Claiming my Inner Bitch

Supreme Court Hears Gonzales v. Carhart

I just heard a news item on NPR's All Things Considered containing excerpts of the arguments being presented before the US Supreme Court regarding the Partial Birth Abortion Ban Act of 2003 and Gonzales vs. Carhart which resulted from Nebraska's ban on partial birth abortion.

When partial birth abortion first came to national prominence, in the mid-1990's, I was still working in a high-risk antepartum setting in a hospital. We performed terminations at my hospital and I participated in them. Our terminations were always for genetic reasons, usually because the fetus was found to have a condition which was not compatible with life. The terminations I assisted in were all prostaglandin induction abortions where prostaglandin suppositories were inserted behind the cervix dilate it and induce termination or laminaria inductions, in which "seaweed sticks" are inserted into the cervcal opening where they would swell and mechanically open the cervix, followed by induction of labor with pitocin. These procedures were performed at my hospital when the pregnancy has progressed to the point of 20 to 26 weeks and vacuum aspiration was no longer an abortion option.

(On a side note, I have spent the last hour plus searching the web for information about induction of abortion using prostaglandin suppositories in lay language. It's nearly impossible to find information that someone who is not a medical professional would understand, even on sites like Medline and WebMD, that is not anti-choice propaganda.)

Since earlier abortions are usually possible in an outpatient setting, I have no clinical experience with those procedures. I understood partial birth abortion to be a procedure of the second trimester and, since this was the population I was dealing with in the hospital, I wondered why I had never heard of such a thing. I asked our head of Perinatology about the procedure and this is how he explained it to me. Intact dilatation and extraction involves inserting an instrument into the fetal skull to evacuate the contents in order to reduce the sizeof the head, allowing for the vaginal birth of a pre-viable fetus which would have otherwise required surgical (i.e. C-section) removal. I don't know if this physician had ever performed an intact dilatation and extraction but he told me it would only be used in those instances where a fetus had such severe hydrocephalus or macrocephaly that it would not survive and the mother would be harmed by continuing the pregnancy or potentially harmed as a consequence of major abdominal surgery.

If you think about it, if a fetus is of a gestational age of 20 weeks (halfway through a term pregnancy) and the fetal head is already too large to pass through the birth canal as is, this is a fetus with severe troubles. These are often fetuses with anencephaly (lacking brain material entirely) with a skull full of fluid instead or microcephaly (very small amount of brain matter) and hydrocephalus (fluid inside the skull). These are not usually children who are destined to survive in the world outside the mother's womb.

I can't attest to what is done in outpatient abortion settings but, in 17 years in Gyn and OB in this facility, I had never heard of an intact dilatation and extraction being performed. These are very rare procedures. It's not as if perinatologists and OB/Gyns are out there rubbing their hands together at the prospect of being able to suck out some fetal brains. The procedure is, typically, reserved for only those circumstances when no other option short of surgery is available without causing maternal morbidity.

This is the big, bad Boogeyman of the "right to life" movement.

So, as you listen to or read about the proceedings at the Supreme Court in this case, bear that in mind. It's the "straw" abortion procedure being used to cast the poorest light on those who feel abortion should be a safe and available option for women in our country faced with unwanted pregnancies.

Here are some great resources on this issue and Supreme Court consideration if it courtesy of the fabulous SCOTUSbLog.

Transcript 11-08-06 Gonzales v. Carhart
Transcript 11-08-06 Gonzales v. Planned Parenthood
Commentary: Kennedy vote in play on abortion
Abortion Roundup
Today's Audio from the Court
Argument Wed., 11/8/06: Abortion -- a host of knotty issues

Here is information from the ACLU (one of the plaintiffs in the Supreme Court case) about abortion myths and facts.

And here is a great "pro/con" list about abortion from Choice Matters.

tags: abortion / "partial birth abortion" / US Supreme Court

posted by Cheryl @ 5:51 PM