Friday, November 05, 2004

Dr. Toby on partial birth abortion and life

Editor's note: I had posted an earlier draft of this, but this is a revision and includes a photo taken with a scope camera at five months.

There has been much said. Mostly rhetoric. Mostly political. The rights of a woman. The right to life. There is distrust. Denial to a partial birth abortion is just the first step to deny all abortions. The government should not insert itself between a patient and her doctor. Only a doctor and patient should decide what is best. The right to privacy. The right to control one’s own life. The rights of the child. The religious right forcing it’s morals on others. It is done to preserve the life of the woman. The ban is a scare tactic to stop doctors from performing abortions.

Lost in the talk is the subject.

Partial birth abortion.

Intact dilation and extraction is the correct medical term. It is done in late term pregnancies usually 21 weeks and beyond. It may be done for malformations diagnosed late in pregnancy. It may be done for major malformations. It may be done for minor malformations. It may be done for a presumptive diagnosis of Down’s. It may be done for any reason that the mother chooses.

Most late term abortions are done by curettage. In the year 2000 the Centers for Disease Control reported 7,501 abortions after 21 weeks gestation by curettage. Curettage is the use of instruments and suction to dismember and remove the baby. This requires carefully removing all tissue from the uterus to avoid further complications.

By contrast, the partial birth abortion or intact dilation and extraction allows the baby to be delivered outside the uterus. Leaving the baby intact and delivering it breech or feet first has an advantage over curettage. For intact dilation and extraction, the baby is delivered feet first, out of the vaginal canal, leaving the head in the uterus. The head is then instrumented and then suction applied to decompress the head. The head can then be removed from the uterus.

Medically necessary?

There are rare times when a pregnancy must be terminated to protect the mother’s health. Congestive heart failure, eclampsia and others. Rapid termination may be a doctor’s only choice. But, look at this in simple terms. If for a mother’s health a pregnancy must be terminated rapidly, how should this be done?

In partial birth abortion the following is done. Induce labor, dilate the cervix, convert the baby to a breech presentation and then partially deliver the baby, then stop the delivery to suction out the contents of the head and then complete the delivery. It can take half an hour or several hours to do this.

Another option is simply deliver the baby. Alive. Or perform a C-section which can be performed in 5-10 minutes. Delivering the baby takes less time and no more trauma to the mother. Delivering a live baby is not harmful to the mother. Granted, a 21 week baby will not survive long. But a 24 week baby will.

I simplified, but anyone can see that if the question is how to most safely and rapidly terminate a pregnancy for a mother’s health, why would you choose an intact dilation and extraction?

The American Medical Association, the largest medical association in the US said, “According to the scientific literature, there does not appear to be any identified situation in which intact D&X is the only appropriate procedure to induce abortion...”

Rarely done?

I’ve heard lots of figures thrown around as rhetoric. Some say it really isn’t done. Some say maybe twenty a year. I wish I knew. The CDC reports in 2000, 8,826 abortions from all types of procedures after 21 weeks gestation. Under curettage which accounted for 7,501, they give a footnote, “includes dilation and evacuation”. They also have a category called “other” which accounts for 888 late term abortions.


The most common date for viability is 24 weeks gestation. About 25% will survive to go home at 24 weeks. At 25 weeks that number of survivors jumps to 50-75%. Many surveys will include 23 weeks in the mix of very early deliveries.

The baby?

baby in uteris at 5 months Posted by Hello


At 1:59 PM, Blogger Brandon Scott said...

this is just me...but anyone who has experienced the miracle of birth and life growing in the womb knows how amazing it can be. I cannot fathom the aprtial birth stuff. It makes me sick.

At 2:07 PM, Anonymous Anonymous said...

This also from Toby posted for him by Greg:

More about the photo--This is done with a fetoscope, a tiny scope that enters the uterus through a tiny incision and used rarely for prenatal diagnostics. It results in incredible pictures of a developing baby, such as the one in the blog at 5 months. I did a couple ultrasounds at Carenet today. Watched the tiny flicker of a heart beat at 6 weeks gestation . . . that's 28 days from conception.
Dr. Toby

At 2:11 PM, Anonymous Anonymous said...

A second comment from Toby posted by Greg:

I changed the structure some to make it clearer. Attach the previously sent pics and you can blog it.
CDC 850,000 abortions in US in 2000. Alan Guttenmacher Institue 1.3 million abortions in 2000.

To comment on the post "A Deeper Look," I understand the guy's endpoint (Sojourners article linked earlier). Better economics and maybe fewer people will choose abortion. But the way he gets there is unsubstantial. He started with an idea and pulled unconnected statics to support what he wanted to say. We all know stats
can be spun in any direction. We also give Presidents too much credit or blame. What has Bush done? He signed the partial birth abortion ban. Clinton vetoed it twice. Under Clinton, Christian run Pregnancy help
centers were attacked by the government. Our Carenet was one of many in the late '90's subpoenaed by the NY attorney general to release client records with out cause or even complaint against our organization. There
was a crusade to shut down pregnancy help centers during the Clinton presidency. Bush put a freeze on further expansion of embryonic stem cell research. He understands like I do that life begins at conception and he acts on that belief just as I do.

At 8:32 PM, Blogger Clarissa said...

You've made me cry. Not necessarily a bad thing. Thank God for Agape and may more ministries like it spring up all over the country to help women in crisis to see there are better options than partial birth abortion (or any unnecessary abortion.) God, help us know how to best approach this travesty rather than endlessly debating it! Show us small and large ways to make an impact somehow. Your kingdom come! (Not trying to plog, just saying what I needed to say. But if it's a plog, so be it.)

At 5:25 PM, Anonymous Anonymous said...

I have two children by adoption. Of course, I am no fan of abortion. At the same time, I would be able to say to a victim of rape, "Yes, I understand why you do not want to carry to full term."

We've just got to stop treating abortion and gay relationships as unforgiveable sins. I don't want anyone to feel socially outcast in the fellowship of believers like I did when I was first divorced twenty years ago.

And we just have to face reality. Outlawing abortion and gay marriage isn't going to put a stop to either one of them. It might make us feel better that we've somehow forced our Christian beliefs into law, but it isn't going to win any souls over to Christ.


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