In the Jan 5, 1998 issue of The New Yorker, an article entitled The Senator's Dilemma by Joe Klein tells the story of Rick and Karen Santorum and the problems that arose in Karen's fourth pregnancy. To review the fateful events of the last few weeks of her pregnancy, according to Klein,
"...(Karen Santorum) was eighteen weeks pregnant at the time (of the 1996 senate debate on the partial birth abortion ban)... . `I was so angry at Carol Mosely-Braun,' she later recalled. `What if there were something wrong with my baby? How horrible that would be...'"
On her television set, Karen Santorum had just seen Sen. Carol Mosely-Braun stare straight at Karen's husband as Mosely-Braun said that none of those in the senate could experience the trauma faced by women in the issue of late term abortions.
One week later Mrs. Santorum had an ultrasound which confirmed her fear that there might be something wrong. A potentially correctable problem with the urinary tract was found, but it required immediate operative amniocentesis, a procedure with a relatively low risk of complications. One of the most disastrous complications that can occur, did occur, and Karen Santorum developed a life threatening chorioamnionitis.
She soon began having uterine contractions which usually, but not always, accompany serious intrauterine infections and she eventually aborted the fetus.) Klein continues,
"...The Santorums, and especially the Senator, have difficulty talking about what they would have done if Karen had not gone into labor - if her life had been threatened. `There are cases where, for the life of the mother, you have to end a pregnancy early,' Santorum said, steering away from the particular. `But that does not necessarily mean having an abortion. You can induce labor, using a drug like pitocin. After twenty weeks, the doctors say, abortion is twice as risky as childbirth. If there's a real emergency, you can do a cesarean section. But in no case is it necessary to kill the baby and then deliver it...'"
Santorum says, "if there is a real emergency, you can always do a cesarean section." This reminds me of a comment by midwife zora to moiv's beautiful diary written on July 3. Zora said moiv's diary, http://www.dailykos.com/... Who Can Find A Virtuous Woman?
"reminds me of an OR death" A poor (low SES) woman whose partner left her when he found out about the pregnancy was happy that her family had rallied in support of her single motherhood. She ruptured membranes prior to viability.
They kept her hospitalized for a month in the hopes of reaching viability because they had a recent case of a 23 week fetus who survived. She became septic at 24 weeks. They attempted an induction of labor as signs of infection arose. This was in an urban university hospital. Three days later they attempted a hysterotomy. We had to stuff blankets under the OR doors because of the stench.
During the procedure the OB's said "Why are her organs blue." At which time the anesthesiologist tried to intubate her and failed. Called his back-up, then the ENT's. No luck. It wasn't even the pregnancy that killed her, it was the anesthesia. I'm not sayin' that she may have lived if she had the pregnancy terminated at the time of rupture of membranes. I'm just saying we'll never know. And she was a bright, warm, wonderful woman
I always am uncomfortable adding to another's distress, and I am well aware of the despairing sorrow and guilt that usually accompany the loss of a child, whether lost after birth or still in the fetal stage. These feelings are especially pronounced in an incident such as that experienced by the Santorums. The doubts - "Was there something else that we could have, should have done? Was it our/my fault that this happened to our/my baby? Did we do right when we made the decision to have an amniocentesis? Should we have waited and trusted in the Lord? Was this a test of our faith, a test we failed?" - come unbidden, unanswered, indeed, unanswerable, for these are questions which have no absolute answer from either medicine or religion.
But I would like to point out a few incongruities in Klein's rendition of this tragedy. Karen Santorum was approximately twenty to twenty-one weeks pregnant when she had the intrauterine procedures that resulted in the initiation of a septic abortion. All that was done by the Santorums and their doctors was done for the best and noblest of reasons (possibly with the exception of Karen's irrationally wanting to continue a seriously infected pregnancy which would have almost certainly led to her death as well as the death of her fetus and left the children she had at home without a mother.)
When Karen developed a serious intrauterine infection at about twenty-one weeks of pregnancy, the outcome was inevitable. Abortion, whether spontaneous or induced, was at this point unavoidable. Or the death of the mother and fetus was a distinct probability. It is regrettable that this happened to the Santorum s, but it is highly disturbing, and to the small number of American women who may require late term abortions for reasons similar to those experienced by Karen Santorum even more regrettable, that the (now former) Senator learned nothing from this horrendous experience. Let's analyze Santorum's statements, first, that
"...(t)here are cases where, for the life of the mother, you have to end the pregnancy early. But that does not necessarily mean having an abortion. You can induce labor... ."
An interesting statement for several reasons. The senator is right, if the fetus is viable. If a fetus is viable it is not necessary to do an abortion in any instance of which I, as an Obstetrician-Gynecologist with thirty years experience, can think. However, if a fetus is pre-viable, that is, if it does not have the capacity to survive outside the womb, and the womb must be emptied as was the case in Karen Santorum's pregnancy, for those fetuses it makes no difference whether they are expelled by spontaneous or induced uterine contractions or removed by hysterotmy, hysterotomy or by abortion instruments. The end result is abortion. The term, abortion, is defined as the removal or expulsion of a previable fetus from the uterus. And although Karen Santorum's septic abortion was accidental, unintended by any of the participants in this drama, abortion after the initiation of intrauterine infection was absolutely indicated by all the tenets of good medicine once that serious intrauterine infection had occured. Had she not had the onset of spontaneous contractions, her doctors certainly would have aborted her by some means or she almost certainly would have died.
The senator goes on to say,
"After twenty weeks, the doctors say, abortion is twice as risky as childbirth."
This is either a deliberate attempt by Santorum to spread information that he knows to be untrue, that is, a lie; or perhaps he is unknowingly spreading false information furnished him by an anti-abortion physician, in which case he was lied to by his doctor. According to the Center for Disease Control, the governmental agency charged with gathering and collecting abortion statistics, as well as private agencies such as the Guttmacher Institute, there is no time in pregnancy up to twenty-six weeks after the last menstrual period when abortion by any method other than hysterotomy (an abortion done by cesarean section) is even as risky, much less "twice as risky as childbirth."
As for Santorum's statement that,
"If there's a real emergency, you can do a cesarean section...in no case is it necessary to kill the baby and then deliver it",
I trust that Senator Santorum is referring to cases in which the fetus is viable. To do a cesarean section (hysterotomy) in a case analogous to that experienced by the Santorums would, almost anywhere in the United States today, be blatant malpractice except in extremely rare circumstances. The risk to the pregnant woman in such a case would so far outweigh any possible benefit for the woman or her fetus that such an act would be malpractice so egregious as to deserve the loss of the privilege of practicing medicine If her doctor did not know how to perform a late second trimester abortion, he or she would be ethically required to seek the help of an experienced abortion care provider unless such a person were not immediately available. Whether one applies a risk-benefit analysis or a balancing-of-interests test to such a problem, the answer remains the same when the fetus is pre-viable.
The "balancing-of-interests" test is a legal concept similar to the term "risk-benefit analysis" currently in vogue in medicine. A difference arises in that when we physicians do a risk-benefit analysis for a patient who is not pregnant, we should consider only what a particular course of diagnosis and treatment implies for that patient who is seeking our care or counsel. But a balancing of interests between the two entities most intimately involved in an abortion decision would seem to be what most of us Pro-Choicers unconsciously do each time we watch or participate in an abortion decision. For "Pro-Lifers," their "balancing of interests" has the great and abiding attraction of being simple and direct. If, as they believe, abortion leads inevitably to the downfall of individuals and the degradation of society, then it is definitely wrong and no amount of rational debate will ever make it right. If abortion is the murder of a baby, it is obviously wrong and no agonizing internal discussion is necessary. If abortion is against the will of God (as the Santorums and many others say they believe), then it is most assuredly wrong and no debate is even desirable. Indeed, to strive against God (they believe) is dangerous and leads to the loss of one's soul. Since they believe that they are dealing with two equivalent moral entities, two essentially equal human beings, attempting to balance the interests of a fetus and the woman carrying it, this becomes an unresolvable dilemma and any choice which may result in harm to either, is wrong. The wisest course? accept the inevitable and do nothing which may be harmful to either.
For those who are Pro-Choice, things are not so cut and dried. We don't accept the idea that a first trimester fetus is the moral equal of a sexually mature female, nor even of a potentially viable premature baby. Most of us don't accept a second-trimester fetus as the essential equivalent of these, either. (Although it becomes much more problematic for many of us as the fetus matures and develops more of the physical attributes and functional capacities of a fullterm infant.) But a majority of Americans, whether they consider themselves Pro-Choice, "Pro-Life" or somewhere between, are willing to accept the personhood of the third-trimester fetus, a developmental stage at which the average person will have some difficulty distinguishing a premature- from a full term-infant except in the presence of both, and most of us have no difficulty pronouncing third-trimester abortion out of bounds of the medical procedures which are morally acceptable. (Possibly excepting cases involving extremely serious health consequences for the mother - as might have been the case for Karen Santorum had her intrauterine procedure and infection been at twenty-seven weeks and she not have gone into labor - or even later for some fetal anomalies incompatible with life as would have been the case had the fetal kidneys already have been irremediably damaged. Even then, the questions and answers are not simple, for most of us don't countenance infanticide even of fatally anomalous infants who will surely die momentarily. (Why then, you might ask, would we condone the destruction of a third-trimester fetus for similar reasons? A good question for which I have no comfortable answer.)
It is well known to those among us who have closely observed both sides, that, just as those who call themselves "Pro-Life" cover a spectrum of opinion wide enough to include all but the most radical Pro-Choicers, so do those who call themselves "Pro-Choice" embrace a variety of views broad enough to cover all but the most hardline "Pro-Lifers." So one must be very careful when assessing the ideological purity of people like the Santorums. That which may be a totally unacceptable reason for an abortion for someone I hardly know, may mandate abortion for me or for my loved one who broaches the subject under similar or even identical conditions. In my practice, a common remark from mothers and fathers, husbands, lovers and friends seeking abortion for someone they love goes something like this, "(I'm, she's, we're) just as "Pro-Life" as anyone else, but this is our little girl (me, my wife, my friend, my loved one) and (therefore) this is a special case. This is different!" They rarely actually say, "therefore." but we all understand that it is implied. They never stop to consider that another mother may believe her little girl, or a husband his wife, or an individual herself, just as special in the same or some different circumstance.
So, who does the balancing. And what are the factors to be taken into account? Those who are strongly "Pro-Life," always assume that they have the answer for everyone. (Or at least they do until they become embroiled in a potentially disastrous pregnancy involving themselves or someone they love.) Senator Rick Santorum, in the interview with Joe Klein, said that one need never choose abortion, for labor can always be induced. And he is right, of course...except for that one minor point. When a fetus is expelled from the womb prior to viability, whether forced out by the expulsive forces of natural or induced uterine contractions, or removed by instruments pulling it, or by sucking it out with a vacuum tube, an abortion has occured.
We who call ourselves Pro-Choice don't believe that we can or should make someone else's reproductive decisions. For us, only the pregnant woman or girl considering her options has information which may be adequate to decide when and under what circumstances she is ready and willing to carry a child to term, to abort, or to die trying to do one or the other. If a choice must be made, a judgement which may carry life-long consequences whether her decision be to carry a pregnancy to term and deliver or to abort, Pro-Choicers believe that the person with the greatest interest in how that verdict affects her own life should be granted the right and the responsibility to reach her own conclusion just as she will surely bear the burden those women and girls granted the right to make their own decisions, with all good intent and as much information as they can consciously or unconsciously gather unto themselves, sometimes make choices they later regret.rdens of her choice. That person is almost always the pregnant woman acting, with the help and counsel of her physician and perhaps of those who know and love her. They are, like the Santorums and their doctors, the only ones who have any idea where along the line of interests the balance point lies for her.