partial birth abortion - page 6

THE OUTCOME of what is almost certain to be a legal battle fought all the way to Supreme Court will hinge on whether the justices accept the findings of Congress that the procedure is never medically... Read More

  1. by   Jo Dirt
    People keep talking about the "medically necessary" reasons for partial-birth abortion, which, by the way, I understand why some people believe it is necessary but this still does not justify it to me when there are other ways, especially when an OB doctor who had been a doctor over 30 yrs says he has never seen a medically necessary reason for a PBA.
    But aside from the excuses you can't get away from the cold hard facts. It's atrocious, I would rather die with the baby in me than have such a procedure done and I mean that wholeheartedly. And you can't tell me it isn't done in normal pregnancies for whatever reason...maternal "distress" or whatever. Babies die in utero and shortly after birth and there is nothing that can be done about that but I feel it takes an unfeeling automaton that can suck the life out of a baby (deformed or not) and go home to dinner.
    I can't help it this is the way I see it.
  2. by   Jolie
    Quote from motorcycle mama
    People keep talking about the "medically necessary" reasons for partial-birth abortion, which, by the way, I understand why some people believe it is necessary but this still does not justify it to me
    motorcycle mama,

    You are absolutely correct that there are no "medically necessary" reasons for partial birth abortion. There ARE medically necessary reasons to bring an end to a pregnancy, for example, severe PIH, DIC, overwhelming infection, trauma, and other conditions which pose an IMMEDIATE threat to a mother's life. In those cirumstances, it is necessary to end the pregnancy in order to salvage the mother's life, and health. HOWEVER, it is NEVER necessary to deliberately and actively kill the fetus in order to accomplish this. Inducing labor and delivering the fetus will suffice. If the fetus is non-viable, it will either pass away during the birth process, or shortly thereafter, in a warm, peaceful environment, possibly in its patents' or a nurse's arms.
  3. by   KellNY
    Quote from Jolie
    If the fetus is non-viable, it will either pass away during the birth process, or shortly thereafter, in a warm, peaceful environment, possibly in its patents' or a nurse's arms.
    Or possibly in a cold metal basin set on the counter. I guess it depends who's working that day and how busy the unit/how acute the case....sorry, but if mom's bleeding out, hypertensive, etc, she's our concern and the nonviable baby will most likely not be swaddled and coddled, but placed, at best in an incubater to die alone.

    I have 27 year old a patient (well, had....she signed out AMA 2 days ago ) who, at 19+ weeks, while getting her pre-cerclage EKG was found an abnormality. They did an echo. Found to have a very large Aortic Aneurysm (not abdominal)--bulging and noted vessel taughtness. Tell that woman that her termination wasn't medically necessary.

    I have no idea what she'll decide--which method...but in her case a D&X may be the best option-with her history of cervical incompetance, the laminarias and dilating rods used with a D&E could further weaken her cervix and destroy her ability to have a viable child in the future, after losing what will now be 4 pregnancies. A D&X--again, after the amniotic sac has been injected with dig--would allow her to be dilated with medications instead of mechanically to a smaller diameter. She won't be holding any babies while they peacefully pass on--she'll be under general anesthesia being prepped for major open heart surgery. I believe it was fergus who mentioned, if she opts for a D&E (the usual 2nd rimester TOP method), her fetus will be pulled out in about 15 different pieces during the D&E. Is this really less barbaric than having the baby die peacefully in utero?

    Jolie-This patient (along with others) was not a candidate for labor or delivery. Her aneurysm may well have bursted if her body were put under that stress, and she could have easily exsanguinated on the OR table in minutes. So sometimes, yes, we must sometimes actively and deliberately "kill the fetus" or end it's life in order to preserve that of the mother.

    There is no reason to turn a fetus into a breech position so that you can deliver all but the head, jam some scissors into the skull to rip a hole into it and suck the brains out while the half born baby twitches and jerks. But that's not what happens in practice. The amniotic sac (for the 4th time? 5th time now being clarified?) is injected with digoxin, causing cardiac arrest. In hydrocephaly-a common reason to perform this procedure, all that is injected into the skull is a simple syringe, the fluid being manually drained.

    You can read true stories like these and ignore them, continuing to say there is no real reason and just thinking that those who opt to participate in, provide, and receive a D&X are monsters.

    That's your choice, I suppose. If this thread hasn't shone any light on the subject for you at all (not saying that all people should be die-hard supporters) than I'm not sure you're open to the answers of the questions that are repeatedly being asked.
    Last edit by KellNY on Aug 25, '07
  4. by   fergus51
    Quote from motorcycle mama
    , I would rather die with the baby in me than have such a procedure done and I mean that wholeheartedly.
    Easy to say when it isn't a reality. I hope no one on this board ever has to make that decision in real life.
    Last edit by fergus51 on Aug 25, '07
  5. by   fergus51
    Quote from Jolie
    Inducing labor and delivering the fetus will suffice. If the fetus is non-viable, it will either pass away during the birth process, or shortly thereafter, in a warm, peaceful environment, possibly in its patents' or a nurse's arms.
    Unfortunately labor isn't really an option for severe hydrocephalus. The birth process is impossible. It's either a large incision and operative delivery (not a great option for someone with PIH or HELLP) or a D&X. Whatever you'd choose is what's best for you. I don't think women or their health care providers are barbaric if they choose differently.


    Unlike at Kelly's hospital, I've never worked somewhere where fetal demises were just plunked somewhere. We always have someone to do bereavement care, though it's not usually the L&D people because like she said, their first priority is often a crashing mother.
  6. by   KellNY
    Fergus-(just to clarify) We often have the mother or father hold the baby, if reasonably intact (obviously not after a D&E...shudder...). If not, a nurse will sometimes be available to swaddle and hold the baby. But unfortunately there are undeniable times where a mother is crashing or having a seizure or we are short staffed, etc. It's sad, but true.

    Most of our TOPs, elective or urgent/emergent are done via D&C or D&E, so there is no "baby" to care for afterward, and with the very few D&X procedures done here, the patient experiences an IUFD.

    And thank you for pointing out that labor is NOT always an option, as with severe hydrocephalus, serious current or past maternal cardiac issues (as mentioned in my PP), Eclampsia, severe trauma, and many of the other reasons that make a termination medically necessary.
    Last edit by KellNY on Aug 25, '07
  7. by   Jolie
    Quote from KellNY
    Fergus-
    And thank you for pointing out that labor is NOT always an option, as with severe hydrocephalus, serious current or past maternal cardiac issues (as mentioned in my PP), Eclampsia, severe trauma, and many of the other reasons that make a termination medically necessary.

    If labor is not an option, then a partial birth abortion isn't an option, either, as it involves laboring, albeit to a lesser dilation than an intact vaginal delivery. And if an operative delivery is indicated, there is still no benefit to the mother's life or health to destroy the baby in the process.

    While I understand the the life of a crashing mother is of primary importance, it is beyond my comprehension that a breathing baby would be left to die in an OR basin.
  8. by   SuesquatchRN
    Quote from Jolie
    If labor is not an option, then a partial birth abortion isn't an option, either, as it involves laboring, albeit to a lesser dilation than an intact vaginal delivery. And if an operative delivery is indicated, there is still no benefit to the mother's life or health to destroy the baby in the process.
    A lesser dilation means less trauma to the mother. And operative delivery of a fetus c severe hydrocephaly requires more invasive surgery than otherwise.

    Quote from Jolie
    While I understand the the life of a crashing mother is of primary importance, it is beyond my comprehension that a breathing baby would be left to die in an OR basin.
    No one has even hinted that a live baby was left in a basin, ever.

    It astonishes me that those who decide to oppose one procedure with which they have no personal experience can so carefully and completely ignore or distort the input of those who do.
  9. by   KellNY
    Quote from Jolie
    If labor is not an option, then a partial birth abortion isn't an option, either, as it involves laboring, albeit to a lesser dilation than an intact vaginal delivery. And if an operative delivery is indicated, there is still no benefit to the mother's life or health to destroy the baby in the process.
    Jolie, I've already explained that the most common method of 2nd trimester TOPs are done with a D&E method. Is pulling the fetus out in pieces more desirable or less barbaric? Or are you saying that the woman in my example with the aortic aneurysm should be forced to have major abdominal surgery the day before she will be having major open heart surgery? I'm honestly confused.

    And I'm sorry but you're wrong. A D&X might require dilation to 6cm with NO PUSHING involved for the compromised woman, where delivery would require pushing and further dilation. A D&E is dpne the way it is so as not to require a full 10cm dilation of the cervix. In either case, the doctor/pt can opt for a manual dilation, which requires no labor, as the cervix is dilated with laminaria rods and/or metal rods (again, not to a full 10cm).

    Not all women requiring (or opting for) a TOP should be forced to experience a hysterotomy when there are experienced nurses here telling you that the level of comfort for the baby is not an issue because s/he would die peacefully. Even if the baby were to be delivered alive, and held and coddled, at 18, 19, 20 weeks, s/he would most likely not be able to breathe...that's maybe not the best thing for that baby either.


    For those who think this procedure is done purely for convenience, I ask you this. Why? Why would a woman opt to carry a pregnancy so far before aborting? When compared to an earlier abortion: It involves more time, effort, an physical energy, as well as a longer recovery time, including a mandatory hospital stay. Emotionally it's very draining on all involved. There are many more risks. On a possibly selfish note, the cost is much higher.
    Last edit by KellNY on Aug 26, '07
  10. by   Jolie
    Quote from suesquatch
    no one has even hinted that a live baby was left in a basin, ever.

    please read kellny's post: or possibly in a cold metal basin set on the counter. i guess it depends who's working that day and how busy the unit/how acute the case....sorry, but if mom's bleeding out, hypertensive, etc, she's our concern and the nonviable baby will most likely not be swaddled and coddled,

    it astonishes me that those who decide to oppose one procedure with which they have no personal experience can so carefully and completely ignore or distort the input of those who do.
    why do you assume that those who oppose this procedure "have no personal experience"? you are correct that i have never undergone this procedure myself. you are wrong to assume that i have no experience in the care of patients who have.
  11. by   SuesquatchRN
    Quote from jolie
    why do you assume that those who oppose this procedure "have no personal experience"? you are correct that i have never undergone this procedure myself. you are wrong to assume that i have no experience in the care of patients who have.
    so do you mean that you have assisted with patients undergoing this, or those who have at some time in the past? because one is experience, the other is anecdotal evidence.
  12. by   KellNY
    Jolie, I'm very interested in your answers to my questions in my PP(both about the specific case that I mentioned and about D&X for "convenience" in general)

    I've been pretty good so far(I think) about addressing your concerns and providing facts.

    Thanks
  13. by   Jolie
    Quote from Suesquatch
    So do you mean that you have assisted with patients undergoing this, or those who have at some time in the past? Because one is experience, the other is anecdotal evidence.
    My moral beliefs prevent me from participating in abortions of any kind. I have cared for patients post-abortion, as well as live-born fetuses in the NICU.

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