In the wake of Dr. George Tiller’s murder in Kansas, I’ve been in some conversations, read other blogs without joining in, and was apprised of conversations other people had had, that discussed the nature of the abortions he performed. One man said that “6,000 women will die every year” because Tiller won’t be able to perform “life-saving abortions” on them. Many other people apparently think that most if not all of post-viability and/or third-trimester abortions Tiller performed were to save the life of the mother. This is not true.
Here is the link to the Kansas Department of Health and Environment’s abortion reports, from 1998-2008. I’ve only looked at a few of them, and as far as I know they don’t mention Tiller by name, but I believe he was the only person in Kansas who regularly performed abortions after fetal viability. The Data Summaries appear to be pretty standard, and starting around page 10 have tables showing abortions performed at 22 weeks or more — where the women were from (Kansas or another state), before or after fetal viability, the reason for the abortion, etc. I looked at the 2001 document (just picked that one at random) and was surprised at several things, which may be of interest to you, regardless of where you fall on the pro-choice/pro-life spectrum.
Let me insert here, that it is a “spectrum”, as polarizing as this debate can get. Few people who call themselves “pro-choice” will literally agree that women should have the right to have an abortion at 39 weeks 6 days for any reason; and few people who call themselves “pro-life” believe that there should be no abortion ever, not even to save the life of the mother in the case of a pre-viable fetus. (I have read a few comments or seen a few polls that way, which is either not consistent with a pro-life stance [sacrificing two lives when one could be saved], or they define “abortion” in such a way that they don’t consider that removing a tubal pregnancy is an actual abortion, because the purpose of the surgery is not to kill the baby, but rather to save the mother’s life, and the death of the baby is an unfortunate and unavoidable end result of saving the mother’s life, since the baby is pre-viable.) Most people are in-between, with lots of shades of variation.
So, there is a wide spectrum, but the abortions I think of when I think of Dr. Tiller are the post-viability and/or third-trimester abortions. “Viability” is the point after which the fetus could live outside the mother’s womb, and this varies depending on the technology of the country and the particular hospital. In America, it’s generally agreed to be about 24 weeks, which is when 50% of all babies survive, albeit with many babies suffering from defects (including things like cerebral palsy, blindness, mental retardation, etc.) due to being born too soon. [Those of you who work with L&D or the NICU or know first-hand statistics can fill in some of the gaps, or correct any mistakes.] The rate of survival goes up and the risk of defects goes down the longer the baby stays in, so delaying birth if possible is always a good thing from that standpoint; and by the beginning of the third trimester, the baby has a good hope of survival with much lower risk of long-term negative side effects. Obviously, the likelihood the baby will survive if born prior to 24 weeks is low, but the youngest surviving baby I’ve heard of is Amillia Taylor, who was born at 21 weeks 6 days of gestation; she turned two last fall, and is starting to walk and talk. Considering that she had less than half the typical womb-time of most babies, this is miraculous; and adding in the nearly 5 months she ought to have gotten before being born, she would be about 18-19 months old, so not even totally off the developmental charts for a baby born at a normal gestational age.
So, back to the 2001 report, dealing with abortions at 22 weeks or greater (on the edge of viability, or beyond) — 1) 585 abortions were performed on out-of-state women, with only 50 done on Kansas women. 2) 385 post-viability women were from out of state. This makes me wonder just how dangerous the woman’s condition was that she could go off to another state for health care, rather than going to her nearest hospital. To those of you who work L&D and particularly antepartum, trying to keep pregnant women safe and alive who are suffering certain health complications — does it sound even remotely safe for you to pack up these women and transport them from all over the country to Kansas for an out-patient procedure, under the “medical care” of the woman’s family or friends? I’ve read numerous blog posts from you, in which you detail working with patients on magnesium drips — how you have to watch them carefully, taking reflexes every hour, among other things, to make sure that they are being treated properly. Does it sound right to you to send off sick women for an out-patient procedure without medical care? Or does it give you the heebie-jeebies? 3) There were no abortions performed to save the woman’s life; all post-viability abortions were done to “prevent substantial and irreversible impairment of a major bodily function” should the pregnancy continue. In fact, I just looked at all the data summaries, and not one case was done to save the woman’s life. But in many cases, these babies are viable, meaning they have a reasonable chance of living outside the womb, if they were allowed to be born alive by induction or C-section, if the pregnancy did indeed need to be terminated for maternal health reasons. (Since there is no break-down of abortion data, we can’t say from here how many abortions were down at 24 weeks, and how many were done at 30 weeks [when there is at least a 90% viability rate, with a low rate of long-term complications due to prematurity] or beyond. 4) There were no “emergency” abortions — which is a good thing, because the abortion procedure Tiller employed took 3 days to complete, usually starting with an injection of digoxin into the baby’s heart to stop it from beating and thus kill him or her, and inserting laminaria into the woman’s cervix to slowly dilate it, before administering some drug (perhaps Cytotec) to induce labor and the woman would give birth to the dead baby. This blog goes more in depth into the data summaries, adding up all the reasons of all the years.
All pregnancies are terminated at some point. The majority of them end somewhere between 37-42 weeks with the birth of a live baby, either by C-section or vaginal birth. There is no doubt that some pregnancies should be terminated early, but whether this ends in the birth of a dead or live baby is where the point of contention lies. What is the reason to ensure that the baby will not be born alive (which is the point of a post-viability abortion, and the only difference between an abortion and a preterm induction)? Except for having limited medical attention over the course of the dilation, and giving the baby a lethal injection prior to birth, Tiller’s procedure is basically an induction — the mother gives birth vaginally to the baby at whatever stage of gestation she is, whether 22, 24, 27, 30, or 36 weeks. If she can give birth vaginally to the baby at that stage (which she obviously can without damaging her “health” or “major bodily function”… since that is exactly what she did), why kill it first?
I will also take another side-track to define “health” and “major bodily function” the way either the United States or the Kansas Supreme Courts do, and that is to include “mental health” as a “major bodily function” and “finances” as an aspect of her “health.” Of course, most people who use the terms “major bodily function” and “health” do not think that finances are an aspect of health, nor that “mental health” is a “major bodily function.” I have to tread lightly here, because I don’t want to seem like a jerk about mental health. I’m not; but I have a major problem with the way the courts have defined it, and more importantly with the way elective abortions have been shoehorned through that loophole. If you want an actual psychiatrist’s take on Tiller’s “diagnoses” of these women, click here to watch an interview with Dr. McHugh, who reviewed the redacted medical records and noted a paucity of actual clinical diagnostic information, and said, “he had mostly social reasons for thinking that the late term abortions were suitable. That the children … would not thrive. That the woman would have her future re-directed. That they wouldn’t get a good education after they had a child. That they would be always guilty in some way about having that child. That they had been abused already and that this — to have the baby would be another form of abuse. These … are not psychiatric ideas… These were social ideas. …. There was nothing to back these things up in a substantial way.”
In response to one hard-headed abortion advocate I was discussing this issue with, I emailed a group of pro-life Maternal-Fetal Medicine specialists with the following letter:
I’m currently in the middle of a debate on a pro-life blog with an abortion proponent who is insisting that the sort of late-term abortions the late Dr. Tiller did were medically justifiable, although he can come up with no such medical reason, and a L&D nurse I know said she could think of none — saying if the mother’s life or health is in danger, they induce or C-section the mom, thus saving both. I’ve asked if he could give evidence of any OB doing what Tiller did (i.e., kill a baby who could be born alive, particularly leave a woman who supposedly needed an abortion to preserve her life or health in a hotel for 3 days with her friends), rather than at least keep the mom in a hospital. He claims that Tiller’s way must be okay since, “you can’t point to even a single case of his way being condemned by any authority.” So, I guess I’m asking for authoritative voices who have condemned Tiller’s method of terminating the pregnancy in such a way as to kill the baby, rather than preserve his or her life. If you could particularly point me towards sources that authoritatively declare that the proper way to end a pregnancy if a woman’s life or health is on the line does not include out-patient procedures, nor injecting digoxin into the fetal heart, but in trying to preserve both mother and baby.
To which they responded:
1) Dr. George Tiller was a family practice doctor. He had NO training in high risk pregnancies, fetal or maternal problems.
2) There is no need after 23-24 weeks to ever perform an abortion in the way that Dr. Tiller did, to save or protect maternal life or health in any way. If life or health is threatened all trained obstetricians and maternal-fetal medicine physicians can and would simply deliver the baby and place the baby in a neonatal intensive care unit. It happens every day, many times, all over the United States .
3) Sometimes before 23-24 weeks (rarely) a pregnancy has to be delivered because the mother’s life is clearly in danger. In this case, the labor can be induced, the baby delivered and the baby will not survive because of the early gestational age, but this can be done without intent of killing the baby.
4) The only reason abortions were done by Dr. Tiller was because the mother did not want a LIVING baby born. He induced their labor and delivered the baby, almost always killing the baby first, before inducing the labor, to achieve the real purpose for which woman came to him: they did not want to deliver a living baby.
5) If a mother’s life or health was really at risk from her pregnancy it would at least border on malpractice, if not be frank malpractice, for a family practice doctor without any special training in high risk obstetrics to induce the labor in such a woman in the outpatient setting. This alone should make it clear to anyone familiar with medical practice that none of the abortions he did were MEDICALLY necessary, at least not with the need to kill the baby before delivery.
You won’t find any “authoritative” voice that will say exactly what you are looking for. It would be like looking for an authoritative source that says if you jump out of an airplane and want to survive you need a parachute. In other words, it is so obvious, and there is no other way it is normally done, that you don’t need an authoritative source to state this in so many words. Any one in medicine who works in obstetrics would have to admit this.
On the other hand, every single text book on obstetrics or maternal-fetal medicine can be scoured and you will not find any description stating that killing a fetus before delivery is necessary to save the life or health of the mother, in any circumstance. This should be evidence enough. . …
Nathan Hoeldtke, MD for the Pro-Life Maternal-Fetal Medicine Group.
For those of you who may still have reservations, thinking there must be some reason for late abortions to be necessary sometimes to save a woman’s life or health, or that ACOG would have some position statement either endorsing or censuring it, let me direct your attention to something. The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) wrote a brief one-paragraph statement about how ACOG arrived at its stance on partial-birth abortion (which is not precisely what was under consideration in the majority of this post — PBA was outlawed in Kansas at some time during Tiller’s career, so he switched from that to digoxin-induction as his method of abortion; but I think it has bearing on the topic). Basically, a select panel met to formulate a policy statement, came to the conclusion that there were no circumstances in which PBA was necessary to save the life or health of the woman… and then the ACOG board unilaterally added the statement that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman. . .” The AAPLOG response to the actual ACOG position statement is here, in which they blast the leadership for issuing such a position without any evidence, saying it “lacks scientific credibility.” If you’re surprised that ACOG would take such a position without evidence… remember their stance on elective C-sections, as well as on home birth.
So if you’re in a conversation about late-term abortion and somebody says that they’re necessary to save a woman’s life or health, or that Dr. Tiller in particular saved women’s lives by performing late-term abortions nobody else would do, ask them, “Where’s the evidence for that?”
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