Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse
This piece was written in the hope that the more we talked openly about the reality of second-trimester abortion, the more accepted all abortion would become. If the author's prediction is true -- that the more we know about how gruesome and violent second-trimester abortions are, and the more we know about the rather prosaic reasons they're committed, the more likely we are to embrace the practice -- well, to paraphrase Jeremy Irons in The Mission, "might makes right and love has no place in the world. And I haven't the strength to live in a world like that."
With that said, I'll provide a few choice (ha!) excerpts.
In the United States (US), approximately 10% of abortions occur in the second trimester, and that proportion has been stable for the past decade.
Ten percent of 1.2 million is 120,000. One hundred and twenty thousand. That's a lot of the violence and accompanying damage to the souls of those who participate. And I'm not the one here saying it's violence. This is an abortionist speaking -- somebody who does abortions and thinks that doing them is doing the woman a great and valuable service.
Many of the factors that lead women to have second trimester abortions are not readily reversible (for example, difficulty with the abortion decision, not recognising pregnancy earlier).
Note the lack of the reasons we're popularly told to believe that women seek later abortions: maternal health problems and babies with terrible congenital defects.
Second trimester abortion by dilatation and evacuation (D&E) uses large forceps with destructive teeth to remove the fetus, generally in parts.
You can go here to learn more about those forceps and exactly how they're used to dismember these babies.
While training is clearly important in the decision to provide abortion, we also know that 38% of residents who are trained do not ultimately provide abortion services.
Gosh, I wonder why?
Kaltreider et al found that some doctors who provided D&E had “disquieting” dreams and strong emotional reactions. Hern found that D&E was “qualitatively a different procedure – both medically and emotionally – than early abortion”. Many of his staff members reported:“…serious emotional reactions that produced physiological symptoms, sleep disturbances (including disturbing dreams), effects on interpersonal relationships and moral anguish.”
Why would they have such nasty responses to later abortions? Why the moral anguish, if it's just pulling out some unwanted tissue?
This doctor writes, after observing her first second trimester procedure at 21 weeks:“Seeing an arm being pulled through the vaginal canal was shocking. One of the nurses in the room escorted me out when the colour left my face… Not only was it a visceral shock; this was something I had to think deeply about…
The author, by the way, goes on to argue that being both physically and morally revolted by killing babies is no reason to stop doing it.
When I was a little over 18 weeks pregnant with my now pre-school child, I did a second trimester abortion for a patient who was also a little over 18 weeks pregnant. As I reviewed her chart I realised that I was more interested than usual in seeing the fetal parts when I was done, since they would so closely resemble those of my own fetus. I went about doing the procedure as usual, removed the laminaria I had placed earlier and confirmed I had adequate dilation. I used electrical suction to remove the amniotic fluid, picked up my forceps and began to remove the fetus in parts, as I always did. I felt lucky that this one was already in the breech position – it would make grasping small parts (legs and arms) a little easier. With my first pass of the forceps, I grasped an extremity and began to pull it down. I could see a small foot hanging from the teeth of my forceps. With a quick tug, I separated the leg. Precisely at that moment, I felt a kick – a fluttery “thump, thump” in my own uterus. It was one of the first times I felt fetal movement. There was a leg and foot in my forceps, and a “thump, thump” in my abdomen. Instantly, tears were streaming from my eyes – without me – meaning my conscious brain - even being aware of what was going on. I felt as if my response had come entirely from my body, bypassing my usual cognitive processing completely. A message seemed to travel from my hand and my uterus to my tear ducts. It was an overwhelming feeling – a brutally visceral response – heartfelt and unmediated by my training or my feminist pro-choice politics. It was one of the more raw moments in my life. Doing second trimester abortions did not get easier after my pregnancy; in fact, dealing with little infant parts of my born baby only made dealing with dismembered fetal parts sadder.
Her heart and soul are telling her she's doing a hideous thing, but her "training" and "feminist pro-choice politics" are brought to bear to trump her humanity, her ability as a mother to relate to another mother and grasp fully the value of the child she's busy destroying.
What kind of dissociative process inside us allows us to do this routinely? What normal person does this kind of work?
An excellent question.
This brings me to the issue of violence.
Yes. Violence. Her word.
There is violence in abortion, especially in second trimester procedures. Certain moments make this particularly apparent, as another story from my own experience shows. As a third-year resident I spent many days in our hospital abortion clinic. The last patient I saw one day was 23 weeks pregnant. I performed an uncomplicated D&E procedure. Dutifully, I went through the task of reassembling the fetal parts in the metal tray. It is an odd ritual that abortion providers perform – required as a clinical safety measure to ensure that nothing is left behind in the uterus to cause a complication – but it also permits us in an odd way to pay respect to the fetus (feelings of awe are not uncommon when looking at miniature fingers and fingernails, heart, intestines, kidneys, adrenal glands), even as we simultaneously have complete disregard for it. Then I rushed upstairs to take overnight call on labour and delivery. The first patient that came in was prematurely delivering at 23–24 weeks. As her exact gestational age was in question, the neonatal intensive care unit (NICU) team resuscitated the premature newborn and brought it to the NICU. Later, along with the distraught parents, I watched the neonate on the ventilator. I thought to myself how bizarre it was that I could have legally dismembered this fetus-now-newborn if it were inside its mother's uterus – but that the same kind of violence against it now would be illegal, and unspeakable.
So what does she make of this schizophrenic attitude?
I understand that the vital difference between the fetus I aborted that day in clinic, and the one in the NICU was, crucially, its location inside or outside of the woman's body, and most importantly, her hopes and wishes for that fetus/baby.
And there you have it. Mom wants baby dead, doctor and society have (in the author's view) an obligation to achieve that baby's death on her behalf. But she never fully explains why. Why is the death of that baby -- a baby that she admits could have survived if put in the NICU -- something that the mother is absolutely entitled to, that we as a society and doctors as professionals are absolutely required to help her to achieve?
But this knowledge does not change the reality that there is always violence involved in a second trimester abortion, which becomes acutely apparent at certain moments, like this one. I must add, however, that I consider declining a woman's request for abortion also to be an act of unspeakable violence.
But why? This is an issue the author never explores. As Albert Camus said, "We shall know nothing until we know whether we have the right to kill our fellow men, or the right to let them be killed. In that every action today leads to murder, direct or indirect, we cannot act until we know whether or why we have the right to kill." The author starts with the right to kill (the fetus) as a premise, and reality -- including the reality of her own humanity -- must be contorted and crushed until it can be made to support that premise.
Currently, the violence and, frankly, the gruesomeness of abortion is owned only by those who would like to see abortion ... disappear....
Who, I would ask, could gaze at the violence and gruesomeness of abortion and not want to see it disappear?
Instead of acknowledging what is on the placards, abortion rights activists may say in response to them that they are fake pictures or that abortions don't really look like that. However, to a doctor and clinic team involved in second trimester abortion, they very well may. Of course, acknowledging the violence of abortion risks admitting that the stereotypes that anti-abortion forces hold of us are true – that we are butchers, etc.
Well, duh! If you spend your days deliberately converting babies like this into remains like this, all I can say is, "If the shoe fits...."
In general feminism is a peaceful movement. It does not condone violent problem-solving, and opposes war and capital punishment. But abortion is a version of violence. What do we do with that contradiction? How do we incorporate it into what we are as a movement, in particular a feminist movement?
An excellent question. One that she doesn't answer.
But where does that leave the abortion provider and team? What do we do when caught between pro-choice discourse that, while it reflects our values, does not accurately reflect the full extent of our experience of abortion and in fact contradicts an enormous part of it, and the anti-abortion discourse and imagery that may actually be more closely aligned to our experience but is based in values we do not share?
Why do you embrace values that you admit are contradictory to the reality you experience every day?
Essays like this bring the inevitable risk that comments will be misinterpreted, taken out of context and used as evidence for further abortion practice restrictions.
Taken out of what context? Out of the context, obviously, that starts with "Abortion is an absolute right" as a premise then tries to deal with the reality that abortion is violent killing of innocent human beings. If you start with questions, rather than presumptions, where would the reality of abortion lead you? What conclusions would you draw? You shall know the tree by the fruit. But abortion supporters look at the poisonous fruits of the abortion tree, yet declare the tree to be sound and good.
To focus on the difficult aspects of second trimester abortion may further entrench abortion as morally tainted, allowing further disavowal and marginalisation of it.
It's hard not to look askance at somebody who recognizes the heinous violence of abortion, who recognizes that it's killing, but keeps on doing it -- especially when the person can't clearly articulate why the destruction of these babies is supposedly so vital that it's worth damaging your own soul to perpetuate the practice.
The last point I want to make on the issue of silence is that I see a hint that this silence may be breaking.
I pray that it does. The huge drop in public approval of abortion since Obama took office is probably largely a result of the huge amount of discussion his candidacy provoked about exactly what abortion is.
As the generation of doctors who provided abortions prior to Roe v. Wade retires, the cadre of doctors who now provide abortions are no longer personal witnesses to the horrific sequelae of unsafe illegal abortion.
Rather, they're more likely to have been personal witnesses to the horrific sequelae of unsafe legal abortion.
This younger generation of providers may go through a different kind of soul-searching in deciding to provide abortion.
Or maybe, after their soul-searching, they'll decide not to perpetuate the practice after all, to help women to avoid abortion rather than to embrace it.
We might conclude at this point that a provider who feels that abortion is violent is simply ambivalent, conflicted, is not really committed to women's abortion rights, and just shouldn't be doing this work.
If the person recognizes that abortion is violent, why would you want him to do it?
“Pro-life” supporters may argue that the kind of stories and sentiments I've relayed spell the end of abortion – that honest speech acts regarding the reality of abortion will weaken the pro-choice movement to the point where it cannot sustain itself any longer.
Evidently we have more faith in basic human decency than the author does. Evidently we believe that few people have the stomach for embracing something as violent as abortion, once they see clearly how violent it is.
There are ethical and moral positions that make complete sense of the position that says women should have full access to abortion – but simultaneously allow for discomfort with aborted second trimester fetuses. .... That is, even as we think that abortion is morally permissible, we are also permitted increasing discomfort, grief or loss with later abortions.
In other words, as long as we're willing to keep doing the violence, it's okay to be queasy about it. Or as long as you're queasy about it, it's okay to keep doing the violence.
[T]he reality is that women have all sorts of compelling and legitimate reasons for choosing abortion, and this is particularly true in the second trimester. In the US, the known risk factors associated with presenting for second trimester abortion include: adolescence, drug and alcohol addiction, poverty, difficulty obtaining funding for the abortion, and African-American race.
Does anybody else see something sinister in the idea that in listing the "compelling and legitimate reasons for choosing abortion... particularly ... in the second trimester" the author includes "African-American race"?
Delays in obtaining second trimester abortion come when a woman does not realise she is pregnant (perhaps a surrogate for poor health or lack of education), has logistical delays, experiences denial about the pregnancy, is uncertain about the decision to have an abortion, or has a change in life circumstances or relationships that makes a previously desired pregnancy undesired.
Um, if she's that uncertain about having the abortion, ought anybody to be actually performing it?
Knowing that we help a woman navigate the complexities of her life is the great reward for doing what might otherwise be overly burdensome work.
Prolife pregnancy centers help women to navigate the complexities of life. Abortion facilities treat women's unborn babies as mere "complications" and kill them.
She goes into a morally revolting description of how the facility she works at decided, in spite of everybody's revulsion, to keep pushing into later and later and later abortions. Interestingly, there was no discussion of having encountered any evidence that there was some unmet need. There was simply, evidently, a presumption that to provide any abortion is to provide all abortion, and that therefore there was an obligation to push the limits further and further, until all abortions that can be done are being done.
I am tired of “pro-life” representation of the work we do. It’s time for the pro-choice movement to claim abortion fully and use the experiences of providers to strengthen our movement.
By all means keep talking. Keep talking about how violent, how physically and morally revolting abortion is. Please.
HT: Jill Stanek