Last week, a friend sent me an article bearing the headline They Are Real: Meet Born-Alive Abortion Survivors. Could I maybe blog about it, she asked? This article led me down to a rabbit hole with numbers that kept getting bigger. When I reached an article that argued that there are 44,000 abortion survivors living in the U.S. today, I knew we had a definitional problem. What is really going on here?

The article my friend sent me profiled five individuals it labeled “abortion survivors.” These individuals are real people. The first one profiled Gianna Jesson, whose mother had a saline abortion at 30 weeks in 1977, and Gianna survived. When she was born alive, she was provided with care and given up for adoption. Melissa Ohden’s biological mother had a saline abortion at 31 weeks in 1977; she, too, survived and was provided care.

The other three individuals profiled had a bit of a different story. They were each born to mothers who had attempted abortions earlier in their pregnancies; in each case, the abortion failed to terminate the pregnancy. (I suspect that these individuals are not what most people mean when they hear of “born-alive abortions survivors.”)

Abortions like those Gianna and Melissa survived are not practiced today. Abortions past the point of viability are expensive and difficult to obtain, and are typically only offered in case of severe fetal abnormality, or other severe cases. Their mothers would be unlikely to access abortions at 30 weeks today. For another thing, saline abortions were deemed unsafe; popular in the 1970s, this procedure has fallen into obscurity.

Before I go deeper in, a few things are worth noting.

First, abortion procedures have changed over the past five decades.

We need to be careful about assuming, based on a story from the 1970s or 1990s, that a procedure would take place again today as described. Many of the horror stories thrown around are decades old, and do not necessarily reflect practices in the present.

Second, pay attention to what numbers are actually counting.

Abortion opponents have long declared that hundreds of babies have survived abortions in Canada, only to be left to die. They base this claim on a specific mortality code: P96.4, Termination of Pregnancy. The problem? This mortality code includes miscarriages where a premature infant is born alive and does not survive.

Third, “born alive” does not mean viable.

Comfort care is sometimes the best (or only) option for a severely premature infant (regardless of the reason for its preterm birth). There are many cases where a woman delivers too early for an infant to have high chances of survival, and chooses to offer only comfort care, holding the infant while it passes. We consider this acceptable care.

Fourth, killing an infant born alive is considered murder.

Under a law passed in 2002, infants born alive are legally persons regardless of their developmental level. By law, they must be afforded the same rights and care as any other infant born alive. This is why infamous illegal abortion doctor Kermit Gosnell was able to be convicted of the murder of three infants.

Fifth, abortion procedures are designed to ensure fetal demise.

The International Federation of Gynecologists and Obstetricians recommends the administration of a feticide for any abortion past 22 weeks to prevent live birth. After this point, doctors frequently begin abortion procedures by administering an injection directly into the heart to stop the fetal heartbeat.

Abortions that occur later in pregnancy are not an easy thing to talk about; that may be why abortion opponents would rather talk about it than about their efforts to close abortion clinics and end women’s access to first trimester abortions. Abortions after the 20th week of pregnancy tend to be performed due to severe fetal abnormality. In many cases, the fetus is not compatible with life.

According to data from the CDC, there were an average of 12 fatalities of infants born alive during an abortion procedure each year between 2003 and 2014. In the UK, an average of 10 infants born alive during an abortion died each year between 1995 and 2004; that number was higher at the beginning of the period and lower at the end, as procedures and guidelines changed.

What is going on here? High resolution ultrasounds designed to identify fetal abnormalities are conducted at 18-20 weeks of pregnancy. As a result, abortions due to fetal abnormalities typically occur around 20-24 weeks. At 20 weeks, a fetus has 0% chance of survival out of the womb. At 24 weeks, a fetus has a 40-70% chance of survival out of the womb. The most common abortion procedure used at this gestation is surgical—in these cases, there is no chance of fetal survival. In other cases, though, a different procedure is used: induction of labor.

Induction of labor is exactly what it sounds like—medication is used to induce premature labor, expelling the fetus. In most cases fetal demise will occur in the process of delivery. When using this procedure at and after 22 weeks of gestation, it is routine to inject a feticide into the heart of the fetus, through the mother’s stomach, before inducing labor (this recommendation did not exist in the 1970s). Some women aborting due to severe fetal abnormality opt not to have the feticide, preferring to hold their infant while she dies. Sometimes, too, fetuses younger than 22 weeks are born alive, but with no chance of survival. These infants are provided with comfort care.

In the UK, infants born alive in the process of an abortion varied between 17 and 33 weeks in gestational age, and had a mean gestational age of 21 weeks (i.e. half were born at less than 21 weeks, and half at more). While data on these infants’ gestational age in Canada does not disaggregate between infants born alive as the result of miscarriages and those born alive as the result of abortions, only 5% of overall fatalities among infants born alive as the result of termination of pregnancy (whether abortion or miscarriage) occurred after 24 weeks (which has a 40-70% chance of survival); a full 20% occurred at week 20 (which has a 0% chance of survival) or before.

Sometimes doctors do not follow the law. Sycloria Williams was 23 weeks pregnant when she went to a clinic for an abortion procedure in 2006. She was given pills to induce pregnancy. A feticide was not administered. The doctor did not show up. Williams went into premature labor and delivered an infant. According to Williams, the baby was breathing and moving. At 23 weeks, her infant had a 10-35% chance of survival. The attendant, who did not have a medical license, put the baby in a sealed biohazard bag and put her in the trash can. No medical care was given to Williams, who had just given birth. The doctor arrived an hour later. He was investigated and he lost his license.

What happened in Williams’ case should not have happened. For starters, the doctor should have actually been present. For another thing, if the procedure was an induction of labor, a feticide should have been administered first. And finally, if the procedure resulted in an infant born alive, that infant should have been provided care.

Here things get dicey—what care? Comfort care? Or more aggressive interventions? Remember, most infants born alive in such circumstances are far younger than Williams’ was at 23 weeks. An infant born alive at 21 weeks, regardless of circumstances, is not viable. Providing interventions to an infant that is not viable can be cruel.

One solution is to opt out of this question altogether—this is where the feticide comes in. In the UK, after guidelines changed to make feticide more standard in cases of abortion at or after 22 weeks, the number of infants born alive dropped. U.S. guidelines now also recommend feticide at or after 22 weeks.

There’s another thing to consider—if women had better access to abortion, they would be less at the mercy of hatchet doctors like the one Williams visited, or Kermit Gosnell. If you could go to your doctor for an abortion like you might for an IUD insertion—and if women had more widespread access to affordable, high quality health insurance that covered these procedures—the Kermit Gosnells would be out of business. If you could go to your doctor for the procedure, you’d also likely be in a better clinic—maybe even a hospital—if something went awry.

But no. Largely as a result of the anti-abortion movement, abortion has been widely confined to separate clinics.

In the past few months, abortion opponents have honed in on what care should be provided for infants born alive in the process of an abortion, but it is important to remember that is not where their concern ends. To see this in action, when you next speak with an abortion opponent concerned about infants born alive during the procedure, try suggesting a law mandating that doctors who perform induction of labor procedures after 20 weeks of gestation ensure that fetal demise has taken place (i.e. via feticide) before inducing labor, with sanctions for failure to do so.

I am not suggesting such a law, because I am not a medical provider with expertise in this area and because hamstringing doctors with rules written by lawmakers can create unforeseen side effects. Still, such a bill would address concerns about infants born alive during the process of an abortion just as effectively as other legislation being thrown about, if not more so. And yet no abortion opponent is going to see that as a solution, because they view abortion itself as murder.

And here we are. If you’re just after basic facts, you’ve got some now. With the rest of this article, I’m going to delve more deeply into the numbers, tracing my own journey as I hunted down statistics and compiled articles. Feel free to join me!

All About Those Numbers

Remember that 44,000 number I referenced briefly? That number came from Christina Dunigan, an anti-abortion blogger who argued that there were 44,000 abortion survivors living in the U.S. today. We’re going to examine that number first because it offers a helpful lead-in before going too deeply into the issues.

The article my friend sent me profiled five individuals: two were born alive in 1977 in the process of botched abortions around 30 weeks of pregnancy, but the other three were born later to women who had earlier had abortions that had failed to end their pregnancies. Dunigan’s claims fit into these same two categories.

From Dunigan’s post:

Research indicates that between about 850 and 1,800 unborn children survive first-trimester abortion attempts in the US every year. We don’t have numbers on what percent of women change their minds about wanting their babies to die and continue their pregnancies…. I’ll just aim for the middle and say that half of those children get to be born alive. That’s about 1,325 survivors of early abortions every year, about 662 of whom are permitted to live to be born. That’s 25,000 (rounded down) since Roe.

Yes, some first-trimester abortions fail. Up to 5% of medication (pill) abortions fail to complete, while fewer than 1% of surgical abortions fail to complete. Given the rising number of women using medication abortions, Dunigan’s numbers on the number of failed first trimester abortions are likely low. However, Dunigan’s guess that 50% of women whose first trimester abortion fails to end their pregnancy change their mind is almost certainly way off.

Women who have abortions are expected to come in for a followup two weeks after the procedure to verify that their abortion completed. If they are still pregnant, these women are offered a second procedure, typically at no additional charge, to complete the abortion. This is understood as routine. Women who have medication abortions especially are informed from the outset that they may have to have a surgical abortion as a followup.

Everything I’ve read indicates that a first-trimester abortion that fails to complete is almost universally followed by a second procedure. Yes, some women may decide to go through with their pregnancy after a failed pregnancy, but that number is nowhere near 50%. Women who do decide to continue their pregnancies may face complications with their pregnancy or fetus. Some infants will be born with deformities; others may be normal.

Are there some people whose mothers had a failed first trimester abortion and decided not to have a followup procedure? Certainly. There are also some people out there whose mothers were turned away from abortion clinics because they waited too long, and people out there whose mothers considered abortion and decided against it. None of these individuals are typically what people think of when they hear of “born alive abortion survivors.”

What about the second part of Dunigan’s 44,000 number? This is the category Gianna Jesson and Melissa Ohden are in. It’s what people typically mean when they reference “born alive abortion survivors.”

Dunigan writes as follows:

Based on the only report we ever got out of the Centers for Disease Control on the subject, abortionists reported about 500 babies surviving later abortion attempts every year. Times 38 years of abortion on demand, that’s 19,000.

I was unable to find anything from the CDC saying that 500 babies survive later abortion attempts each year. This does not appear to be an actual statistic. (I did find other numbers from the CDC, which we’ll get to later.) Dunigan may have misunderstood, interpreting a number that covered a decade more more as an annual sum, and using a statistic that includes infants who are born alive during miscarries and do not survive.

Even if Dunigan’s claim were correct, it’s odd that she would assume these 500 infants would all survive. First, as we know, infants who are born alive in the course of an abortion are typically too premature to survive, and often suffer from fetal defects that make their survival only less likely. Second, though, if the anti-abortion movement is concerned with these infants allegedly being killed, it’s odd that Dunigan would assume they all survive.

I reference Dunigan in part to show you how wild these claims can get, and in part because I found a surprisingly large number of pro-life sites that took her seriously in the course of my research.

At this point, we are going to part ways with Dunigan.

What Is “Termination of Pregnancy”?

Many abortion opponents both in the U.S. and in Canada who have raised concern about infants born alive during an abortion procedure point to a specific mortality classification: Termination of Pregnancy [P96.4]. But here’s the problem: according to the CDC, “this category includes spontaneous terminations of pregnancy and induced terminations of pregnancy.” P96.4, in other words, includes miscarriages that involve live births. Many abortion opponents tout the CDC’s P96.4 category without understanding that this category also includes miscarriages. (You can see an article to this effect from the conservative American Center for Law and Justice here.)

In response to a Congressional inquiry regarding which P96.4 fatalities involve induced abortion, following the discovery of Kermit Gosnell’s horrific illegal abortion clinic, the CDC published a report identifying which P96.4 fatalities were the result of induced abortions. The CDC data showed 588 deaths classified as P96.4 from 2003 to 2014; of these, the CDC was able to identify just under a quarter as involving an induced abortion.

The CDC explained as follows:

Analysis of the text as reported by the cause-of-death certifier show that of 588 deaths [from 2003-2014] with mention of P96.4, 143 (24.3%) could definitively be classified as involving an induced termination.

The report lists 143 deaths among infants born alive after an abortion procedure over the course of 12 years. The report included this breakdown regarding how long these infants lived before they died:

Age at death Frequency Percent <10 minutes 25 17.5 10-59 minutes 35 24.5 1-4 hours 68 47.6 5-23 hours 9 6.3 1 day or more 6 4.2

The chart above is not evidence of foul play.

First, the report did not state how many weeks along these infants were, which would help tell us whether they were actually viable. Next, the report did not state what care these infants were offered, and whether these infants were offered interventions beyond comfort care—although we can assume, I think, that the six infants who survived more than a day received more than comfort care. Finally, the report also did not state how many infants born alive after an induced termination may have survived (P96.4 only includes fatalities).

A data request for cases listed with the P96.4 fatality code in Canada resulted in this breakdown (remember that this includes deaths among infants born alive as the result of both miscarriages and induced abortions):

Gestational age Percent 13-16 0% 17-20 19% 21-24 76% 25-28 4% 29 + 1%

An infant being born alive after an abortion is not necessarily a sign that something went wrong. Why? Because some women who abort due to severe fetal abnormality want to hold their child while he passes.

The death of an infant born alive during an abortion procedure is also not necessarily evidence of infanticide. Why? Have a look at the numbers in the chart above. The 19% born in weeks 17-20 would not been non-viable. While the numbers do not break down the 76% that were born between week 21 (0% chance of survival) and week 24 (40-70% chance of survival), we can theorize that the breakdown is heavily loaded at the beginning, given that similar data in the UK found that the mean age was 21 weeks. This means that most of these infants were not viable due to prematurity alone. The 5% at or after 25 weeks were very likely to have fetal defects, making survival less likely.

One anti-abortion writer says this of the CDC’s 143 recorded born alive abortion-related fatalities:

That is to say, at least 143 infants died after they were born alive following abortion, whether due to injuries sustained as a result of the abortion attempt, due to active neglect or denial of care of injured or preterm infants or some combination of both.

Do you see what’s missing? He writes that these babies died either “due to injuries” sustained during the abortion attempt or “due to active neglect or denial of care.” This is balderdash. If the breakdown of these cases is anything like those in Canada or the UK (which we’ll look at in a moment), the vast majority of these cases had not reached the point of viability. Further, most abortions performed after 20 weeks are due to fetal abnormalities, which in some cases may themselves render the infant incompatible with life.

When abortion opponents talk about infants born alive during an abortion procedure, they tend to focus on cases like Kermit Gosnell, who ran a “house of horrors” illegal abortion clinic. Conditions at Gosnell’s clinic were unsanitary. Women died, or suffered horrendous complications. When infants were born alive in his clinic, Gosnell snipped their spinal cords. Gosnell was sentenced to life in prison, and he deserves everything he got.

But this is the important part: Gosnell was convicted of the murder of three infants, under existing law. What he did was illegal. It is against the law to kill infants born alive in the process of an abortion procedure. That is murder. He got caught, he got charged, and he got put away. The system ultimately worked.

It is a horrendous mistake to assume that all 143 abortion-related P96.4 deaths reported to the CDC were like those of the infants at Gosnell’s clinic. We are talking about infants born extremely prematurely. Consider this: between 2003 and 2014, there were 445 infant deaths due to miscarriage. These were infants that were also born alive, and also then died. Why? Because they were born prematurely; not because of foul play. There is every reason to assume the same of the 143 CDC recorded abortion-related born-alive infant fatalities from 2003-2014.

Let’s turn, for a moment, to a 2007 study from the UK. This study examined all “terminations of pregnancy for fetal anomaly (TOPFAs)” in a database of pregnancies with congenital anomalies. Of the 3,189 TOPFAs identified between 1995 and 2004, there were 102 cases of live birth. Researchers found as follows:

Of the 102 live births [recorded between 1995 and 2004], the gestation ranged from 17 to 33 with a median of 21 weeks. The survival duration for liveborn TOPFAs was a median of 80 minutes. Thirty‐seven cases survived for 1 hour or less and six cases survived 6 hours or more. The proportions of live births at different gestations were 14.7% between 16 and 20 weeks; 65.7% between 20 and 24; and 19.6% at or after 24 weeks.

The chance of survival of an infant born alive at 21 weeks is 0%. These chances go up slightly each week, reaching a 40-70% chance of survival at 24 weeks and a 90% chance of survival at 27 weeks. And remember—abortions performed during these weeks frequently involve fetal abnormalities that make chances of survival even lower.

When an infant is born prematurely (or with abnormalities that make her incompatible with life), parents typically choose whether to give her comfort care while she passes or whether to offer more aggressive interventions. Under current law, infants born alive during abortion procedures are to be afforded the same care.

The Born Alive Infants Protection Act of 2002

Let’s take some time to look at the Born Alive Infants Protection Act, passed in 2002, and Jill Stanek. I’ll give you Stanek in her own words, from testimony before Congress during the debate over the bill. Quick warning—this gets a bit graphic. If you’d rather skip the quotes here and read my summaries, feel free to do so.

Stanek’s testimony began as follows:

I am a Registered Nurse who has worked in the Labor & Delivery Department at Christ Hospital in Oak Lawn, Illinois, for the past five years. Christ Hospital performs abortions on women in their second or even third trimesters of pregnancy. Sometimes the babies being aborted are healthy, and sometimes they are not. The method of abortion that Christ Hospital uses is called “induced labor abortion,” also now known as “live birth abortion.” This type of abortion can be performed different ways, but the goal always is to cause a pregnant woman’s cervix to open so that she will deliver a premature baby who dies during the birth process or soon afterward. The way that induced abortion is most often executed at my hospital is by the physician inserting a medication called Cytotec into the birth canal close to the cervix. Cytotec irritates the cervix and stimulates it to open. When this occurs, the small, preterm baby drops out of the uterus, oftentimes alive. It is not uncommon for one of these live aborted babies to linger for an hour or two or even longer. One of them once lived for almost eight hours. In the event that a baby is aborted alive, he or she receives no medical assessments or care but is only given what my hospital calls “comfort care.” “Comfort care” is defined as keeping the baby warm in a blanket until he or she dies, although even this minimal compassion is not always provided. It is not required that these babies be held during their short lives. One night, a nursing co-worker was taking an aborted Down’s Syndrome baby who was born alive to our Soiled Utility Room because his parents did not want to hold him, and she did not have time to hold him. I could not bear the thought of this suffering child dying alone in a Soiled Utility Room, so I cradled and rocked him for the 45 minutes that he lived. He was 21 to 22 weeks old, weighed about ½ pound, and was about 10 inches long. He was too weak to move very much, expending any energy he had trying to breathe. Toward the end he was so quiet that I couldn’t tell if he was still alive unless I held him up to the light to see if his heart was still beating through his chest wall. After he was pronounced dead, we folded his little arms across his chest, wrapped him in a tiny shroud, and carried him to the hospital morgue where all of our dead patients are taken.

In the late 1990s, Stanek was a nurse in the labor and delivery ward at Christ Hospital in Oak Lawn, Illinois. While she did not participate in the abortions that were performed there, she heard stories from nurses who did. The procedure typically used was called an “induced labor abortion” or a “live birth abortion”: drugs are used to induce labor, and the pregnant woman gives birth prematurely. According to a Christ Hospital spokesperson, “between 10 percent and 20 percent of fetuses with genetic defects that are aborted survive for short periods outside the womb.”

When an infant was born alive during an induced labor abortion, Stanek reported, that infant would be provided comfort care. Stanek went public with concerns about what she had seen at Christ Hospital for two reasons: First, she did not feel that the comfort care provided was adequate. (She spoke of a time when she came upon a nurse on her way to leave a premature infant in a utility room to die because she did not have time to hold it and the parents did not want to; Stanek held it so it would not die alone.) Second, Stanek argued that the induced labor procedure was used in cases where it should not have been, such as for non-fatal abnormalities like Down syndrome.

A description of Stanek’s criticism of Christ Hospital’s procedures, as well as similar criticism from other nurses, is included in a Congressional report on the Born Alive Infants Protection Act, which was passed in 2002:

According to medical experts, this procedure [“induced labor” or “live-birth” abortions] is appropriately used only in situations in which an unborn child has a fatal deformity, such as anencephaly or lack of a brain, and infants with such conditions who are born alive are given comfort care (including warmth and nutrition) until they die, which, because of the fatal deformity, is typically within a day or two of birth. According to the testimony of Mrs. Stanek and Mrs. Baker, however, physicians at Christ Hospital have used the procedure to abort healthy infants and infants with non-fatal deformities such as spina bifida and Down Syndrome. Many of these babies have lived for hours after birth, with no efforts made to determine if any of them could have survived with appropriate medical assistance. The nurses have also witnessed hospital staff taking many of these live-born babies into a ‘‘soiled utility closet’’ where the babies would remain until death. Comfort care, the nurses say, was only provided sporadically.

The Born Alive Infants Protection Act definitively stated that any fetus that was expelled from its mother and showed signs of life, regardless of its developmental stage, was a person. This is why Kermit Gosnell could be tried for murder. Infants born alive as the result of an abortion have the same rights as any other infant born alive.

The Use of Feticide in Later Abortions

If you’ve read the wrenching stories of women who had late term abortions that have proliferated in the past few months, you may have noticed a common theme—before inducing labor, their doctors gave them an injection that stopped the fetal heartbeat. In fact, if you’ve read enough of these stories, you may have been scratching your head in confusion when reading Stanek’s testimony. There’s a good reason for that.

In June 2007, the International Federation of Gynecology and Obstetrics’ Committee for the Ethical Aspects of Human Reproduction and Women’s Health released a report titled Ethical Aspects Concerning Termination of Pregnancy Following Prenatal Diagnosis. Translated into plain English, this was a report from the International Federation of Gynecology and Obstetrics that made recommendations on ethical issues surrounding abortions performed due to fetal abnormality. Feel free to read the whole thing.

The report included this recommendation:

Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide starting with the injection into the fetal circulation of anesthetics and anti-pain medication.

This recommendation was made in 2007. It may not have been in practice at Christ Hospital when Stanek worked there: the hospital may have been simply inducing labor, and not administering feticide. And that may be why, as a Christ Hospital spokesperson stated, “between 10 percent and 20 percent of fetuses with genetic defects that are aborted survive for short periods outside the womb.” That’s a really high number!

On this pregnancy forum thread, women who had late term abortions discuss whether or not they were offered feticide beforehand. Several state that their doctors did not think it necessary, because their fetuses had such severe abnormalities they were unlikely to survive the birthing process.

Another quick look at the TOPFA study from the UK is of interest:

Within our study 3.2% of TOPFAs result in a live birth. The proportion has reduced significantly over the period of this study from 4.0% in 1995 to 1.7% in 2004. In particular, those of 22–23 weeks gestation have reduced significantly over the period of this study from 6.5% in 1995 to 3.0% in 2004. This is likely to be due to the impact of guidelines issued [in 1998] by the RCOG [Royal College of Obstetricians and Gynecologists], that feticide should be offered to ensure that live birth does not occur following TOPFA after 22 weeks. Our data show a significant chance of live birth at 20 and 21 weeks, which we have quantified as being 3.5% and 5.4%, respectively. The RCOG guidelines do not recommend feticide at these gestations.

In 1998, the Royal College of Obstetricians and Gynecologists changed their recommendations to state that feticide should be offered in all TOPFAs (termination software pregnancy for fetal abnormality) performed at or after 22 weeks. As a result, the rate of TOPFAs that resulted in live births fell from 4.0% to 1.7%. The researchers further recommend extending that guideline to 21 weeks for cases where fetal abnormalities are less imminently lethal.

We can have a conversation about what renders an abnormality severe enough to indicate abortion. I am myself uncomfortable with the rate of abortions due to indication of Down syndrome. But I also think that we need to have other conversations—are we as a society doing enough to support families that raise children with disabilities? What standards should be set for when doctors encourage termination, and when they should not? Do doctors offer women pregnant with a fetus with trisomy 21 contact info for local support groups, before they decide?

I want to bracket that conversation here, though, because that is not the topic of this post. Instead, I want to focus more specifically on the topic at hand: over time, abortion procedures have been adjusted to ensure that an abortion will not result in an infant being born alive. Indeed, the UK-based Nuffield Council on Bioethics’ report on critical care decisions in fetal and neonatal medicine: ethical issues contains the following:

The Abortion Act 1967 only permits termination of pregnancy after 24 weeks if a fetus is at “substantial risk of serious handicap or there is a risk of grave permanent injury to the woman”. For terminations at 22 weeks or later, feticide (ending the life of the fetus, usually by lethal injection into the heart) is usually carried out to ensure that a baby is not born alive. When a woman does not want feticide, some doctors may have concerns because they believe that they are legally obliged to try to save a baby who shows signs of life when born. However, there is no legal obligation to prolong the life of a baby when they have no hope of survival or they will suffer more than benefit from the treatment. What is done should be appropriate to the baby’s condition. The Council recommended that healthcare teams develop codes of practice that make clear what the law does and does not require doctors to do, and that pregnant women be given information about “possible outcomes if a baby is born alive following termination on grounds of fetal abnormality.” This seems completely reasonable.

What Is a Live Birth?

I want to take a moment to quote from a blog post published last week by Dr. Jen Gunter, an OB/GYN who has performed abortions. I’m an OB/GYN and infanticide is not part of abortion care, Gunter wrote.

Gunter discusses what a “live birth” means:

This is the definition that most states use for live birth: ‘‘Live Birth’’ means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. The key part is the last sentence: Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. Movement or cardiac activity does not equate life, by the medical and the legal definitions. Whether a birth is recorded as “live” in situations of extreme prematurity or fetal anomalies — the kind of situations we are talking about — is not cut and dried. For example, when my son Aidan [one of three triplets] was born at 22 1/2 weeks I was asked if I wanted his birth to be considered a live birth? It was my choice. I had no idea? I mean he lived 3 minutes or so, but he could never live a life. What a live birth got me was a birth certificate. I said yes, but in retrospect I wished I hadn’t. A live birth meant he was now a hospital patient and so I was charged $600 for the care he received — a blanket and a nurse holding him. Why was I charged? As he lived 3 minutes I obviously didn’t apply for health insurance. With no insurer to bill, I was charged for his post delivery care as if he were a term infant in the hospital for less than 24 hours. Nice, huh? It was super special fighting that bill with collections when my other two boys [born at 26 weeks] were in the neonatal intensive care unit struggling to not die. So awesome the forced birth advocates are involved in helping women like me when we are literally penalized for having a live birth. (Heavy sarcasm). The take away — a live birth does not mean a life is possible. There is a huge difference. And, the recording of a live birth can be fluid based on parental wishes.

What counts as a “live birth”? Of the 143 CDC-reported fatalities among live births after an induced abortion, 25 lived less than 10 minutes. So, too, there’s the issue of viability—an infant can be alive, but not be viable.

Gunter writes as follows:

Most Abortions Can’t Possibly End in a Live Birth Because They are Abortions I can’t believe I have to spell this out either. I mean, really? [A]bortions at or after 23-24 weeks—the only theoretically possible “live birth scenario”— are done by two methods: surgical or induction of labor. A surgical abortion does not in any situation result in a live birth. It’s not possible. The end. So that leaves induction of labor. Again, these are almost always severe fetal anomalies, so the live birth scenario is preposterous and, quite frankly, offensive to those patients who are living the tragedy. Many patients have a procedure to stop fetal cardiac activity before the induction, so fetal demise has already occurred. Some providers think this may shorten the time it takes for induction. And some patients prefer it. Often there is fetal demise during labor, because that is what happens with severe fetal anomalies. In the rare scenario where there is a live birth, parents hold their baby for comfort care.

Abortion opponents point to rare cases where these guidelines aren’t followed, like Williams’ case. But that case was plagued by malpractice. The abortion doctor failed to show up and was not even present. Reading between the lines, it sounds like a surgical abortion was intended, but after Williams took medication to soften her cervix, the doctor was not there, so she sat there until she went into labor. Wrong, wrong, wrong. The doctor lost his license.

Gunter also discusses Gosnell, and then notes:

Legal, available, affordable abortion prevents back alley and clandestine procedures. If you want to prevent infanticide from predators, stop writing laws that restrict abortion. It’s that simple.

Conclusion

While abortion doctors estimate that the vast majority of abortions after 20 weeks are performed in cases of fetal abnormality, abortion opponents disagree with this claim. One anti-abortion article I saw linked to a study of women who have had abortions that included a number of women who had abortions between 20 and 24 weeks due to not knowing they were pregnant earlier, or having difficulty access abortion care earlier.

The alter abortions are performed, the more they cost and the greater the associated health risk. To the extent that women are having abortions past 20 weeks for reasons other than fetal abnormality, we need to look at reasons that delay these women from seeking abortion earlier and work to remedy them. We need better sex education, to help ensure that women will recognize when they are pregnant. We need better access to medical care, so that women have a doctor and the ability to book an appointment if they have questions about their health. And, of course, we need better access to abortion care, so that women aren’t required to drive hours away from home.

Those eager to disentangle later abortions from fetal abnormalities (in an attempt to turn public opinion against later abortions) oppose the very things that would decrease the number of later abortions performed for reasons other than fetal abnormality. This means that there is a serious level of disingenuousness at play.

In 2013, after Kermit Gosnell’s house of horrors was discovered, the House Judiciary Committee asked each state’s attorney general whether “prosecutors in your state treat the deliberate killing of newborns, including those newborns who were delivered alive in the process of abortions, as a criminal offense.” Attorney generals across the country responded that they would, and submitted reports. No widespread problems were revealed.

As I reflect on all of this, it seems to me that the central contention—beyond disagreement over numbers—is what care should be provided in cases where an infant is born alive during an induction of labor abortion. If current guidelines are followed, cases that occur at or after 22 weeks of gestation involve the administration of a feticide before inducing labor. These infants should not be born alive. Infants younger than this may be born alive, in rare cases, but they are not viable—babies born at 21 weeks of gestation or earlier cannot survive.

Administering aggressive interventions to a nonviable infant is cruel. What an infant in these circumstances needs is to be kept warm and held until she passes. I’m reminded of the death of one of my great-grandmothers. When the paramedics arrived after she had already passed, they wanted to restart her heart. My mother disagreed. My great-grandmother was gone. We didn’t need more trauma—and her body didn’t either. The same is true here.

That said, any infant born alive during the course of an abortion should be assessed to determine whether it is viable, and if it is viable, it should be provided more than comfort care. This is currently required by law; doctors who do not respond appropriately risk sanctions. But remember, these born alive cases are rare, and in the vast majority of them, the correct assessment will be comfort care. Lawmakers should be careful about legislating specific aspects of medical procedures. They are not doctors, and unintended consequences are far too common.

I appreciated the UK guidelines I quoted from earlier, which advised medical teams to come up with guidelines outlining what care should be provided for in the unlikely case that an infant is born alive in the course of a later abortion—and to ensure that women who undergo these procedures are aware of these guidelines.

I dearly wish we could just let medicine be medicine, and divorce it from politics. The fraught political climate around abortion isn’t helping. The partisanship gets in the way of honestly discussing real issues.

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