Intact dilation and extraction
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Intact dilation and extraction is an abortion technique in which the patient's cervix is dilated and fetus extracted in substantially one piece. The term "dilation and extraction" or "D&X" was coined in 1992 by Dr. Martin Haskell, who developed the procedure as an alternative to dilation and evacuation or D&E (see below). Slightly later, the term "intact dilation and evacuation" was proposed by Dr. James McMahon. The term "intact D&X" was later settled upon by combining elements of both proposals.
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Circumstances in which the procedure is performed
Intact D&X procedures are extremely rare, carried out in roughly 0.2% (two-tenths of one percent) of all abortions in the USA. According to the Alan Guttmacher Institute there were 1,310,000 abortions (2000) which would put the figure of Intact D&X somewhere between 2500 and 3000. They are performed during the third trimester of pregnancy for various reasons, such as:
- The fetus is dead.
- The fetus is so malformed that it can never gain consciousness and will die shortly after birth.
- The fetus is alive, but continued pregnancy would place the woman's life in severe danger.
- The fetus is alive, but continued pregnancy would grievously damage the woman's physical health and/or disable her.
- The fetus is alive, but the woman wishes to end her pregnancy for mental health reasons.
Some of the fetuses which fall into this category have developed hydrocephalus, a treatable condition since 1952 that has made good progress in recent years. Approximately 1 in 2,000 fetuses develop hydrocephalus while in the womb; this is about 5,000 a year in the United States. The defect is not usually discovered until late in the second trimester of pregnancy. If a fetus develops hydrocephalus, the head may expand to a size of up to 250% of the radius of a normal newborn skull, making it impossible for it to pass through the cervix. In such a case, the physician may elect to perform an intact D&X procedure by draining off the fluid from the brain area, collapsing the fetal skull and withdrawing the dead fetus. A caesarian section delivery would allow the safe delivery of a hydrocephalic fetus, but with increased risks to the mother, in comparison to an intact D&X procedure. The risk to the viable, treatable, hydrocephalic fetus of intact D&X is essentially 100%.
In the 2 to 3 day procedure, the cervix is dilated. The fetus is delivered feet-first. The surgeon inserts a sharp object into the back of the fetus' head, and inserts a vacuum tube through which the brains and its fluids are extracted. The head of the fetus contracts at this point and allows the fetus to be more easily removed from the uterus. The fetus can then be removed with less damage to the woman. The technique was pioneered by Dr. Martin Haskell in 1992.
Intact D&X procedures are not performed during the first trimester, because there are better ways to perform abortions. There is no need to follow such a procedure because the fetus' head is quite small at this stage of gestation and can be quite easily removed from the woman's uterus.
Legal and political situation in the United States
About the terminology
This procedure is referred to as "partial-birth abortion" in the media and among pro-life groups. In the medical field intact dilation and extraction is sometimes referred to as a D&X procedure (not to be confused with D&E procedure (dilation and evacuation.)
Efforts to ban the procedure
Since 1995, led by Congressional Republicans, the United States House of Representatives and U.S. Senate have moved several times to pass measures banning the procedure. After several long and emotional debates on the issue, such measures passed twice by wide margins, but President Bill Clinton vetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Subsequent Congressional attempts at overriding the veto were unsuccessful.
On October 2, 2003, with a vote of 281-142, the House again approved a measure banning the procedure. Through this legislation, a doctor could face up to two years in prison and face civil lawsuits for performing such an abortion. A woman who undergoes the procedure cannot be prosecuted under the measure. On October 21, 2003, the United States Senate passed the same bill by a vote of 64-34. The measure does not contain health exemptions but does contain an exemption to save a woman's life. On November 5, 2003, President George W. Bush signed the Partial-Birth Abortion Ban Act (HR 760, S 3), which defined partial-birth abortions as:
- . . . [A]n abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.
Note that this definition of "partial-birth abortion" is not equivalent to "intact dilation & extraction," and covers a different range of procedures. The bill does not ban intact D&X when the fetus is already dead, making it clear that it is not a medical technique that is the issue, but the purposeful death of the partially born that is unacceptable, as it is only inches away from classic infanticide. This infanticide protection enhancement was also addressed in the Born-Alive Infants Protection Act which protects babies who are born as the results of botched abortions.
On November 6, through efforts of the American Civil Liberties Union and the National Abortion Federation, three United States district court judges issued temporary restraining orders against enforcement of the ban.
Legal and political situation in the United Kingdom
Questioned about UK government policy on the issue in Parliament, Baroness Andrews stated that "We are not aware of the procedure referred to as 'partial-birth abortion' being used in Great Britain. It is the Royal College of Obstetricians and Gynaecologist's (RCOG) belief that this method of abortion is never used as a primary or pro-active technique and is only ever likely to be performed in unforeseen circumstances in order to reduce maternal mortality or severe morbidity."
