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- From: dsh@csl36h.csl.ncsu.edu (Doug Holtsinger)
- Subject: Survivors of Abortion: The Dreaded Complication
- Message-ID: <1992Jul21.141808.11160@ncsu.edu>
- Followup-To: talk.abortion
- Sender: news@ncsu.edu (USENET News System)
- Reply-To: dsh@csl36h.csl.ncsu.edu (Doug Holtsinger)
- Organization: North Carolina State University
- Date: Tue, 21 Jul 1992 14:18:08 GMT
- Lines: 485
-
- The following article about the live birth of babies following abortion
- originally appeared in The Philadelphia Inquirer, August 2, 1981.
- It is reprinted in The Congressional Record, April 21, 1986, S 4621,
- and it is taken from the latter source. Unfortunately, the
- Congressional Record contains only the second part of the article.
- If you have information on an accessible source for the first part
- of the article, please e-mail it to me.
-
-
- ---------------------
- Abortion: The Dreaded Complication, PART II
- Originally appearing in The Philadelphia Inquirer, August 2, 1981
- by Liz Jeffries and Rick Edmonds
- Reprinted in The Congressional Record, April 21, 1986, S 4621
-
-
- Something happens in a very small number of abortions, per-
- formed relatively late in pregnancy, that no one wants to talk
- about. It horrifies many of the medical personnel who have
- encountered it.
-
- What happens is that about once a day somewhere in the U.S.,
- something goes wrong and an abortion results in a live baby.
-
- ...
-
- Not every doctor who performs a late term abortion has to con-
- front an aggressive prosecutor like Anders. But even those abor-
- tion live births that escape public notice raise deeply troubling
- emotions for the medical personnel involved. ``Our training dis-
- ciplines you to follow the doctor's orders,'' explained a Cali-
- fornia maternity nurse. ``If you do something on your own for the
- baby that the doctor has not ordered and that may not meet with
- his commitment to his patient, the mother can sue you. A nurse
- runs a grave risk if she acts on her own. Not only her immediate
- job but her license may be threatened.''
-
- Nonetheless, nursing staffs have led a number of quiet revolts
- against late abortions. Two major hospitals in the Fort Lauder-
- dale area, for instance, stopped offering abortions in the late
- 1970s after protests from nurses who felt uncomfortable handling
- the lifelike fetuses.
-
- A Grand Rapids, Mich. hospital stopped late-term abortions in
- 1977 after nurses made good on their threat not to handle the
- fetuses. One night they left a stillborn fetus lying in its
- mother's bed for an hour and a half, despite angry calls from the
- attending physician, who finally went in and removed it himself.
-
- In addition, a number of hospital administrators have reported
- problems in mixing maternity and abortion patients--the latter
- must listen to the cries of newborn infants while waiting for the
- abortion to work. And it has proved difficult in general hospi-
- tals to provide round-the-clock staffing of obstetrical nurses
- willing to assist with the procedure.
-
- One young nurse in the Midwest, who quit to go into teaching,
- remembers ``a happy group of nurses'' turning nasty to each other
- and the physicians because of conflicts over abortion. One day,
- she recalled, a woman physician ``walked out of the operating
- room after doing six abortions. She smeared her hand [which was
- covered with blood] on mine and said, `Go wash it off. That's the
- hand that did it.' ''
-
- Several studies have documented the distress that late abortion
- causes many nurses. Dr. Warren M. Hern, chief physician, and Bil-
- lie Corrigan, head nurse, of the Boulder (Colo.) Abortion Clinic,
- presented a paper to a 1978 Planned Parenthood convention enti-
- tled ``What About Us? Staff Reactions. ..."
-
- The clinic, one of the largest in the Rocky Mountain states,
- specializes in the D&E (dilatation and evacuation) method of
- second-trimester abortion, a procedure in which the fetus is cut
- from the womb in pieces. Hern and Corrigan reported that eight of
- the 15 staff members surveyed reported emotional problems. Two
- said they worried about the physician's psychological well-being.
- Two reported horrifying dreams about fetuses, one of which
- involved the hiding of fetal parts so that other people would not
- see them.
-
- ``We have produced an unusual dilemma,'' Hern and Corrigan con-
- cluded. ``A procedure is rapidly becoming recognized as the pro-
- cedure of choice in late abortion, but those capable of perform-
- ing or assisting with the procedure are having strong personal
- reservations about participating in an operation which they view
- as destructive and violent.''
-
- Dr. Julius Butler, a professor of obstetrics and gynecology at
- the University of Minnesota Medical School, is concerned about
- studies suggesting that D&E is the safest method and should be
- used more widely. ``Remember,'' he said, ``there is a human
- being at the other end of the table taking that kid apart.''
-
- ``We've had guys drinking too much, taking drugs, even a sui-
- cide or two. There have been no studies I know of of the prob-
- lem, but the unwritten kind of statistics we see are alarming.''
-
- ``You are doing a destructive process,'' said Dr. William Ben-
- bow Thompson of the University of California at Irvine. ``Arms,
- legs, chests come out in the forceps. It's not a sight for every-
- body.''
-
- Not all doctors think the stressfulness is overwhelming. The
- procedure ``is a little bit unpleasant for the physician,'' con-
- cedes Dr. Mildred Hanson, a petite woman in her early 50s who
- does eight to 10 abortions a day in a clinic in Minneapolis, just
- a few miles across town from where Butler works. ``It's easier to
- ... leave someone else--namely a nurse--to be with the patient
- and do the dirty work.''
-
- ``There is a lot in medicine that is unpleasant'' but
- necessary--like amputating a leg--she argues, and doctors
- shouldn't let their own squeamishness deprive patients of a pro-
- cedure that's cheaper and less traumatic.
-
- However, Dr. Nancy Kaltreider, an academic psychiatrist at the
- University of San Francisco, has found in several studies ``an
- unexpectedly strong reaction'' by the assisting staff to late-
- abortion procedures. For nurses, she hypothesizes, handling tis-
- sues that resemble a fully formed baby ``runs directly against
- the medical emphasis on preserving life.''
-
- The psychological wear-and-tear from doing late abortions is
- obvious. Philadelphia's Dr. Bolognse, who seven years ago was
- recommending wrapping abortion live-borns in a towel, has stopped
- doing late abortions.
-
- ``You get burned out,'' he said. Noting that his main research
- interest is in the management of complicated obstetrical cases,
- he observed: ``It seemed kind of schizophrenic, to be doing that
- on the one hand (helping women with problem pregnancies to have
- babies) and do abortions.''
-
- Dr. John Franklin, medical director of Planned Parenthood of
- Southeastern Pennsylvania, was the plaintiff in a 1979 Supreme
- Court case liberalizing the limits on late abortions. He does not
- do such procedures himself. ``I find them pretty heavy weather
- both for myself and for my patients,'' he said in an interview.
-
- Dr. Kerenyi, the New York abortion expert, who is at Mt. Sinai
- Hospital, has similar feelings but reaches a different conclu-
- sion. ``I first of all take pride in my deliveries. But I've seen
- a lot of bad outcomes in women who did not want their babies--so
- I think we should help women who want to get rid of them. I find
- I can live with this dual role.
-
- The legal jeopardy, the emotional strain, the winking neglect
- with which ``signs of life'' must be met--all these things nur-
- ture secrecy. Late abortions take place ``behind a white cur-
- tain,'' as one prosecutor put it, well sheltered from public
- view.
-
- Only one large-scale study has been done of live births after
- abortions--by George Stroh and Dr. Alan Hinman in upstate New
- York from July 1970 through December 1972 (a period during which
- abortion was legal in New York alone). It turned up 38 cases of
- live births in a sample of 150,000 abortions.
-
- Other studies, including one that found signs of life in about
- 10 percent of the prostaglandin abortions at a Hartford, Conn.,
- hospital, date from the mid-1970s. No one is so naive as to think
- there is reliable voluntary reporting of live births in the
- present climate, according to Dr. Cates of the Center for Disease
- Control.
-
- Evidence gathered during research for this story suggests,
- without proving definitively, that much of the traffic in late
- abortions now flows to the New York and Los Angeles metropolitan
- areas, where loose practice more easily escapes notice.
-
- ``The word has spread,'' the Daily Breeze, a small Los Angeles
- suburban paper, said in July 1980, ``that facilities in greater
- Los Angeles will do late abortions. How late only the woman and
- the doctor who performs them know.''
-
- This kind of thing is disturbing even to some people with a
- strong orientation in favor of legal abortion. For instance, the
- Philadelphia office of CHOICE, which describes itself as ``a
- reproductive health advocacy agency,'' will recommend only Dr.
- Kerenyi's service at Mt. Sinai among the half-dozen in New York
- offering abortion up to 24 weeks. The others have shortcomings in
- safety, sanitation or professional standards in the agency's
- view.
-
- An internal investigation of the abortion unit at Jewish
- Memorial Hospital in Manhattan showed that six fetuses aborted
- there in the summer of 1979 weighed more than 1 1/3 pounds. The
- babies were not alive, but were large enough to be potentially
- viable. A state health inspector found in June 1979 that the unit
- had successfully aborted a fetus that was well over a foot long
- and appeared to be of 32 weeks gestation. Hospital officials con-
- firmed in an interview that later in 1979 a fetus weighing more
- than four pounds had been aborted.
-
- ``It's disconcerting,'' Iona Siegel, administrator of the
- Women's Health Center at Kingsbrook Jewish Medical Center in
- Brooklyn, said of abortions performed so late that the infant is
- viable. When Ms. Siegel hears, as she says she often does, that a
- patient turned away by Kingsbrook because she was past 24 weeks
- of pregnancy had an abortion somewhere else, ``that makes me
- angry. Number one, it's against the law. Number two, it's
- dangerous to the health of the mother.''
-
- Though one might expect organized medicine to take a hand in
- bringing some order to the practice of late abortions, that is
- not happening.
-
- ``We're not really very pro-abortion,'' said Dr. Ervin Nichols,
- director of practice activities for the American College of
- Obstetrics and Gynecology. ``As a matter of fact, anything beyond
- 20 weeks, we're kind of upset about it.''
-
- If abortions after 20 weeks are a dubious practice, how does
- that square with abortion up to 24 weeks being offered openly in
- Los Angeles and New York and advertised in newspapers and the
- Yellow Pages there and elsewhere?
-
- ``That's not medicine,'' Nichols replied. ``That's huckster-
- ism.''
-
- Cates, of the Center for Disease Control, concedes that he has
- ambivalent feelings about those who do the very late procedures.
- There is obviously some profiteering and some bending of state
- laws forbidding abortions in the third trimester. But since late
- abortions are hard to get legally in many places, Cates puts a
- low priority on trying to police such practices. Medical author-
- ities leave the late abortion practioners to do what they will.
- And so, too, by necessity, do the legal authorities.
-
- The Supreme Court framed its January 1973 opinion legalizing
- abortion around the slippery concept of viability. As defined by
- Justice Harry Blackmun in the landmark Roe vs. Wade case, viabil-
- ity occurs when the fetus is ``potentially able to live outside
- the mother's womb albeit with artificial aid.''
-
- The court granted women an unrestricted right to abortions, as
- an extension to their right of privacy, in the first trimester of
- pregnancy. From that point to viability, the state can regulate
- abortions only to make sure they are safe. And only after a fetus
- reaches viability can state law limit abortion and protect the
- ``rights'' of the fetus.
-
- ``Viability,'' Blackmun wrote, after a summer spent researching
- the matter in the library of the Mayo clinic, ``is usually placed
- at about seven months (28 weeks) but may occur earlier, even at
- 24 weeks.''
-
- The standard was meant to be elastic, changing in time with
- medical advances. Blackmun took no particular account, though, of
- the possibility of abortion live births, or of errors in estimat-
- ing gestational age.
-
- In subsequent cases, the high court ruled that:
-
- A Missouri law was too specific in forbidding abortion after 24
- weeks. ``It is not the proper function of the legislature or the
- court,'' Blackmun wrote, ``to place viability, which essentially
- is a medical concept, as a specific point in the gestational
- period.''
-
- A Pennsylvania law was too vague. The law banned abortions ``if
- there is sufficient reason to believe that the fetus may be
- viable.'' The court said it was wrong to put doctors in jeopardy
- without giving them clearer notice of what they must do.
-
- State laws could not interfere with a doctor's professional
- judgement by dictating the choice of procedure for late abortions
- or by requiring aggressive care of abortion live births.
-
- According to a 1979 survey by Jeanie Rosoff of Planned
- Parenthood's Alan Guttmacher Institute, 30 states have laws regu-
- lating third-trimester abortions. Some of these laws prohibit or
- strictly limit abortions after the fetus has reached viability.
- Some require doctors to try to save abortion live-born babies.
- Only a few states have both types of laws.
-
- In addition, a number of these laws have been found unconstitu-
- tional. Others obviously would be, in light of Supreme Court
- rulings. Virtually all the state laws would be subject to consti-
- tutional challenge if used as the basis of prosecution against an
- individual doctor.
-
- New York and California, ironically, have among the strongest,
- most detailed laws mandating care for survivors of abortions. But
- these laws have proved only a negligible check on the abortion of
- viable babies.
-
- ``We've had a number of claims come up that a baby was born
- live and full effort was not given to saving it,'' said Dr.
- Michael Baden, former chief medical examiner of New York City.
- ``We've not had cases of alleged strangulation [as with Dr. Wad-
- dill in California] and that surely must be rare. All [the doc-
- tor] has to do is nothing and the result is the same.''
-
- Alan Marrus, a Bronx county assistant district attorney, has
- investigated several live-birth cases and the applicable New York
- law. He has yet to find ``a case that presented us with facts
- that warranted prosecution. You need an expert opinion that in
- fact there was life and that the fetus would have survived. Often
- the fetus has been destroyed--so there is nothing for your expert
- witness to examine.''
-
- The incidents only come to light at all, Baden and Marrus
- noted, if some whistle-blower inside the hospital or clinic
- brings them to the attention of the legal authorities. The credi-
- bility of that sort of witness may be subject to attack. And even
- if the facts do weigh against a doctor, he has some resources
- left. Almost always he can claim to have made no more than a
- good-faith error in medical judgement.
-
- ``This is happening all over the place,'' said a California
- prosecutor. ``Babies that should live are dying because callous
- physicians let them die.'' But he despairs of winning any convic-
- tions. ``Nobody's as dumb as Waddill. They're smarter today. They
- know how to cover themselves.''
-
- Unfortunately, advances in medical technique may only aggravate
- the overall problem. Fetuses are becoming viable earlier and ear-
- lier, while the demand for later abortions shows no signs of
- abating. Some argue that Justice Blackmun's definition of viabil-
- ity as ``usually seven months'' was obsolete the day it was pub-
- lished. It clearly is now.
-
- A decade ago, survival of an infant less than 3 pounds or 30
- weeks gestation was indeed rare, principally because the lungs of
- smaller infants, unaided, are too undeveloped and fragile to sus-
- tain life. Now, infants with birth weights of about 1 2/3 pounds
- routinely survive with the best of care, according to Dr. Richard
- Behrman, chief of neonatology at Rainbow Babies and Childrens
- Hospital in Cleveland and chairman of a national commission that
- studied viability in the mid-1970s.
-
- Sometimes even smaller babies make it, and the idea that most
- of them will be retarded or disabled is out-of-date, Behrman
- said, ``Most ... survive intact.''
-
- Even with the medical advances though, some live-born infants
- are simply too small and undeveloped to have a realistic chance
- to survive. A survey last year of specialists in neonatal care
- found that 90 percent would not order life-support by machine for
- babies smaller than 1 pound 2 ounces or less than 24 weeks gesta-
- tion. And on occasion, a newborn may manifest muscular twitches
- or gasping movements without ever ``being alive'' according to
- the usual legal test of drawing a breath that fills the lungs.
-
- Still, it is no longer a miracle for an infant of 24 weeks
- development (which can be legally aborted) to be saved of born
- prematurely.
-
- ``It is frightening,'' said Dr. Roger K. Freeman, medical
- director of Women's Hospital at the Long Beach Memorial Medical
- Center in Long Beach, Calif. ``Medical advances in the treatment
- of premature babies enable us to save younger fetuses than ever
- before. When a fetus survives an abortion, however, there may be
- a collision of tragic proportions between medicine and maternity.
- Medicine is now able to give the premature a chance that may be
- rejected by the mother.''
-
- In 1970, Freeman developed the fetal stress test, a widely used
- technique for monitoring the heart rate of unborn fetuses. Also,
- he and a colleague at Long Beach, Dr. Houchang D. Mondalou, have
- developed a drug, betamethzene, that matures lungs within days
- instead of weeks. The hospital claims a 90 percent success rate
- with infants weighing as little as 1 pound 11 ounces.
-
- At the University of California at Irvine, work is under way on
- an ``artificial placenta'' that doctors there say could, within
- five years, push the threshold of viability back even further.
-
- The life-saving techniques are not exclusive to top academic
- hospitals, either. In fact, the lively issue in medical circles
- these days is not whether tiny premature babies can be saved, but
- whether it's affordable. Bills for the full course of treatment
- of a two-pound infant typically run between $25,000 and $100,000.
- To some that seems a lot to pay, especially in the case of an
- abortion baby that was not wanted in the first place.
-
- The only way out of the dilemma, it would seem, would be for
- fewer women to seek late abortions. Though some optimists argue
- that this is happening, there is evidence that it is not.
-
- Studies show that women seeking abortions late in the second
- trimester are often young, poor and sexually ignorant. Many
- either fail to realize they are pregnant or delay telling their
- families out of fear at the reaction. The patients also include
- those who have had a change of circumstance or a change of heart
- after deciding initially to carry through a pregnancy; some of
- these women are disturbed.
-
- As first-trimester abortion and sex education become more
- widely available, the optimists' argument goes, nearly all women
- who choose abortion will get an early abortion. But in fact, a
- new class of older, well-educated, affluent women has now joined
- the hardship cases in seeking late abortions.
-
- This is because a recently developed technique, amniocentesis,
- allows genetic screening of the unborn fetus for various heredi-
- tary disease. Through this screening, a woman can learn whether
- the child she is carrying is free of such dreaded conditions as
- Downs syndrome (mongolism) or Tay-Sachs disease, a genetic
- disorder that is always fatal, early in childhood.
-
- The test involves drawing off a sample of amniotic fluid, in
- which the fetus is immersed in the womb. This cannot be done
- until the 15th or 16th week. Test cultures for the various poten-
- tial problems take several weeks to grow. Sometimes the result is
- inconclusive and the test must be repeated. The testing also
- reveals the unborn child's sex and can be used to detect minor
- genetic imperfections.
-
- To many women, particularly those over 35, amniocentesis seems
- a rational approach to minimizing the chances of bearing a defec-
- tive child. A few, according to published reports, go a step
- further and make sure the baby is the sex they want before decid-
- ing to bear the child.
-
- In any case, it is late in the second trimester--within weeks
- of the current threshold of viability--before the information
- becomes available on which a decision is made to abort or not
- abort. The squeeze will intensify as amniocentesis becomes more
- widely available and as smaller and smaller infants are able to
- survive.
-
- The abortion live-birth dilemma has caught the attention of
- several experts on medical ethics, and they have proposed two
- possible solutions.
-
- The simplest, advocated by Dr. Sissela Bok of the Harvard Medi-
- cal School among others, is just to prohibit late abortions. Tak-
- ing into account the possible errors in estimating gestational
- age, she argues, the cutoff should be set well before the earli-
- est gestational age at which infants are surviving.
-
- Using exactly this reasoning, several European countries--
- France and Sweden, for example--have made abortions readily
- available in the first three months of pregnancy but very diffi-
- cult to get thereafter. The British, at the urging of Sir John
- Peel, an influential physician- statesman, have considered in
- each of the last three years moving the cutoff date from 28 weeks
- to 20 weeks, but so far have not done so.
-
- But in this country, the Supreme Court has applied a different
- logic in defining the abortion right, and the groups that won
- that right would not cheerfully accept a retreat now.
-
- A second approach, advocated by Mrs. Bok and others, is to
- define the woman's abortion right as being only a right to ter-
- minate the pregnancy, and to have the fetus dead. Then if the
- fetus is born alive, it is viewed as a person in its own right,
- entitled to care appropriate to its condition.
-
- This ``progressive'' principle is encoded in the policies of
- many hospitals and the laws of some states, including New York
- and California. As the record shows, though, in the alarming
- event of an actual live birth, doctors on the scene may either
- observe the principle or ignore it.
-
- And the concept even strikes some who do abortions as misguided
- idealism.
-
- ``You have to have a feticidal dose'' of saline solution, said
- Dr. Kerenyi of Mt. Sinai in New York. ``It's almost a breach of
- contract not to. Otherwise, what are you going to do--hand her
- back a baby having done it questionable damage? I say, if you
- can't do it, don't do it.''
-
- The scenario Kerenyi describes did in fact happen, in March
- 1978 in Cleveland. A young woman entered the Mt. Sinai Hospital
- there for an abortion. The baby was born live and, after several
- weeks of intensive care at Rainbow Babies and Childrens Hospital,
- the child went home--with its mother.
-
- The circumstances were so extraordinary that medical personnel
- broke the code of confidentiality and discussed the case with
- friends. Spokeswomen for the two hospitals confirmed the sequence
- of events. Mother and child returned to Rainbow for checkup when
- the child was 14 months old, the spokeswoman there said, and both
- were doing fine.
-
- The mother could not be reached for comment. But a source fami-
- liar with the case remembered one detail: ``The doctors had a
- very hard time making her realize that she had a child. She kept
- saying, `But I had an abortion' ''.
-
-
-