Thursday, February 23, 2006

ABORTION: Intact Dilation & Extraction

The following is a re-working of a letter I wrote last year to my mother in response to her regurgitation to me of myths about the "Partial Birth Abortion" procedure -- deliberately, maliciously misnamed by the Extreme Right Wing Christofascist Neocon Zombie Brigade.

Given the Supreme Court's declaration of its intent to hear arguments about the so-called "Partial Birth Abortion Ban," I thought it pertinent.

I apologise for the lack of link references, but at the time I wrote it, I wasn’t thinking like a writer – and I knew the links would just confuse the hell out of my intended reader.

Dearest, dearest Mom,

I can’t just respond to the main question. Whenever I hear someone use the misnomer “partial birth abortion” and back it up with a description without context, I must clarify it.

First, let’s get our terms straight. The so-called “partial birth abortion” is a misnomer, to say the least. The procedure is not abortion as defined within medical science. The term "abortion" means the termination of pregnancy before the fetus is viable. However, it does fall within the definition of "abortion" which is used by most of the public.

The medical terms: "D&X" procedures, an abbreviation of "dilate and extract," or "Intact D&E," or "Intrauterine Cranial Decompression" procedures.

The odious and dishonest term "Partial Birth Abortion" was recently created by pro-life groups when the procedure became actively discussed at a political and religious level.

By the way, the vast, VAST majority of D&Xs are performed on non-viable fetuses, generally having little brain tissue at all -- or a mass of liquefied brain tissue. Obviously, your claim that "...If you were not afraid it would come out kicking screaming and breathing like a real baby it would not be necessary to de-brain it..." does not apply in those cases. I wonder if that is made clear in pro-life propaganda?

What is the D&X Procedure?

The D&X procedure is usually performed during the fifth month of gestation or later. The woman's cervix is dilated, and the fetus is partially removed from the womb, feet first. The surgeon inserts a sharp object into the back of the fetus' head, removes it, and inserts a vacuum tube through which the brains are extracted. The head of the fetus contracts at this point and allows the fetus to be more easily removed from the womb.

Why D&X procedures Are Performed:

1st Trimester:
D&Xs are not performed during the first three months of pregnancy, because there are better ways to perform abortions. There is no need to follow a D&X procedure, because the fetus' head quite small at this stage of gestation and can be quite easily removed from the woman's uterus.

2nd Trimester:
D&Xs are very rarely performed in the late second trimester at a time in the pregnancy before the fetus is viable. These, like most abortions, are performed for a variety of reasons, including:

-- She is not ready to have a baby and has delayed her decision to have an abortion into the second trimester (or perhaps has been OBSTRUCTED from receiving the abortion earlier, as is OFTEN the case) .As mentioned above, 90% of abortions are done in the first trimester.

-- There are mental or physical health problems related to the pregnancy.

-- The fetus has been found to be dead, badly malformed, or suffering from a very serious genetic defect. This is often only detectable late in the second trimester. Obviously, "...If you were not afraid it would come out kicking screaming and breathing like a real baby it would not be necessary to de-brain it..." does not apply, since in most cases the fetus doesn't HAVE a brain -- not one that will ever FUNCTION, anyway.

3rd Trimester:
D&X procedures are also very rarely performed in late pregnancy. The most common justifications at that time are:

-- The fetus is dead.
I repeat: Obviously, "...If you were not afraid it would come out kicking screaming and breathing like a real baby it would not be necessary to de-brain it..." does not apply.

-- The fetus is alive, but continued pregnancy would place the woman's life in severe danger.

-- The fetus is alive, but continued pregnancy would grievously damage the woman's health and/or disable her.

-- The fetus is so malformed that it can never gain consciousness and will die shortly after birth. Many which fall into this category have developed a very severe form of hydrocephalus. Obviously, "...If you were not afraid it would come out kicking screaming and breathing like a real baby it would not be necessary to de-brain it..." does not apply.

-- In addition, some physicians violate their state medical association's regulations and perform elective D&X procedures - primarily on women who are suicidally depressed.

There appears to be no reliable data available on how many D&X procedures are performed for each of the above reasons.

The physician is faced with two main alternatives at this late point in pregnancy:

-- a ”hysterotomy,” which is similar to a Cesarean section, or

-- a D&X procedure.

Approximately 1 in 2000 fetuses develop hydrocephalus while in the womb. About 5000 fetuses develop hydrocephalus each year in the U.S. This is not usually discovered until late in the second trimester. Some cases are not severe. After birth, shunts can be installed to relieve the excess fluid on the newborn's brain. A pre-natal method of removing the excess fluid is being experimentally evaluated. However, some cases are much more serious. "It is not unusual for the fetal head to be as large as 50 centimeters (nearly 20 inches) in diameter and may contain...close to two gallons of cerebrospinal fluid." In comparison, the average adult skull is about 7 to 8 inches in diameter. A fetus with severe hydrocephalus is alive, but as a newborn cannot live for long; it cannot achieve consciousness. The physician may elect to perform a D&X by draining off the fluid from the brain area, collapsing the fetal skull and withdrawing the dead fetus. Or, he might elect to perform a type of caesarian section. The former kills a fetus before birth; the latter allows the newborn to die after birth, on its own. A caesarian section is a major operation. It does expose the woman to a greatly increased chance of infection. It poses its own dangers to a woman and any future pregnancies. Allowing a woman to continue in labor with a severely hydrocephalic fetus is not an option; an attempted vaginal delivery would kill her and the fetus.

The exact number of D&Xs performed is impossible to estimate with accuracy. Many states do not have strict reporting regulations.

One often quoted figure was that over 1000 D&Xs had been performed annually in New Jersey. From this number, many inflated national totals were estimated. But the New Jersey figure appears to be an anomaly. A single physician in a single NJ hospital had been ignoring the regulations of the state medical association and performing D&Xs in cases not involving the potential death or serious disability of the woman.

Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, estimated (Nightline program, 1997-FEB-26) a total of 3,000 to 4,000 annually in the US -- about ten a day.

Pro-life groups discovered an internal memo by Planned Parenthood which estimated that up to 60 (0.24%) of the more than 25,000 abortions performed annually in Virginia were D&Xs. If this figure is accurate nationally, then there would be up to 2,880 D&X procedures per year in the U.S.

Referring to a Virginia state law, Bennet Greenberg, executive director of Planned Parenthood Advocates of Virginia said: "I'm not aware of a need for this bill in the first place, since this procedure is very, very rare, and I'm not aware it's ever been used [in Virginia]."

And now, for some sources of some DISINFORMATION about D&X:

-- On 1995-JUL-19, on the radio program Focus on the Family Dr. (sic) James Dobson referred to “PBAs” (sic) as a type of "Nazi era experimentation" in which doctors "suck the brain matter out of a living, viable baby for use in medical experiments.”

The incorrect impression given was that this is a procedure requested by researchers eager to study brain structure. They arbitrarily select an about-to-be-born fetus at random from the nearest delivery room, and kill it in order to get more research material. The program generated a flood of telephone calls which paralyzed Federal government switchboards.

To our knowledge, Dr. Dobson has never apologized for his misleading statements or corrected his misrepresentation of the facts.

-- Senator Rick Santorum, one of the leaders in the Senate of a D&X ban, said that the procedure is a gruesome form of infanticide.

[The term infanticide refers to the killing of a newborn infant; it is not applicable to an unborn fetus during a D&X procedure.]

Senator Santorum also said that it is a lie to argue that a D&X is sometimes required to protect a woman from a serious health risk.

But if he truly believed that statement, then he would not have objected to President Clinton's request that an exemption be added to the bill in cases of serious health risks to the woman. After all, if there was no risk of a devastating health problem, then the exemption would never be exercised, and there would be no harm in including it in the bill.

D&X is, as you can see, not a common procedure, not by a long shot – it is performed in cases of ABSOLUTE necessity. The way the pro-life movement refers to it, you’d think it was as common as a first trimester abortion. That’s not a mistake. They WANT you to think that, because it is a horrifying procedure, one no woman undergoes unless she has to – but that fact, which should be obvious, is obscured in favour of the incendiary and mendacious lies perpetrated by people who would like nothing more that to outlaw all abortion.

And why is that? Because they consider abortion to be murder. I’ll make a brief mention of this hypocrisy and move on: a majority of the same people who are trying to outlaw abortion support the death penalty and George W. Bush’s unjust, immoral war on Iraq, where thousands of innocent people have died and will continue to die.

Whew. Now, as to your question – when is it a person and no longer a fetus? You’re not going to like my answer.

I could delve into the vagaries of “quickening,” “immortal souls,” “functioning brain waves,” “beating hearts” and many more – but I consider them beside the point, while you consider the question to BE the point -- though it's rather disingenuous to ask the question when you refuse to accept any answer but your own.

Which is why neither side will ever move on this issue. There’s a lot of grey area, to be sure, but when you come right down to it, the pro-choice side – MY side – demands that the decision to have an abortion belong to the woman alone. Rather than speak for everyone on the pro-choice side, I’ll speak for myself from this point -- finally, here comes the answer...

When does a fetus become a person? It’s a person when the woman carrying it says it’s a person. It’s not an absolute. It would be so very nice if God would come down and tell us “at X date in a pregnancy,” but that hasn’t happened yet. I doubt it ever will.

If you want to know when I would consider it a person, I’d have to take it on a case by case basis. Once I decided Terry would be carried to term, he became a person. If I get pregnant again, it’s not ever going to be a person. I don’t want another child, and if birth control fails me, I’ll have an abortion to prevent it. For medical reasons, a tubal ligation is off the table, so to speak. We’ve investigated vasectomy, but it’s not covered by insurance and we don’t HAVE the extra money.

I cannot have another child. Never mind the financial and logistical problems it would cause – I don’t think my body could survive another full term pregnancy. For the record, neither do my doctors.

I want to pose a hypothetical here:

Let’s say I did get pregnant and DID want to have another baby, and DID decide to carry to term. Further, let us suppose that at 7 months, the fetus inside me were to DIE.

Are you aware that according to the “Partial Birth Abortion Ban” law, I would be PROHIBITED from having that fetus removed from my body vaginally? THAT my only other options would be to WAIT for it to FALL out of me… or to be cut open, caesarean-style, to facilitate the removal of a dead fetus from my uterus?

Extreme? Yeah. Let’s say it wasn’t dead… just malformed to the point of being UNVIABLE. Would you force me to carry to term a fetus incapable of surviving outside my body? A fetus with a liquefied brain? A fetus with no arms or legs and lacking, say, two or three vital organs? The PBAB dictates that must be the case.

Or, let’s say, the doctor determined that carrying to term would result in my death or severe health problems – paralysis, brain damage…

Shall we now begin to write laws demanding that a doctor PROVE to some Investigatory Body that the D&X was medically necessary to save my life or prevent said health damage? What proof would be required? Will there be footnotes? Videotape of me on the table, of the fetus, of the body parts?

If THAT sounds extreme, it ought. But last year a legislator in Virginal attempted to pass a law that would require women to PROVE they had a MISCARRIAGE. (After a righteous public outcry, he took it off the table. But I bet the sucker would have PASSED if it weren’t for an enterprising BLOGGER who raised the hue and cry.)

I realize I am in a minority in that I would have no restrictions at all -– aside from standard health regulations, of course -- at a federal, state or local level. I believe this is a medical issue best left to a woman and her doctor, and that any government edicts regarding abortion are reprehensible.

Women must be free to make their own medical decisions-- and trusted to make the correct decisions, with the guidance of medically trained professionals. If anyone wants to split hairs with me about this by throwing out late term abortion or D&X, I would simply repeat: It is a MEDICAL decision and it is up to the woman and her doctor.

Certainly, in the case of the D&X, the decision is heavily dependent on the doctor. But as opposed as I am to allowing the state to make medical decisions by outlawing abortion, so am I opposed to allowing doctors to make them completely; I would submit that if a doctor tells a woman she must have a D&X or risk death – and that woman chooses NOT to have the procedure, that is ALSO her choice.

For some women, the fetus is always a baby.

But, sometimes, maybe, never.

If you've got a fetus growing in you that you don't want there, to YOU, it might not be a baby. It might be a parasite. And you might just be willing to do anything ...

That's why there will always be abortions -- legal or not. Always have been, always will be.

I’ll leave the moral questions to the individual. For me, the issue is simple: It’s my body. And I don’t want the state or any group of people whose religious beliefs differ from mine (and increasingly, those two groups are becoming terrifyingly melded) coming into my gynecologist’s office while I’m on the table and dictating which procedure I may and may not have.

I don’t believe in the same God you do. I don’t believe the same things about life, the universe and morality that you do. Why should you have the right to force me to adhere to “moral laws” created, interpreted and dictated by a God in whom I don’t believe?

It’s tricky, I know, because so many other “moral laws” of ours are in agreement. Murder, rape, theft, brutality, cruelty – and the various methods in which these crimes are perpetrated – all of these we share.

But we’re stuck, I think. You believe a fetus is a person from the moment of conception; I do not. You believe that “person” has the right to life, and that abortion is murder. I do not. You are, therefore, compelled by your own standards of morality, acquired through your life experience and your religion, to fight against abortion; I am compelled by my own standards, acquired through my own life experience and my own spiritual beliefs, to fight for it. Impasse.

I hope I have clarified any questions about my beliefs you have on this issue.

Incidentally, you still haven’t clarified for me how you can choose to vote for George W. Bush SOLELY on the basis of his “pro-life” stance and probable Supreme Court appointments to reverse Roe v. Wade…

when George W. Bush is an avid proponent of the death penalty and has taken us into a war, killing hundreds of thousands, perhaps millions by the time it ends.

I, at least, have some moral ambiguity on my side, due to my belief that abortion is not murder.

You seem to be choosing the lives of the unborn over the lives of those dying in Iraq, Afghanistan and off Death Row. Is it about quantity, then, not quality?

Another Bush term in the White House might well result in a reversal of Roe v. Wade, perhaps even send abortion back to the alleys and illegal abortionists, thereby cutting down on the number of abortions (and increasing the number of abused, neglected, malnourished children without health care or parents who want them – and the number of women who die from illegal abortions) – but it is also guaranteed to send more American soldiers back in body bags, and more Iraqis into mass graves.

I just don’t understand that. It would seem that you believe George W. Bush is the lesser of two evils; that you believe eliminating safe, legal abortion is a lesser evil than mass murder by way of war, along with the unpleasant repercussions of criminalizing abortion I just mentioned.

I choose the living over the “potentially living.” I choose the woman over the fetus. I choose to allow for the reckless abuse of abortion by the few in order that the MANY may have the freedom to make their own medical decisions without government interference. And until someone can prove to me beyond a SCIENTIFIC doubt that a “potential human being” has a SOUL, I’m going to assume that whatever Deity there is out there, if there is one, has factored abortion into the universal equation and that those SOULS… are doing just fine wherever they may be, thank you very much. The God in whom I believe (occasionally) is not so sadistic as to consign millions of unborn souls to limbo, nor so sadistic as to have created a world where women are forced to give birth to their rapists’ offspring because every sperm if fucking sacred. If that’s the kind of God that exists, I want NO PART of that God. That God can kiss my apostate, irreligious ASS.

Sorry – you wanted a simple answer, but you know better than that. There are no simple answers in this world outside of a restaurant.

My mother did not read this. I wrote it for her, to further clarify both my position AND the facts surrounding the D&X procedure. But, as is unfortunately so OFTEN the case with her and people who feel as she does, the FACTS are so much less compelling than the MYTHS that she opts to stick with the emotional manipulation of propagandists and charlatans.

I'm sorry, mom, but if we're going to communicate, I have to tell the truth. And, like it or not, I communicate in this new medium. I don't think I've portrayed you unfairly, but if you feel that's so, I WELCOME your response here in print, since you refuse to discuss it on the phone.

And while I have you here, I feel it imperative to reiterate my frequently posed question to you, the one you answer with, "I can't explain it, it's just the way I FEEL:"

What kind of an omniscient, omnipotent, LOVING God would decree that a fertilised egg in a petri dish is, as you admit, "Just a bunch of cells," but then decree also that once that "bunch of cells" is implanted in a uterus, it is Now A Human Being with A Soul and Must Not Be Removed?

It. Makes. No. Sense. Not scientifically, that's patently obvious -- but not ECCLESIASTICALLY, either. Either a fertilised egg is human, or it AIN'T. You CANNOT HAVE IT BOTH WAYS. What, now the UTERUS is the mechanism that imbues Life and a Soul?

Aaaaaargh! The illogic makes me fucking INSANE!