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WHY ARE SOME ABORTIONS DELAYED UNTIL LATE IN PREGNANCY?

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Terminology:

Dialog about abortion is very difficult because different groups assign conflicting meanings to important terms:

bulletWe will use the term "abortion" to refer to any intentional medical intervention which terminates a pregnancy at any stage. This is the definition used most commonly by the public. The medical definition of the term is more restrictive.
bulletWe will define the start of "pregnancy" as occurring when the the embryo becomes implanted in the uterine wall. This the definition used by the medical profession and by most of the public. Many pro-lifers follow their own definition which has pregnancy beginning at conception.

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Terminating pregnancies:

Relatively few conceptions result in the birth of a newborn baby. A fertilized ovum has to survive many hurdles on the way to childbirth:

bulletFailed pregnancies: A very large percentage -- 50% is sometimes mentioned in the medical literature -- of fertilized ova fail to implant themselves in the uterine wall. For them, pregnancy does not even begin.
bulletMiscarriages: Approximately 25% of all pregnancies end in a miscarriage -- sometimes called a spontaneous abortion. For whatever reason, the pregnancy cannot continue; the fetus dies and is expelled naturally from the woman's body. Often, this happens so early in pregnancy that the woman is not aware that she was pregnant.
bulletEctopic pregnancies (a.k.a. Tubal pregnancies): In approximately one in every 4,000 pregnancies, the embryo lodges in a location other than the endometrial lining of the uterus. In 95% of these cases, it becomes implanted in one of the woman's fallopian tubes. Emergency surgery is normally necessary to quickly remove the embryo in order to prevent massive loss of blood, and almost certain death to the woman. Unfortunately, this necessarily results in the death of the embryo. A small percentage of "pro-lifers" oppose all abortions, even to the extent of allowing the woman to die during an ectopic pregnancy. However, there is a broad consensus among both pro-lifers and pro-choicers that such an operation is morally justifiable, even though the death of the fetus is inevitable.
bulletFirst trimester surgical, and medically induced abortions: Most abortions are elective procedures performed sometime during the first two months of pregnancy when the fetus is one inch or less long. Over 90% of abortions are done during the first trimester (i.e. the first three months). They total about 1.2 million/year in the US -- a number that is gradually decreasing. In almost all cases, there is no medical reason why the pregnancy needs to be terminated. The abortion is chosen simply because the woman does not want to have a baby. Many women feel that a baby would interfere with her education or career. Others feel that they are not financially or emotionally capable of raising a child. Still others feel that they lack adequate support from a partner, family, or society itself to continue with the pregnancy.
bulletSecond trimester surgical abortions: About 140,000 second trimester abortions are performed yearly. They represent 9% of the total. Some are performed because the woman simply does not wish to remain pregnant. There are many reasons for the delay until the second trimester:
bulletShe may be young and in denial about her pregnancy
bulletShe may have not sought an abortion in her first trimester, but has waited until she can no longer hide her pregnancy.
bulletSome fetuses are found to have a serious genetic defect. Ultrasound examinations are normally given at about 17 weeks gestation, when "fetal organs have developed enough to detect such abnormalities." An amniocenteses procedure is sometimes done at this time, particularly for women over the age of 35. Either procedure can detect abnormalities that can cause the fetus:
bulletTo die during pregnancy.
bulletTo be born alive but die within hours or days, perhaps in pain, perhaps without gaining consciousness.
bulletTo be born with very serious mental or physical disabilities that will severely limit their quality of life. 
bulletDr. Katharine O'Connell of New York's Columbia-Presbyterian Hospital commented: "If the defect is diagnosed early, to wait the months knowing what the inevitable outcome will be is much more upsetting and detrimental. This is one of the worst things a woman can go through. We want to provide her with as many options as possible." A small percentage of couples will elect to take no action, and to continue the pregnancy. Almost all couples, when faced with these prognoses, will elect to terminate the pregnancy. As of 2003-NOV-6, their options are limited to:
bulletInduced labor,
bullet"D&E" (dilation and evacuation), and
bullet"D&X" (dilation and extraction). This is often popularly called "Partial Birth Abortion" although that is a vague term which lacks a definitive medical definition. More details.

President Bush has signed a bill into law which will criminalize almost all D&X abortions. Constitutional experts are divided over whether the law can survive a court challenge. A number of court injunctions have been obtained to prevent the application of the law.

bulletThird-trimester abortions: Medical intervention to terminate pregnancies during the third trimester is quite rare. The Alan Guttmacher Institute estimates that 1% of all medical terminations of pregnancies are done at or after 21 weeks - (1994 data). It is sometimes done when the fetus has died in the womb. Termination of the life of a fetus is generally prohibited by medical societies' regulations after the 20th or 21st week of gestation.  Exceptions do occur if required to save the life of the woman or avoid very serious, disabling health consequences. e.g.: 
bulletTo save the life or health of a women experiencing a deteriorating health problem. This problem can rapidly grow worse with every day in late pregnancy, and can only be reversed by terminating the pregnancy. It is most often caused by diabetes or heart disease. 
bulletA midwifery web site quotes Dr. William F. Harrison, a diplomate of the American Board of Obstetrics and Gynecology. 2 He wrote that "approximately 1 in 2000 fetuses develop hydrocephalus while in the womb." About 5,000 fetuses develop hydrocephalus each year in the U.S. This is not usually discovered until late in the second trimester. A fetus with severe hydrocephalus is alive, but cannot live for long; it will never achieve consciousness.
bulletIn rare cases, the delivery of the fetus can go terribly wrong, threatening the life of the woman.

As of 2003-OCT-9, their options are limited. The main ones are:
bulletHysterotomy: This involves major surgery. It is essentially identical to a Caesarian Section. It involves significantly higher risk to a woman than a D&X. 
bullet"D&X" (dilation and extraction). The third method is often popularly called "Partial Birth Abortion" although that is not a medical term.

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Related essay:

bulletThe procedures used to terminate very late pregnancies

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Reference:

  1. Suzanne Batchelor, "Abortion Procedures Ban Limits Endings for Doomed Pregnancies," Women's Enews, 2003-SEP-29, at: http://www.now.org/
  2. "Information about Hydrocephalus and D&X," at: http://www.gentlebirth.org/archives/hydrceph.html

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Home > "Hot" religious topics and conflicts > Abortion > Facts> here

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Copyright 2003 & 2004 by Ontario Consultants on Religious Tolerance
Originally written: 2003-OCT-9
Latest update: 2004-MAR-8
Author: B.A. Robinson

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