late term abortions - highly absorbent material

by:Demi     2019-08-26
late term abortions  -  highly absorbent material
At a White House ceremony on April, President Clinton vetoed a bill banning abortion in the second half of her pregnancy.
Called "part-
By condemning it for "abortion", by the people who executed it for "full expansion and evacuation", the technology has become the latest lightning bolt in the intense debate on abortion in the United States.
When the president announced the veto, five women standing next to him experienced being late
Because their fetus has serious developmental defects, regular abortions are performed with controversial techniques.
The women "represent a small but very vulnerable group," Clinton said. . . .
They all want their children very much.
They don't want an abortion.
Only when their children are clearly unable to survive, their own lives, their health, and in some cases their ability to have children in the future is threatened can they make painful decisions.
Similar paintings were also drawn by others.
The United States family planning Federation says the procedure is "very rare and will only be carried out if a woman's life is at risk or the fetus is extremely abnormal.
The National Abortion Federation, an abortion provider organization, said that "in most cases where it is used" there are "severe fetal abnormalities {birth defect}.
But it is not certain who has gone through "full D & E" because "part-
"Birth abortion" is well known in medicine.
This information is not collected by the federal government.
Doctors do not have to report to the state health department.
The researchers will not look at the problem, nor will they publish their findings in the Journal of Medicine.
Interviews with doctors using the procedure and public comments from others suggest that the situation is much more complicated.
These doctors say that while many of their patients have delayed abortion for medical reasons, many others--
Maybe most people-do not.
They are often young or poor.
Some are victims of rape or incest.
Doctors who performed abortion more than three days before pregnancy said it was very rare to use the complete D & E.
Just over 1% (about 17,000)
In this country, all abortions occur 20 weeks after the development of the fetus;
After this, the full D & E program is sometimes used.
Only a small part is considered complete D & Es, a controversial method in which the fetus is pulled out of the uterus by the foot and the head is punctured so that it can also pass through the cervix.
More importantly, there are very few doctors doing this surgery;
Interviews with abortion experts showed that there were fewer than 20 people.
The following is the experience of several doctors who perform a complete D & E procedure, as well as the experience of doctors who use alternative techniques to have an abortion for patients with advanced pregnancy.
As a whole, the descriptions and observations of these practitioners depict a more complete picture of who decides to end the pregnancy in the late stage and why.
A better security issue
The well-known full D & E practitioner is Martin Haskel, a doctor in Ohio who presented in 1992 "how
Published a paper on the technology at a medical conference in Texas.
The dissemination of this document to anti-abortion activists laid the foundation for the current campaign to ban the technology.
Although Haskell declined to be interviewed for the article, in his 1992 papers he said he had completed "more than 700 of these procedures ".
"Three years ago, the American Medical Association's weekly publication, American Medical News, interviewed Haskel about his technology.
"I will say very frankly: most of my abortions are at 20-
Within the 24-week range, Haskel said that according to the record of the interview, which has been widely distributed in the debate on the issue, "part
Abortion Act.
"In my special case it could be 20% {
Abortion}
Because of the gene.
The other 80% is a pure elective course.
"Selectivity" is not a medical term commonly used for abortion, but is often used in medicine to indicate that medical procedures are not required.
In this case, it seems to mean that the fetus is normal or that the pregnant woman is not seriously ill.
The American Medical News reporter also asked Haskel if the fetus died early.
The doctor replied, "No, no . "
No, not really.
There are various reasons for a percentage. . . .
In my case, I think the third of them must have died before I start taking out the fetus.
Maybe two more. thirds are not.
"Complete D & E abortion in Ohio is also 45-year-
Old doctor named Martin Ruddock.
In a recent interview, he declined to estimate how many abortions he had done each year, but said he had only done five to 10% late pregnancy.
After 18 or 19 weeks, rudoc prefers to use the full D & E technology.
He believes it is safer than the most common alternative, which is called "dismemberment expansion and evacuation ".
"In the process, the fetus is first taken out, usually the limbs.
It requires surgeons to exert a great deal of force on the fetus in the uterus, and often produce sharp bone fragments that damage the female reproductive organs.
In rare cases, "dismemberment D & E" will also expose women to fetal substances (
Mainly brain tissue)
Can cause a dangerous reaction.
"Minimizing these issues is why {intact}
"The process has been developed," Ruddock said . ".
In practice, however, he only uses it for the third time he is willing, he said.
Normally, the location of the fetus or some other variable makes it impossible for the complete D & E to be replaced by dismemberment.
However, whenever he uses the complete method, he cuts the cord first-
An action designed to ensure that the fetus dies before puncture the skull.
Basic argument {
Opponent of the technology}
The fetus is alive.
"What I'm saying is that this has never happened in my practice," he said . ".
He said that in cases of more than 20 weeks of pregnancy, 45% of the fetus had obvious developmental abnormalities, or women carrying the fetus had a disease that was exacerbated by pregnancy.
However, the fetus is normal in the other 55% people.
Another doctor who did not want to be named is a doctor in the New York area, who is affiliated with several teaching institutions.
He did about 750 in the second month of pregnancy.
He said he used the full D & E in "less than one quarter" of it. About one-
The third is his private patient, and the rest is the patient he saw at the teaching hospital, where he directed the doctor to train.
The doctor said that "the vast majority" of private patients have medical reasons for abortion: either fetal abnormalities or the health of pregnant women is threatened by pregnancy.
However, non-private patients are different.
Their income is often low, and the proportion of medical reasons for abortion is "not high ,{but}
"I can't quantify it," he said . ".
In the absence of a medical indication, the fetus is usually normal.
The experience of a doctor in California is that the complete D & E is only completed later in pregnancy-
Very late pregnancy, usually after 24 weeks-
Only when the fetus has a catastrophic defect, it seems to be due to the widespread publicity of the practice of Los Angeles doctor James T.
McMahon who died last year
His specialty is the late abortion of a severely developing fetus.
Patients come from all over the United States, sometimes even from abroad.
All the women who appeared with Clinton at the veto ceremony were aborted by him.
McMahon uses the complete D & E extensively, because the dismemberment of the fetus is very difficult, if not impossible, after 26 weeks of pregnancy.
In a letter to the doctor dated 1993, he said that in 1991 he did 65 times for the third time
Abortion for three months.
All of these cases are "non-selective", he said ".
Of all abortions over 20 weeks, 80% is what he calls "treatment indications "---
Is the medical reason.
In the submission to the house constitutional subcommittee, McMahon provided a list of some of these reasons.
He classified 1,358 abortions he had done over the years, all of which were (
His testimony suggested)
Women at least 24 weeks pregnant
Most of them are due to extremely rare genetic defects.
The list contains some slightly more common cases, including brain-free malformation (Missing a brain)
29 cases of cracked (
Open spine)
There were 28 cases of congenital heart disease and 31 cases.
However, some of the conditions on the list are rarely fatal.
In 9 cases the rabbit lip, known as the "indications", can be surgically corrected after birth, sometimes permanently disabled and sometimes not.
Similar changes have been made to maternal indicators in Macmahon's list.
Although many of the problems he gives are not common, the severity of the disease cannot be inferredthreatening.
Including breathing difficulties during hard work, 1 case;
1 Case of electrolyte interference;
5 cases of diabetes;
And vomiting (
Vomiting during pregnancy), six cases.
The two most common indications for women are depression (39 cases)
And sexual assault. 19 cases).
Although a small number of other doctors known to use the complete D & E approach declined to be interviewed, an overseas doctor would be interviewed.
He's David Goldman, 49. year-
The old doctor from Brisbane, Australia, learned the technology from McMahon during a visit to the United States about five years ago.
Glendeman had an abortion at 22 weeks of pregnancy and, like McMahon, served patients traveling long distances.
He and his two partners complete 60 to 100 complete R & D cases each year.
In an interview last week, he said there were serious defects in the fetus in about 15% of the cases.
About 2% of pregnant women are seriously ill, and about 10% have serious concerns about suicide.
"In other cases, the reason for the abortion was rape, incest, and a former doctor failed to find out that the woman was pregnant or denied that she was pregnant until it was too late for her to get pregnant earlierstage abortion.
It is difficult for these women to say that these five doctors are representative of other complete D & E practitioners in the United States.
Interviews with doctors using other abortion techniques-
General dismemberment--
May help indirectly clarify why it is the latest
Regular abortion including complete D & E abortion.
Warren Henn, 57year-
The old doctor who practiced in Boulder, Colorado.
With a master's degree in public health and a doctorate in anthropology.
He is one of the few suppliers in recent years.
Published in the Journal of Medicine, the topic of research on stage abortion.
Hern has 1,500 to 2,000 abortions per year.
About 500 of women are pregnant for 20 to 25 weeks.
Which, about one-
Abnormal fetus involved in the quarter.
He said that he had 10 to 25 abortions per year for women who were pregnant for more than 26 weeks, all of which involved fetal abnormalities or severe maternal diseases.
"It is true that after 26 weeks, a large part of the community was offended by any abortion without medical evidence," he said . ".
"We practice medicine in a social context.
So that's why I'm not going to have an abortion after 26 weeks just because a woman decides she doesn't want to get pregnant.
"Women who seek abortion later in pregnancy" are usually young and often not married, and many people already have a child, or more, "said Steve lishher, who said
A gynecologist in Chicago who had an abortion for 22 weeks.
He said many people are poor, have not completed their studies, have not been fully neutral in the labor force, and are in good health.
"It's not uncommon for us to see several patients each week with a history of rape or incest.
The number of people who voluntarily provide this information is far less than the number of people who actually suffer social or sexual violence.
Herbert Viskin was the 19 th century manager.
Four doctors at Atlanta Midtown Hospital had about 25 abortions per week for women who were pregnant for at least 18 weeks.
According to his experience, many late procedures occur only because of the refusal.
"You have a young girl who is 15 or 16 years old who is pregnant," he said . ".
"She doesn't know how to tell her parents or boyfriend.
So she went on a diet and tried to deny that she was pregnant.
However, Wiskind said that some fetal defects were not diagnosed until late pregnancy due to unavoidable reasons.
Amniotic fluid puncture is a technique for fetal genetic screening that takes place between 15 and 17 weeks of pregnancy.
He said that a few weeks can pass before the test results are known, and when the test results indicate that there is a problem, it usually takes a few weeks for women to decide on abortion.
In addition, many abnormalities can only be diagnosed by ultrasound and are not obvious until the midpoint of pregnancy or later. Thomas J.
According to the ultrasound measurement of the fetal head, Mullin performed abortion 24 weeks pregnant.
He worked as an intern in the New York area.
In the program that Mullin does in 20 to 24 weeks, there is about one-
Third, he says, is fetal abnormalities.
In about 10% of cases, women suffer from diseases such as severe diabetes or pain in uterine fibroids, not necessarily life.
But pregnancy will obviously make the situation worse.
"The rest is just a mistake," he said . "
Many of them are young patients. -
12 to 20 years old-
They don't keep in touch with the reproductive system as they should, so they get stuck later than they want to get pregnant.
Basically, they will be surprised.
"Jaroslav Hulka, a professor of obstetrics and gynecology at the University of North Carolina, said overseeing a teaching program where doctors perform between 250 and 300 abortions per year for women carrying a fetus from 13 to 22 weeks old. "Ninety-
It's normal 5%. -
"It's fair," he said . ".
Occasionally, if the fetus is suffering from a disease that is incompatible with life, the 24-week-old fetus will have a miscarriage.
The doctor uses dismemberment technique--
A difficult and potentially risky process
Technology of concern to the National Congress {intact D&E}
"This is a skill that is above this level," Hulka said . ".
"They are doing what we should all do ---
That is, to minimize the risk to patients.
"Practitioners of complete surgery believe that among the many expanded and evacuated abortion variants used, their approach is minimal trauma, not--
As their critics say-
The most brutal
The late James McMahon wrote in his testimony to the Congressional subcommittee last year: "In ideal pregnancy, when the baby is damaged or the mother is at risk, the decision to give up may be intellectually obvious, but emotionally it is always a huge personal pain. . . .
For doctors who are willing to help patients in this dilemma, there are very few options.
Complete D & E is usually the best in a range of difficult options. . . .
Dealing with the tragic situation I face every day makes me constantly aware that I can only limit injuries by doing gentle surgery and giving compassionate advice.
"Will the fetus feel pain when abortion?
Will the fetus feel pain in abortion in the third trimester or abortion in the third trimester?
This is a question that caused repercussions in the debate on so-Called partbirth abortion.
"If you want to know what I think is at the heart of this issue. . .
It was a feeling that you killed someone who knew what you did to them, "said Chicago doctor Steve Lichtenberg, who performed very late. term abortions.
"This is one of the reasons for this particular dispute.
When asked, almost all doctors who provide late
Regular abortions say they believe the fetus will not feel pain at the very late stages of pregnancy, and they will do the surgery at this stage.
Except in a few cases, this is no later than 38-in all cases-week gestation.
Current knowledge of the anatomy and physiology of the fetal nervous system suggests that this belief may be ---
But not absolutely. -correct.
Scientists must infer the existence of pain. or absence)
By looking for physiological signs of sensation.
These include hormones and other biochemical substances that appear in the blood when pain arises, as well as more subjective signs such as facial expressions or movement of the limbs.
However, no one can say with certainty whether these things mean the suffering of developing humans.
Many neuroscientists
Almost all abortion doctors
It is believed that the muscle movement when the fetus is touched is purely as a reflex.
They believe that these events lack the necessary brain activity and cognition to register them as pleasant or harmful.
Some even claim that humans must be able to store memories and emotions in order to feel pain.
Nerve fibers must be "wired" in order to carry impulses ".
Impulse cannot reach the cortex of the brain without a specific circuit, and most scientists think this is where pain is perceived.
Before 20 weeks of pregnancy, the sensory nerve ends were already covered in the skin of the fetus.
Key parts of the circuit--
A structure at the bottom of the brain called the connection between the mound and the cerebral cortex-
Development did not begin until 22 to 34 weeks.
Until about 29 weeks of pregnancy, the clear "arrival" of the sensory impulse in the cortex can not be detected through the electrical test.
However, the development of the fetal nervous system is a process that involves the growth of a large number of cells, the establishment of new connections or death.
In any fetus, it is impossible to know when the pain will begin to feel.
A study published two years ago in the Lancet found signs of fetal pain in 15 people still receiving blood transfusion in the uterus.
Six deliver blood by needles placed in the umbilical cord, without feeling.
Nine times of blood transfusion was entered into a blood vessel in the abdomen--
At least at birth, the area has a good feeling. Nicholas M.
Fisk and his colleagues at Queen Charlotte hospital and Chelsea Hospital in London, after the needle entered, and then at the end of the blood transfusion, measured two substances in the fetal blood.
One is a hormone that is produced when a person is under pain or physiological pressure.
The other one is beta-
β-EP, morphine
Like a substance formed by the body. in painkiller.
The blood concentration of the two substances rises in the fetus where the needle passes through the abdomen, but does not rise in the fetus transmitted through the umbilical cord.
Although the average gestational age of the first group was 30 weeks, one of them was only 23 weeks, and its cortical and β-endorphin.
Nevertheless, more and more doctors admit that even babies who are very premature may feel pain.
"I use anesthesia or pain relief for every premature baby I treat," K said . ". J. S.
Anand is a pediatrician at the Emory University School of Medicine and Eggleston Children's Hospital in Atlanta and an outstanding researcher on fetal pain issues.
"I have treated a lot. to 28-weekers.
They react to the pain and I'm sure they will feel the pain.
This is a point that others may not agree.
Some doctors are late.
Long-term abortion does not consider the pain issue to be critical, as anesthesia given to women also results in anesthesia for infants.
In most cases, these patients were given intravenous injections of a town-setting agent, a babittin drug, or an effective opioid painkiller.
However, the anesthesia doctor objected to the statement.
"If you use these drugs appropriately, then it has little or no effect on the fetus," said David bernabbach, chair of the Society for obstetrics anesthesia and circumference.
"From a clinical point of view, you can't rely on the fetus to fall asleep.
"Many narcotic drugs enter the fetus through the" placenta barrier ", but usually the effect is not as significant as that of the pregnant woman only after the delay.
Vice President Mark Rockoff
The president of anesthesiology at the Boston Children's Hospital said he "would be seriously concerned that if the procedure was very fast, in fact, the baby might not have been fully under anesthesia.
"As doctors perform more surgery on unborn babies, the subject of fetal pain sensation will certainly become more practical than a philosophical issue.
The authors of the Lancet article pointed this out and suggested that doctors consider giving "adequate pain relief"Painkillers}
"Treat the fetus like a newborn.
They ended their article with an amazing, albeit unavoidable observation: "This is not only applicable to the diagnosis and treatment procedures of the fetus, but also may apply to termination of pregnancy, in particular, surgical techniques involving dismemberment
"The normal time for human pregnancy is 266 days, that is, 38 weeks.
This is about 40 weeks after a woman's last menstrual period.
Pregnancy is usually divided into three parts, that is, "pregnancy ".
"However, there is no point in this division, both legal and medical.
On the one hand, there is no exact agreement as to when a three-month period ends and when the other three-month period begins.
Some authorities described the first three months of pregnancy as the end of 12 weeks of pregnancy.
Other people say 13 weeks.
Usually, the late pregnancy is defined as the beginning of fetal development after 24 weeks.
Still, the concept of three months-
Especially the division between the second and the third-
Usually in later discussions. stage abortion.
Third, contrary to what the public generally believes
In the United States, abortion for three months is not illegal.
Supreme Court verdict Roe v. Wade and Doe v.
Bolton jointly decided on 1973 to allow abortion on demand before the fetus "survives.
"After that, states can restrict abortion for women.
The court did not specify when viability began. In Doe v.
Bolton court ruled that if the surgeon judges the procedures necessary to protect the life or health of a woman, an abortion can be performed after the fetus survives.
"Health" is widely defined.
"Medical judgment can be exercised based on all factors ---
Age of body, emotion, psychology, family and woman-
Well related-
"As a patient," the court wrote . ".
"All these factors may be related to health.
This allows the attending physician to make the best medical judgment in the room he needs.
Because of this definition, life
In order for a woman to get a third, the threat condition does not need to exist
Three months of miscarriage.
However, for the most part of this century, survival is limited to the third trimester because of the severe neonatal condition.
Nursing medicine cannot make the fetus younger than this.
This is no longer the case.
In an article published in the journal Pediatrics in 1991, doctors reported the experience of 1,765 babies with very low birth weight in seven hospitals.
About 20% of these babies are considered to be 25 weeks or less pregnant.
Of those who completed 23 weeks of development, 23% survived.
At 24 weeks, 34% people survived.
None of these babies are in the third trimester.
Abortion Method about 1. 90%.
In the United States, 3 million miscarriages occur every year in the first 12 weeks of fetal pregnancy.
At that stage, the program was very safe and simple.
Put a small suction catheter into the vagina and insert it into the opening of the uterus, called the cervix.
An embryo or fetus usually less than 3 inch long is "sucked out ".
Abortion after 20 weeks-
About the midpoint of pregnancy--
It's another thing.
Technically and emotionally, they are more risky and demanding.
At this relatively high stage, there are generally two strategies for termination of pregnancy.
One is induction of labor, usually by injecting toxic substances into the fetus with a needle passing through the woman's abdomen.
This method is no longer popular in the last 15 years as it requires the patient to give birth within a few days-
Usually alone, pain in the maternity ward--
Before she gave birth to a dead fetus.
Now it is more common for doctors to take out the fetus ---
About 9 inch in 20 weeks--
Surgical instruments are used when women are severely sedated or under anesthesia.
While actual surgery usually takes less than half an hour, it takes a few days to prepare the female reproductive system.
Specifically, put the small stick with high absorption material into the cervix.
When they pick up the liquid and expand, they slowly open the cervix until it is large enough for the doctor to insert the instrument.
However, the opening has never been as big as it was at the time of delivery, and it is not even big enough to allow half of the developing fetus to pass through.
Most abortion doctors avoid the problem by dismounting the fetus and cutting it into small enough pieces to cross the cervix.
This is clearly a fatal procedure, although in fact the fetus is often dead at the time of occurrence.
Doctors usually inject one or more toxic substances into the fetus the day before surgery, which softens the tissue and makes dismemberment easier.
This also eliminates the possibility of live production.
Alternatively, some doctors cut the cord 15 or 20 minutes before the operation, which will kill the fetus.
Several recent suppliers
However, different strategies are used for stage abortion.
They took out the fetus completely.
This requires less physical strength than dismemberment, and in general it may be less risky for patients, although this has not yet been demonstrated as there is no study to compare the complete method with the dismemberment method.
Practitioners of complete technology strive to open the cervix wider than usual, but it is never wide enough to hold the head of the fetus.
So the doctor put the foot of the fetus
First, until only the head is left in the uterus.
The doctor then made a hole in the bottom of the fetal skull and removed the brain and spinal fluid with a suction hose.
Since the bones of the skull have not yet fused to form a solid structure, the empty skull can flatten and pass through the cervix.
Usually, the fetus dies when the doctor does this "decompression.
"If not, the action will obviously kill it.
In the latter case, the exact moment and cause of fetal death are known-
Almost all other methods of terminating pregnancy are incorrect, which is one of the reasons why this method causes such a strong mood.
Fetal development stage 1 week sperm in the fallopian tube fertilization 2 weeks the egg enters the uterus and enters the endometrium 4 weeks the heart begins to shrink, early ventricular formation: most abnormalities start at this critical period of 8 weeks, almost all body organs begin to develop.
Now there are 12 weeks of ears on both sides of the head;
At 14 weeks, the fetal head has fine hair, and the eyes move from the head to the head;
The umbilical cord is attached to the abdomen;
The nails are well formed and the fetus can survive outside the uterus for 28 weeks;
Weigh about 3 lbs.
Picture Description: pregnancy usually lasts 38 weeks.
In the first 28 weeks, the embryo grew from a small group of cells to three-pound fetus.
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