What is "Intact D&E"?

Revolutionary Worker #906, May 11, 1997

The easiest and safest time for a women to have an abortion is during the first "trimester" of pregnancy, or up to 13 weeks. 45% of women in the U.S. will have an abortion in their lifetime, and 90% of those are done in the first trimester. After that time, abortion is more complex because the fetus is bigger and the woman's uterus is more stretched. 9% of abortions take place during the early second trimester (13 to 19 weeks) using a variety of safe methods. After 20 weeks (about five months) only 15,000 abortions are done a year. Many second and third trimester abortions involve some form of dilation and evacuation (d&e) where the cervix must be "dilated" or stretched, and the uterus "evacuated," meaning that the fetus is removed, or "extracted." Some doctors, in some cases, use "intact d&e" where the fetus is evacuated intact, because they think it's safest for the woman. D&x is a variation on the dilation and evacuation d&e procedure used for abortions after the first 12 weeks of pregnancy. D&e is a broader category, which includes any situation where the cervix is dilated and the uterus is evacuated. Other methods used for late term abortions are various forms of inducing labor, which is generally considered to be more stressful to the woman.

The procedure that the bill before Congress is trying to ban is what is known in the medical community as "intact dilation and evacuation" (intact d&e). In this procedure the woman's cervix is dilated (the opening is enlarged) using a natural dilator called laminaria. But the cervical opening is still not large enough for the fetus to be removed without injuring the woman. So the doctor has to remove some fluid from the cranium of the fetus in order to bring the head out without injuring the woman's cervix. This procedure, where the fetus is extracted whole, or intact, was developed in abortion clinics by doctors looking for a way to avoid the trauma to the woman of various induced labor procedures or cesarean section surgery.

There are relatively few doctors who regularly do late term abortions, and they don't all use "intact d&e." But all are against banning this particular procedure and agree that their patient is the woman, not the fetus, and that they must be allowed to do what's medically best for her.

The American College of Obstetricians and Gynecologists opposes this legislation which would "supersede the medical judgement of trained physicians and criminalize medical procedures that may be necessary to save the life of a woman." Many physicians and other medical professionals and medical organizations have come forward to urge the defeat of this legislation. The medical community overwhelmingly supports maintaining the availability of the procedure. The American College of Obstetricians and Gynecologists, American Medical Women's Association, American Nurses Association, American Public Health Association, California Medical Association, and the Association of Women's Psychiatrists have all publicly stated their opposition to the ban on intact d&e. No major medical organization has supported this legislation. And while the National Conference of Catholic Bishops is waging an all-out campaign to criminalize doctors who use intact d&e, over 70 religious leaders, representing 18 national religious denominations and faith groups, formed a unified front to support a veto of the bill.

Intact d&e is NOT, as the anti-abortion movement claims, the murder of a "baby." As Mary Lou Greenberg has written, "People need to take a scientific approach. A pregnancy is a nine-month process during which a fertilized egg grows, develops and goes through a series of transformations before it can finally become a baby--a new human being--at the time of its birth. Before birth, it is not a child or a person with an independent existence or independent `rights.' It is a developing mass of tissue integrally connected to the woman's vital biological processes. It is part of the woman with no separate social existence of its own. It has the potential to become human. But it is not yet a separate social being with separate social rights. For that it must have entered society as a separate entity. That is, it must have been born. If this is not the approach taken to analyze abortion procedures, women will suffer intolerable violations of rights."

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