Elena 
These are statements I made on the Stony Creek Digest blog that I want to save on my own blog for future reference.
Zach asks some good questions. I asked similar ones on my blog and not surprisingly , no one bothered to try and answer them. Perhaps I will have better luck here.
Some say that Cesarean sections are not a good choice in these type of life or death situations where only a partial birth abortion would suffice, because C-sections are more invasive and may interfere with the womans’ ability to have more children.
But if that is true, why are C-sections the one of the most commonly performed surgery in the United States? Why are some doctor’s even promoting the idea of women only have C-sections instead of vaginal birth under the umbrella of being “better” for the mother? And isn’t there also a risk with the D and X procedure in forcibly dilating the cervix? Isn’t there also the risk of infection, or harming the cervix and/or uterus with surgical instruments?
And if the D&E is so rarely performed anyway as many pro-abortion proponants have said, then wouldn’t the C-section be a safer option anyway since so many more physicians know how to do it and perform it hundreds of times a year?
I have heard some say that women will die if this procedure is unavailable. How many women died before this procedure was available? Do we know that these women would have been saved by a D&E instead? What are the statistics to prove that after the D&E procedure was developed and implemented that the maternal mortality improved?
If there are no guarantees, then how can all of these pro-abortion pronponants keep saying that the partial birth abortion (D&E) is lifesaving? Where is the guarantee that it absolutely will save the life of the mother each and every time it is used, especially when by their own statistics it is used so rarely that I wonder how anyone could have developed anywhere near the proficiency at it that average OB/GYN has with C-section! What about the associated risks of infection, damage to the cervix, uterus or other structures! The way they make it sound we have finally reached panacea folks- a risk free, infection free, blood-loss free procedure with no side effects, risks or potential complications!
I also don’t get this complete trust of the medical community where standard of care in just regular childbirth has been driven by fear of malpractice and compensation rates! Which brings me to another question, if the D&E is coded and reimbursed at a lesser rate than the Cesarean, I wonder how that will affect the recommendations of the doctors?
I am a woman, a mother, I have had three C-sections, three vaginal births and I deliverfed a stillborn son. I deeply care about women of course, but I also care about babies. I think C-section in most cases would be the best option, but in options where that is not possible, in a second trimester pregnancy I support delivering the baby via the D&X procedure, without deliberately puncturing the skull. Instead delivering the baby as outlined in the procedure including the head, and then wrapping the baby and giving it palliative care. I also support peri-natal hospice to support the parents as they say hello and goodbye to their babies and making memories of the brief time they have together.
And then this is an exchange with a pro-choice commenter.
(some women) have the problem that their blood pressure is skyrocketing…therefore inducing contractions or doing major abdominal surgery would be very risky for her stroking out.
I just had an RN quoting an OB on my blog who said that in conditions where it is crucial to get the baby out to prevent stroke, C-section is the fastest easiest way to go and the one that most OBs would choose.
However, generally in cases where the uterus is weak and the mother would like to try again to have a child, then D&X or PBA is used as there is less sharp instrumentation used inside the womb.
I’ve read conflicts on this too. The forcible dilation of the cervix can make damage the cervical integrity and make carrying to term in the next pregnancy more uncertain. In fact, the blogger over at Hyperemesis Gravidarum blames her abortion on her incompetent cervix and the problems she had in subsequent pregnancies.
Now, you might say – correctly – that the PBA bill would allow a woman to abort because her life is at risk. BUT remember that she’s already in the hospital. A stroke wouldn’t necessarily kill her. Her kidney’s were failing, but again…she’s in the hospital with access to dialysis. So would she die?
If you go into the archives, there was 24 hours or so between the time of diagnosis and delivery of the babies. That throws up a lot of red flags in my mind as to why something wasn’t done sooner. And also why a procedure that requires dilation instead of an immediate C-section wasn’t performed.
And of course, this bill stops NO abortions, just makes the doctor use a method that may not be the best choice for the few women that would other be given a PBA. And why? Because its “gruesome”. But what makes PBA more gruesome then D&E? D&E is the one where the child/fetus is literally ripped apart.
Which gives me even more questions as I listed above. Dilation isn’t risk free and since it isn’t performed that often why isn’t the more common C-section which most Obs are very proficient to perform considered the best option. It is of course, unless you are trying to prevent a live birth.
So that is why I’m horrified by this bill. No abortions stopped, legislators deciding that women aren’t allowed to have the safest procedure available,
I don’t think any one has established that it is the safest procedure available.
1. It still compromises the cervix.
2. Same risks of infection and injury
3. Requires more time to perform.
4. Fewer done so fewer OBs as proficient in performing them as the C-section.I don’t think it has been established that is is the “safest” by a long shot.
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1. It takes THREE DAYS to dilate the cervix enough to perform a D&X. What possible life-threatening complication could necessitate delaying the delivery for three days, when a c-section can have the baby out within the hour?
2. These PBAs are done as outpatient procedures in clinics, with the woman spending the vast majority of her time in a motel room, attended by her family or friends that she brought with her. What possible medical reason could there be to have her in such a setting rather than in a hospital?
3. The cranioclast (made to crush the fetal skull in cases of obstructed labor) had lay covered in dust in the medical museum for 50 plus years. Why are they revamping it now? Do they have 50 years of medical journal articles written by desperate obstetricians wondering why, alas, was the cranioclast discarded? I think not. Then why the drive to bring it back now?
4. The shoulders are the widest part of the baby anyway. What reason, other than achieving death, can there be for collapsing the skull once the shoulders are out?
(some women) have the problem that their blood pressure is skyrocketing…therefore inducing contractions or doing major abdominal surgery would be very risky for her stroking out.
I just had an RN quoting an OB on my blog who said that in conditions where it is crucial to get the baby out to prevent stroke, C-section is the fastest easiest way to go and the one that most OBs would choose.
I’m not sure if your response here is fully acknowledging the point the pro-choicer is trying to make. If a woman’s blood pressure is going through the roof the pregnancy may need to be ended quickly to save her life. A C section is the quickest way to end a pregnancy (I seem to recall Cecily writing about her doctor being able to get Tori out in about 45 seconds). But (and I think this is the point your opponent was trying to make) if your blood pressure is sky high then a C section is dangerous surgery that could kill you. If a pregnancy must be ended for the life of the mother and the fetus is not capable of surviving, why use a procedure that could greatly endanger the mother just because it is less gruesome to the doomed fetus?
Plumbob, do you get that you can’t just dilate the cervix open and take the baby in 45 seconds?
So here is the disconnect. This is a “life saving procedure” but it’s slower. Huh?
C-section is one of the most commonly performed surgeries in the country. most OB/GYNs are proficient at it. The D&E is “rare” even according to pro-abortion sources. But it’s safer? Even though most OB/GYNs have less experience with it? Huh?
Oh and I asked this but I haven’t ever gotten an answer to it. Since the PBA has been in place what are the stats on maternal deaths? Did they soar? the same? Decrease?
And that is the big battle cry at UCW – this is a “life saving procedure.” Where are the stats?
By the way, you might want to check out some of my archives. Try the Mothesloveyourbabies label for stories of babies who defied grim medical prognoses and lived!
I can’t understand why any woman would choose something like that when it takes three days to do it.
Yes, I understand that a D & E takes longer than a C section. How can it then be lifesaving? If you had appendicitis and needed an appendectomy quickly the fastest way would be for you to grab a steak knife from your kitchen drawer and cut it out yourself. But the best and safest option would be to get yourself to the hospital and let the doctors do it even though that would take longer.
Just because something needs to be done quickly that doesn’t mean that the fastest option is automatically the best when you consider all the risk factors.
And I’m puzzled where this whole three days thing came from. Cecily didn’t have to wait three days. Once they realised her son could not possibly be saved they did it right away.
Like you, I would be interested to hear the stats. But they are kind of besides the point for me. If there has been no significant increase in maternal deaths since the banning of intact D & E that doesn’t make someone like Cecily less alive because of it. It doesn’t mean that every single doctor that performed one didn’t decide, with all his or her best knowledge at the time, that it was the best possible procedure for the health and safety of the patient. I always want doctors to be able to make that educated choice for their patients because one day it could be me.
“Yes, I understand that a D & E takes longer than a C section. How can it then be lifesaving? If you had appendicitis and needed an appendectomy quickly the fastest way would be for you to grab a steak knife from your kitchen drawer and cut it out yourself. But the best and safest option would be to get yourself to the hospital and let the doctors do it even though that would take longer.”
Um…okay. I think that’s a bit of a strawman argument. We have a patient in the hospital with dangerously high blood pressure. We have a procedure that is rarely done and takes hours or days to accomplish vs. one that is done routinely and in minutes. So I’m just not seeing how this D&E is the big life saver it’s being billed to be.
I also want to see stats. Even Alan Guttmacher doesn’t have them and I’ve checked! How many women have died since this ban took affect last April. How many died before the development of this procedure. Where the heck are the controlled studies?
Just because something needs to be done quickly that doesn’t mean that the fastest option is automatically the best when you consider all the risk factors.
Well I am certainly open to looking at controlled studies that take into consideration the risk factors. Feel free to share.
And I’m puzzled where this whole three days thing came from. She didn’t have to wait three days. Once they realised her son could not possibly be saved they did it right away.
Nope. It was at least 24 hours. Go back read the archives.
Like you, I would be interested to hear the stats. But they are kind of besides the point for me. If there has been no significant increase in maternal deaths since the banning of intact D & E that doesn’t make someone less alive because of it.
But I think that’s the wrong question. The question is, would the more common cesarean section have been just as life saving and beneficial? And if the answer to that is yes, then there is really no reason to have the D&E unless it is to guarantee the demise of the infant.
It doesn’t mean that every single doctor that performed one didn’t decide, with all his or her best knowledge at the time, that it was the best possible procedure for the health and safety of the patient.
Well except even ACOG doesn’t say that and has never said that! I haven’t found a single statement from any professional organization that condoned this as the best possible procedure.
I always want doctors to be able to make that educated choice for their patients because one day it could be me.
Well me too. But one thing I have learned, when it comes to OB/GYN, a lot of stuff that happens to women in hospitals during childbirth and even pregnancy does not have any scientific or medical data to back it up!! I think this might fall into that category.
I checked Cecily’s archives, and while she was in the hospital longer than 24 hours, much of that time was trying to stabilise her and still maintain the fetus. They only stepped things up once she started going downhill quickly. There is no mention of a long wait for the D & E once they realised that’s what they needed to do.
I don’t think I was using a strawman. My point was that while the imperative might be to do something quickly that doesn’t make it the only consideration. It seems to me that in instances like Cecily’s the doctor decided that the risks associated with the wait for a D & E were less risky than the faster option of major surgery.
I don’t have any studies to link you to. And even if there exists data that shows that 95% of the time a C section is safer than a D & E I would still want my doctor to be able to sum up the situation and decide whether or not he felt I was one of the 5% that needed the D & E.
But I think that’s the wrong question. The question is, would the more common cesarean section have been just as life saving and beneficial? And if the answer to that is yes, then there is really no reason to have the D&E unless it is to guarantee the demise of the infant.
Well, yes if saving the mother’s life is the only consideration (which it is of course the most important) and a C section was shown to be just as safe then it might be an argument that D&Es aren’t necessary. But what about the mother’s choice to avoid damage to her uterus that could impede her ability to have more children?
Anyhoo, I might duck out of this debate. I’m not going to change your mind and I’m sure you don’t appreciate me trying.
I guess the point I was trying to make is that pregnancies can turn dangerous and if it were me I would want the only opinions that matter to be mine, the father’s, and my doctor’s.
I checked archives, and while she was in the hospital longer than 24 hours, much of that time was trying to stabilise her and still maintain the fetus. They only stepped things up once she started going downhill quickly. There is no mention of a long wait for the D & E once they realised that’s what they needed to do.
But there is mention of an epidural. An emergency “we’ve got to do this NOW” type of medical emergency does not wait for an epidural. If there was time for that, there was time for a C-section.
I don’t think I was using a strawman. My point was that while the imperative might be to do something quickly that doesn’t make it the only consideration.
The two big selling points on that blog seem to be 1. quick and 2. safe. I still haven’t seen compelling evidence that the D&E or D&X has either of those advantages over the C-section.
It seems to me that in instances like her doctor decided that the risks associated with the wait for a D & E were less risky than the faster option of major surgery.
Well for the sake of argument, let’s say that is true. Then what was to prevent him from removing the 20-22 week infant intact and giving it palliative care until natural death. Even in that scenario the mom still “benefits” from the “preferred” treatment of her provider and gets the additional benefits of being able to say “hello/goodbye.” And if you read the archives you’ll find that having remains to bury was somewhat of an issue as well. I’m not anti woman Bob – far from it, but I’d like to see some consideration for the other human patient in this equation. As it stands I still have a lot more questions than answers.
I don’t have any studies to link you to. And even if there exists data that shows that 95% of the time a C section is safer than a D & E I would still want my doctor to be able to sum up the situation and decide whether or not he felt I was one of the 5% that needed the D & E.
I want the doctor to do the standard of care and something that he has done routinely. Guess what that’s gonna be?
But what about the mother’s choice to avoid damage to her uterus that could impede her ability to have more children?
Then by all means go with the C-section! (I’ve had 3) A clean straight surgical incision as opposed to instruments blindly probing into the dark uterus!
Hey I don’t mind discussion and debate Bob. Not at all. I’m just looking for some compelling reason that this Partial Birth Abortion Ban was so “bad” for women. The ban went into effect last April. Surely there should be some information out by now of whether this was indeed the huge hit to women’s health that some are saying that it is!
“And lest someone dare try it, Cecily and her supporters are never going to change their opinion about the advisability of the procedure in her case because it is a medical, scientific fact that it was what she needed.”
So much for letting the facts lead the discussion… I know you’re reading Slim, albeit not very carefully. I for one totally agree that delivery was the only option here. I am questioning the medical and scientific reasoning and studies that the procedure performed was the only or even the best standard of care. That’s really it.