partial birth abortion - page 7

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   Jolie
    Quote from 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
    KellNY,

    I don't know where you got the impression that I have accused anyone of having a partial birth abortion for "convenience" sake. Perhaps you have confused me with another poster on that point, because that is not my belief. Nor have I stated that TOP is never necessary for the sake of the mother's life and health. No one with OB experience would make that claim. I have simply stated that terminating a pregnancy does not have to involve the deliberate destruction of the fetus. As we know, it is ending the pregnancy (in the case of PIH, DIC, infection, hemorrhage, trauma, etc.) that facilitates improvement in the mother's health, not the death of the fetus.

    I don't doubt that you have greater knowledge than I of the actual procedure itself. I have never cared for a patient undergoing a partial birth abortion, but have certainly gotten report on them, witnessed the care they have received, participated in conversations with their direct care-givers, and provided post-procedure care, giving me more knowledge that the "average" person or nurse. Perhaps our facility followed different protocols than yours, because the care of partial-birth abortion patients on our unit was essentially the same as other 2nd trimester terminations, up to the point of delivery, and most were due to fetal abnormalities. I don't ever recall a patient undergoing a second trimester abortion of any kind due to life-threatening illness.

    You (and Fergus?) have cited 2 examples of critical situations involving fetal hydrocephalus and maternal aneurysm. Those are indeed heartbreaking examples of parents facing unfathomable decisions, one in which the pregnancy poses a significant risk to the mother's life, one which does not. But neither is cut and dried. The patients in both examples have more than one option, including induction of labor, partial birth abortion, surgical delivery of the infant, and continuing the pregnancy until natural labor sets in.

    I realize that there are different risks/benefits to these options, some of which may be unacceptably high to the patient(s). But my point here is that there are multiple options.

    In the case of the mother with the aneurysm, it sounds possible that no action may be needed at all, given her history of repeated 2nd trimester losses. I don't mean to imply that she doesn't need monitoring, support, and assistance in formulating a plan of care, but it may be "jumping the gun" to subject her to an emotionally draining procedure that may not be necessary by the time she is ready to undergo her aneurysm repair. In the other case, fetal hydrocephalus does not endanger the mother's life. I can underatand and sympathize with a family that does not wish to continue a non-viable pregnancy, and perhaps wishes to terminate in order to heal and prepare for a future (hopefully healthy) pregnancy, but I don't understand destroying a fetus that poses no threat to a mother's life. That is my bias, and is one of the reasons I choose not to care for patients who are terminating their pregnancies.

    Thank you for the respectful debate.
    Last edit by Jolie on Aug 26, '07
  2. by   Mrs.S
    Quote from KellNY
    I've been pretty good so far(I think) about addressing your concerns and providing facts.

    Thanks


    I think you've done a fantastic job shedding some light on a procedure that some of us nurses (myself included) have absolutely no experience with, and providing information to dispel some of the misperceptions about D&X (or "partial birth abortion"...a term that bugs me). I really appreciate it.
    It does seem that some participating in this conversation who hold "very strong beliefs" are actually fairly closed-minded; aeb repeating the same stuff even after being provided plenty of information to the contrary.
  3. by   KellNY
    Thank you Jolie, for your clarification, I appreciate it. (and I'm using that smiley genuinely, not to be sarcastic, honest)

    I did want to clarify that the aneurysm was not something they had wanted to sit on in case she had another loss. The aneurysm was quite large (I don't remember measurements), bulging and the walls of the aorta were visibly thinned and thereby weakened.

    To clarify how urgent a situation this was, our cardiac surgery team (one of the best in the area) was called in within 30 min of the discovery. They called some big shot cardios in Manhattan, "pulled some strings" and were planning on transporting her there the next day for the surgery.

    They were already calling her family (at 11pm) to find those who would be willing and able to donate blood for her.

    An induction of labor for her wasn't an option, as no doctor would be willing to do that given her situation. It seems that for now, she has taken the option (albeit after signing out AMA) to wait and see. She claimed she was going to get a second opinion at "her" hospital, even after we told her they didn't do cardio, nor did they do high risk ob (they sent both types of cases to us).


    I know that this is a one in a million type of patient. But a D&X is a one in a million type of procedure. Less than 0.02% of all terminations are done utilizing this method. (that's not to you, Jolie, just a general statement)
  4. by   crissrn27
    I have, over the years, went from strict pro-life to cautious pro-choice. I still believe that aborting is taking a life, I can just see that sometimes that is the best option. If someone told me today (if I was pregnant, that is) that I had a 90% chance of dieing if I carried the baby any longer, I would probably have to abort. I have 3 other children here that need me. Or if the baby was dxed with anecephaly, or a host of other not-compatible with life dx. Even with this change in my thinking I started reading this thread with the thought that I wouldn't do a d&x for anything.

    Now, I see in a few, very, very rare instances, where I might consider it. But I would still make them do the dig injection before d&x. Is there any reason why you couldn't do dig ever time?

    Thanks for sharing your experiences and views, it really has opened my eyes on the very few situations where this procedure might be the best option.

    Ps, ? for KellNY, is there a reason they couldn't attempt to repair the AAA, without terminating the pregnancy, and see what happens? I assume ( I do OB, so I don't know much about it) that they would have to put the mom on heart-lung bypass and the survival rate for the baby wouldn't be good, but could that be offered as an option? Like I said, so not my area, just curious what the option are for this woman.
    Last edit by crissrn27 on Aug 27, '07
  5. by   fergus51
    Quote from Jolie
    I don't understand destroying a fetus that poses no threat to a mother's life.
    It isn't destroying the fetus. That's the thing. A D&E destroys the fetus (that's never been banned). A D&X in the case of severe hydrocephalus isn't really different from doing a tap in the NICU to drain fluid while waiting for a shunt to be placed. You are making the head look as close to normal as you can.

    A woman with a fetus with severe hydrocephalus can't wait for labor to set in and deliver it normally, especially if she chose to carry the pregnancy to term as some posters have suggested they would. Her choices other than a D&X are a c-section (with the larger incision and increased risks) or a D&E (which rips the fetus apart in the womb). The D&X allows the most normal looking baby to be delivered and mourned over while presenting the least risk to the mother's health and future fertility.
  6. by   KellNY
    Quote from crissrn27
    Ps, ? for KellNY, is there a reason they couldn't attempt to repair the AAA, without terminating the pregnancy, and see what happens? I assume ( I do OB, so I don't know much about it) that they would have to put the mom on heart-lung bypass and the survival rate for the baby wouldn't be good, but could that be offered as an option? Like I said, so not my area, just curious what the option are for this woman.
    It's not even a AAA, it's at the root of the aorta...right at the heart itself. Open heart surgery. They have to stop her heart while they do the actual repair, from what I've heard. They're expecting her to need multiple transfusions, from what I understand. I'm not a cardio nurse, so not my area either. This would not only seriously compromise the pregnancy right there (if not end it), but make the surgery much more dangerous for the mother. They want every drop of blood available to her brain, her lungs, etc, not re-routed to the placenta/uterus.

    And if she were to start contracting...god, could you imagine her delivering on the OR table while her chest is cracked? Again, I'm not cardiac, but I can't see how that would "work" (as in, not kill her).

    The increased blood volume alone required for pregnancy would hinder he healing process (ie, making it likely for the surgery to have been successful) and could likely kill her. She wouldn't be able to labor/deliver having been so newly post op, the stress of a c/s could kill her if she were to make it viability.

    As it is, there's a good chance she won't survive the surgery, even if she were a healthy non-pregnant or non-postpartum/postop woman.

    It's just a REALLY sad situation, no matter what happens. Even in the best case scenario, it's just awful. We (the nurses and the docs) keep hoping she'll either show up with a plan of action, or that her "second opinion" made her come to her senses, and she ended up going to the city for the repair.

    Regarding the digoxin administration...I can honestly say that I can't think of a reason that it wouldn't be indicated, why a doctor would not administer it. The dig acts very quickly, and can be done in the OR if it were emergent. Like I said, our TOPs receive dig unless they're being induced/augmented (ie a PPROM at 17weeks where baby's already engaged or something), then usually the mom wants her baby born alive.

    I'm not saying that there is no reason, and while I have experience and have done lots of research, I'm not an expert. For the life of me I can't see a reason, unless the woman refuses for some reason. Or maybe a history of maternal allergy?
    Last edit by KellNY on Aug 27, '07
  7. by   crissrn27
    Thanks KellNY, I see what your saying about blood supply, gosh, that poor woman. I'll bet the docs don't know exactly what to do either, it has got to be a once in a lifetime thing, that you would have to treat a patient with this womans problems. I can't imagine being in her situation. I'm glad dig is usually done, haven't had any experiences with this yet, just your usual pprom, or delivery of under 24 weeker, where they usually are born alive. Now that I am at a bigger hospital, I might have to deal with this at some point.
    Last edit by crissrn27 on Aug 27, '07
  8. by   Spidey's mom
    "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 think if this were me i'd get more opinions from cardiac. i know lots of people who are medically managed who have aneurysms, my own dad included. so, i'd want to know first if there was a way to medically manage this so i could still have my baby.

    i realize this is all speculation since we don't have exact info on the aneurysm.

    of course these are all rare examples. heartbreaking examples nonetheless.

    thanks for the respectful conversation.

    steph
  9. by   KellNY
    Quote from stevielynn

    i think if this were me i'd get more opinions from cardiac. i know lots of people who are medically managed who have aneurysms, my own dad included. so, i'd want to know first if there was a way to medically manage this so i could still have my baby.
    oh, i totally agree, i'd get 2nd and 3rd opinions if there were time.

    but we're the major cardiac center in this area (we've won awards and get life flights in often, sometimes from out of state), and our specialists were concerned enough to have an attending in the city paged at night, right then and there. the residents said cardiac turned white when they saw the echo.

    the hospital she went to for her "2nd opinion" doesn't do cardiac surgery...they life flight or ambulance them here.

    i'm not really comfortable discussing this particular case any further, as i've changed enough minor details and am teetering on the edge of overstepping my boundaries here.
  10. by   SuesquatchRN
    Kell and fergus, I want to thank you for being able to take on this topic without getting so ticked that your brains shoot out of your nose.

    You've taught me a lot.
  11. by   imenid37
    Quote from KaroSnowQueen
    Roe v. Wade made abortion legal in all fifty states up to the time of delivery. Up until six months, there is very little restriction, any restrictions are usually the clinic/physician's personal choices. AFter six months, the inidividual state can regulate it, must be in a hospital, as an inpt, for mother's health only, etc.
    There is a rather infamous clinic, I think it is in Kansas City that not only does late abortions, but honest to God offers funeral services for the infant also. I think that is most twisted logic I have ever seen. If I can find the link to it, I will edit my post and put it in here.\
    I found it:

    www.drtiller.com/remembrance.html
    This guy is in Witchita. He is an FP MD, not OB-Gyn. Last I looked, he wanted 10K up front for third trimester ab's, up to abt. 36 weeks. I had a pt. w/ multiple anomalies who was set to go there. Her baby died in utero the evening before she was to leave for his clinic. Gee, I wonder if he gives a refund. I am sorry, but I think (my opinion) that there's lots of greed on his end. If you are very pro-choice, I suppose he's helping women, but only the ones who can afford the astronomical cost. There are many untruths on both sides of this issue and it doesn't help those who do want an honest debate of this issue.
  12. by   Jo Dirt
    Quote from fergus51
    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.

    Maybe I'm just special (sarcasm here) but YES I HAVE MADE IT KNOWN TO GOD AND EVERYONE THAT I WILL PERISH BEFORE MY FETUS (ergo baby) WILL. And that is not some half-baked fantasy.

    I WILL DIE, IF NECESSARY, aortic aneurism or no. Maybe that sounds crazy to you but God as my witness I would go, and don't be so self-assured that I would cower and repent and change my mind because I have been in a life and death situation before (no it wasn't pregnancy related) and when you are in this situation it is funny but something changes and you really feel quite comfortable with the idea you are fading out.

    It's easy to assume everyone thinks life is worth clinging to at all costs when you've never stood on the edge of the abyss yourself.

    Syringe or scissors it's a wretched practice, and it is too easy to use what appears to others to be the obvious when making an argument for such an objectionable procedure when I would bet those arguing for the mother's life are as comfortable with the idea of this procedure as if it is a matter of convenience. And just because some people feel that repeating information somehow gives their argument/experience more legitimacy and makes it more "right" doesn't make it so. There is no excuse.

    Think I'll stick with taking care of the old folks.
    Last edit by Jo Dirt on Aug 28, '07
  13. by   Jo Dirt
    Quote from Suesquatch
    Kell and fergus, I want to thank you for being able to take on this topic without getting so ticked that your brains shoot out of your nose.

    You've taught me a lot.

    Oh now, nobody's brains are shooting anywhere.

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