Background: According to a report in the National Review, the ACOG (American College of Obstetrics and Gynecologists) originally opposed the procedure

the select ACOG panel “could identify no circumstances under which this procedure . . . would be the only option to save the life or preserve the health of the woman.”

But Kagan wrote them a memo instructing them to change the language:

So Kagan set about solving the problem. … On a document [PDF] captioned “Suggested Options” — which she apparently faxed to the legislative director at ACOG — Kagan proposed that ACOG include the following language: “An intact D&X [the medical term for the procedure], however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman.”

If this is true, then someone at the ACOG needs to discipline those on that panel. You don’t put a mom’s life at risk to please a politician.

This procedure is so dangerous to the mother that we don’t use it, even if the baby is dead.

That’s the political scandal. The rest of the article is clinical, only to be read for those with a strong stomach.

Theoretically the only situation that an intact D&X (the procedure use in “partial birth abortion) it is indicated is if you have a baby with hydrocephalus whose mom comes in to the Emergency room with the body of a dead kid hanging out her vagina.

When you try to deliver the child, you find that the head is too large to deliver.  Yet even then, most docs would first try to decompess the fluid in the skull with a needle and deliver the kid, or else do an emergency Caesarian section and pull the kids out from above.

In Africa, in populations where Caesarian section of the mom might result in her being divorced and so she refuses the procedure, if the head won’t come, we then do a symphysiotomy, pop the pelvic bones open, and pull out the dead kid, then suture and bind the pelvis back into place.

Even 20 years ago in Africa, this was rarely done: having the local nurse midwife learn to do Caesarian sections with a ketamine drip and local anesthetics was actually safer for mom and baby for obstructed births.

So why is an intact D&X so dangerous?

Because the procedure consists of putting scissors up into the fetal head, removing the brain, then pulling it out.

But the problem is that in a late delivery, the cervix, the part of the womb in the vagina that opens up during labor, tends to be soft, mushy, and bleeds easily.

A cervical tear is not an uncommon problem, (especially if the mom pushes too soon) but can cause massive bleeding, and if not repaired properly, can result in premature deliveries in later pregnancies (Incompetence of the cervix).

But the insertion of scissors into a skull is even more worrisome, because they are inserted several inches up into the uterus, and the skull is harder than the cervix and the uterus. So you have the danger of not only a cervical tear but that of uterine perforation, where the scissors go completely through the soft uterine wall.

Uterine perforation can be fatal. This was one of the reasons that women died before Roe V Wade.  With legal abortion, in skilled hands,there is a tiny risk of uterine perforations in early abortions (8 in 10,000 cases).

In other words, the risk to the mom’s health is so great that we don’t use it to deliver a dead kid.

So why do it? Because other procedures used for late term abortions rarely can result in a live kid, or might require several visits.

The safest alternative for the mother is to inject the heart of the unwanted fetus with a drug, and then induce labor to deliver the dead child.

As a Catholic and a human being, I object to this too, but it is hard to think of any ethical system, even one where a unborn child is considered not a person, that would not prefer a quick death to the painful horrors of an “intact d&X”.

I should bring up one other controversial subject that has nothing to do with this: it is called a “live birth abortion” but is actually inducing a premature birth of a child who has an abnormality that is incompatible with life.

In this, the child is born, and given to a loving mom or nurse to cuddle, and it is only given basic treatment (warmth, oral fluids). In cases of anencephaly or other severe malformations where the mother has so much amniotic fluid that she has trouble breathing, it would be ethical for Catholics to induce such an early labor: such a child might live a few days, but it is allowed to die a  natural death.

But doing this and then sticking the kid in the corner to get cold and die of neglect, such as is sometimes done with Down’s syndrome, is not the same thing, but a cruel variation of abortion.

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Nancy Reyes is a retired physician living in the rural Philippines. She worked as a young physician in rural Africa.

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