By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Editor’s note. In Part One, Dr. O’Bannon provided the background to the very unfortunate reality that Doctors Without Borders is involved with a new website giving women instructions on how to use abortion drugs. It is called howtouseabortionpill.org.
Doctors Without Borders (the acronym in French is MSF) says they have “teamed up” with HowToUseAbortionPill.org “to create a free, open-source, evidence based online course on medication abortion, or abortion with pills” by means of “five animated videos.”
VIDEO #4 Taking It to Extremes
Video #4 describes how these same abortion pills can be used by women in their second trimesters, at 13 to 22 weeks gestation (measured from the mother’s last menstrual period, this means the child herself is 11 to 20 weeks). Though there have been studies about using these drugs later in pregnancy, there has not been a general move to get governments to approve or authorize their use for second trimesters, at least not in America. This video may signal a new and troubling development in this regard.
They say, once more, that while these abortions are still “very effective and very safe,” they warn these later abortions are more complicated: “[I]t will usually take more time, the bleeding may be heavier, and the expulsed pregnancy will be larger and more recognizable as a fetus.”
Because of the increased difficulty, MSF suggests that these be done in a health care facility staffed by trained health care workers.
However, not surprisingly, they go on to say that “this is not always feasible, especially in humanitarian settings.” In other words, though it’s a serious medical procedure that ought to be done by professionals, don’t let the lack of any such personnel stop you if someone is determined to get one.
Under such circumstances, they say, “the focus is on helping the woman to avoid an unsafe abortion and to be as safe and healthy as possible given the constraints of the situation.” (Emphasis added.)
How far they expect this to go is unclear. They suggest that women undergoing these abortions “outside a health care facility or at home should understand what to expect and have a clear plan in place, especially for seeking emergency medical care if needed.” Again, it is unclear if this is confirmed or required before a worker gives a woman the abortion pills.
While the regimen they recommend is very similar to that for abortions performed earlier in pregnancy, the dose of misoprostol [the first of two drugs that ordinarily make up the abortion technique] is reduced because of the uterus’ increased sensitivity later in pregnancy. Additional misoprostol may be taken every three hours, women are told in the video, until the abortion is complete.
They do not say so directly, but taking too large a dose of misoprostol all at once can lead to potentially deadly uterine ruptures at later gestations.
As noted, these abortions take longer than those performed earlier in pregnancy. MSF admits that complications are more frequent at later gestations, but still call these “rare.” They say that these complications can usually be treated with prompt emergency care.
This presupposed, but does not require, that such emergency help is available. “In very rare cases,” they grant, “women may require surgical intervention, blood transfusion or other advanced care.”
What good is “requiring” such medical services if whomever is giving out the pills is gone and the nearest doctor is hundred miles away or more?
Unborn children at this stage are larger and considerably developed. Even at the beginning of this time frame, at thirteen weeks gestation (the baby is 11 weeks old), the child is more than two and a half inches tall from crown to rump, has fingers, toes, and is responsive to touch. Every organ system is in place.
At 22 weeks gestation (the baby is 20 weeks old), the child is nearly eight inches tall and active, doing somersaults in the mother’s womb. The child cannot only hear her mother’s voice, but can feel pain.
This is considerably more than being “recognizable as a fetus.”
How does MSF show regard for this marvel? Here is what they suggest. We read
Depending on the woman’s wishes, the fetus can be wrapped for her to hold, or wrapped and kept out of sight and removed.
The fetus may demonstrate some transient signs associated with life like breathing, grunting, or spontaneous movements.
These signs usually go away after a few minutes, but can be upsetting for those who are present.
This possibility should be discussed with women, families, and staff ahead of time so they can be prepared and the appropriate arrangements can be made to minimize distress and respect their wishes.
The fetus and placenta should be handled respectfully and in accordance with infection prevention and control standards.
In low-resource settings, the fetus and placenta can be placed in a properly built and maintained placenta pit or incinerated.
Health care facilities that conduct vaginal deliveries should already have necessary waste management systems, including a placenta pit, in place.
If sterilization paper or other biodegradable cloth is available, the fetus can be wrapped in this material after the expulsion before placing in a placenta pit.
Rarely, a woman may want to take the fetus home and bury it herself.
In this case, her wishes should be respected.
However, health care workers should not force women to take the fetus home if she does not want to.
However sincere (and late) this concern for the feelings of these mothers for their children might be, the lack of respect for the feelings and humanity of their aborted children is appalling, especially for a “humanitarian” group.
Editor’s note. Part Five will run Tuesday.