Two weeks ago, the house passed The Pain-Capable Unborn Child Protection Act which criminalizes abortion after 20 weeks. Relying on scientifically unsubstantiated claims about fetal pain, this callous bill impacts the slightly more than one percent of women who seek abortion services after the 20 weeks’ gestation. This bill greatly impacts poor women as research suggests a common reason for delays in obtaining a first trimester abortion is financial difficulty or lack of insurance coverage. It also devastates women and families who are seeking abortions after 20 weeks because they learned (often at the 16 or 20 week ultrasounds or anatomy scans), that their much-wanted child has a serious fetal anomaly.
There has been so much rhetoric around the politics of “late term” abortion but not much about the reality of what it is and is not. Given that our president, then candidate Donald Trump said during a debate “”you can take the baby and rip the baby out of the womb in the ninth month, on the final day,” it’s time to set the record straight on what an abortion after 20 weeks really looks like.
For more on that, I am grateful to have Dr. Julie Bindeman, a reproductive psychologist, writer, and advocate share more about this. Her insights are below.
At this point in pregnancy, there are two options for abortion care, and it absolutely depends upon where you live. In many states, there are no options, and a person has to travel to another state for medical care. The potential options are: 1. D&E (dilation and evacuation) 2. Labor and Delivery. A D&E is a surgical procedure performed under sedation where the physician removes the fetal remains in piecemeal. It is done after the cervix is dilated using medication, and requires skill and practice to perform. It is notable that D&E’s are not part of medical school training and learning the procedure requires a specialty fellowship. The second procedure is Labor and delivery, where a woman is again dilated using mediation (ingested rather than IV administered) and then waits to go into labor. This can be done at a hospital (again, depending on state laws) or at a Clinic. If it is done at a clinic (and only three in the United States have doctors that will perform is), it takes several days. The first step is to inject a substance into the fetus that stops the heart. The majority of the several day procedure is spent ripening the cervix using seaweed sticks called lamaria. The baby is then delivered at the Clinic, fully intact. In a hospital setting, the labor is commenced by inserting a cervix opener vaginally, every 6 hours. Typically, this needs to be administered at least 3 times before labor can begin. The baby is then delivered, and depending on gestational age, may or may not be alive after delivery. In both of these delivery scenarios, parents are able to hold their babies, take pictures, get a tuft of hair (if available) and create footprints or handprints.
Saying goodbye to a desired pregnancy is a gut wrenching experience, no matter how it occurs. What has been described was done so in more clinical terms, and doesn’t capture the simultaneous physical and emotional pain that comes about. This is only a part of the choice that a parent makes, as the burden of grief is carried long after the delivery. These are very personal decisions that a family can make, and ultimately, the choice is up to the person that is pregnant—not the government, the state, a physician, or a partner.
Dr. Julie Bindeman graduated from the George Washington University and is the co-owner of the practice Integrative Therapy of Greater Washington located in Rockville, Maryland. As a result of her own reproductive story, she pursued post-graduate training in the field of Reproductive Psychology, where she actively writes, lectures, and presents on the topic. She has been on several committees for the Mental Health Professional Group of the American Society for Reproductive Medicine including serving as Chair of the Continuing Education Committee and on the Social Media committee; she served as a Board Member of the Maryland Psychological Association for 8 years, and was the first Early Career Psychologist Committee Chair; and has been on other boards such as Uprooted and JCADA. Additionally, Dr. Bindeman is a member of a variety of organizations that are focused on Maternal Mental Health. She was appointed by the Governor of Maryland to serve on the Maternal Mental Health Task Force representing psychologists in the state. In 2014, Dr. Bindeman was honored to receive both the Woman Who Dared Award conferred to her by the National Council of Jewish Women and the Volunteer of the Year Award from the Maryland Psychological Association.
For more info on Dr. Bindeman check out