Misleading term ignores reality of pregnancy complications

Recently, politicians and commentators — including current Montana congressional candidates — have used the phrase “abortion up to the moment of birth.” This phrase is intentionally misleading; there is no such thing. Worse, it exploits personal tragedy for political gain.

Abortions after 21 weeks, which is about halfway through pregnancy, are very rare. They make up 0.7% of all abortions in Montana. The American College of Obstetrics and Gynecology and other medical societies are clear about the reasons abortions happen late in pregnancy (1). The truth is that these are almost exclusively tragic medical situations that result in parents ending wanted pregnancies.

Families find themselves facing these situations for different reasons. They may be told during their routine fetal anatomy ultrasound, performed typically at 18 to 20 weeks, that there is something terribly wrong with how their baby is developing. Errors in development can lead to missing kidneys, a badly malformed heart, or even missing brain – all of which are incompatible with life. Processing this news and finding answers to why this has happened takes time, and parents often find themselves past 21 weeks grappling with this information.

Dangerous medical complications can also occur before 23 weeks. Sometimes there can be heavy bleeding from the placenta, threatening the mother’s life. Sometimes the water breaks. At that point, infection can set in, or there just isn’t enough fluid left for the baby’s lungs to develop — and they depend on this fluid to form the parts of the lungs that exchange air. There is no chance a baby will survive long term.

Sometimes, there is nothing wrong with the baby, but the mother’s health is in danger. She has a new cancer diagnosis; she has dangerously high blood pressure; she is in the intensive care unit on a ventilator, and is unlikely to survive if her body has the added burden of pregnancy. The decision to save a mother’s life, in many cases to allow her to raise her other children, seems impossibly difficult. But the only people equipped to make that decision are the people directly affected by it.

These situations are tragedies. Parents face heart-wrenching choices. Some choose to continue the pregnancy as long as they possibly can, increasing health risks to the mother – in cases of fatal anomalies, to say goodbye to their baby at delivery several months later. Some can’t bear the idea of carrying a fetus that can never become a child, all the while answering the inquiries of strangers, and thinking of whether their baby is suffering, or will suffer after delivery. Families make their decision based on their shared values, their religion, the realities of their home situation.

Abortion in these circumstances can be either absolutely necessary to save mom’s life or the “least bad” option for a family with a fetus that can never survive, who hope to prevent suffering of a dying infant.

Politicians and commentators have been repeatedly claiming that abortions occur up to moment of birth, insinuating that medical professionals are performing these procedures up until the mother’s due date. This is not true. If a mother is very ill and past the point in the pregnancy where her baby could survive outside the womb, delivery of the newborn in the presence of a neonatologist occurs. This allows the physicians taking care of mom to continue to work to save her life while the neonatologist and his or her team help with the intensive care that the newborn needs.

It’s insulting to hear politicians claim that parents seek to abort pregnancies on a whim. Or to hear people say that doctors are willing participants in something like that. These are moments that are among the most difficult in parents’ lives.

Please keep in mind if you’re hearing the phrase “abortion up until the moment of birth” from a politician, this term ignores the reality of pregnancy complications and abortion. The use of such language is misleading and inflammatory, and harms families who experience pregnancy complications that lead to the need for a (rare) late abortion.

Dr. Leah Miller, Legislative Chair, Montana American College of Obstetrics and Gynecology; Dr. Lauren Wilson, President, Montana Chapter of the American Academy of Pediatrics.