A stinkpot by any other name.

First posted on Introibo ad altare Dei 7 December 2006

The United States Supreme Court has recently heard arguments the Partial-Birth Abortion Ban Act, which was passed by Congress and signed by President Bush in 2003. Subsequently stuck down by six federal courts, the whole affair is now in front of the Supreme Court. During the proceedings, Justice Ruth Bader Ginsburg noted that partial birth abortion was "basically the same" as the procedure used in the second trimester, making it difficult to distinguish how a doctor could be prosecuted for performing the one procedure but the other. Although I'm certainly not privy to Justice Ginsberg's mind, her reasoning might go like this: the Partial Birth Abortion Ban bans only "partial birth abortions”. However, there's no meaningful difference between how a "partial birth abortion” is performed, and how other second or third trimester abortions are performed. Since the Ban doesn't ban these other abortions, but only "partial birth" abortions, banning only one procedure makes no sense. When asked by Justice Ginsberg if the two procedures were "basically the same", Solicitor General Paul Clement, arguing for the ban, said, "I don't think so, Justice Ginsberg."[1] With all due respect to Solicitor General Clement, I think Justice Ginsberg is correct on this one.

There are 6.6 million pregnancies in the United States each year.[2] About one quarter of them, 1.3 million, end in deliberate abortion.[3] The number of abortions has held more or less steady for years now, although it does not include the number of abortions caused by abortifacient contraceptives. That number is unknown, but it’s a topic for another essay. So, at what point in gestation are abortions typically executed? Most - 88% - are performed in the first trimester, before 13 weeks.[4] About 10% are executed between 12 and 20 weeks (second trimester), with about 1.5% of all abortions being "late second trimester or third trimester", over 21 weeks gestational age.[5] By the second trimester, the baby has grown too large to abort by simply vacuuming her out (the usual first trimester method). Instead, a dilatation and extraction or D&E, also known as a "sharp curettage" is performed. The cervix is dilated, followed by "mechanical destruction and evacuation of fetal parts."[6] In other words, the living unborn baby is cut into bits prior to removal. In late second trimester it recommended that the fetus be killed prior to the sharp curettage, by injecting a lethal medicine directly into the baby's heart.[7] This is not done out of some odd sense of mercy, as one would kill an animal prior to butchering it rather than butchering it alive. It is done because, as the National Abortion Federation Clinical Policy Guidelines 2005 states, "avoidance of a live birth is an important consideration."[8] You bet'cha. It's hard to imagine worse press for the local abortion clinic than to have a live, mutilated, armless, legless, or partially eviscerated aborted child lying around, mucking and mewling, gasping out her short life in her own blood and meconium. This is not rare event, as the London Timesonline has recently observed.[9]

By the third trimester, the baby is quite large. In fact, the age where she could have a reasonable chance of survival outside of the womb is around 24 weeks. However, if the mother chooses to abort her instead, she’s too big to simply chop up, so an alternative procedure was developed in 1992 by Dr. Martin Haskell, known as intact dilation and extraction (D&E or D&X).[10] Quoting Williams Obstetrics exactly, “In political parlance, this procedure has been termed partial birth abortion.”[11] How is it done? The physician first mechanically dilates the mother’s cervix. He then ruptures the amniotic sac, and snakes a long, thin, curved forceps into the cervix, slides it up, past the baby’s head (the baby is usually head down by this point in the pregnancy), along her body, up, up, until he can grab one of her feet. Once he’s clamped onto a foot, he pulls it, flipping the baby around feet first, and he keeps pulling until he pulls the foot and leg out of the cervix. He then grabs the other foot and pulls it out as well, sliding the baby’s bottom, belly, and torso out of the womb, until only the head is left up in there. Now the physician applies gentle traction on her tiny body with one hand, while, with the fingers of the same hand, he pushes the lip of the cervix out of the way, to expose the back of her neck and base of her skull. With the other hand, he pushes the point of a pair of closed scissors into the base of her skull. He removes the scissors, inserts a sucker, sucks out her brains, and her skull collapses.[12] She is now rendered dead, and the lifeless body is delivered the rest of the way. How often is the D&X performed? Using 1,300,000 abortions per year as a working number, 1.5% of which are done at over 21 weeks, this makes about 8600 abortions per year. Since D&X is the procedure of choice, it's not unreasonable to conclude that most or all of them are done using this procedure. How can this freak show happen 8600 times a year in these United States? Because, as Dr. George Annas, Chair of the Department of Health Law, Bioethics and Human Rights at Boston University School of Public Health has noted (more than once),
“An almost born child is not yet born, and is not a person under the Constitution.[13]

So, when Justice Ginsberg was saying she could see no difference between “partial birth abortions” and abortions bone earlier, I don’t know if she meant a D&X done at 40 weeks vs. a D&X done at 20 weeks, or a D&X vs. a sharp curettage. But I agree with her, in principle: there’s no meaningful difference between sucking the unborn baby’s brains out, chopping her to bits, or vacuuming her out if she’s small enough.

Endnotes.
[1] "Justices have pointed abortion discourse." Mark Sherman, Associated Press, 8 November 2006.
[2] Saraiya, M. et al, "Estimates of the Annual Number of Clinically Recognized Pregnancies in the United States, 1981-1991." American Journal of Epidemiology 149(11): 1025-1029, 1999.
[3] "Facts in Brief: Induced Abortion in the United States" The Alan Guttmacher Institute, Washington, DC/NY,NY, 2005. Available at www.guttmacher.org.
[4] Obstetrics: Normal and Problem Pregnancies, 4th Ed. Gabbe, S.G., Neibyl, J.R., & Simpson, J.L. (Ed's) Churchill-Livingstone, 2002. See Section entitled "Fertility Control and Health".
[5] ibid.
[6]Williams Obstetrics 22nd. Ed. McGraw-Hill, 2005, Ch.9 , pg 243.
[7] Gabbe, pg. 640.
[8] National Abortion Federation Clinical Policy Guidelines 2005, pg.17. Available at NAF website, www.prochoice.org
[9] "Fifty babies a year are alive after abortion." Timesonline, 27 November 2005, The Sunday Times edition, at www.timesonline.co.uk
[10] Haskell, M. “Second Trimester D&X, 20 wks and beyond.” and a companion article, “D&E for late trimester abortions.” Originally presented at the 1992 meeting of the National Abortion Federation, and are available in original form through the Priests for Life website, www.priestsforlife.org/partialbirth.html
[11] Williams, pg. 243.
[12] There are numerous technical descriptions of the D&X procedure, including the original cited above. I developed this one from Gabbe (ibid), pg. 640.
[13] G. Annas, quoted in Gabbe (ibid), pg. 1350.