partial birth abortion

Specialties Ob/Gyn

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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 necessary and poses additional health risks to the mother.

DENOUNCED AS 'UNCONSTITUTIONAL'

Abortion rights supporters have pledged a court challenge. "This bill is unconstitutional," argued Sen. Barbara Boxer, D-Calif., citing the lack of an exemption in cases where the health of the mother is in jeopardy. The bill does exempt a partial-birth abortion that is necessary to save the life of a mother.

The procedure involves partial delivery of a fetus until the head or part of the lower body is outside the mother's body.

At that point, the doctor punctures the skull of the fetus with a scissors, then inserts a suction tube and vacuums out the developing brain, killing the fetus.

The bill, sponsored by Sen. Rick Santorum, R-Pa., says the procedure "blurs the line between abortion and infanticide in the killing of a partially born child just inches from birth."

It was approved by a vote of 64 to 33, with 16 Democrats joining 48 Republicans in supporting it, while three Republicans and independent Jim Jeffords of Vermont joined 29 Democrats in opposing it.

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Not voting were Sens. Joe Biden, John Edwards and John Kerry, all Democrats.

The House is expected to pass the bill in about a month. Congress twice before passed legislation to impose a ban, but former President Clinton vetoed both measures.

JAIL SENTENCE OR FINE

The bill says that anyone who performs the procedure known as partial-birth abortion "thereby kills a human fetus" and will be fined or imprisoned for not more than two years.

A woman upon whom a partial-birth abortion is performed may not be prosecuted under the bill.

The Santorum bill includes a non-binding amendment, approved by a 52 to 46 vote Wednesday, that says it is the sense of the Senate that the Supreme Court's 1973 Roe v. Wade decision, which legalized most abortions in every state, "secures an important constitutional right" and should not be overturned.

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The battle after Bush signs the bill will center on how much deference the courts give to the findings of fact that Congress made with regard to the abortion procedure.

The bill says that based on testimony Congress has found that "a partial-birth abortion is never necessary to preserve the health of a woman" and "poses significant health risks to a woman upon whom the procedure is performed."

The legislation also says that Congress found that "the gruesome and inhumane nature of the partial-birth abortion procedure and its disturbing similarity to the killing of a newborn infant promotes a complete disregard for infant human life."

SUPREME COURT PRECEDENT

In a 2000 decision called Stenberg v. Carhart, the Supreme Court affirmed lower court rulings that had struck down a Nebraska abortion statute similar to the Santorum bill.

A five-justice majority held that the Nebraska law was invalid because it lacked an exception for the preservation of the health of the mother.

The majority also said the Nebraska law imposed an undue burden on a woman's ability to get an abortion. The court had ruled in a case called Casey v. Planned Parenthood in 1992 that states could regulate abortion but not place "a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus," that is, a fetus that could not survive outside the mother's womb.

The majority relied on a lower federal court's factual findings that the partial-birth abortion procedure was medically as safe as, and in many cases safer than, alternative abortion procedures. The Santorum bill relies on congressional testimony that disputes that federal court's findings.

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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 lady partsl 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.

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.

Specializes in High Risk In Patient OB/GYN.
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 lady partsl 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.

Specializes in Maternal - Child Health.

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.

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.

Specializes in High Risk In Patient OB/GYN.

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 :)

Specializes in Maternal - Child Health.
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.

Specializes in Maternal - Child Health.
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.

Specializes in postpartum, nursery, high risk L&D.

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.

Specializes in High Risk In Patient OB/GYN.

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).

:o

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)

Specializes in nursery, L and D.

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.

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.

Specializes in High Risk In Patient OB/GYN.

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?

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