From: dsh@odin.ece.ncsu.edu (Doug Holtsinger)
Subject: The Survivors of ``Choice''
Organization: North Carolina State University
Distribution: na
Date: Mon, 17 Aug 1992 03:09:44 GMT

The following article about the live birth of babies following abortions
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.  This article won a Pulitzer
Prize.  

---------------------
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' ''.

-----


 "For some of us, abortion on demand *is* no more serious than demanding a
  hamburger."
   -- Adrienne Regard


Doug Holtsinger

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