So that was a black hole of a week where I was just sitting with bad news and very little information. Google became my friend. I had noted the medical terms the doctor mentioned, and I searched them furiously as I waited for the appointment.
That week of waiting and wondering was awful. My husband and I discussed our potential options, and we were prepared to consider termination if it was brought up. At the time, we were living in Farmington Hills, Michigan, so we went to see a genetic specialist in Detroit. There, the technicians did another ultrasound using better technology. It took two hours, though it felt like forever. It was excruciating to see our baby on the screen We met with the genetic counselor first.
She told us many of the anomalies had cleared up. It varies greatly in severity. About 10 to 20 percent of people who have it don't even realize they have it until late childhood or adulthood, according to the National Institutes of Health. In others, it can be extremely severe, leading to partial paralysis, seizures, heart defects, and other developmental issues, per the NIH.
The doctor said she was 90 percent sure our baby had a severe case. But Dandy-Walker is often linked to two severe chromosomal disorders called trisomies: trisomy 18, also known as Edwards syndrome, and trisomy 13, or Patau syndrome, according to the NIH.
Only 5 to 10 percent of babies with trisomy 13 and trisomy 18 live past the first year, per the NIH. Our doctor suggested an amniocentesis, a test of the amniotic sac that would help reveal any trisomies.
We had the test that same day. She also presented our options, which included termination. They showed us graphs of the occurrence of seizures in kids with Dandy-Walker.
They told us that our baby might not have the ability to walk or sit up straight or feed himself. Because we had our appointment on the Friday before Labor Day weekend, we had to wait until Tuesday to get the amnio results. We spent that long weekend thinking about our options. In the end, the results for trisomy 13 and 18 came back negative, so there was not a chromosomal issue. However, the Dandy-Walker diagnosis remained. Infants born at 23 weeks' gestation do not have sufficiently developed lungs and cannot breathe on their own; such infants will die at birth if not given life-sustaining therapies.
This report provides answers to frequently asked questions concerning abortions that are performed in the second trimester of a woman's pregnancy because Congress and many state legislatures are considering legislation that would limit or ban abortions in midpregnancy. L egislation at the federal and state levels seeking to limit or ban abortions in midpregnancy has focused attention on the procedure and the relatively small number of women who choose to undergo such an abortion.
Pregnancy: A typical pregnancy spans 40 weeks about nine months , from the start of the last menstrual period—a date most women can identify—until birth. Pregnancy is often described in terms of three trimesters, each trimester being roughly three months or 13 weeks in duration. The first trimester is week 1 through week 13, the second trimester is week 14 through week 27, and the third trimester is week 28 through birth at 40 weeks.
In a standard day menstrual cycle, ovulation typically occurs midcycle, at about day Fertilization occurs just after ovulation, but the date and time of fertilization cannot be pinpointed by any test. Adding two weeks to a reported "probable postfertilization age" is equivalent to gestational age, accounting for time from the start of the last menstrual period until ovulation in a standard day cycle.
If enacted, under the Pain-Capable Unborn Child Protection Act, a physician performing an abortion procedure "may do so only in the manner which, in reasonable medical judgment, provides the best opportunity for the unborn to survive. This report provides answers to frequently asked questions concerning abortions that are performed in the second trimester of a woman's pregnancy.
The largest study of women in the United States seeking abortions at 20 weeks or more is the Turnaway study.
The data were collected from through the end of For comparison purposes, the Turnaway study recruited three groups of women: 1 those who obtained a first trimester abortion, 2 those who obtained an abortion just under the clinic's gestational limit, and 3 those who were turned away because of advanced gestation.
The Turnaway study found that women who obtained later abortions group 2 were similar to women who obtained an abortion in the first trimester group 1 in terms of "race, ethnicity, number of live births or abortions, mental or physical health history or substance use. According to Diana Greene Foster, the lead investigator on the Turnaway study described above and a professor at the University of California, San Francisco, Bixby Center for Global Reproductive Health, "[t]here aren't good data on how often later abortions are for medical reasons.
Foster believes that abortions for fetal anomaly "make up a small minority of later abortion" and that those for life endangerment are even harder to characterize. A study published in found that due to advancements in prenatal testing, the gestational age at the time of abortion for fetal aneuploidy decreased substantially from 19 weeks in to 14 weeks in A woman might experience a delay in seeking or receiving an abortion for a variety of reasons, such as late recognition of pregnancy, inability to obtain transportation, and difficulty in raising the necessary funds e.
Some facilities refuse to perform an abortion on women with certain physical conditions, such as obesity. According to the study authors, "[a]lmost two-thirds of the women seeking later abortion and fewer than one-third of those seeking a first trimester abortion said they were delayed because they were raising money for travel, the procedure, and other costs.
A January study of more than 8, U. In states with an in-person counseling requirement this could hinder access to very early abortion. The January study identified several characteristics of women who were more likely to have a second trimester abortion.
They included not having graduated from high school, recognizing the pregnancy late, using financial assistance e. Abortion in the second trimester can be performed by a surgical procedure, or by a medical abortion method that relies on drugs to induce labor.
According to CDC, in a surgical method was used for In a randomized controlled trial RCT , participants are randomly assigned to two or more groups. Randomization ensures that any patient characteristics that might affect the outcome will be roughly equal across each group in the study.
Any difference in outcomes between the groups is then likely due to the intervention. The RCT is often called the gold standard of evidence for a clinical trial. In the medical abortion method, a drug or drug combination is given to the patient to induce labor. In one method, a drug e. This method has largely been replaced by a second method, which uses the drugs mifepristone and misoprostol. Misoprostol may be used alone if mifepristone is unavailable.
The median induction time for regimens using misoprostol alone ranges from 12 to 45 hours. A Cochrane Collaboration review looked at the small number of randomized controlled trials RCTs that have compared surgical and medical abortion methods used in the second trimester.
RCTs that evaluated efficacy, side effects, adverse events, and acceptability. Inexperienced providers are advised to use medical methods. In contrast, in Finland and Sweden virtually all abortions in the second trimester are performed medically. Another source provides information on the use of second trimester medical abortion in Europe: "In the Scandinavian countries, the use of second trimester medical abortion assures wide access to induced abortion since it can be performed in all gynecological clinics.
Furthermore, in these settings mid-level providers with adequate training and back-up can provide the abortion care. According to a study published in , almost all U. A total of 1, abortion facilities participated in this study: were located in the Northeast, in the West, in the South, and in the Midwest. According to a study published in , "[a]bortions at 20 weeks' gestation typically take 2 or more days to complete, and involve greater skill and resources.
In general, federal law prohibits the use of federal funds for abortions, except in cases of rape, incest, or endangerment of the woman's life. Medicaid is jointly funded by state and federal dollars. According to a report by the U. Department of Health and Human Services HHS , in FY, there were 69 Medicaid abortions for which federal financial participation was claimed 2 were due to incest, 33 were due to rape, and 34 were due to endangerment of the woman's life.
As noted above, federal Medicaid funding for abortion is limited to cases of rape, incest, or endangerment of the woman's life. Some state Medicaid programs cover other abortions with state-only funds. The Guttmacher report does not break out these abortions by gestational age. Another Guttmacher study used a nationally representative sample of 8, nonhospital abortion patients in and The study did not indicate whether federal dollars contributed to any second trimester abortions. It noted that "Medicaid was the second most common method of payment.
The overwhelming majority of these patients lived in one of the 15 states that use their own Medicaid funds to cover abortion. Measures of safety during a medical procedure generally refer to the probability of an adverse outcome, the most severe being death due to the procedure serious medical complications are discussed in the next question and answer. For women in the United States, the mortality rate associated with childbirth or continuing the pregnancy is higher than the abortion mortality rate.
The NAS study states that the "risk of death subsequent to a legal abortion 0. Abortion-related mortality is also lower than that for colonoscopies 2. However, the abortion mortality rate increases with gestational age. For the woman, such a predictable scenario is often psychologically preferable" to the unknown number of hours spent in labor with the mifepristone-misoprostol induction procedure.
Side effects e. Methods: Each woman received mg mifepristone orally followed by vaginal misoprostol microg 36 to 48 h later. Three hours after the initial misoprostol administration, microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h.
This sort of rhetoric necessarily dehumanizes the women who choose to get such procedures, reducing them to mere vessels — sites of violence, not individuals with needs and feelings of their own. The only one granted any degree of humanity here is the fetus.
The reality of abortion after 20 weeks is far too complicated to reduce to some sort of abstract, incendiary ethical quandary. Only one percent of procedures take place this far along, which makes sense — abortion is more dangerous, more invasive, and far more expensive after this point.
There are countless complex reasons someone might decide to get an abortion after 20 weeks. Some felt conflicted afterwards; others simply felt relieved. In their own words, here are their experiences:. Doctors had assured Kate her pregnancy was healthy until she was seven months along. After a series of tests, her gestating daughter was diagnosed with Dandy-Walker malformation and agenesis of the corpus callosum, two serious brain malformations. I had not decided in my head because I just had not processed anything yet.
Does she just sleep all the time? I considered every other option, and I considered in depth. I never thought that I would consider putting a child of mine up for adoption.
But I did. I thought hard about it. I have to be very clear that I also care about my own life: I did not want the life of her mother for myself, and I did not want that life for my daughter. But that also matters, and I have come to greater comfort talking about that, too.
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