A Doctor's Grisly Experience with Abortion

Editor's note: This letter first appeared in the July 23, 2003 edition of the Washington Times, and is reprinted with the permission of the author, Dr. Hanes Swingle.

According to the Washington Times, Senate Democrats are slowing progress of legislation banning partial-birth abortion ("Abortion bill faces conference setbacks" Nation, Monday). Both the House and Senate have overwhelmingly passed bills that ban this procedure, and President Bush has promised to sign such legislation. Here is my experience with this issue:

In 1976, I was a medical student on my first obstetrical-gynecological clinical rotation. In my second week on the gynecology service, I checked the operating room schedule and saw I was to assist with a hysterectomy/TAB. At the operating table, I learned that a hysterectomy/TAB was the surgical procedure where the pregnant uterus is removed. TAB stands for therapeutic abortion; the hysterectomy was for sterilization. I held the retractors as the professor methodically excised the gravid uterus.

I already had assisted on two other hysterectomies, one for endometrial cancer and the other for a benign tumor. I had been taught during those first two cases to "always open the uterus and examine the contents" before sending the specimen to pathology. So, after the professor removed the uterus, I asked him if he wanted me to open it, eager to show him I already knew standard procedure. He replied, "No, because the fetus might be alive and then we would be faced with an ethical dilemma."

A couple of weeks later, now on the obstetrical service, I retrieved a bag of IV fluid that the resident physician had requested. The IV fluids were to administer prostaglandin, a drug that simply induces the uterus to contract and expel. The patient made little eye contact with us. A few hours later, I saw the aborted fetus moving its legs and gasping in a bedpan, which was then covered with a drape.

Several years later, I had my only experience with a partial birth, or late term, abortion during my neonatology training.

One day, the obstetrical resident who was rotating through the neonatal intensive care unit (NICU) was excited that he was going to get to learn a new procedure, a type of abortion. This obstetrical resident explained to several of the pediatric residents and me that a woman in labor and delivery in her late third trimester had a fetus who was breech (a baby positioned buttocks, not head, first) and also was severely hydrocephalic.

The resident described how he was going to deliver the body of the baby and then, while the head was entrapped, insert a trochar (a long metal instrument with a sharp point) through the base of the skull. During the final portion of this procedure, he indicated that he would move a suction catheter back and forth across the brainstem to ensure that the baby would be born dead.

Several of the pediatric residents kept saying, "You're kidding" and "You're making this up," in disbelief. The pediatric residents all had experience caring for infants and children with hydrocephalus and had been taught that with any one infant the degree of future impairment is difficult, if not impossible, to predict.

Later that afternoon, the obstetrical resident performed the procedure, but, unfortunately, the infant was born with a heartbeat and some weak gasping respirations, so the baby was brought to the NICU. All live-born infants, even if it is clear that they were going to die in a short period of time, were always brought to the NICU so they could die with dignity, not left in the corner of Labor and Delivery.

I admitted this slightly premature infant, who weighed about 4 pounds or 5 pounds. His head was collapsed on itself. The bed was a mess from blood and drainage.

I did my exam (no other anomalies were noted), wrote my admission note, then pronounced the baby dead about an hour later.

Normally, when a child is about to die in the NICU and the parents are not present, one of the staff holds the child. No one held this baby, a fact that I regret to this day. His mother's life was never at risk.

When I was in medical school, abortions were done up until 28 weeks (full term is 40 weeks). It was confusing that on one side of the obstetrical unit, pediatricians were placing extremely premature infants on warmers, intubating them to help them breathe, and rushing them off to the NICU, while on the other side similar premature infants/fetuses were being delivered in bedpans and covered with drapes. Most 28-week fetuses died back then, even with NICU care. Today, more than 95 percent of all 28-week premature infants survive and thrive. ...[T]oday more than 50 percent of all 24-week premature infants survive if delivered in a hospital with an NICU, and infants as young as 22 weeks have survived and done well. Infants weighing as little as 9 ounces or 10 ounces have survived.

As a neonatologist who has cared for numerous spontaneously aborted and a few intentionally aborted fetuses in the past 20 years, I now realize that the difference between a fetus and a premature infant is a social distinction, not a biologic one.

If it is wanted, it is a baby; if not wanted, it is a fetus. When I started medical school, I viewed abortion as just another medical procedure and the products of conception as tissue. After 20 years of practicing neonatology, I now know this is not the case. I believe that after abortion became legal, the mantra of "it's just tissue" took hold in the medical and lay communities, and most never stopped to question if it were correct.

More than 1.2 million induced abortions are done annually in this country; roughly one out of every four pregnancies is terminated by abortion. Medical or social euphemisms such as TAB, D&C (dilation and curettage), choice, women's health or reproductive freedom don't change the fact that abortion is a violent and unethical - - if legal - - procedure. Elective abortions have degraded both the medical profession and the women who have made this choice.

Of course, partial-birth or late-term abortions constitute only a minute fraction of the abortions done daily in this country.

Why should Congress and the president limit the few partial-birth abortions that are done? Simply because it is the right thing to do.

Dr. Hanes Swingle is a Pediatric Fellow at the University of Iowa in Iowa City.