Doctors and activists who argue that intact dilation and extraction is a much safer procedure for some women have no studies to prove their point, but a visit to the operating room does make aspects of their argument very clear. I spent a day in the operating rooms of a major New York teaching hospital to watch both procedures performed and was present for five second-trimester abortions involving fetuses ranging from 19 to 23 weeks. Of the five abortions I observed, the first three were intact dilation and extractions, and the last two were standard dilation and evacuation procedures.
The 34-year-old woman estimated to be 23 weeks pregnant was the first case. She had a cough that morning, and because of a risk of choking while under the standard general anesthesia, she received an epidural, which numbs the patient from the waist down, prior to the procedure. The doctor said he would determine which procedure to use, D&E or intact D&X, based on the conditions as they presented themselves. He chose to do the latter.
This was the most difficult procedure to watch, mostly because of the pain experienced by the least sedated of the women. As the doctor, with a resident by his side, slid most of his hand deep into the patient's vagina, she moaned horribly and could not remain still. Only when the anesthesiologist administered a drug to increase her sedation could things proceed.
The doctor, using only his fingers, pulled a foot into view and then another. "OK," he said, "now I have the sacrum." Letting the resident take over, the doctor instructed: "Pull down. Down! Not Up! Down! All right, now the shoulder, then twist. Then the other shoulder."
At this point, only a few minutes had passed. The fetus was perfectly limp, its tiny feet and hands flaccid as they immediately darkened from oxygen depletion. In the three intact D&X procedures I witnessed, not once did I see even a glimmer of response from the fetuses -- the anesthesia having passed through the placenta into their bloodstreams.
Once the entire fetal body was out of the womb, the doctor quickly made an incision into the base of the skull that remained lodged against the woman's cervix and inserted a suction catheter into the perforation to drain the brain matter and allow the full removal of the fetus. The placenta came next and the doctors finished suctioning the uterus to drain any remaining blood.
The final two procedures I monitored were standard D&E abortions. These procedures are not outlawed by the proposed federal ban on "partial birth" abortions or any of the 31 bans passed by individual states. However, the Supreme Court found that the wording of the Nebraska ban was so broad that it included the D&E procedure. Wrote Justice Stephen G. Breyer, author of the court's majority opinion in the ruling: "prosecutors ... may choose to pursue physicians who use D&E procedures ... "
Both D&E procedures I observed started in exactly the same manner as the three abortions earlier in the day, but the doctor in these cases quickly determined that intact extraction would not be possible because neither woman's cervix was dilated enough. Once that decision was made, the resident inserted a long-handled metal instrument into the woman's uterus -- called a Bierer forcep -- and began what the doctor called "blind" pulling. I watched as the doctor instructed the resident to "Stop and feel where you are! Put your hand on the abdomen. No, you're not getting it! Watch out! Don't get the cervix."
Time after time, the resident plunged the Bierer into the woman's womb, removing a leg, then an arm, then the liver, then the placenta, which the doctor ranted about, because this can make the fetal head extraction more difficult. The last step that I saw was the collapse of the skull and the removal of the brain matter.
Overall the piecemeal procedure seemed less dignified and somehow more harsh than the intact version, and the number of times the forceps entered the woman's womb was indeed much higher. The whole procedure took about 15 minutes longer than the intact D&X procedure, but the duration varies from woman to woman.
During the procedures, I had focused on and intently looked for specific differences between the two techniques, monitoring such things as variations in pain, tearing of the tissue below the vagina, and blood loss. (Only the first woman seemed to experience pain; a small peritoneal tear occurred during one standard D&E procedure; and less bleeding occurred with the intact procedures.)
I also watched for any signs of fetal distress, but even as one foot was pulled off, I could see no response, no reflexive spasm, nothing. Whether this was a result of the anesthesia or an undeveloped fetal system for pain sensitivity, one thing was clear: There was no discernable response by the fetus. And in the operating room there was no emotional one from me.
But as I left the operating room, and changed from surgical garb into my street clothes, I allowed myself a moment of reflection. I have always had a sort of Einsteinian view on abortion: God does not play dice with the souls of this universe. Maybe that reason, coupled with the simple fact that my trip to the OR was motivated only by a desire to understand and demystify the science behind this politically mired surgical procedure, I felt the relief of finally knowing, combined with the burden of knowledge. Seeing a potential human collapsed and torn in a dish was disturbing; watching a very human woman, knowing she would be the one to carry the wounds, hurt too.
Next page: "For me, this was the most humane procedure"