For doctors, new abortion risks

The difficult job of terminating pregnancies will become more complicated for physicians after Wednesday's Supreme Court ruling upholding the 2003 ban on one controversial abortion method.

Some doctors said they were not sure how they would abide by the federal law. The biggest uncertainty, they said, is they don't know what will qualify as an illicit procedure.

"There is nothing that we call by the name 'partial-birth abortion,' " said Dr. Eleanor Stanley, an obstetrician-gynecologist who works at three family-planning clinics in Las Vegas and Phoenix. The phrase doesn't appear in gynecological textbooks or medical research journals, she said.

"That's just a lay term," said Dr. Amy Meg Autry, a clinical professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. "What they describe could be actually almost any abortion procedure."

That ambiguity has many doctors wondering how they will treat their patients.

The Partial Birth Abortion Ban Act, signed into law by President Bush in 2003, outlaws any procedure that begins by partially removing a live fetus from the uterus and then killing it. The law was aimed at a rarely used abortion method doctors call dilation and extraction, or D&X.

For most surgical abortions, doctors use instruments to remove a fetus in pieces, a procedure known as dilation and evacuation, or D&E. Doctors begin by dilating the patient's cervix, which can take days. If the woman has been through childbirth many times, sometimes the fetus will slide out, Autry said. "Potentially, you could accidentally be doing a dilation and extraction."

There are also cases where a D&X would be preferable to a D&E, doctors said.

About 90 percent of abortions occur during the first trimester. But if ultrasound examinations in the second trimester reveal a fetus has a devastating genetic disorder, it might be too large for the surgical instruments, so D&E would not be an option.

"Sometimes the pregnancy is a threat to the life of the woman," said Dr. Warren Hern, who runs the Boulder Abortion Clinic in Colorado.

He recalled a patient who had uncontrollable high blood pressure because her fetus had a chromosomal defect. A D&X was the only viable option to save her life, he said.

Dilation and extraction is also preferable in cases where doctors want to keep the fetus intact to perform an autopsy, Autry said. The examination could give parents critical information that will help in future attempts to have children.

Without the option of D&X, some patients might have to go through labor. It can take several days to induce premature labor, and in 30 percent of cases, women need surgical intervention anyway, Autry said.

At some clinics, the fetus is injected with potassium chloride or saline solution to stop its heart before it is removed. The injection introduces a small degree of risk for patients, but Stanley predicted more doctors would begin doing it. "If you look at the wording of the law, it says 'a living fetus' " Stanley said. By giving an injection, "the ruling won't apply."

At Planned Parenthood clinics, physicians are awaiting guidance from medical and legal teams. The recommendations are expected in three to four weeks. Other doctors are awaiting advice from the American College of Obstetricians and Gynecologists, the National Abortion Federation, NARAL Pro-Choice America and Physicians for Reproductive Choice.

In Boulder, Hern said, "I don't know at this point that what I'm doing is illegal, so I'm going to keep doing it."