The Reality of Partial Birth Abortion

Endeavour Forum, Inc.
Newsletter No. 115, June 2004
Reproduced with Permission

The ban on this procedure became federal law in the United States last November. Immediately Planned Parenthood, the National Abortion Federation, and the American Civil Liberties Union filed lawsuits in three federal courts claiming the ban takes away a fundamental constitutional right. Abortion doctors have taken the witness stand to describe how they abort children in the fifth and sixth months of pregnancy. Below some extracts from their testimony.

New York Case. Day Three: March 31, 2004

Excerpts from National Abortion Federation's direct examination of Dr. Timothy Johnson:

Q. Do you have an opinion, Dr. Johnson, as to which of the two D&E variations, the intact or the dismemberment variation, may best facilitate the extraction of the fetal skull during an abortion procedure?

A. I think that the intact procedure is actually developed in part to deal with the problem of the fetal skull. When one does a D&E, technically one of the challenges is to remove the fetal skull, partly because it is relatively large, partly because it is relatively calcified, and it is difficult to grasp on occasion. So one of the common technical challenges of a dismemberment D&E is what is called a free-floating head or a head that has become disattached and needs to be removed. This can lead to more passages of instruments through the cervix. And technically it is difficult to grasp the head; it is round, it slips out of the instruments that we generally use. Either those instruments or the head can be extruded outside the uterus and cause perforation.

Q. Did you make any observation of the way the physician performing that intact D&E effected the incision into the skull?

A. In the situations that I have observed, they either -actually, the procedures that I have observed, they all used a crushing instrument to deliver the head, and they did it under direct vision.....

THE COURT: Can you explain to me what that means.

THE WITNESS: What they did was they delivered the fetus intact until the head was still trapped behind the cervix, and then they reached up and crushed the head in order to deliver it through the cervix.

THE COURT: What did they utilize to crush the head?

THE WITNESS: An instrument, a large pair of forceps that have a round, serrated edge at the end of it, so that they were able to bring them together and crush the head between the ends of the instrument.

THE COURT: Like the cracker they use to crack a lobster shell, serrated edge?


THE COURT: Describe it for me.

THE WITNESS: It would be like the end of tongs that are combined that you use to pick up salad. So they would be articulated in the center and you could move one end, and there would be a branch at the center. The instruments are thick enough and heavy enough that you can actually grasp and crush with those instruments as if you were picking up salad or picking up anything with --

THE COURT: Except here you are crushing the head of a baby.


THE COURT: Was the body outside the woman's body to an extent?

THE WITNESS: Some of it. It can be or not. Some of it can be or -- it depends on where the cervix is. It depends on where the uterus is. It depends how long the baby is. It depends how long the mother's vagina is.

THE COURT: At some times that you observed it was?

THE WITNESS: Right. And sometimes during the procedure the cervix can actually be brought down so that -the cervix and the uterus can be moved up and down relative to the opening of the vagina.

THE COURT: An affidavit I saw earlier said sometimes, I take it, the fetus is alive until they crush the skull?

THE WITNESS: That's correct, yes, sir.

THE COURT: In one affidavit I saw attached earlier in this proceeding, were the fingers of the baby opening and closing?

THE WITNESS: It would depend where the hands were and whether or not you could see them.

THE COURT: Were they in some instances?

THE WITNESS: Not that I remember. I don't think I have ever looked at the hands.

THE COURT: Were the feet moving?

THE WITNESS: Feet could be moving, yes.

THE COURT: If you are all finished let me just ask you a couple of questions, Dr. Johnson. I heard you talk a lot today about dismemberment D&E procedure, second trimester; does the fetus feel pain?

THE WITNESS: I guess I --

THE COURT: There are studies, I'm told, that says they do. Is that correct?

THE WITNESS: I don't know. I don't know of any -- I can't answer your question. I don't know of any scientific evidence one way or the other.

THE COURT: Have you heard that there are studies saying so?

THE WITNESS: I'm not aware of any.

THE COURT: You never heard of any?

THE WITNESS: I'm aware of fetal behavioral studies that have looked at fetal responses to noxious stimuli.

THE COURT: Does it ever cross your mind when you are doing a dismemberment?

THE COURT: Simple question, Doctor. Does it cross your mind?

THE WITNESS: Does the fetus having pain cross your mind? THE COURT: Yes.


THE COURT: Never crossed your mind.? THE WITNESS: No.

THE COURT: When you have done D&Es or when you have done abortions, do you tell the woman various options that are available to her?


THE COURT: And do you explain what is involved like in D&E, the dismemberment variation? Do you tell her that?

THE WITNESS: We would describe the procedure, yes.

THE COURT: So you tell her the arms and legs are pulled off. I mean, that's what I want to know, do you tell her?

THE WITNESS: We tell her the baby, the fetus is dismembered as part of the procedure, yes.

THE COURT: You are going to remove parts of her baby?


THE COURT: Are you ever asked, Does it hurt?

THE WITNESS: Are we ever asked by the patient?


THE WITNESS: I don't ever remember being asked.

THE COURT: And although you have never done an intact D&E, do you know whether or not the incision of the scissors in the base of the skull of the baby, whether that hurts?

THE WITNESS: Well, I guess my response would be I think that the baby feels it but I'm not sure how pain registers on the brain at that gestational age. I'm not sure how a fetus at 20 weeks or 22 weeks processes and understands pain.

THE COURT: You have never done one of these procedures but did you ever ask what --you say you know about it clinically, did you ever ask one of those who perform them whether it hurts the fetus?


THE COURT: When you describe the possibilities available to a woman do you describe in detail what the intact D&E or the partial birth abortion involves?

THE WITNESS: Since I don't do that procedure I wouldn't have described it.

THE COURT: Did you ever participate with another doctor describing it to a woman considering such an abortion? THE WITNESS: Yes. And the description would be, I would think, descriptive of what was going to be, what was going to happen; the description.

THE COURT: Including sucking the brain out of the skull?

THE WITNESS: I don't think we would use those terms. I think we would probably use a term like decompression of the skull or reducing the contents of the skull.

THE COURT: Make it nice and palatable so that they wouldn't understand what it's all about?

THE WITNESS: No. I think we want them to understand what it's all about but it's -- I think it's --I guess I would say that whenever we describe medical procedures we try to do it in a way that's not offensive or gruesome or overly graphic for patients.

THE COURT: Can they fully comprehend unless you do? Not all of these mothers are Rhodes scholars or highly educated, are they?

THE WITNESS: No, that's true. But I'm also not exactly sure what using terminology like sucking the brains out would -

THE COURT: That's what happens, doesn't it?

THE WITNESS: Well, in some situations that might happen. There are different ways that an after-coming head could be dealt with but that is one way of describing it.

THE COURT: Isn't that what actually happens? You do Use a suction device, right?

THE WITNESS: Well, there are physicians who do that procedure who use a suction device to evacuate the intercranial....

THE COURT: Do they give full disclosure as to the various procedures available and what is entailed, such as the dismemberment, in some forms of D&E?

THE WITNESS: If they do not and then the patient is referred to me for D&E, we do tell the patient what's entailed in a D&E.

THE COURT: ln simple, clear English?

THE WITNESS: I think so, your Honor, yes. Now, there are variations, depending on the patient's own kind of psychological situation that we clearly take into consideration, but we actually have a large number of patients who look at us and say, let me get this straight. What you will be doing is dismembering the fetus. And we say, yes, that's exactly what we are doing.

THE COURT: Do you tell them what happens when they do an intact D&E?

THE WITNESS: If the patient--

THE COURT: The brain is sucked out?

THE WITNESS: Well I don't -- as a point of fact, your Honor, I don't usually do the suction part. I do compress the calvarium and I do some other procedures. I don't actually do suction so I don't explain that part.

THE COURT: You don't explain that to them?

THE WITNESS: Well I explain the method.

THE COURT: You explain what a compression of the calvarium is?

THE WITNESS: Yes, sir; that I do explain.

THE COURT: That that's crushing the skull? THE WITNESS: I explain that, yes.

Nebraska Case. Day Two: March 30, 2004.

Excerpts from Abortion Doctors' direct examination of Dr. William Fitzhugh:

Q. All right. Going back now, I think you said in some instances when you use a suction cannula, that part of the fetus or the umbilical cord will come out through the cervix. Then what do you do at that point?

A. Well, if the umbilical cord comes down, I unattach that from its integrity. I just break it and pull on it. If a foot comes down, I grab the foot and pull down on that.

Q. If no part comes down, as a result of the suction, what do you do?

A. Then I have to place the ring forceps up into the uterus and find a part.

Q. And is there a particular part that you're trying to grasp, at that point?

A. I take whatever I can get, because I have really -- I have a feel of when you feel the cranium of the head, but that's about the only thing I have a feel of when you grasp until you pull it down.... I just pull down with the forceps and, you know, see what part you have, and see if you can get more of that part out. If you get more of the part out, you twist to try to get more tissue out. If that doesn't happen, then you pull hard enough that it will disarticulate at that point or break off at that point.

Q. Do you have other concerns, when you find yourself in that situation, to cause you to use forceps to compress the skull?

A. As I mentioned earlier, my preference is that when I use a suction, my preference is that I obtain the umbilical cord and separate the umbilical cord. The one thing that I want -- and I don't want the staff to have to deal with is to have a fetus that you remove and have some viability to it, some movement of limbs, because it's always a difficult situation.

Q. So one of the reasons that you use the forceps to compress the skull is to ensure that the fetus is dead when you remove it?

A. That's one of the reasons.

Q. ...what actions do you take during a D&E that would be fatal to the fetus?

A. Well, number one, I like to interrupt the umbilical cord.... And we break up parts in the uterus and we crush skulls.

Excerpts from the Government's cross-examination of Dr. Fitzhugh:

Q. So when you're doing the D&E procedure that you do, you expect dismemberment to occur; is that correct?

A. It happens in the majority of cases, not expected, but it sure would be nice if it happened more often.

Q. When there have been instances where the -- you have been doing D&E and the fetus has come out intact, have you been aware of reactions from others in the operating room?

A. Yes, they certainly show more interest in that when it happens than they do on a routine situation.

Q. In fact, they gasp, don't they, when that kind of thing happens?

A. Some of them gasp, yes, sir....

Excerpts from the Government's cross-examination of Dr. Vibhakar:

Q. Okay. When the head was struck, you disarticulated the body from the head; is that correct?

A. Yes.

Q. And you removed the body, compressed the head and removed the head; is that correct?

A. Yes.

Q. And in decompressing the skull, you're trying to reduce its sides [sic] so it can fit through the cervix?

A. Yes.

Q. And when you are doing this, you're trying to remove skull pieces so the liquid brain will empty from the cranium and the head will decrease in size; is that correct?

A. And in compressing it, if it doesn't fit, and in my experience it hasn't fit without decompressing it in the process of crushing it or grasping it, it becomes punctured enough so that the cranial contents will drain, and then it will fit through the cervix.

Day Three: March 31, 2004.

Excerpts from Abortion Doctor' direct examination of Dr. William Knorr:

Q. Can you tell the Court approximately how many abortions you performed last year?

A. Somewhere between five and six thousand.

Q. Of those, can you estimate how many were second trimester abortions?

A. Somewhere between 12 and 15%.

Q. Dr. Knorr, before you begin to remove the fetus during a D&E procedure, is the fetus typically alive?

A. ...the majority of the fetuses are alive.

Q. And you don't routinely induce fetal demise, as part of your second trimester abortion procedures, is that right?

A. That's right. Very rarely.

Q. And why not?

A. I just don't believe in it. I think that it's extra procedure and, you know, we first have to remember, don't do any harm.

Q. When it happens and the fetus comes through the cervix except for the head, how do you proceed?

A. I first evaluate the cervix to see if I have enough room to slip a finger between the cervix and the fetal head, and if I can do that, I can then insert my crushing forcep around the head, crush the head and extract it. If the cervix is very tight, I can't do that, I will use a craniotomy procedure, will turn the fetus so the back is up and find the area that I want to open, and either with a finger, dialator or a scissor will open that area and gently pull down. That pressure alone is enough to empty the cranium and extract the head.

Q. And why don't you routinely do second trimester abortions by induction?

A. I don't really have the ability to do that. I cannot put a woman in the hospital where I have privileges and admit her for an elective abortion beyond 12 weeks of gestation, and even if I wanted to do 12 weeks and under, I can usually never find a nurse that will accompany me to the OR to do it.

Excerpts from Government's cross examination of Dr. Knorr:

Q. Also when you bring out a fetus in pieces, you make sure that you have got all the parts that you want; right? You kind of --

A. Yes.

Q. You try and lay them out and put them back together as best you can to see if you have everything?

A. Not necessarily. Some of us keep track on the way out.

Q. Dr. Knorr, is the procedure you perform consistent with this definition in DX 651?

A. No.

Q. In what way?

A. ... Breech extraction of the body excepting the head, well, according to the way I do my procedure, that sometimes occurs. Partial evacuation of the intracranial contents of a living fetus to effect delivery of a dead but otherwise intact fetus, yes, I do do that.

Q. Doctor, when you do have an intact extraction and the head gets stuck at the cervical os and then you do something to bring the head out, you testified on direct that sometimes the fetus is alive before you open the skull?

A. Yes....

California Case. Day One: March 29, 2004

Excerpts from PPFA's direct examination of its lead witness, Dr. Maureen Paul:

Q. And when you begin the evacuation, is the fetus ever alive?

A. Yes.

Q. How do you know that?

A. Because I do many of my procedures especially at 16 weeks under an ultrasound guidance, so I will see a heartbeat.

Q. Do you pay attention to that while you are doing the abortion?

A. Not particularly. I just notice sometimes....

Q. You testified earlier, Dr. Paul, that the fetus can be alive when the evacuation begins; is that correct?

A. That's right.

Q. When in the course of the abortion does the fetus -does fetal demise occur?

A. I don't know for sure. I certainly know that if I deliver intact and collapse the skull that demise occurs.

Excerpts from the Government's cross-examination of Dr. Paul:

Q. In performing a D&E at 20 weeks gestational age and above, in your previous capacity, was there ever a time when you saw any indication that the fetus was experiencing pain?

A. I have no idea what that means.

Day Two: Tuesday, March 30, 2004

Excerpts from PPFA's direct examination of Dr. Katharine Sheehan:

Q. So do you ever use a chemical agent to cause fetal demise?

A. Yes.

Q. What is that agent?

A. The agent is Digoxin.

Q. And at what gestational age do you use Digoxin?

A. We start using it at 22 weeks.

Q. Why do you choose 22 weeks?

A. We like to prevent an eventuality of a live birth, and because it seems to make the procedure move along a little bit easier on the day of the procedure....We administer the Digoxin with a needle through the abdominal wall of the woman into the uterus. We are aiming to get it into the fetal heart, or at least into the fetal thorax. However, we are not able to do that every time. If we are not able to do that, then we attempt to put the Diogoxin into the amniotic fluid. And it seems to work less often when it is just put into the amniotic fluid.

Q. What percentage of time are you successful in getting the Digoxin into the fetal heart?

A. I would say approximately 50 percent.

Q. And what about the term "living fetus," what does that mean to you?

A. It would be a fetus that still has a heartbeat, and that would still apply to many of my cases .....

Read the complete up-to-date notes from the New York trial at: