The Dilatation and Evacuation (D&E) Abortion Procedure — Analysts of public opinion widely acknowledge that the public debate on partial-birth abortion, beginning in 1995, caused many Americans to re-evaluate their assessment of whether abortion should be legal in all circumstances.
A key element of the public debate was the fact that illustrations of the procedure were shown on national television and in print ads…
Following are some quotes from medical and legal sources about the D&E procedure, which is legal throughout the United States.
"Dilatation and evacuation has become one of the two most frequently used methods of abortion in the second trimester" (Berger et al, ed., Second Trimester Abortion: Perspectives After a Decade of Experience, Martinus Nijhoff Publishers, 1981, p.120).
[Note: According to the Alan Guttmacher Institute, 12% of abortions are performed at 13 weeks or more, by any procedure, which would translate into approximately 156,000 per year.]
"Second-trimester D&E abortions are performed on an outpatient basis in both hospitals and free-standing clinics…Most surgeons rely on large forceps to evacuate the products of conception" (Berger, op cit., p.121-128).
The following account of D&E is part of sworn testimony given in US District Court for the Western District of Wisconsin (Madison, WI, May 27, 1999, Case No. 98-C-0305-S), by Dr. Martin Haskell, an abortionist:
"And typically when the abortion procedure is started we typically know that the fetus is still alive because either we can feel it move as we're making our initial grasps or if we're using some ultrasound visualization when we actually see a heartbeat as we're starting the procedure. It's not unusual at the start of D&E procedures that a limb is acquired first and that that limb is brought through the cervix and even out of the vagina prior to disarticulation and prior to anything having been done that would have caused the fetal demise up to that point."
"When you're doing a dismemberment D&E, usually the last part to be removed is the skull itself and it's floating free inside the uterine cavity…So it's rather like a ping-pong ball floating around and the surgeon is using his forceps to reach up to try to grasp something that's freely floating around and is quite large relative to the forceps we're using.
“So typically there's several mis-directions, mis-attempts to grasp. Finally at some point either the instruments are managed to be place around the skull or a nip is made out of some area of the skull that allows it to start to decompress. And then once that happens typically the skull is brought out in fragments rather than as a unified piece…"
Note: Color diagrams of the D&E procedure can be viewed here.
From Mary Kay Culp of Kansas City:
The doctor speaking at the Rally at Dr. Tiller's… admitted under oath to twisting off limbs from still living unborn babies during partial birth abortions.
Following is court testimony by Dr. Leroy Carhart, partial birth abortionist from Nebraska and the principle in the U.S. Supreme Court Stenberg vs. Carhart decision of June 28, 2000.
Under oath (Doc. #4:97CV3205) in July 1997, he explained how he goes about his …business. Here verbatim, but in summary, is Carhart questioned in court by his own attorney about his experience as an abortionist. Please prepare for some very gruesome descriptions:
*Question: Are there times when you don't remove the fetus intact?
Carhart: Yes, sir.
*Question: Can you tell me about that, when that occurs?
Carhart: That occurs when the tissue fragments, or frequently when you rupture the membranes, an arm will spontaneously fall out through the vaginal opening… When the patient…the uterus is already starting to contract and they are starting to miscarry, when you rupture the waters, usually something falls out through the uterine, through the cervical opening, not always, but very often an appendage will.
*Question: What do you do then?
Carhart: My normal course would be to dismember that appendage and then go back and try to take the fetus out either foot or skull first, whatever end I can get to first.
*Question: How do you go about dismembering that appendage?
Carhart: Just pulling and rotation, grasping the portion that you can get a hold of which would be usually somewhere up the shaft of the exposed portion of the fetus, pulling down on it through the opening, using the internal opening as your counter-traction and rotating to dismember the shoulder or the hip or whatever it would be. Sometimes you will get one leg and you can't get the other leg out.
*Question: In that situation, when you pull on the arm and remove it, is the fetus still alive?
*Question: Do you consider an arm, for example, to be a substantial portion of the fetus?
Carhart: In the way I read it, I think if I lost my arm, that would be a substantial loss to me. I think I would have to interpret it that way.
*Question: And then what happens next after you remove the arm? You then try to remove the rest of the fetus?
Carhart: Then I would go back and attempt to either bring the feet down or bring the skull down, or even sometimes you bring the other arm down and remove that also and then get the feet down.
*Question: At what point does the fetus die during that process?
Carhart: I don't really know. I know that the fetus i
s alive during the process most of the time because
I can see fetal heartbeat on the ultrasound.
The Court: Counsel, for what it's worth, it still is unclear to me with regard to the intact D&E (partial-birth abortion) when fetal death occurs.
*Question: Okay, I will try to clarify that. In the procedure of an intact D&E where you would start foot first, with the situation where the fetus is presented feet first, tell me how you are able to get the feet out first.
Carhart: Under ultrasound, you can see the extremities. You know what is what. You know what the foot is, you know, what the arm is, you know, what the skull is. By grabbing the feet and pulling down on it or by grabbing a knee and pulling down on it, usually you can get one leg out, get the other leg out and bring the fetus out… I just attempt to bring out whatever is the closest portion of the fetus.
*Question: At the time that you bring out the feet in this example, is the fetus still alive?
*Question: Then what's the next step you do?
Carhart: I didn't mention it. I should. I usually attempt to grasp the cord first and divide the cord, if I can do that.
*Question: What is the cord?
Carhart: The cord is the structure that transports the blood, both arterial and venous, from the fetus to the back to the fetus, and it gives the fetus its only source of oxygen, so that if you can divide the cord, the fetus will eventually die, but whether this takes five minutes or fifteen minutes and when that occurs, I don't think anyone really knows.
*Question: Let's take the situation where you haven't divided the cord because you couldn't, and you have begun to remove a living fetus feet first. What happens next after you have gotten the feet removed?
Carhart: We remove the feet and continue pulling on the feet until the abdomen and the thorax came through the cavity. At that point, I would try … you have to bring the shoulders down, but you can get enough of them outside, you can do this with your finger outside of the uterus, and then at that point the fetal … the base of the fetal skull is usually in the cervical canal.
*Question: What do you do next?
Carhart: And you can reach that, and that's where you would rupture the fetal skull to some extent and aspirate the contents out. [Translation: The skull is punctured with scissors and the contents sucked out]
*Question: At what point in that process does fetal death occur between initial…removal of the feet or legs and the crushing of the skull, or I'm sorry, the decompressing of the skull?
Carhart: Well, you know, again, this is where I'm not sure what fetal death is. I mean, I honestly have to share your concern, your Honor. You can remove the cranial contents and the fetus will still have a heartbeat for several seconds or several minutes, so is the fetus alive? I would have to say probably, although I don't think it has any brain function, so it's brain dead at that point.
*Question: So the brain death might occur when you begin suctioning out the cranium?
Carhart: I think brain death would occur because the suctioning to remove contents is only two or three seconds, so somewhere in that period of time, obviously not when you penetrate the skull, because people get shot in the head and the don't die immediately from that, if they are going to die at all, so that probably is not sufficient to kill the fetus, but I think removing the brain contents eventually will.