Warning: Graphic Medical Stuff Ahead
This is it, my friends. Today is the day we learn about intact dilation and extraction. It’s best known by its political name, “partial-birth abortion.” Let’s take a look.
I want to start off by clarifying that I have a lot to say about this procedure; however, I will not be saying it right now. This post is just about how the procedure is done. I know, I’m biting my fingers not to write a novel here. I’ll be putting my own thoughts down later.
Oh, and quick note: if you do a Google search for the political name of the procedure, “partial-birth abortion,” you’re just going to get a whole bunch of anti-choice sites. It goes without saying those aren’t reliable, unbiased sources, but there, I just said it. Just in case. If you want facts, search for the medical name, “intact dilation and extraction.”
Intact dilation and extraction, or IDX, was banned in November 2003 when Bush signed into law the Partial-Birth Abortion Ban Act, with an exception to save the life of the mother (/pregnant person). 16 states have laws in effect that ban it completely. It was very rarely used even before the ban; the Guttmacher Institute put the percentage of IDXs performed out of all abortions at .17% in 2000.
IDX is a late-term abortion procedure. It involves removing the fetus intact, rather than in pieces. It is rarely performed in the second trimester, as there are quicker, safer, more effective methods at that point. However, later on in the pregnancy, procedures such as D&E, which involve removing the fetus in pieces, can risk more damage to the uterus and cervix, which is why some argue that IDX is safer.
IDX takes two or three days to complete. The first step is to dilate the cervix using osmotic dilators, usually laminaria, or sticks made of seaweed. This can be done under general anesthesia. Dilation will cause cramping and bleeding as the uterus contracts.
There are a number of methods for this, so it could take one or two days. I’m linking to a woman’s personal account of her experience with IDX in which she states dilation took just one day and she was able to come back to finish the procedure the next morning. Other sources on the methods put the time at two days.
The Supreme Court allows this procedure to be done provided the fetus is dead before it is delivered (Gonzales v. Carhart, 2007), so the doctor will, at some point before delivery, deliver an injection to the fetus that will kill it, if it has not already died.
Sometimes the waters will break during dilation; other times the physician will rupture the membranes once the cervix is fully dilated. The cervix is scrubbed (ouch) and anesthetized, then grasped with forceps to be held in place. The surgical assistant will perform an ultrasound to locate the lower extremities of the fetus. Using the ultrasound as a guide, the doctor will use a large grasping forcep to firmly grasp a lower extremity. The doctor will pull the extremity into the vagina, then repeat for the rest of the body.
Usually, there is not enough dilation for the head to pass through the cervix, so the doctor will puncture the base of the skull with medical scissors, which are used to widen the opening. A suction catheter is inserted into the skull and used to evacuate the contents. This allows the skull to collapse. The fetus is then completely removed from the patient. If they wish, the patient can now be given the opportunity to hold their baby, name it, baptize it, and arrange memorial services.
The placenta is removed with forceps, and the uterus is scraped and/or suctioned to remove any remaining tissue.
Afterward, the patient will be monitored for a few hours. Recovery is similar to recovery after childbirth: some bleeding and cramping is normal. Sex should be avoided for a number of weeks (whatever the doctor instructs), and follow-up visits are necessary to check for infection or retention of products of conception.
There are a wide variety of emotions felt after an abortion, but late-term abortions do carry the extra risk of negative emotions, due to pregnancy hormones and the situation that brought the patient there. Some people may experience grief, guilt, and sadness after an IDX, even if the pregnancy was not wanted. It’s extremely important to find counseling if needed. I’ll link again to some counseling hotlines.
Intact dilation and extraction (Wikipedia)
Dilation and Extraction for Late Second Trimester Abortion (presented by Martin Haskell, M.D. at the National Abortion Federation Risk Management Seminar, 1992)
Data Lacking on Abortion Method (Washington Post)
Real Life: Why I Chose Abortion (MSN Lifestyle)
