Most countries allow abortion even after viability if the mother’s life is at risk. But I would assume in most of those cases the doctors would try to deliver the baby and save both, rather than perform an abortion. So what are some circumstances where an abortion would be necessary to save the mother’s life even after the fetus is viable?
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Colibri
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“Life threatening conditions may…develop later in pregnancy. These include conditions like early severe preeclampsia, newly diagnosed cancer requiring prompt treatment, and intrauterine infection (chorioamnionitis) often in conjunction with premature rupture of the amniotic sac (PPROM). If these conditions arise before the fetus is viable, the pregnant individual may pursue termination of pregnancy to preserve their own health. If these conditions arise after the fetus is considered viable, Roe v. Wade still protects the right for these individuals to obtain an abortion in cases of health or life endangerment, however it may be difficult to find a provider for this service as previously mentioned. Typically every effort is made to save the life of both the pregnant individual and the fetus, pursuing delivery rather than abortion.”
Note: there’s no hard and fast “viability” date for a fetus. Generally it seems to be placed at between 22-23 weeks gestation.
That’s what I thought, but it doesn’t answer the question of under what circumstances this would not be possible. Any doctors know? @Qadgop_the_Mercotan?
No idea. I stopped doing OB back in 1990.
Here are some “late-term abortion” accounts that include the experience of a woman who had to have an abortion at 24 weeks—generally considered around the start of fetal viability—due to severe preeclampsia and imminent risk of a stroke.
AFAICT, the fetus in that case was developmentally delayed and would have required another two weeks to be viable. But even if it had been viable right then, the mother’s body apparently could not have withstood the stress of either a regular vaginal delivery or a C-section. So a D&E termination was the safest option for the mother.
IANAObstetrician or any kind of MD, but I get the impression that a lot of people have an impression that at any given stage of pregnancy, delivery and abortion are pretty much equivalent as far as the mother’s body is concerned. You just reach into some opening or other and pull out the baby: if the baby is viable, why wouldn’t you prefer to remove it alive rather than dead? Seems logical, right?
However, AFAICT, that equivalence doesn’t necessarily exist. Labor is hellacious hard work, and a C-section necessarily involves a major traumatic wound. If the mother’s body can tolerate induced labor or a C-section in order to deliver the fetus normally, then both the doctor and the mother in the vast majority of cases would prefer to try to keep the fetus alive no matter how premature.
But if a live delivery is considered too risky for the mother’s safety, then the alternative of a D&E is much faster and less invasive for ending the life-threatening pregnancy. Fatal for the fetus, but lifesaving for the mother.
That is correct, and with current technology, babies born before about 22 weeks have a 100% death rate because the lungs do not function.
The treatment team and the woman, and her partner if she has one, when faced with this heartbreaking decision must come up with the option that produces the best outcome, whatever that might be.
This must be the explanation. I know labour is hard work! (Though I would have thought less so earlier in pregnancy.) I didn’t know that abortion at that stage was any easier on your body. I’ve read about cases where the baby died late in pregnancy, and the mother still had to go through labour and delivery, so it can’t always be better to use D&E?
The fellow running for re-election as senator in Michigan (he lost), Gary Peters, shared his story about their sort-of-late abortion back in the 1980’s. His wife’s water broke at 4 months, way too early. At that point, the fetus was certainly not going to live. without an abortion, his wife would lose her uterus and almost certainly die too. Their regular hospital refused to make an exception for their abortion policy and suggested they wait for a miscarriage, even 3 days later when her health was getting precarious - eventually they were directed to another hospital.
Not sure what the policy or outlook is if this happened to a fetus at 6 months. It almost sounds like the hospital’s refusal to do an abortion would mean the child would have to die in utero before they would remove it in some hospitals. based on this account, sometimes waiting is too late.
That’s pretty much what happened to Savita Halappanavar:
On 21 October 2012, Halappanavar, then 17 weeks pregnant, was examined at University Hospital Galway, after complaining of back pain, but was ultimately discharged without a diagnosis. She returned to the hospital later that day, this time complaining of lower pressure, a sensation she described as feeling “something coming down,” and a subsequent examination found that the gestational sac was protruding from her body. She was admitted to hospital, as it was determined that miscarriage was unavoidable, and several hours later, just after midnight on 22 October, her water broke but did not expel the fetus.[9]:22–26[9]:29[10] The following day, on 23 October, Halappanavar discussed abortion with her consulting physician but her request was promptly refused, as Irish law, under the influence of the Catholic Church, at that time forbade abortion if a fetal heartbeat was still present.[9]:33[11] Afterwards, Halappanavar developed sepsis and, despite doctors’ efforts to treat her, had a cardiac arrest at 1:09 AM on 28 October, at the age of 31, and died.
Waiting was too late.
AFAICT, for a stillbirth where an unborn baby dies more than 20 weeks into an otherwise normal and safe pregnancy, a woman can usually choose whether she wants to terminate the pregnancy via labor (either induced or natural) or D&E.
From the info I’ve seen, many women in that situation prefer to go through labor and delivery because (a) it helps with the grief/closure experience after the loss of their baby, (b) their OB is more experienced and/or comfortable with delivery than with termination procedures (especially in the US where such termination procedures are often stigmatized as “partial-birth abortion” and legally prohibited), and (c) it may be easier to get diagnostic information about the cause of fetal death if the fetus is delivered intact.
But AFAIK, from the sole standpoint of medical safety, a competently performed D&E is unambiguously, althought not necessarily drastically, less risky for the mother on average than a competently performed induction of labor. Here’s a report comparing the two in second-trimester miscarriages, and here’s a medical study.
This personal narrative from a woman who experienced severe and fertility-threatening post-stillbirth complications from induced labor that she could have avoided with a D&E illustrates some of the risks involved.
Pre-eclampsia is the main one. The mother’s body can be under too much strain to deliver a baby safely, even by C-section, which is major surgery.
It can mean that, due to the pre-eclampsia, the foetus is not as developed as it should be despite the date usually meaning the foetus would be viable.
There’s one example here. They had abortions late in their pregnancies. These are their stories | CNN
Sam, just noting that that’s the same article I linked to in post #6.
Sorry, I didn’t recognise it from your description.
(I also can’t see post numbers and have always been baffled when people refer to them, but at least this is a short thread so I could see which one you meant).
Yeah, in this new board format they seem to require you to click the delta-timestamp on the upper right corner of the post to see the post number.
The post numbers are also shown in the scroll bar thingy on the right (this may depend on your theme) and there’s an option to jump to a particular post number.
That number may differ from the number in the upper right of the post, however.
For one thing, if any fractional bit of the post above is showing in the window, the scroll bar will show the number of that post, not of the one taking up the main field of view.
For another, if a post has been removed (eg spam), that seems to screw up the numbers.
The scroll bar is indeed useful for jumping to a particular post or time/date, though.
Yes, it shows the number of the post at the top of the window; took a bit of getting used to.
I didn’t know that, is it only due to posts being removed?
You can also press the ‘#’ key to open up the ‘Jump to…’ dialogue. I discovered this because my baby likes to hammer on the keyboard. 
Sorry to nitpick, but Gary Peters won his re-election bid this year.
Hah!
I think I’ll still be finding out new things about Discourse twenty years from now, if it and I both live that long.