From: diana@wetware.com (CatWoman )
Subject: Re: Survivors of Abortion
Followup-To: talk.abortion
Organization: Castle WetWare MouseCatcher
Date: Mon, 16 Nov 1992 11:31:16 GMT

I found this lovely bit in alt.romance.chat - where it
does NOT belong.  I've sent mail to Doug telling him to
keep this stuff OUT of a.r.c and to stay in t.a.  I've
also posted a followup to a.r.c asking that if they WANT
to get in on the abortion debate that they come read over
here in t.a, and leave a.r.c OUT of the debate.  I have
set the followups on that post to here in t.a.

Diana

dsh@eceyv.ncsu.edu (big tree) writes:

]      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' ''.
] 
] 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