The American Society of Anesthesiologists (ASA) recently issued a warning that medical "misinformation" about a bill awaiting action in the U.S. Senate is posing a threat to the health and lives of pregnant women nationwide.

The president of the ASA, Dr. Norig Ellison, said, "We at ASA have...felt it our responsibility as physicians specializing in the provision of anesthesia care to seek every available forum in which to contradict" this misinformation, which has been widely disseminated in the mass media.

That sounds like an important "women's health" story, right? Yet, the ASA's warning has gone virtually unreported, so far.

The misinformation in question originated with, and has been widely circulated by, opponents of a proposed bill to ban the partial-birth abortion procedure (HR 1833). In this procedure, a fetus/baby (4® to 9 months into pregnancy) is pulled feet-first from the womb, except for the head, which is deliberately kept just within the womb. Then the doctor punctures the base of the skull and suctions out the brain.

The misinformation is a claim that anesthesia given to the mother kills the fetus, before the fetus is removed from the womb.

The ASA says that this claim has "absolutely no basis in scientific fact," and is "misleading and potentially dangerous." ASA President Dr. Ellison told Congress that regional (local) anesthetics "do not reach the fetus." (This is the form of anesthesia used in many partial-birth abortions and most normal childbirths.) General anesthesia affects the baby less than the mother, and has "absolutely no adverse effect on the fetus," Dr. Ellison testified.

"I am deeply concerned, moreover," Dr. Ellison testified, "that widespread publicity [given to this claim]...may cause pregnant women to delay necessary and perhaps life-saving medical procedures, totally unrelated to the birthing process, due to misinformation regarding the effect of anesthetics on the fetus."

The misinformation has been embraced as fact and disseminated by many reporters, editorial boards, commentators, and politicians. For example, Ellen Goodman said it in a recent column, which is very widely syndicated. Even though the originators of the myth may now drop the claim, it continues to propagate through the media in ever-widening waves.

This issue transcends the merits or demerits of the bill itself. Consider what would have happened if a conservative group had made up some comparable baseless claim (e.g., "Women who use Norplant later have babies with birth defects"); if that bogus claim had then been disseminated by prominent conservatives (Rush Limbaugh? Pat Robertson? Newt Gingrich?); and if a national medical-specialty society then came forward to say that propagation of this misinformation was endangering the health and lives of pregnant women and their babies. Clearly, such an event would be regarded as a newsworthy "women's health" story in it sown right.

HR 1833, the Partial-Birth Abortion Ban Act, would ban the performance of a partial-birth abortion, except in a circumstance (if any) in which a doctor "reasonably believed" that a mother's life was in jeopardy and that no other procedure would suffice. The bill specifically defines "partial-birth abortion" as "an abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery."

In a 1992 paper explaining step-by-step how to perform this type of abortion, Dr. Martin Haskell wrote that he performs the procedure "under local anesthesia" [emphasis added], which would have no effect on the baby/fetus. Nevertheless, since HR 1833 was introduced in June, many critics of the bill have insisted that the unborn babies are killed by anesthesia given to the mother, prior to being "extracted" from the womb. For example, Dr. James T. McMahon, who had performed thousands of partial-birth abortions, said in a June 23, 1995 submission to the House Judiciary Constitution Subcommittee:

"The fetus feels no pain through the entire series of procedures. This is because the mother is given narcotic analgesia at a dose based upon her weight. The narcotic is passed, via the placenta, directly into the fetal bloodstream. Due to the enormous weight difference, a medical coma is induced in the fetus. There is a neurological fetal demise."

This claim has also been made by other opponents of the bill. For example:

£ syndicated columnist Ellen Goodman wrote in mid-November that, from reviewing statements by supporters of the bill, "You wouldn't even know that anesthesia ends the life of such a fetus before it comes down the birth canal."

USA Today said in an editorial opposing the bill (Nov. 3),"The fetus dies from an overdose of anesthesia given to its mother."

Senator Carol Moseley-Braun (D-Il.) said during Senate floor debate on the bill (Nov. 8), "The fetus dies during the first dose of anesthesia."

Kate Michelman, president of the National Abortion and Reproductive Rights Action League (NARAL), said at a Nov. 7 press conference, "These experts have made it very clear that the fetus undergoes demise before the procedure begins. And because of the anesthesia, which is, you know, something like 50 to 100 times what a fetus can withstand, because it's given according to the weight of the woman."

Dead wrong, according to Dr. Norig Ellison, president of the American Society of Anesthesiologists, whose testimony before the Senate Judiciary Committee follows:

Chairman Hatch, members of the Committee. My name is Norig Ellison, M.D. I am the President of the American Society of Anesthesiologists (ASA), a national professional society consisting of about 32,000 anesthesiologists and other scientists engaged or specially interested in the medical practice of anesthesiology. I have previously served ASA in a variety of capacities, including serving as its Vice-President for Scientific Affairs for three years. I am also Professor and Vice-Chair of the Department of Anesthesiology at the University of Pennsylvania School of Medicine in Philadelphia, and am a staff anesthesiologist at the Hospital of the University of Pennsylvania. I am a Diplomat of the American Board of Anesthesiology.

I appreciate your allowing me to testify before the Committee on such short notice, and I will be very brief. I appear here today for one purpose, and one purpose only: to take issue with the testimony of James T. McMahon, M.D., before a subcommittee of the U.S. House of Representatives last June. [EDITOR'S NOTE: in June, Dr. McMahon was invited to testify before the House Judiciary Subcommittee on the Constitution, but he did not actually choose to appear at the subcommittee's June 15 public hearing. Dr. Ellison is referring here to the June 23 document that was submitted by Dr. McMahon to the subcommittee, quoted above.] As I understand it, that subcommittee was considering legislation banning "partial birth" abortions, apparently the same issue now before this Committee.

According to his written testimony, of which I have a copy, Dr. McMahon stated that anesthesia given the mother as part of the procedure eliminates any pain to the fetus, and that a medical coma is induced in the fetus, causing a "neurological fetal demise", or-- in lay terms-- "brain death".

I believe this statement to be entirely inaccurate. I am deeply concerned, moreover, that the widespread publicity given to Dr. McMahon's testimony may cause pregnant women to delay necessary and perhaps life-saving medical procedures, totally unrelated to the birthing process, due to misinformation regarding the effect of anesthetics on the fetus.

The fact is that when general anesthesia is administered to the mother, only a portion of that anesthetic reaches the fetus-- the amount varying depending on the type of anesthetic; anesthetics administered regionally do not reach the fetus. As a result, many pregnant women-- currently totally over 50,000 each year in this country-- are safely anesthetized without ill effects to mother or fetus.

Although it is certainly true that some general analgesic medications given to the mother will reach the fetus and perhaps provide some pain relief, it is equally true that pregnant women are routinely heavily sedated during the second or third trimester for the performance of a variety of necessary surgical procedures, with absolutely no adverse effect on the fetus, let alone death or "brain death." In my medical judgment, it would be necessary-- in order to achieve "neurological demise" of the fetus in a "partial birth" abortion-- to anesthetize the mother to such a degree as to place her own health in serious jeopardy.

I have not spoken with one anesthesiologist who agrees with Dr. McMahon's conclusion, and in my judgment, it is contrary to scientific fact. It simply must not be allowed to stand.

Mr. Chairman, I want to make it clear that ASA's House of Delegates has taken no position on the appropriateness of any abortion procedure, including the type under consideration here today, and I do not appear to speak for or against the proposed legislation before the Committee. We at ASA have nonetheless felt it our responsibility as physicians specializing in the provision of anesthesia care to seek every available forum in which to contradict Dr. McMahon's testimony. Only in that way, we believe, can we provide assurance to pregnant women that they can undergo necessary surgical procedures safely, both for mother and unborn child.

Thank you for your attention. I am happy to respond to your questions.

SEN. ABRAHAM [to Dr. Campbell]: Would you make the statement then that the fetus dies due to the anesthesia? Is that your position?

DR. CAMPBELL (Medical Director, Planned Parenthood of Metropolitan Washington): I think the fetus has no pain because of the anesthesia. I do not...

SEN. ABRAHAM: No, I'm asking you whether you think that's what causes the fetus to die?

DR. CAMPBELL: I do not know what causes the fetus to die. The fetuses are dead when delivered.

SEN. ABRAHAM: Well, let me just direct you, if I could -- I have here a fact sheet that indicates it was prepared by you which relates to the House legislation in which...

[Sen. Abraham was referring to "H.R. 1833, Medical Questions and Answers," which contains the caption, "Fact Sheet Prepared by Mary Campbell, M.D." This document was circulated to members of the House of Representatives in October, before HR1833 came to a vote in that house. This document contains the following passage:

"Q: When does the fetus die?

"A: The fetus dies of an overdose of anesthesia given to the mother intravenously. A dose is calculated for the mother's weight which is 50 to 100 times the weight of the fetus. The mother gets the anesthesia for each insertion of the dilators, twice a day. This induces brain death in a fetus in a matter of minutes. Fetal demise therefore occurs at the beginning of the procedure while the fetus is still in the womb."]

SEN. ABRAHAM: So you no longer adhere to the position that you say in here, "the fetus dies of an overdose of anesthesia given to the mother intravenously." That is no longer your position?

DR. CAMPBELL: I believe that is true.

SEN. ABRAHAM: You believe that is true?

DR. CAMPBELL: I believe that is true.

SEN. ABRAHAM: Dr. Ellison, would you like to comment on that?

DR. ELLISON (President, American Society of Anesthesiologists): There is absolutely no basis in scientific fact for that statement. There is -- I can present you a study in the American Journal of Obstetrics and Gynecology, 1989, by [names inaudible] et al, of 5,400 cases of women having surgery having general anesthesia or regional anesthesia in which the fetus did not suffer demise. I think the suggestion that the anesthesia given to the mother, be it regional or general, is going to cause brain death of the fetus is without basis of fact.

DR. CAMPBELL: I have not said brain death. I'm saying no spontaneous respirations, no movement.

SEN. ABRAHAM: Well, that's what you are saying today, but in this fact sheet, which you prepared I believe fairly recently, it says, "The fetus dies"-- there's no qualifying regarding breathing or anything else-- "of an overdose of anesthesia." I mean, that is a very clear statement assertion.

DR. CAMPBELL: [Pause] I simplified that for Congress. [Outburst of laughter from audience.] I do not actually believe that you want a full discussion of when death occurs.

SEN. ABRAHAM: Well, we are forced to make those decisions, and I guess my question is that how many other things would you say in the fact sheet or in your statements today have been likewise simplified in this dramatic fashion?

DR. CAMPBELL: Since I have over 28 years of education and experience in medicine, I would say that is a great deal less and a great deal more simple than what I know.

SEN. ABRAHAM: Well, it seems to me that there's a rather substantial disparity between what Dr. Ellison says and what you are both saying now and have certainly written here. I just am wondering how that bears on other comments that have been made.