By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research
Editor’s note. This post ran a few months ago and received such positive attention that it seemed appropriate to run it again today.
Much attention has rightly gone to the horrible practices of convicted murderer Kermit Gosnell, who aborted babies alive, stabbed them in the back of the neck with surgical scissors, and snipped their spinal cords. Now come reports that the Harris County district attorney’s office “would investigate charges that a Houston doctor had delivered live babies during third-trimester abortions and killed them after they emerged, which federal and state laws forbid,” according to the New York Times (5/15/2013).
As bizarre and ghastly as these practices might be, though, it is a mistake to imagine that they are exceptions—that somehow other clinics doing second and third trimester abortions employ “humane” ways of taking the lives of unborn children. In truth, brutality is the nature of their awful business.
As proof, one need not rely solely on reports by former clinic employees willing to step forward and share their stories. One can also look at the medical literature and texts written by abortionists themselves, discussing various late abortion methods. Not surprisingly, they don’t tend to focus on the trauma endured by the baby as his or her life is ended, but the descriptions reveal the callous barbarity that is part and parcel of such abortions, no matter who performs them.
Of course, all abortions are brutal, no matter what trimester they are performed, no matter whether they are done surgically or chemically. Most modern first trimester surgical abortions use a cannula (tube) with a sharp cutting notch and some form of suction, whether mechanical or manual, to scrape the child off the uterine wall and collect his or her body parts into a syringe or a bottle. Chemical abortions in the first trimester with drugs such as RU-486 essentially starve the child to death before another drug, a prostaglandin, stimulates powerful contractions to expel the tiny corpse from the mother’s womb.
As the child increases in size and bones harden, though, abortions get more complicated. Though some abortionists use larger cannula up to 14-16 weeks gestation, suction does not work well very far into the second trimester. Yet there are tens of thousands of abortions performed in the second and even third trimesters.
Abortions in the second and third trimesters generally seek to either surgically remove the child in pieces or intact, or to chemically induce labor so that the child is delivered prematurely.
Surgically, an abortionist is likely to use one of two methods – Dilation and Evacuation (D&E) or Dilation and Extraction (D&X, though some call this an “Intact D&E”). Both involve dilating the cervix, probably with osmotic dilators, for a day or two, to allow the entry of surgical instruments and the removal of the fetus, either in whole (D&X) or in parts (D&E).
Once the cervix is sufficiently widened, the abortionist will use one instrument (a tenaculum) to grip the uterus and another (a speculum) to hold it open while he inserts a long steel clamp or forceps to grab the child and pull him or her out (D&X) or to grasp and tear off parts of the child’s body one by one until everything is removed (D&E).
Owing to the size and hardness of the child’s skull, the abortionist may crush the child’s head to facilitate its removal. If not carefully removed, sharp edges of the bones can cause cervical lacerations.
While laws may prohibit such mutilation of the child’s body once born alive, it is currently perfectly legal at this time to perform this dismemberment inside the womb, even if the child is the exact same age.
To prevent the possibility of a live birth or a triggering of the federal Partial-Birth Abortion statute (and some abortionists say, to soften the bones and ease the process), abortionists often take some additional step to insure that the child is dead before removal. Some inject a chemical agent such as digoxin or potassium chloride into the amniotic fluid, the umbilical cord, into the fetus, or directly into the fetal heart to stop the child’s heart. Others have mentioned the severing of umbilical cord while the child is in the womb.
After these lethal measures or “injections to cause fetal demise,” as one abortion industry text puts it, the abortionist is able to complete the “procedure.” In the D&X or “intact D&E” procedure, the baby is removed largely intact after the fetal skull has been compressed and the brains (or “intracranial contents”) are removed. The only relevant distinction between this method and the banned Partial-Birth Abortion procedure is simply that the killing of the child takes place prior to the partial removal of the child from the womb.
Later chemical abortion methods, though involving different drugs and different means of administration, aim to prematurely induce powerful contractions that will expel both the child and the placenta.
Prostaglandins like misoprostol, which mimic natural chemical compounds normally involved in the birthing process, trigger violent labor and the eventual birth of the child maybe 10-15 hours later. Misoprostol may be taken orally or sub-lingually (under the tongue), but vaginal administration is common. Other prostaglandins and chemicals such as hyperosmolar urea have been given by injection into the amniotic fluid.
Ethacridine lactate, or Rivanol, is a drug used as a solution introduced into the uterus via a catheter inserted through the cervix into the uterus. Abortions with ethacridine lactate can be slow, so these are often augmented with another labor stimulator, oxytocin.
As with the late surgical abortions, the birth of live child is a potential “risk” with these chemical methods, so abortion textbooks again offer the use of digoxin or potassium chloride injections to insure the death of the baby prior to delivery. 
When it comes down to it, perhaps the only significant legal difference between the abortions performed by Gosnell or allegedly by the Houston area abortionist and the clinic in your neighborhood which performs late abortions is that your clinic may take steps to insure that babies the same age and size that Gosnell aborted are dead before they are delivered.
Those babies killed in the “respectable clinics” will still have their bodies ripped apart, or their brains sucked out, will be pummeled by powerful contractions, or will be executed with lethal injections.
What Gosnell did was monstrous, but what the industry’s respected late abortionists do can hardly be called “humane.”
References used in this article include the National Abortion Federation’s guide to “comprehensive abortion care,” Management of Unintended and Abnormal Pregnancy, eds. Maureen Paul, Lynn Borgatta, David A. Grimes, Phillip G. Stubblefield, and Mitchell D. Creinin (Chichester, West Sussex, U.K.: Wiley Blackwell, 2009); Ipas’ Clinician’s Guide for Second-Trimester Abortion, 2nd Ed., eds. Traci L. Baird, Laura D. Castleman, Alyson G. Hyman, Robert E. Gringle, and Paul D. Blumenthal (Chapel Hill, NC: Ipas, 2007); and Second Trimester Abortion, Eds, Gary Berger, William E. Brenner, Louis G. Keith (Dordrecht, The Netherlands: Kluwer Academic Publishers, 1981).
 There are other methods, such as hysterotomy (similar to a Caesarean section, in which the woman’s belly is cut into and the baby removed), or saline amniocentesis (“salting out” in which the baby was chemically burned), but these are rarely used any more owing to the possibility of serious side effects and high mortality rates.