Medical Examiner

The Medical Complexity of “Late-Term” Abortions

The rhetoric employed by Donald Trump refuses to recognize the reality of these situations.

Republican presidential nominee Donald Trump gestures as he speaks during the third U.S. presidential debate at the Thomas & Mack Center on October 19, 2016 in Las Vegas, Nevada.
When asked about late-term abortion at Wednesday night’s debate, Donald Trump provided a nonsensical, non-reality-based description.

Win McNamee/Getty Images

Wednesday night, most of America heard Donald Trump and Hillary Clinton discuss, among other things, late-term abortion. Their positions came as no surprise. Clinton reiterated her position that late-term abortions, which are performed in cases of severe maternal or fetal complications, represent heart-wrenching, intimate decisions that must be protected. Trump provided a nonsensical, non-reality-based description and condemnation of full-term infants being “ripped out of the womb … in the ninth month on the final day” and declared his intention to have the constitutional right to abortion overturned.

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As a pediatric resident at a major academic medical center, I have the privilege of working day in and day out with a remarkably diverse population of children, including countless children born with congenital anomalies such as structural heart disease, genetic disorders such as trisomy 18 and cystic fibrosis, and significant injuries sustained in utero such as perinatal strokes. The treatments these patients receive are incredible: There are phenomenally complex staged cardiothoracic surgeries performed on inconceivably tiny hearts and great vessels. And highly controlled whole-body cooling that drastically improves the neurologic outcomes for some babies born with hypoxic-ischemic injury.

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Some of these babies go on to have remarkably meaningful, productive lives. Others will die as infants while receiving palliative and hospice care, or while receiving attempts at life-prolonging care. Some will continue to grow with significant neurologic and developmental deficits, and will be dependent on their caregivers for some or all activities of daily living. Some can smile, grasp the string of a balloon or a rattle, and laugh. Some have tracheostomies and require mechanical ventilation, with homes equipped with oxygen and back-up oxygen and power generators. Others are on dialysis and waiting for a kidney transplant. Some “beat the odds.” Some don’t.

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Many families feel that every moment with their child is meaningful, and that it is worth any cost—financial, psychological, logistical—to pursue all possible life-sustaining treatment. Other families judge their child’s quality of life to be such that the benefits of life-prolonging care do not, to them, outweigh the risks and burdens. Some, knowing what they know now, would go back and choose not to continue their pregnancy. Others may wonder what would have happened had they chose to go on.

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The decisions that these families make about their children are extremely complex, personal, and often painful. Sometimes these decisions are made after their children are born. Sometimes these decisions must be made when their children are still in utero. This is the reality of late-term maternal and fetal complications. They are heartbreaking in both circumstances.

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I once had to make such a decision. I am the mother of three healthy daughters, and one son who was never born. As I have written previously, I had an abortion halfway through my pregnancy when our baby was diagnosed with a severe lower urinary tract obstruction. His prognosis was uncertain but poor. For so many reasons, including a desire for our baby not to suffer and concern for the psychological well-being of our family, we chose to terminate the pregnancy.

This was a personal decision. It was a complex decision. It should not have been illegal, any more than a parent should not be allowed to decide, based on medical advice, to move a sick and suffering child into palliative care.

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And still as a society, we are unable to talk about the reality of these situations in a logical, fact-based manner.

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During the debate Trump was asked about his position on late-term and partial-birth abortions. Never mind that these kinds of abortions represent a vast minority of abortions performed in this country. That they are performed in exceptional circumstances characterized by serious threat to the health of the mother or the fetus. That the very terms used to describe them—late-term abortions and partial-birth abortions—aren’t even medically valid.

Never mind all of that. Here is what Trump said:

If you go with what Hillary is saying, in the ninth month, you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby.

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Now, you can say that that’s OK and Hillary can say that that’s OK. But it’s not OK with me, because based on what she’s saying, and based on where she’s going, and where she’s been, you can take the baby and rip the baby out of the womb in the ninth month on the final day. And that’s not acceptable.

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It is simply unconscionable for the Republican Party to stand behind the “scare rhetoric” Trump used as he telescoped the entire complexity of reproductive health rights into a warped and imaginary fight between good and evil, righteousness and sin.

It is the height of hypocrisy to glorify the extraordinary lengths we go to sustain the lives of children who would not otherwise survive without intensive and invasive intervention—often with nontrivial suffering, requiring full-time care that usually falls to mothers and utilizing tremendous societal resources—while reducing heart-wrenching late-term abortion cases to some barbaric and unique act of hubris and interference with God’s will. With respect to reproductive rights and the American democracy more broadly, I fear for my daughters and for the future of this country when this is the level of rhetoric—reductive, inaccurate, and cruel, predicated on forcing women to bear children against their will—surrounding one of the most important issues of the modern era.

Read more Slate coverage of the 2016 campaign.

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