thanks,** divemaster**, but I guess that was my point. The statements linked to above, suggest that there’s “no medical reason” to perform the procedures. I would suspect that given what you and I have presented, that anyone making the statement “there’s no medical reason” would have to include the premise that the abortion ITSELF is not a “medical reason”, which then brings it back to the phlisophical, and not the medical stance.
So, if the procedure is, in fact, the most safe way medically, to achieve the outcome of abortion at that stage, then we should cease with all of the rhetoric about how the procedure is done and go back to the basic question of (GD) “should abortions ever be done”.
To make assertions about the “medical necessity” of any elective procedure does nothing to further the aims of logical thoughts. And abortions are largely an elective procedure (except in the cases where the woman’s life is in physical danger).
So. I guess the answer to the OP then, is that these late staged abortions are done that way because they are the best way to achieve the intended results at that stage.
I know I’m probably helping to push this towards GD, and I apologize beforehand. I just felt this should be responded to and I wanted to bypass the extra step of providing a link from GD in order to provide reference for my response.
Unfortunately you’re probably right. It’s far easier for women’s organizations to fall back on some moralistic argument, i.e. “If you’re against this, you’re endangering women’s lives” than take a principled stand such as “We defend a woman’s right to terminate her pregnancy at any point she chooses.” The latter is much sharper and less likely to get serious holes poked in it, as the above citations show.
The ancient Greeks would leave a defective or unwanted child on a rocky hill.
The Egyptians, and others with rivers, would float orphans on rafts.
The key is the same as when mutineers abandoned their captain on a desolate islet.
You never knew the exact fate, so your conscience was clear.
I have substantial experience in this area, and will try to answer the OP without treading into GD areas. This discussion is relatively clinical and may not be for the squeamish.
Partial-birth abortion is, as someone has said, a political term and not a medical one, and the main difference is that it has been politicized. There is no medical difference between D&E (see below) and an intact late-term abortion.
There are three basic types of surgical abortion (as opposed to medical abortion, with mifepristone or another drug). In the early stages of pregnancy, the common method is known as suction curettage, or vacuum aspiration. Basically, the cervix is dilated slightly, a tube is inserted and suction applied to remove the products of conception. Sometimes, later in the first trimester (up to about 13 weeks lmp, or after the woman’s last menstrual period), a dilatation and curettage will be performed, which is further dilation of the cervix and scraping the interior of the uterus to ensure that all the products of conception have been removed.
After about 13 weeks lmp, the fetus is too large for vacuum aspiration to work. There are two methods used from this time until viability (which is around 24 weeks nowadays). First is induction, where chemicals are used to induce labor and delivery of a non-viable fetus. In general, this is very hard on the woman because of the drugs used and the fact that her body is not yet ready to undergo this process. Additionally, it is generally ineffective between 13 and 16 weeks lmp because the uterus is not sensitive to the drugs used.
The alternative, which accounts for about 95% of post-first-trimester abortions, is dilatation and evacuation (D&E). The cervix is first dilated. Then, the physician uses forceps to remove the fetus. Because collagen has not yet formed sufficiently, the result when the physician grasps a limb or other fetal part is that the fetus dismembers when it reaches the interior cervical wall. The fetus is removed in as few passes as possible.
Later in pregnancy (after about 18-20 weeks lmp), it is sometimes the case that the fetus will not dismember when a portion of it is drawn into the birth canal. The fetus therefore comes through relatively intact. However, because this generally started out to be a D&E, the cervix is only dilated to about 2cm (vs. 10cm for birth). The head often is too big to fit through the cervix, and the physician must reduce the calvarium (note the clinical jargon) in order to finish delivery of the fetus (which, keep in mind, is not viable - there are other laws regulating post-viability abortion).
In order to focus the political debate, ACOG (the American College of Obstetricians and Gynecologists) defined “intact dilatation and extraction” (D&X) as[ul][li]deliberate dilatation of the cervix;[]instrumental conversion of a fetus to a footling breech;[]breech extraction of the body excepting the head; and[*]partial evacuation of the intracranial contents of the living fetus to effect vaginal delivery of a dead but otherwise intact fetus[/ul][/li]However, there are other ways to perform a late-term intact abortion procedure, including a head-first delivery where the head is collapsed before any portion of the fetus is delivered.
There are several reasons women wait until after the first trimester to have abortions. The August 26, 1998 edition of JAMA has a good article by Janet E. Gans Epner et al. describing this (280 JAMA 747), but I can’t get to the JAMA site right now to link it. (I linked the article in a Pit thread about anti-abortionists, started by blessedwolf, IIRC.)
As for why this procedure over another, it has not been tested sufficiently to know whether the intuitive advantages outweigh potential costs, but it[ul][li]requires fewer instrumental passes in the uterus; generally, the fewer instrumental passes, the less chance for damage;[]it allows study of an intact fetus in case of genetic anomaly;[]it allows the parents to grieve in case it was a wanted pregnancy terminated for medical reasons (induction does as well, but may be contraindicated in cases of hypertension, heart disease, or other factors); and[*]it uses many techniques familiar to OBs from the birthing process and therefore requires less specialized (surgical) training.[/ul][/li]
Beats me. If a woman is having a late-term abortion, it seems to me that the determination of her physician, in consultation with the patient, should be the only factors involved in the decision. If a woman is squeamish about this method, then the physician should not intentionally perform it (although it may be impossible to avoid later in pregnancy, if a D&E does not result in dismemberment). It seems to be a much more humane method than D&E, which even ardent opponents of “partial-birth abortion” agree is absolutely appropriate as a method of abortion.
As for whether the method is “necessary” to save a woman’s life: it may not be “necessary” – after all, she can always have a hysterectomy – but in many cases it might be the most medically appropriate abortion method to use, and to outlaw it is to reduce substantially the already narrow choices a physician terminating a pregnancy in the late stages has.
That is as factual an answer as I think there is, without straying at all into GD territory. I hope manhattan and Chronos appreciate it.
Thanks, Olentzero and manhattan! It just happens to be an area in which I actually know something. As opposed to other topics, which I’m not shy discussing anyway.
I was hoping that this would clear up my confusion, but it has only intensified it.
Some questions of my own:
[list]
[li]When they talk about banning “partial birth abortions” do they mean all D&E procedures which would include those even during the 1st trimester? Or are the talking simply about late term abortions?[/li][li]If so, does Congress feel they need these laws for the ten states that were not on AerynSun’s list of states that ban abortions after viability? Or was it all just politic grandstanding (I had assumed that abortion laws were a state issue, rather federal)[/li]
I’m not trying to start a GD either, but it has been hard thus far to find a dispassionate analysis where I didn’t feel either side was bending facts to suit their purpose. I’m hoping someone here can give me the straight dope.
Wait, I withdraw my question aboout “political grandstanding”. That question would rely on people’s opoinions and is a poor general question. I only asked because the content of certain local re-election commercials had left me wondering if the issue was election year manuvering.
[QUOTE]
*Originally posted by beakerxf *
[list]
[li]When they talk about banning “partial birth abortions” do they mean all D&E procedures which would include those even during the 1st trimester? Or are the talking simply about late term abortions?[/li][li]If so, does Congress feel they need these laws for the ten states that were not on AerynSun’s list of states that ban abortions after viability? Or was it all just politic grandstanding (I had assumed that abortion laws were a state issue, rather federal)[/li][/QUOTE]
beakerxf, the laws that have been passed have uniformly (with one or two exceptions that have been negated by the Supremes’ decision in Carhart v. Stenberg) been overturned precisely because they define “partial-birth abortion” in language so broad as to encompass not only intact delivery, but also D&E and, in some cases, suction curettage. (For the record, D&Es are not performed during the first trimester.) Most of the laws do not limit themselves to post-first-trimester procedures, although the political rhetoric would have people belive otherwise.
Frankly, it was all political grandstanding. The laws that were passed were all based on a “model statute” drafted by the National Right to Life Committee (I believe it was James Bopp, but I may have his name wrong). The law was, AFAIK, purposely drafted so vaguely that, if it had been accepted, it would have been able to be interpreted by prosecutors to encompass all common abortion methods - an “end run” around Roe v. Wade, in the eyes of most abortion providers.
I’m not at my office at the moment and so can’t cite the various states’ laws, but if you go to any state’s legislature’s home page, find their state statutes and put in “partial birth abortion”, you should find them. The CRLP site has most of the briefs filed in the case, so you can make your own decision. (They’re in .pdf format, or I’d link to them directly.)
Cantrip–excellent job. I was just diving for an OB textbook to offer similar information, but you’ve done much better than I could have.
It should be noted in passing that the AMA should not always be looked at as a source of objective information, or of the collective opinion of physicians. A majority of American physicians are not members of the AMA, and their politics could often be described as right-wing, although less so on the issue of abortion than on health care reform. I’ve never known JAMA to show any such consistent bias, but the AMA itself is a political body and should be viewed as such.
