How are near-viability abortions actually performed?

June 1, 2015 6:11 PM

My state legislature is having a hearing on a "fetal pain" bill, and I intend to testify against. Is it correct that later-term fetuses are generally euthanized prior to the grisly dismembering politicans and the media so often describe? If not, why not?

I'm thirty-one weeks pregnant so, regardless of whether twenty-two weeks is a meaningful cut-off date, I'm not particularly interested in wading into a debate that could yield (highly ironic) death threats toward me/my fetus. I had been intending to argue instead that, if fetal pain is really the issue*, we should mandate that physicians performing abortions utilize a mechanism that seeks to minimize, insofar as possible, any chance of it -- but it seems like that might basically be the standard of practice anyway!?

I just came across that article, so am reeling at the idea that I, a scientifically literate person interested in this topic, have been lied to/fooled about the tearing-apart of living fetuses being a common thing that happens, and want to be certain I understand. Therefore, I'm hoping someone can explain what an average later-term abortion of an unwanted pregnancy looks like in the US, and what decisions would go into the mechanism of fetal demise. Most relevantly, would I be erring and/or walking into some sort of trap by pointing out that the way abortions are commonly done already "circumvent[s]" "the issue of whether the fetus could experience pain during the abortion", as the linked article claims?

Unfortunately, right now I'm finding research and close reading on this topic very emotionally taxing, so I apologize if there's an obvious source of this information I've missed. Although I would appreciate detailed descriptions for the sake of knowing exactly what I'm talking about, I definitely can't handle personal stories about people who have had to end wanted pregnancies, and have pretty well had my fill of political commentary from all sides. I do have online access to a very large selection of academic/scientific journals, if you have any specific recommendations in that direction. In that context, I can cope with information about non-viable wanted pregnancies and/or selective terminations, though I suspect those circumstances inherently bias the process toward less awful-sounding methods.

* I am aware that this bill isn't actually about fetal pain.

posted by teremala to Health & Fitness (13 answers total)

Best answer: Most late abortions are Dilation and Extraction (D&X), and are performed because the fetus isn't viable outside of the womb and/or has significant developmental defects. Virtually none of these pregnancies are "unwanted". The rest of the late abortions are performed by inducing labor, knowing that the fetus isn't viable once delivered.

A decent source describing the D&X procedure is here (Warning: no pictures, but still pretty graphic).

To answer your question... before the procedure itself (or as one of the very first steps), a fluid is injected into the amniotic sac for the purpose of causing fetal demise (or in some circumstances, the umbilical cord is cut for the same purpose). By the time the fetus is removed (which can truthfully be described as gory), the fetus no longer has a heartbeat or any brain function and can't feel pain.
posted by toxic at 6:35 PM on June 1, 2015 [13 favorites]

Most late abortions are ... performed because the fetus isn't viable outside of the womb and/or has significant developmental defects.
This is also my understanding as well - you can only get a late term abortion in certain (extreme) circumstances, not just because you want it. The time to get an abortion because you don't want to be pregnant is in the first trimester (or perhaps up to 16 weeks/viability). I have an aunt who is a rabid right-to-lifer and this is a common... misperception, I think.

The rest of the late abortions are performed by inducing labor...
This is also common if you lose the baby in utero and is going to be stillborn (and you aren't going into labor on your own).

You might try running the question past your local Planned Parenthood - I bet they know!
posted by jrobin276 at 7:59 PM on June 1, 2015

Best answer: Dr. Warren Hern's clinic page on 2nd trimester abortion has a detailed (not graphic) description of another common method to ensure fetal demise--an injection directly into the fetal heart (through the mother's belly). The injection of digoxin stops the fetal heart instantly. This is done before the abortion procedure begins.

Here is his clinic page on 3rd trimester abortion; it's very similar.
posted by Secret Sockdentity at 8:05 PM on June 1, 2015 [2 favorites]

Best answer: You might also find this article useful: Fetal Pain: A Red Herring in the Abortion Debate, by Joyce Arthur. It's from 2004/2005, but has lots of citations from peer reviewed sources.
posted by Secret Sockdentity at 8:10 PM on June 1, 2015 [3 favorites]

I respectfully disagree with the above information from toxic. The vast majority of second trimester (14-24 weeks) abortions are performed by D&E. D&X is, in fact, illegal per Carhart v Gonzalez (2007).
posted by pocksuppeteer at 8:59 PM on June 1, 2015

This is the recent report that people refer to internationally. The conclusion was that 24 weeks is the absolute earliest that a foetus could feel pain, though it still is unlikely and pain relief for the foetus is not necessary.

Injection to cause fetal demise in utero is standard to prevent "signs of life" because most (I would even dare say all in the US) late term abortions are of wanted pregnancies. Most will be selective abortions and people want to give birth to an intact baby they can have pictures with, cuddle and mourn.

Dismembering can be done but in western countries it generally isn't because as toxic said, these are wanted pregnancies/babies, but 2nd trimester diagnostic testing has found a chromosomal anomaly or some other congenital 'defect'. People are heartbroken when they decide to do this so no one would/should add to it by butchering the 'baby'.

In Victoria, Australia, routine abortion for unwanted pregnancy can be done up to 24weeks. This is a recent change, 2008. It's one of the most progressive pieces of abortion legislation I've seen. You can find it here. The Victorian law reform commission recommendations leading up to it might be helpful if you need help refining your position or certain points.

Good luck at the hearing.
posted by stellathon at 9:33 PM on June 1, 2015 [1 favorite]

D&X is very much still performed in the US, just not on "living" fetuses, for the reasons stellathon mentioned and others.

The Partial-Birth Abortion ban of 2003, upheld by Carhart v. Gonzalez in 2007, does not apply unless the fetus is alive when it is delivered vaginally (cite, see §1531(b)(1)(A)).

By administering a drug that causes fetal demise, the ban does not apply.
posted by toxic at 9:46 PM on June 1, 2015 [1 favorite]

I'm wondering if contacting an organization like Medical Students for Choice might not be helpful. I'm sure they are used to breaking down the facts for people.
posted by gaspode at 9:48 PM on June 1, 2015

Response by poster: To be clear, I'm aware that unwanted pregnancies are generally dealt with much much earlier, but I have good reason to think that others will have the "wanted but ultimately non-viable pregnancies" angle thoroughly and heartbreakingly covered. In any case, I think that with topics like this, we tend to focus on the most obviously-sympathetic case and simply hope that other aspects will follow. However, I would not regard a hypothetical "compromise" bill that allowed abortions only for pre-viable fetuses found to have certain defects as acceptable, and so can't in good faith ignore the possibility of someone choosing to abort an otherwise-healthy fetus much later than usual.

Thank you for your answers so far. I especially appreciate those who have clarified that the fetus is generally dead before it's removed. That's the part that I was having trouble finding additional sources that would commit to. I had been under the impression that "when can a fetus experience pain?" was generally worth talking about, lest we inadvertently cause unnecessary suffering, but it seems an entirely moot point if nobody's actually causing them any "pain" as it stands.
posted by teremala at 10:27 PM on June 1, 2015

When I testified before my state senate on this issue, we (my fellow medical students/residents/pro-choice community) were asked to keep firmly on message. Per poling, the message that resonates best with the non-rabid/undecided is to keep politics out of a woman's relationship with her doctor. It seemed very repetitive to have a hundred people talk on that theme, but every article and news clip was really clear where we stood on the subject. Our lobbyist reminded us that we wouldn't actually convince anyone in the room- we were there to make the news, to get the message to those who weren't passionate enough to come out that day.
posted by aint broke at 4:35 AM on June 2, 2015 [1 favorite]

Response by poster: Our governor, who is currently going around bragging about how hard he's going to sign this bill, used the exact phrase "between a woman and her doctor" in his last campaign.

We testify so they can't say we didn't.
posted by teremala at 6:52 AM on June 2, 2015 [1 favorite]

I wanted to correct my earlier comment--I got mixed up, and I'm pretty sure the cardiac injection is actually potassium chloride. It's minor, but I didn't want to tell you the wrong thing.

Good luck at the hearings, and please know that your brave decision to testify is hugely important and much appreciated.

And congrats on your pregnancy, as well!
posted by Secret Sockdentity at 10:01 AM on June 2, 2015

One thing: Be careful about language when you talk about this. 'Euthanized' implies that the fetus is already alive in an independently viable sense, which it is not.
posted by yellowcandy at 6:01 PM on June 2, 2015