rather than several passes. This is accomplished either one of two ways: head first or feet first. The feet first method is known as "Dialation & Extraction (D&E). D&E is what we commonly think of as partial-birth abortion. D&X is superior to and safer for the mother afetr a certain period.

[/B]

:smack: Please make that "The feet first method is known as Dialation & Extraction (D&X). D&X is what we commonly think of as partial birth abortion."

Very confusing the other way.

[pravnik]

Originally posted by pravnik
pass Constitutional muster, a law concerning abortion cant' place an undue burden on a woman's right to have an abortion before fetal viability, and must have a provision allowing for abortion to protect the health of the mother after fetal viability. Usually, in the second trimester, this is performed by a method called Dilation & Extraction,(D&E) involving diltaion, removal of fetal tissue using non-vacuum surgical instruments and (after the 15th week) potential dismemberment of the fetus or collapse of fetal parts to facilitate evacuaton from the uterus. This is the standard abortion procedure.

:smack: :smack: Man, how many mistakes can I make? The first procedure I mentioned, D&E, should be Dilation & Evacuation.

So,

D&E: Dilation and Evacuation.

D&X: Dilation and Extraction.

[Earl Snake-Hips Tucker]

It seems that there are about 500-2000 such procedures per year.

[Xema]

When a PBA is done, what are some typical medical conditions the mother might have that would make this procedure necessary to protect her health?

[Uncommon Sense]

Originally posted by Xema
When a PBA is done, what are some typical medical conditions the mother might have that would make this procedure necessary to protect her health?

I`ve wondered this too. How can this procedure be "safer than a C section"? Or what health problems can a mother have that would not allow her to deliver naturally or otherwise? Is the passing of the head through the birth canal sometimes lethal?

[Philster]

C sections are 'invasive" surgery...riskier, so the theory goes, than birth...infections, anasthesia...

Isn't the health issue that leads to a PBA an issue of just "carrying the baby to term"? ....not necessarily delivery as the risk?

[Nametag]

JAMA and ACOG have both stated that Intact D&X is indefensible as a medical procedure. Most such procedures are performed for the purpose of ending a healthy, viable pregancy, and in the rare event that a high-risk pregancy is carried into the third trimester, there are no circumstances in which IDX is the safest method. The technique involves reaching into the uterus and turning the fetus feet-first, which exposes the mother to great risk of uterine rupture, amniotic fluid embolism, etc. The surgeon then blindly forces scissors into the skull while it's in the birth canal, risking cervical laceration or other trauma. The manipulation of the fetus in the uterus is for the sole purpose of classifying the procedure as abortion instead of infanticide, which, as a fervent, perhaps even rabid, supporter of abortion rights, I nevertheless find an appalling sophistry.An extraordinary medical consensus has emerged that intact D&X is neither necessary nor the safest method for late-term abortion. In addition to American Medical Association (AMA) and ACOG policy statements, Warren Hern, MD, author of Abortion Practice has questioned the efficacy of intact D&X. "I have very serious reservations about this procedure....You really can't defend it....I would dispute any statement that this is the safest procedure to use."-- From the Journal of the American Medical Association Women's Health Information Center (http://www.ama-assn.org/special/womh/library/readroom/vol_280a/cv80000x.htm)

[pravnik]

Yes, but that issue is very hotly debated. Supporters of D&X say that after bones begin to calcify, intact removal is far safer because it reduces both the risk of laceration and complications from not completely removing the fetus which can happen with D&E in late term abortions. In D&X, the fetus is removed from the wonb as a whole instead except the skull, which is collapsed via cervical incision and suction. With a D&E it would have to be crushed with forceps, ordinarily not a problem except that once the skull has begun to calcify you're now dealing with bone fragments which could remain in the womb and/or lacerate. Supporters say it lessens uterine perforation, significantly reduces the number of times a potentially damaging instrument must be introduced into the uterus, and is a shorter procedure.

[jack@ss]

So, the medical terms are D&E (Dilation & Evacuation) or D&X (dilation & extraction). Who invented the term "partial birth abortion"?

[rsa]

I found what appears to be an excellent and unbiased resourse at www.religioustolerance.org.

DILATION & EXTRACTION (PBA) PROCEDURE (http://www.religioustolerance.org/abo_pba.htm)

In particular the INTRODUCTION (http://www.religioustolerance.org/abo_pba1.htm).

As an example, it includes the part that Nametag convienently left out of his quote.

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.
bolding mine

Nametag also said: <<Most such procedures are performed for the purpose of ending a healthy, viable pregancy...>>

From my link:

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 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.

[Uncommon Sense]

Without getting too philisophical, if the fetus is healthy then the procedure is for the benefit of the mother only. When the procedure is performed, they are assuming that the mother may develop complications from a natural child birth. How would any one know for certain? Seems if the mother had some grave medical condition, she would have known about it earlier in the pregnancy, making this procedure unnecessary. H.O.

[zev_steinhardt]

The trouble I've always had with this procedure and the explanation that it is only used when the life of the mother is in danger is this:

If the baby (including the shoulders -- which is the widest part) is already out and the doctors are more or less holding the head in to do the procedure, under what circumstances can simply letting the mother make the last push be more lethal than holding the head in? I would think that holding it in so that the procedure can be done would be more painful and dangerous to the mother (since the head is in the birth canal) than simply allowing her to make the final push and get the kid out.

Zev Steinhardt

[Trinopus]

Originally posted by zev_steinhardt
If the baby (including the shoulders -- which is the widest part) is already out . . .


The shoulders aren't the widest part of a newborn. They sort of fold up forward. The head is the widest part.

Trinopus

[PosterChild]

Originally posted by Philster
First, is "partial birth abortion" legal - the abortion in the last trimester ?
...
I just want facts so that I can form my own opinions.

Thanks, Dopers. Just, FYI, but abortions are only performed (in all but two, IIRC, locations) only until the 24th week- i.e.- the limit is before the end of the second trimester, not in the last trimester.

PC

[Diceman]

ISTR congressional hearings where a bunch of doctors testified about the medical necessity of partial birth abortions. They said, essentially, that there is no medical justification. Given modern medical technology, any complications that might threaten the woman's health can be dealt with in ways that will save both mother and baby. (Assuming the fetus is viable.)

Oh, and [b]rsa[b]: There is no such thing as an unbiased resource. The best you can hope for is relative impartiality. :)

[zev_steinhardt]

Originally posted by Trinopus
The shoulders aren't the widest part of a newborn. They sort of fold up forward. The head is the widest part.

Trinopus

Could've fooled me. I remember when taking my EMT training for emergency childbirth the instructor specifically stating that the shoulders were the widest part of the newborn.

Zev Steinhardt

[rsa]

zev, although I don't know the answer in general, in many PBA cases the head is huge. (BTW I also thought that the head was the largest part of the fetus even in an healthy birth.)

1 in 2000 fetuses develop hydrocephalus while in the womb." About 5000 fetuses develop hydrocephalus each year. This is not usually discovered until late in the second trimester. Some cases are not severe. A pre-natal method of removing the excess fluid on the fetal brain 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.
empasis mine

[rsa]

Sorry, I meant to say "emphasis" mine.

[drachillix]

Originally posted by zev_steinhardt
Could've fooled me. I remember when taking my EMT training for emergency childbirth the instructor specifically stating that the shoulders were the widest part of the newborn.

Zev Steinhardt

I was an EMT as well and I was taught that the head was the big part, shoulders can shift and twist a bit....babies move in a "typical pattern" when being delivered (the "cardinal movements" IIRC). Shoulders can get hung up at certain angles but it doesen't take much force to snap a clavicle and let baby free...it happens sometimes in the process of even otherwise uncomplicated deliveries.

Something else to note, the medical community generally refers to any termination of pregnancy, natural, or artificial as an "abortion". Ending a pregnancy is never pretty, then again neither is a head on collision. The vast majority of medical folk try to be open minded about things like voluntarily aborting. We all know its sometimes needed, and in many cases prudent, even if it isn't the most "moral" thing to do. Its not really our place to judge the reasons why, just to get everyone taken care of...whatever their needs might be.

[zev_steinhardt]

If that is the case (where hydrocephalus babies have "enormous" heads), then you have presented a case that I was unaware of where this procedure could reasonably save the life of the parent.

Zev Steinhardt

[dauerbach]

No, the head is the widest part. The shoulders do indeed fold forward and become narrower than the head. It's why nature decided that the head should come out first. It stretches everything so all the smaller parts follow easily. After the head is delivered the baby basically falls out. OTOH, in a breech presentation, where the shoulders come out in first they cannot be properly "folded" and then they do indeed become the widest part. This is overcome by delivering the shoulders one at a time.

[drachillix]

Originally posted by zev_steinhardt
If that is the case (where hydrocephalus babies have "enormous" heads), then you have presented a case that I was unaware of where this procedure could reasonably save the life of the parent.
Zev Steinhardt

There are several situations where babies can threaten moms life. I will try to get my wife Cyn to check this thread in the morning. She works high risk specialized labor and delivery, all the moms with no prenatal care, multiple births, drug addicts, known birth defects, very old/young moms. They lose moms and babies there sometimes, comes with the territory. She can give you a better rundown on mom killing pregnancy problems.

[Broomstick]

Someone with more medical knowledge than I have might be able to flesh this out in more detail, but there are some bizarre and rare conditions in the fetus than can endanger the mother.

One is if the fetus has a massively growing tumor (in some case, the tumor is larger than the fetus) which, if allowed to continue to progress, may make it impossible for the mother to deliver just because it's so big.

In another one (I think it's called "fetal hydrops"??) the baby absorbs fluid and swells up. Almost always fatal to the baby, it can also kill the mother. I'm not entirely clear on the mechanism of how that happens.

Just because a condition is rare doesn't mean an extreme procedure isn't justified.

Speaking of extreme conditions - in both the above cases, there have been attempts at pre-birth surgery in an attempt to save the life of the baby. Quite controversial, certainly not always successful, and very much experimental.

[irishgirl]

PBA aren't performed in the UK and ireland.
they cannot be an "essential" medical procedure if several countries refuse to perform them, with no increase in maternal death rates.

[pravnik]

It bears repeating that what's being potentailly outlawed here is the procedure being used and not the abortion itself. A woman's Consititutional right to an abortion under Casey is simply that the state can't place an undue burden on a woman's right to have an abortion if the fetus is not yet viable, and must allow for abortions where the fetus is viable if the health of the mother is endangered. The test under Roe involved which trimester the fetus was in, but that's been scrapped in favor of the test of fetal viability.

So if a woman has a right to an abortion under the Consitution and wants or needs one, she's going to have one, and no state law can stop her. All a ban on the Dilation & Extraction procedure accomplishes is it forces the doctor to use a different procedure, typically Dialtion & Evacuation, which may or may not be the best thing for her medically. The end result is the same either way-the fetus is aborted. The doctor was just forced to use a different procedure than he might have used otherwise.

[PosterChild]

Originally posted by Nametag
JAMA and ACOG have both stated that Intact D&X is indefensible as a medical procedure. Most such procedures are performed for the purpose of ending a healthy, viable pregancy, and in the rare event that a high-risk pregancy is carried into the third trimester, there are no circumstances in which IDX is the safest method. The technique involves reaching into the uterus and turning the fetus feet-first, which exposes the mother to great risk of uterine rupture, amniotic fluid embolism, etc. The surgeon then blindly forces scissors into the skull while it's in the birth canal, risking cervical laceration or other trauma. The manipulation of the fetus in the uterus is for the sole purpose of classifying the procedure as abortion instead of infanticide, which, as a fervent, perhaps even rabid, supporter of abortion rights, I nevertheless find an appalling sophistry.-- From the Journal of the American Medical Association Women's Health Information Center (http://www.ama-assn.org/special/womh/library/readroom/vol_280a/cv80000x.htm)
On the sophistry point (rsa explained some of the justifications): During my Ob/Gyn rotation, our director told us of the case in which a resident was doing a c-section/abortion for a woman to remove the fetus (before it was viable- I don't remember the reason). It was alive which was not of concern to the doctor because the woman wanted it aborted. An OR nurse noticed that it was alive and called pediatrics who came and tried to keep it alive, but failed (after a few days, IIRC). The doctor was sued, of course and his rationale was that it was intended to die and would not have survived anyway, so why do anything. Of course, I don't remember the outcome of the case, but if you are going to perform an abortion, you'd better make sure it comes out dead.

PC

-Just need to add that "alive" and "dead" are just as relavent to tissue cells, bacteria, sperm and eggs (the eggs lost during menses were just as alive before they were lost), so they do not (in my post) imply good or evil in (in themselves) in terms of the fetus.