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Reposted from 7/6/08.  I have been too distressed to write a new Diary on my friend Dr. Tiller.  But, many people have asked me to repost this Diary written last year that explains late abortion.  It had 526 comments and was on the Recommended list.  Carry on.

Fewer than 2200/year or 0.2% of the 1.3 million abortions performed yearly are past 24 weeks.  But, the anti-abortion propagandists have successfully maligned procedures at this stage of pregnancy by calling them "Partial Birth Abortions" (not a medical term, but a political one).  Even pro-choice Democrats don't understand the reality of late abortion.

I call abortions past 24 weeks Mercy Abortions...and I'll tell you why.

More below the fold.

For 14 years, I worked at Midtown Hospital in Atlanta, a woman's hospital specializing in late abortion.  The hospital opened in 1977 because at that time, Georgia law mandated that an abortion past 12 weeks had to be performed in a hospital.  Abortion had just been made legal in 1973 and it became the first procedure to be widely performed on an outpatient basis.  

Let me repeat that:  Early abortion was the first medical procedure to be widely performed on an outpatient basis.  That means that medical professionals performing abortions invented outpatient health care in this country.

But, abortions past 12 weeks were still rare and very few hospitals would allow them to be performed.

At that time, there were 2 types of procedures for abortions:

  1.  Vacuum aspiration performed from about 7 weeks until 12 weeks.
  1.  Saline induction abortions performed from about 16 weeks to 24 weeks.

So, you can see that there was a gap where women couldn't get abortions from 12 weeks until 16 weeks.  That meant that a woman who was 13 weeks pregnant had to wait 3 weeks before she could get an abortion.  Then she had to undergo what is essentially a medically induced miscarriage.

As abortion medical professionals matured and were able to openly discuss options and medical procedures and medicines and investigate problems, procedures became more refined.  Now, induction type abortions have been pretty much eliminated, and more sophisticated procedures involving instrumentation and general anesthesia and abortifacent drugs have made abortion even more safe and accessible and comfortable for women throughout all stages of pregnancy...early to late.

And, let me add a few more things about the evolution of abortion in this country.

  1.  Abortion was the first widely performed outpatient procedure.
  1.  Abortion procedures have barely tripled in price from the early 70's.  In the 70's an early abortion was about $150.  Now they are about $400.  Name any other medical procedure that's only tripled in cost in the past 35 years.  You can't.
  1.  Abortion clinics were some of the first medical providers to mandate informed consent.  And the consent is very detailed, unlike the general consent you sign in a hospital.
  1.  Abortion clinics were some of the first medical providers to openly advertise directly to consumers.
  1.  Abortion is one of the safest medical procedures performed.  It's 8-12 times safer than childbirth.  The mortality rate is very low.

I could go on and on, but want to now focus on Mercy Abortions.  These are abortions past 24 weeks.

Who are the women who delay into the second and third trimester?  There are several characteristics:

  1.  In general, they are younger.
  1.  They are less educated.
  1.  They are more rural, where healthcare is more inaccessible.
  1.  They tend to be poorer than women who get early abortions.
  1.  And they have more lifestyle and emotional issues.  Oftentimes, the unintended pregnancy is the easiest of their problems to solve.

Now, I'm sure your first concern is Why.  Why would a woman wait so long?  Here's a few of the many reasons why women delay getting abortions:

  1.  Money.  Many women don't have $400 sitting around in a savings account to pay for an early abortion.  Delay happens in raising the money, borrowing it, pawning stuff for it, etc.
  1.  Denial.  Many young women especially so want not to be pregnant that they deny their obvious symptoms of pregnancy and attribute them to other causes.  They're missing their period because they're irregular.  They're gaining wait because they've been eating too much.  They've got the flu.  Many young women even hide their pregnancies from their parents with big baggy shirts, fake periods, etc.  
  1.  Fetal anomalies.  

I'm going to discuss Fetal anomalies in detail because this is the number one reason women get abortions past 24 weeks.

That's why I call them Mercy Abortions.  

One of the largest providers of late abortions, Dr. George Tiller in Wichita KS, has been the object of harassing investigations by Kansas authorities, culminating in an unprecedented Grand Jury trial prompted by anti-abortionists.  He was just recently vindicated and the Grand Jury refused to bring charges.  But, his detractors won't stop, and more harassment is anticipated.

Another major provider of late abortions is Dr. Warren Hern in Boulder CO.

Both of these doctors are extremely compassionate and committed medical professionals.  I've been to both clinics and have known them personally and can attest to their credibility as both doctors and humane individuals.

Without a doubt, the number one reason for abortions past 24 weeks is the late discovery of a fetal anomaly incompatible with life.  I've talked with many women who find themselves in this situation and it is always an extremely difficult and heart wrenching situation.  Many women even underwent infertility treatments to become pregnant.  But, when the pregnancy goes horribly awry, a Mercy Abortion is the best solution in a no-win situation.  These are women who need abortion more than many others.  Therefore, it's ironic that they are the ones being punished by focusing on the procedures that are life saving for them.

One of the reasons for this is that many of these anomalies aren't apparent in pregnancy until the later stages.  Also, most women get a sonogram paid for by insurance in the early weeks of pregnancy, but don't get another one until well after 20-22 weeks.  

Imagine if you can that you are happily carrying a baby that you've wanted all your life.  You've had the baby showers and decorated the room already.  Then comes the devastating news that the baby is anencephalic.  That means that the baby has no brain and will die a horrible death shortly after birth.  

The Prognosis:

There is no cure or standard treatment for anencephaly and the prognosis for affected individuals is poor. Most anencephalic babies do not survive birth, accounting for 55% of non-aborted cases. If the infant is not stillborn, then he or she will usually die within a few hours or days after birth from cardiorespiratory arrest.

In almost all cases anencephalic infants are not aggressively resuscitated since there is no chance of the infant ever achieving a conscious existence. Instead, the usual clinical practice is to offer hydration, nutrition and comfort measures and to "let nature take its course". Artificial ventilation, surgery (to fix any co-existing congenital defects), and drug therapy (such as antibiotics) are usually regarded as futile efforts. Clinicians and medical ethicists may view the provision of nutrition and hydration as medically futile. Occasionally some may even go one step further to argue that euthanasia is morally and clinically appropriate in such cases.

You're 28 weeks along and the OB/GYN that's been caring for you can't help you out.  You see, the hospital where he practices will gladly take your money and let you give birth there, but they won't let your OB/GYN perform a Mercy Abortion on you so that you can maintain your fertility for future pregnancies and lessen the devastation on you and your family by ending the pregnancy now.  

Oh no.  The powers that be want you to carry that anencephalic baby for 10 more weeks, then give birth, then slowly watch it die right in front of your eyes.  Now, if that's how you want to handle the situation, fine.  But, if you'd like a more merciful ending to this tragic situation, a trip to Dr. Tiller or Dr. Hern might be in order. For now, that is.

You say.  "This is just an isolated instance."  Oh no... this scenario is played out every day.  And many of the families that this happens to are anti-abortion.  But, at that moment where they are told that the pregnancy is flawed, many choose the Mercy Abortion to alleviate their suffering and the suffering of their child.

Mercy Abortions are also extremely necessary in maintaining the woman's fertility so that a successful pregnancy can be possible in the future.

So, as Democrats committed to pro-choice values, let's not jump into the Rovian trap that the anti-abortion framing has given us on late abortions.  They demonized a procedure that mercifully saves women and promotes healthy families.  It may be you or someone in your family that needs a Mercy Abortion in the future.

Originally posted to Hot Flash Report on Tue Jun 02, 2009 at 09:46 AM PDT.

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