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End of Life Care Before It Begins


What would you do if a premature baby, so premature that it didn’t have working lungs yet, were suddenly born right in front of you?

A) I would give it comfort care until it passed away on its own.

B) I would put a tube down its throat for breathing and insert multiple needles into it to place lines for fluids and medicines knowing that there was a 99% chance it would die anyway and a 100% chance that it would be severely incapacitated, possibly vegetative, if it lived.

C) I don’t know because I’m neither a doctor nor a person who has ever had to face that situation.

This is the impossible question posed to a Planned Parenthood representative in the video posted below that has made its way around the Internet. There are a few things you should be aware of prior to watching it:

1) The Partial-Birth Abortion Ban Act of 2003 ensures that any physician who desires to continue practicing medicine will not allow a live birth of an aborted fetus.

2) Asking someone who is not a physician what they would do in a clinical scenario is like asking someone who is not a pilot what they would do if the right jet engine went out. It is unfair and akin to trying to squeeze water from a stone.

The video:

This woman was not qualified to answer medical questions, regardless of how they are phrased. That being said, it was no wonder she was uncertain 1) what they were asking and 2) how to answer.

I, however, am qualified to answer their questions and I will.

During an abortion in the 2nd trimester, specifically after 22 weeks, it is general practice to perform feticide (injection of a lethal medicine into the amniotic cavity or into the fetal heart) to essentially euthanize the fetus prior to the dilation and evacuation (D&E) procedure. It is therefore not alive once the abortion procedure is started. This is routine practice due to the Partial-Birth Abortion Ban Act passed in 2003 and requires physicians to perform the invasive procedure of intra-amniotic injection (putting the woman at risk of injury and infection) prior to the D&E. That being said, for an abortion to be “botched” (which is an unprofessional and inappropriate term to use) and the “baby to be born alive” will not happen. It cannot happen if the physician wishes to stay out of jail and continue practicing medicine. The baby cannot be born alive during an abortion because of the Partial-Birth Abortion Ban Act. The entire discussion in this clip is moot.

I’ll tell you what I would do if this impossible scenario were to happen, however: I would do whatever the patient wanted me to. The newborn would be unable to make medical decisions for itself and therefore medical-decision making would legally fall to the parents. There comes a difficult legal area, however, and if the infant were able to survive outside of the womb (> 24 weeks), were able to be resuscitated, the pediatricians may presume control over the care of the newborn if its life were in danger due to the parents’ decision. This gets into a whole legal battle I am not qualified to speak to, however, as previously stated, the scenario of an incomplete abortion with the fetus being delivered alive would not happen.

Even in cases of 3rd trimester abortion, the fetus is euthanized. This is not only due to the Partial-Birth Abortion Ban Act, but it is also humane medicine. It would be very traumatic to the mother, father (if present), and caregivers (physicians, nurses, etc) if during the induction of the abortion the baby were born alive then left to die. How horrific! Despite popular opinion, we are not monsters. We are physicians who seek to minimize the trauma of this difficult decision. In the rare cases of 3rd trimester abortions that are most commonly performed because of severe, lethal fetal anomalies that would not allow the newborn to live for very long (and suffer significantly if/while it did live), the fetus is euthanized and therefore not born alive.

As an OB/Gyn who takes care of women who are young and old, pregnant and not pregnant, my responsibility is to my patient. In the case of a pregnant woman, my responsibility is to her. When a woman comes to me for an office visit and her pregnancy test is positive, my first response is: “How do you feel about that? If you are not sure, I want to talk to you about all of your options which include continuing the pregnancy and keeping the baby, continuing the pregnancy and giving the baby up for adoption, or terminating the pregnancy by having an abortion.” If she desires I care for her and her pregnancy, I will do so and provide her with the best prenatal care I can so that she can have a safe, healthy pregnancy and childbirth experience. If my pregnant patient wishes to have an abortion, I will perform that as well so that she may have a safe procedure and termination of her pregnancy. My responsibility is to provide safe, evidence-based, comprehensive medical care, and that is what I do.

Dispelling the Myths: Abortion and Mental Health

She said, “I deserve this” as she moaned with pain while I dilated her cervix. I tried to numb her, keep her as comfortable as possible, so I asked for more numbing medicine to try to take the pain away. Something told me there was a bigger problem that lidocaine wouldn’t be able to fix.

Guilt, regret, post traumatic stress disorder (PTSD): these are some of the buzz words that anti-choice folks throw at women to deter them from taking control of their own lives. My patient, this woman who could have been a friend or cousin of mine, believed she deserved to be in pain for what she was doing. She believed she fully deserved the pain she was experiencing because she was doing what she needed to do to take care of herself. Why would she feel this way?

She feels guilty, clearly. Why would someone feel guilty about ensuring their own well-being and/or the well-being of their family? Isn’t that what good people do? Perhaps because all too often society, religious leaders, and politicians tell women, “You’re killing your unborn child,” when they really should be saying, “I’m proud of you for being responsible and doing the right thing for you and your family.” The impact on a woman’s mental health before and after her abortion has a great deal more to do with the social stigmatization of her decision and her support system than it has to do with the abortion itself. Deciding the best course of action for an unplanned pregnancy is a decision no woman makes lightly. Those who disagree with abortion may do so, but should do so with compassion and sympathy, not with anger and derision.

Poor-quality research on mental health and abortion has been published (and is often cited by inexperienced readers) stating that abortion increases a woman’s probability of experiencing depression, regret and PTSD. This is not true, however, and the majority of the medical research community has criticized these publications as being borderline criminal. High-quality research has shown the following:

Most women do not experience psychological problems or regret their abortion 2 years post-abortion, but some do. Those who do tend to be women with a prior history of depression.” “Most women were satisfied with their decision, believed they had benefited more than had been harmed by their abortion, and would have the abortion again. These findings refute claims that women typically regret an abortion.
— Major et al, Arch Gen Psychiatry, 2000

The vast majority of women expect to cope well after their abortion. A small number make the decision to terminate their pregnancies even though they anticipate difficulty coping after the procedure.
— Foster et al, Contraception, 2012

Protesters do upset some women seeking abortion services. However, exposure to protesters does not seem to have an effect on women’s emotions about the abortion 1 week later.
— Foster et al, Contraception, 2012

The name-calling, guilt-laying, and self-righteous proclamations of why she should do as you say (and you know who you are) must end. There is no malice in having an abortion. It is a decision that a woman makes for herself most importantly, and for her family as well. She does not make it for anyone else; it would be detrimental if she did. A woman having an abortion will most often have feelings of relief knowing that she was able to take care of herself safely and live the life she desires. Guilt and regret come from stigmatization, not from doing the right thing. The stigmatization of abortion must come to an end.

Libertyville abortion protesters