Is there such a thing as a nine month abortion?

One topic that caught the attention of women (and religious groups) was abortion.Clinton defended choice, and Trump countered with this: “I think it’s terrible if you go with what Hillary is saying... in the ninth month you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby. Now, you can say that that’s okay, and Hillary can say that that’s okay, but it’s not okay with me. Because based on what she’s saying and based on where she’s going and where she’s been, you can take the baby and rip the baby out of the womb in the ninth month, on the _ nal day. And that’s not acceptable.” But what are the facts on “late term abortion”? Here are excerpts from an article by Jennifer Gunter, an American doctor who trained in late term abortions. The article was published in the Huffington Post with an earlier version appearing on DrJenGunter.wordpress.com.

First of all, we don’t “rip” anything in OB/GYN. In surgery, we use sharp dissection and blunt dissection, but we don’t rip.

Some women do tear during a vaginal delivery, but that’s not a doctor ripping the baby out. Even with a forceps delivery, I wouldn’t call it ripping. We also don’t rip tissues during C-sections.

Trump’s statement, as incorrect as it may be, supports the fallacy of the due-date abortion. It is a common anti-choice narrative that women come in at 39 weeks and have some kind of abortion for fun or out of boredom and that we doctors are only too happy to comply. The more graphic the description of the procedure, the better as it helps to distract from the facts.

Talking about abortion from a medical perspective is challenging when you are not a health care provider. For example, Mrs Clinton made an error speaking about lateterm abortion when she said it was a health of the mother issue. Typically, it is not (it’s almost always foetal anomalies).

However, this error on Clinton’s part only underscores how important it is for politicians to not practice medicine.

To put it in perspective, 1.3 percent of abortions happen at or after 21 weeks and 80 percent are for birth defects. Put another way, 1 percent of abortions that are at or after 21 weeks and are for birth defects and 0.3 percent of abortions are at or after 21 weeks and are not for birth defects (some of these will be health of the mother and a very few will be for other indications). Let’s take it situation by situation.

Birth Defects This could range from Down syndrome to anomalies incompatible with life. The generally accepted limit of viability is 24 weeks. Before that, gestational age abortions can happen for any reason. After 18 or so weeks, the options are an induction of labour or a dilation or an evacuation (or D and E), which is a surgery.

With induction, it can take a few days as labour can be hard to trigger so early. If all goes well, the cervix dilates and the foetus delivers. Sometimes inductions fail because you can’t always get such a premature uterus to contract. With a D and E, the cervix is dilated, with the help of medication, instruments or both, and the foetus is removed. The foetus is essentially taken apart with a D and E to _ t through the dilated cervix (the cervix is dilated less with a D and E than for an induction). This is no secret to the women having the procedure. This is also no ripping; there is simply surgical technique. Women know they were pregnant before the procedure and that they were not after _ and trust me, they don’t think their doctor waved a magic wand or had a time turner.

After 24 weeks, birth defects that lead to abortion are very severe and typically considered incompatible with life. These procedures are either a traditional induction, just like labour, or something that requires instrumentation. Because of the partial birth abortion law (in America) women who wish to have a dilation and extraction (a modi_ ed technique for more advanced procedures) need to have foetal cardiac activity stopped with an injection into the uterus. Either way, it’s a two or three (or even four) day process to get the cervix to dilate enough.

The further along in the pregnancy, the more likely the procedure will be an induction of labour. But a skilled practitioner can do a dilation and extraction at 32 or 34 weeks.

I’ve never heard of a dilation and extraction for any other reason than severe birth defects, and often, it is for a woman who has had two or three C-sections for whom inducing labor might pose other health hazards, like uterine rupture.

Why do some women end up with these procedures later on in their pregnancy? Sometimes it can take weeks or even longer to fully understand what is going on with the foetus. Some patients might think they can make it to term and then at 34 weeks cave and ask to be delivered because they just can’t bear one more person asking them about their baby. Do they just smile and walk away or say, “Well, actually, my baby has no brain and will die at birth”? Some women go to term and others can’t Regardless, terminations for birth defects isn’t ripping “the baby out of the womb in the ninth month.” At 38 or 39 weeks, it’s always an induction and is simply called a delivery.

Health of the Mother This de_ nitely happens between 20 and 24 weeks. The most likely scenario is ruptured membranes and an infection in the uterus. The treatment of this is delivery or the infection will spread and kill the mother; however, someone with lupus or renal disease or heart disease (for example) could have a deterioration of their health and with their providers make the decision to have a termination.

After 25 weeks, this would simply be a C-section or an induction of labour and the baby would go to the neonatal intensive care unit. Between 24-25 weeks, there could be some leeway as conditions that are serious enough to require delivery at 24 weeks often also have devastating effects on the foetus. For example, the foetus could be so severely growth restricted making viability at 24 weeks unlikely and a woman with a severe heart condition may not elect to risk her health with a C-section for a likely non viable pregnancy and choose a termination.

These are difficult and nuanced decisions, and everyone is simply working together to make the best decision for the pregnant person. I don’t know where Mrs Clinton got this “bad news at the end” of the pregnancy being about maternal health. I have only ever heard of one very late abortion for maternal health and that was for the rape of a minor by her brother and that was still not at term.

So no one is performing health of the mother abortions at 38 or 39 weeks. We just do deliveries. It’s called obstetrics.

Other Some of the 0.3 percent of abortions after 21 weeks will be for personal reasons. Often these are called elective abortions, but I don’t like that term. Usually this happens when it took too long to _ nd a clinic and raise the money. These abortions happen before 24 weeks. There is no ninth month action here either.

The Facts There are no ninth month abortions. Really. A ninth month abortion is a unicorn and so it’s ridiculous to even discuss it.

Terminations after 24 weeks are for severe foetal anomalies.

(huffingtonpost.com)