Changes

[[File:Cranioclast.jpg|thumb|200px| Cranioclast: an instrument used to crush

[[File:Lilpba1.jpg|thumb|200px| Partial birth abortion: Grasping the fetal extremity]]

the baby's skull so as to allow the extraction.]]

'''Partial Birth Abortion''' is a late-term [[Abortion|abortive procedure]] in which all of a fetus (except for the head) is removed from the womb through the [[cervix]] (the same pathway through which birth occurs; hence the name), and is then killed. The official medical term is "intact dilation and extraction" abortion.  

'''Partial Birth Abortion''' is a late-term [[Abortion|abortive procedure]] in which all of a fetus (except for the head) is removed from the womb through the [[cervix]] (the same pathway through which birth occurs; hence the name), and is then killed. The official medical term is "intact dilation and extraction" abortion.  

==History==

==History==

In the immediate post-''Roe'' era, abortions past the midpoint in pregnancy were typically performed by [[saline abortion | instillation]], in which drugs or chemicals, alone or in combination, were used to cause fetal demise and induce labor. These abortions carried with them numerous drawbacks. They were risky for the mother, since the chemicals used to kill the fetus could severely injure or even kill the mother if they entered her bloodstream.<ref name="Wagatsuma1">Wagatsuma, T.: "Intraamniotic Injection of Saline for Therapeutic Abortion," ''American Journal of Obstetrics and Gynecology'', November 1, 1965</ref> They were also logistically challenging, requiring a typical multi-day hospital stay. Furthermore, they required a delay until about 16 weeks into the pregnancy, prior to which point there was not sufficient amniotic fluid for the practitioner to extract and replace.<ref name="Cates1">Cates, W. Jr., Schulz, K.F., Grimes D.A., et al: "The Effects of Delay and Method of Choice on the Risk of Abortion Morbidity," ''Family Planning Perspectives'', 9:266, 1977.</ref>

[[File:Lilpba2.jpg|thumb|200px| Partial birth abortion: Rotating the fetus into position for extraction]]

The dilation and evacuation (D&E) abortion technique had already been developing, "in part because surgeons needed a `right now' solution to complete suction abortions inadvertently started in the second trimester and in part to provide a means of early second trimester abortion to avoid necessary delays for instillation methods." As practitioners became more skilled and more confident, they performed D&E later and later in pregnancy, and this method began to eclipse the use of instillation methods.<ref name="Haskell">Haskell, M.: "Dilation and Extraction for Late Second Trimester Abortion," Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992</ref>

The dilation and evacuation (D&E) abortion technique had already been developing, "in part because surgeons needed a `right now' solution to complete suction abortions inadvertently started in the second trimester and in part to provide a means of early second trimester abortion to avoid necessary delays for instillation methods." As practitioners became more skilled and more confident, they performed D&E later and later in pregnancy, and this method began to eclipse the use of instillation methods.<ref name="Haskell">Haskell, M.: "Dilation and Extraction for Late Second Trimester Abortion," Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992</ref>

As one practitioner noted, "Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix."<ref name="Haskell"/> He also noted that at and beyond 20 weeks of gestation, most abortionists found the fetal tissues too tough to easily tear apart. Thus, methods were developed to kill the fetus in-utero a day or more prior to dismemberment, so as to allow autolysis or softening of the fetal tissues. This method, however, also carried a risk of infection.<ref name="Haskell"/>

As one practitioner noted, "Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix."<ref name="Haskell"/> He also noted that at and beyond 20 weeks of gestation, most abortionists found the fetal tissues too tough to easily tear apart. Thus, methods were developed to kill the fetus in-utero a day or more prior to dismemberment, so as to allow autolysis or softening of the fetal tissues. This method, however, also carried a risk of infection.<ref name="Haskell"/>

[[California]] [[abortionist]] [[James McMahon]] is credited with resolving the difficulty, around 1983, by developing what he called "intrauterine cranial decompression", involving extensive dilation of the cervix to extract the fetus feet-first, then kill it just before completing the delivery by removing the [[brain]] with a suction cannula.<ref>Tumulty, K.: "[http://www.time.com/time/nation/article/0,8599,1613078,00.html The Abortion Ruling: An Isolated Win?]" ''Time'', April 20, 2007</ref> [[Ohio]] abortionist [[Martin Haskell]] indicated that he stumbled across the method himself independently of McMahon:

[[California]] [[abortionist]] [[James McMahon]] is credited with resolving the difficulty, around 1983, by developing what he called "intrauterine cranial decompression", involving extensive dilation of the cervix to extract the fetus feet-first, then kill it just before completing the delivery by removing the [[brain]] with a suction cannula.<ref>Tumulty, K.: "[http://www.time.com/time/nation/article/0,8599,1613078,00.html The Abortion Ruling: An Isolated Win?]" ''Time'', April 20, 2007</ref> [[Ohio]] abortionist [[Martin Haskell]] indicated that he stumbled across the method himself independently of McMahon:

<nowiki>[D&E abortions up to 24 weeks]</nowiki> were very tough. Sometimes it was a 45-minute operation. I noticed that some of the later D&Es were very, very easy. So I asked myself why can't they all happen this way. You see the easy ones would have a foot length presentation, you'd reach up and grab the foot of the fetus, pull the fetus down and the head would hang up and then you would collapse the head and take it out. It was easy. At first, I would reach around trying to identify a lower extremity blindly with the tip of my instrument. I'd get it right about 30-50 percent of the time. Then I said, "Well gee, if I just put the ultrasound up there I could see it all and I wouldn't have to feel around for it." I did that and sure enough, I found it 99 percent of the time. Kind of serendipity.<ref>"http://www.nrlc.org/abortion/fetal_pain/Haskell%20Cincinnati%20Medicine.pdf", ''Cincinnati Medicine'', Fall 1993</ref>

<nowiki>[D&E abortions up to 24 weeks]</nowiki> were very tough. Sometimes it was a 45-minute operation. I noticed that some of the later D&Es were very, very easy. So I asked myself why can't they all happen this way. You see the easy ones would have a foot length presentation, you'd reach up and grab the foot of the fetus, pull the fetus down and the head would hang up and then you would collapse the head and take it out. It was easy. At first, I would reach around trying to identify a lower extremity blindly with the tip of my instrument. I'd get it right about 30-50 percent of the time. Then I said, "Well gee, if I just put the ultrasound up there I could see it all and I wouldn't have to feel around for it." I did that and sure enough, I found it 99 percent of the time. Kind of serendipity.<ref>"http://www.nrlc.org/abortion/fetal_pain/Haskell%20Cincinnati%20Medicine.pdf", ''Cincinnati Medicine'', Fall 1993</ref>

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The technique gained popularity after Haskell presented a paper about his refinement of the technique, which he was now calling dilation and extraction or D&X, at the 1992 [[National Abortion Federation]] (NAF) Risk Management Seminar in Dallas, Texas.<ref>[http://www.nrlc.org/abortion/pba/pbafact1.html Johnson, D.: "What is partial-birth abortion, and what is the Partial-Birth Abortion Ban Act (HR 1833)?", National Right to Life]</ref>

The technique gained popularity after Haskell presented a paper about his refinement of the technique, which he was now calling dilation and extraction or D&X, at the 1992 [[National Abortion Federation]] (NAF) Risk Management Seminar in Dallas, Texas.<ref>[http://www.nrlc.org/abortion/pba/pbafact1.html Johnson, D.: "What is partial-birth abortion, and what is the Partial-Birth Abortion Ban Act (HR 1833)?", National Right to Life]</ref>