Testimony of Kathi A. Aultman, MD
Before the Committee on the Judiciary
Subcommittee on the Constitution
U.S. House of Representatives
Hearing on H.R. 4965
The "Partial-Birth Abortion Ban Act of 2002"
July 9, 2002
Chairman Chabot and distinguished members of the House Judiciary Subcommittee on the Constitution, Thank you for allowing me to testify before you regarding H.R.4965, the "Partial-Birth Abortion Ban Act of 2002".
My name is Kathi A. Aultman, MD. I am a board certified obstetrician gynecologist, a fellow of the American College of Obstetricians and Gynecologists (ACOG), and a member in good standing with the American Medical Association (AMA). I have been in private practice in Orange Park, Florida for 21 years. I am on the Ethics Commission of the Christian Medical and Dental Associations (CMDA) and a member of Physicians’ Ad Hoc Coalition for Truth (PHACT).
I have spent my entire career as a women’s advocate and have a keen interest in issues that impact women’s health. I was the co-founder and co-director of the first Rape Treatment Center of Jacksonville, Florida and performed sexual assault exams as a medical examiner for Duval and Clay Counties. I also served as the Medical Director for Planned Parenthood of Jacksonville from 1981 to 1983.
After mastering first trimester and early second trimester dilation and curettage with suction (D&C with suction) procedures I was able to "moonlight" at an abortion clinic in Gainesville, FL. I sought out special training with a local abortionist in order to learn mid second trimester dilation and evacuation (D&E) procedures. Although I do not currently perform abortions, I have continued to dialogue with abortion providers regarding current practices and have studied the medical literature on abortion. I continue to perform D&C with suction and rarely D&E and Inductions in cases of incomplete abortion and fetal demise.
I see and treat women with medical and psychological complications from abortion and have managed and delivered women with pregnancies complicated by fetal anomalies, and medical, obstetrical, and psychological problems. I have personally had an abortion and I have a delightful adopted cousin who survived after her mother aborted her.
I have first hand knowledge and familiarity with the partial-birth abortion issue, having testified before legislative bodies in Florida and Vermont. I also testified in court as an expert witness in Arkansas and Virginia and assisted Florida and several other states in designing and/or defending their bans.
I support HR4965, the "Partial-Birth Abortion Ban Act of 2002", for the following reasons:
1) This bill clearly distinguishes Partial-Birth Abortion from other abortion procedures.
2) This bill will not endanger women's health.
3) It protects women from being subjected to a dangerous unproven experimental procedure.
4) Partial-Birth Abortion has blurred the line between abortion and infanticide.
5) It bans a procedure that is abhorrent to the vast majority of Americans.
1) HR 4965 clearly distinguishes Partial-Birth Abortion from other abortion procedures.
Partial-Birth Abortion is a legal term that covers a set of circumstances that culminate in the physician intentionally killing the fetus after it has been partially born.
As defined in the act:
"the term ‘partial-birth abortion’ means an abortion in which (A) the person performing the abortion deliberately and intentional vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus: and (B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;"
(In the rest of the text the term "partially born" will be defined as the position of the fetus as described in HR 4965.)
Partial-Birth Abortion includes but is not limited to D&X performed on live fetuses. It would also include a procedure used in China where formaldehyde is injected into the baby’s brain through its fontanel (soft spot), after the head has been delivered, in order to kill it prior to completing the delivery. It does not prohibit medical abortions, D&C with suction, or D&E procedures. It would not cover Induction unless the physician intentionally intervened during the delivery portion of the procedure and killed the fetus after it had been "partially born. It would not cover a D&X on a dead fetus nor would it cover the accidental death of baby during the normal birth process. Under HR 4965 a Partial-Birth Abortion is allowed if it is "necessary to save the life of a mother whose life is endangered by a physical disorder, illness, or injury.
The "Partial-Birth Abortion Ban Act of 2002" eliminates the concern that D&E is prohibited under the act by more precisely defining what is meant by a Partial Birth Abortion. According to the Supreme Court in Stenberg v Carhart, the Nebraska statute banning Partial-Birth Abortion was unconstitutional because it applied to dilation and evacuation (D&E) as well as to dilation and extraction (D&X). The court held that the statute was unconstitutional because it imposed an undue burden on a woman’s ability to choose D&E (the most common 2nd trimester abortion procedure), thereby unduly burdening her right to choose abortion itself. The Court commented, however, that if the definition were more narrowly defined to clearly differentiate D&E, a ban might be constitutional.
Despite assertions to the contrary by some abortionists, both the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) clearly distinguish between D&X and D&E.
D&X (dilation and extraction or intact dilation and evacuation) is generally performed from about 20-22 weeks gestation and beyond and has been done as late as 40 weeks (full term). It is prohibited by HR 4965 if it is performed on a live fetus. In D&X the fetus is delivered intact except for the decompressed head. In order to accomplish this, Laminaria (dried seaweed) or a synthetic substitute, is inserted into the cervix over the course of several days. The goal is to dilate the cervix just enough to allow the body, but not the head, to be pulled through the cervix. The membranes are ruptured and the lower extremities are grasped under ultrasound guidance. If the fetus is not already breech (feet or bottom first) the baby is converted to that position using forceps. The fetus is then delivered except for its head by a method called breech extraction. The abortionist then thrusts a scissors into the base of the skull, suctions out the brains, and then completes the delivery. The placenta is then extracted using forceps and the cavity is curetted to remove any additional tissue. Prostaglandins and/or oxytocin may be used to help "ripen" the cervix and/or help the uterus contract. (There are times when the head may be pulled through the cervix as the abortionist is extracting the body. In that circumstance, if the abortionist isn’t careful to hold the fetus in the vagina prior to killing it, he will be faced with the complication of an unwanted live baby.)
D&E (dilation and evacuation) is generally used from about 13-15 weeks up until 20-22 weeks and occasionally 24 weeks gestation (early to mid second trimester) and is not prohibited under HR`4965 because the fetus is removed in pieces. In D&E the cervix is dilated usually using Laminaria over the course of 1-2 days. It is dilated just enough to allow the forceps to be inserted into the uterine cavity and for body parts to be removed. The membranes are ruptured and the fluid is generally suctioned. The forceps are inserted into the uterine cavity with or without ultrasound guidance. Usually an extremity is grasped first and brought down into the vagina. The rest of the body cannot pass through the cervix so the abortionist is able to detach it by continuing to pull on it. After the smaller parts have been removed, the thorax and head would be crushed and removed from the uterine cavity. The ability to dismember the fetus is based on not over-dilating the cervix. Prostaglandins and/or oxytocin may be used to help "ripen" the cervix and/or help the uterus contract. D&E is not prohibited under the act because fetus dies as a result of being dismembered or crushed while the majority of the body is still within the uterus and not after it has been "partially born".
D&C with Suction (dilation and curettage with suction) is generally used from 6 weeks up until 14-16 weeks gestation (first and early second trimester). It is not prohibited by HR 4965. In this procedure the cervix is generally dilated with metal or plastic rods at the time of the procedure, but occasionally Laminaria are inserted the night before for the later gestations. A suction curette is then inserted and the contents of the uterus are suctioned into a bottle. The cavity is then usually checked with a sharp curette to make sure all the tissue has been removed. At times forceps are needed to remove some of the fetal parts in the later gestations. Prostaglandins and/or oxytocin may be used to help "ripen" the cervix and/or help the uterus contract. It would not be prohibited under this act because the fetus or fetal parts pass from the uterus through the suction tubing directly into a suction bottle. The fetus is therefore not intentionally killed while it is "partially born". The fetus is usually killed as it is pulled through the tip of the suction curette or on impact in the suction bottle.
Medical Induction is generally performed from 16 weeks gestation to term. This method induces labor and subsequent delivery of an intact fetus and would not be prohibited by HR 4965. Labor may be induced in several ways. The older methods are termed Instillation Methods because they involve injecting something into the uterus. Saline (a salt solution) injected into the amniotic cavity generally kills the fetus and then causes the woman to go into labor but is associated with significant risk. Urea may also be instilled and appears safer than saline but there is a higher incidence of delivering a live baby. It may also need to be augmented with prostaglandins. In another method a prostaglandin called carboprost (Hemabate) is injected into the amniotic cavity or given IM to stimulate labor but may not always kill the fetus. An intra-fetal injection of KCL or Digoxin may be necessary to prevent a live birth. (Gynecologic and Obstetric Surgery, Nichols 1993, 1026-1027) Newer methods employ the use of prostaglandins. PGE1 (misoprostol) and PGE2 are generally used vaginally, often in conjunction with oxytocin. These methods generally result in the delivery of a live baby so if an abortion is intended an intra-fetal injection of KCL or Digoxin is generally utilized. PGE2 and oxytocin may be used in cases of previous C-section or uterine surgery. HR 4965 would not prohibit a Medical Induction unless the abortionist purposely halted the birth process in order to intentionally kill a still living "partially born" fetus.
Some of the concerns expressed about Inductions, as opposed to surgical methods (D&E and D&X), include 1) the psychological and physical pain of labor, 2) the time involved, and 3) the fact that they are often done in a hospital and are therefore more costly. Especially if an abortion is the goal, the pain and even the memory of labor can be eliminated with medication. All three procedures generally require more than one day except perhaps in the case of an early D&E. The mean Induction time with vaginal prostaglandins is 13.4 hours and 90 % are delivered by 24 hours. All of these methods have been performed in both inpatient and outpatient settings, however, as the gestational age and therefore the risk increases, the inpatient setting generally becomes safer.
Cephalocentesis is a medical procedure during which a needle is inserted into the head of a fetus with hydrocephalus (water on the brain) in order to drain the fluid. It would not be prohibited by HR4965. This procedure can be lifesaving for the fetus and may prevent brain damage by taking pressure off the brain. The needle is usually inserted through the abdomen but may also be inserted vaginally if the fetus is in the head first position. This is done while the fetus is still inside the womb. This would not be prohibited even if the fetus had been delivered breech if were done to draw off fluid (not brain tissue) in order to shrink the head to allow delivery of an entrapped hydrocephalic head.
Death during the birth process would not be prosecuted under HR 4965, whether or not labor was induced, as long as the fetus was not intentionally killed while it was partially born.
Passage of RH 4965 will not create an undue burden on a woman seeking an abortion because its narrow definition of Partial-Birth Abortion excludes the commonly used methods of abortion which provide alternatives at every gestational level.
Some abortionists have begun to use parts of the D&X technique on earlier gestations. The mere fact that it is possible to use this procedure on pre-viable fetuses should not prevent it from being banned.
2) HR 4965 would not endanger woman's health .
Obstetricians regularly handle medical complications of pregnancy that may threaten a woman’s health or life without having to resort to using a Partial-birth Abortion. When the baby is wanted and the pregnancy must be terminated after or near viability, Induction and C-section are commonly used in an attempt to save both the mother and the baby. Destructive procedures are only considered pre-viability or if the pregnancy is unwanted. Standard procedures such as D&C with suction, D&E, and Induction may be used to terminate an unwanted pregnancy. In an emergency situation, when immediate delivery is necessary D&X would not be used because of the length of time required to dilate the cervix. In it’s report on Late Term Pregnancy Termination Techniques, the AMA stated, "Except in extraordinary circumstances, maternal health factors which demand termination of the pregnancy can be accommodated without sacrifice of the fetus, and the near certainty of the independent viability of the fetus argues for ending the pregnancy by appropriate delivery." (AMA PolicyFinder HOD, A-99, H-5.982 Late Term Pregnancy Termination Techniques).
Although a Partial-Birth Abortion is never necessary to safeguard the health of the mother, HR 4965 provides an exception just in case "it is necessary to save the life of a mother whose life is endangered by a physical disorder, illness or injury." The AMA report on Late Term Pregnancy Termination Techniques states that, "According to the scientific literature, there does not appear to be any identified situation in which intact D&X is the only appropriate procedure to induce abortion and ethical concerns have been raised about intact D&X." (AMA PolicyFinder HOD, A-99, H-5.982 Late Term Pregnancy Termination Techniques). Even if there were such a situation, however, the fetus could be injected with Digoxin or KCL, or the cord could be cut at the start of the procedure, in order to kill the fetus so that the procedure could be performed without risking prosecution.
In my opinion the health exception required under current case law is so broad that it basically allows elective abortion through term.
3) It protects women from being subjected to a dangerous unproven experimental procedure.
D&X is an experimental procedure that has not been adequately evaluated. There have been no peer reviewed controlled studies that have looked at the benefits and risks of D&X as compared to D&E, Induction, Delivery, or C-Section. We do not have adequate data on its mortality or morbidity. The complications of D&X include hemorrhage, infection, DIC, embolus, retained tissue, injury to the pelvic organs including the bowel and bladder, as well as an increased risk of cervical incompetence. These risks are the similar to those associated with D&E, however, these risks increase with increasing gestational age and D&X may be done at much later gestational ages. There was some suggestion in earlier studies that greater artificial cervical dilation increases the risk cervical incompetence. With D&X the cervix must be dilated significantly more than with D&E.
One of the problems in determining both the frequency and mortality and morbidity of the various abortion procedures is that the reporting of the numbers and types of abortion procedures at various gestational ages is grossly inadequate. Four states including California don’t report their statistics to the CDC and many don’t record the necessary details. D&X is not reported separately nor is it clear which category it should be reported under. There is also inadequate reporting of the complications of abortion.
At times I am called to see women in the ER with complications of abortions. I had always assumed that when I wrote the diagnosis on the hospital face sheet that those cases would be reported to the state. I was shocked when I found out that they aren’t reported to anyone and that there is no requirement to report them. In light of that, how can we determine what the true complication rate is for any of these procedures since many never return to their abortion provider.
D&X is often done in outpatient settings. The abortionist may not have hospital privileges or know how to handle the complications of the procedure especially if he is not an OB/GYN.
Although, previous C-section has been cited as a reason why D&X might be preferred over Induction, Dr.Haskell, the originator of the procedure, excluded those cases. It is now accepted practice to use prostaglandin E2 and /or oxytocin for Induction after previous C-section.
4) Partial-Birth Abortion has blurred the line between abortion and infanticide.
When I first heard the term I thought it strange that it would called Partial-Birth Abortion and not Partial-Birth Infanticide. I didn’t understand why Drs. Haskell and McMahon weren’t charged with murder, or at least lose their license to practice medicine, once they revealed what they were doing in a D&X. The fact that the babies weren’t 100% born when they were killed seemed to me like an awfully flimsy technicality.
Who decided that just because a fetus was within the birth canal, the abortionist could still kill it? Does this mean that the abortionist may kill a baby that has just one foot still in the vagina? Can a woman request, even demand, that the physician attending her delivery, kill her child once it’s head has been delivered if she finds it is the wrong race or has a cleft lip? Currently, her claim would be valid if she stated that the birth would damage her psychologically and might actually place her life at risk if her abusive husband found out.
We already have had cases where an infant was not treated with the same care because the mother had intended to abort it. We had several cases where teens killed their babies after delivery and we were horrified. What hypocrites we are. Had they been smart enough to leave a foot in the vagina prior to killing the baby they could only have been charged with practicing medicine without a license.
When my daughter was working on a paper on the Holocaust for school, I became particularly interested in one of her sources. It discussed the mindset of the medical community in Germany right before the holocaust. I was saddened and concerned when I considered where we are as well. Not only are we killing babies during the process of birth, but there are also those in the medical community who are advocating. euthanizing babies up to 3 months at the request of the parent. In Nazi Germany defective babies were the first to be eliminated.
In light of current case law, the passage of HR 4965 is necessary in order to re-establish a bright line between abortion and infanticide.
5) HR 4965 bans a procedure that is abhorrent to the vast majority of Americans.
Even though I had done mid 2nd trimester D&Es, I was appalled when I heard about D&X and really didn't believe it was being done. The majority of Americans also have found Partial Birth Abortion abhorrent and have supported legislation in numerous states banning its use.
When Nebraska's Partial-birth Abortion Ban was ruled unconstitutional several things happened:
(1) The line between abortion and infanticide was blurred,
(2) The State’s ability to regulate abortion at any gestation even in the case of a procedure as repugnant as PBA was effectively blocked and
(3) The State's ability to promote any interest in the potentiality of human life, even post viability, was lost.
For these reasons I feel that this committee is justified in sponsoring legislation to once again attempt ban partial-birth abortion.
Both Roe and Casey stated that the State has an interest in potential life and could even proscribe certain techniques as long as it did not create an undue burden for women obtaining abortions.
The court emphasizes that "By no means must a State grant physicians unfettered discretion in their selection of abortion methods," and yet with this decision they have done just that. The fact that a D&X can be done on a nonviable fetus does not mean that it cannot be banned as long as the prohibition does not unduly burden a woman’s ability to obtain an abortion. Since there are other more acceptable procedures available this is not an issue.
As a former abortionist I can tell you that the worst complication for an abortionist is a live baby at the end of the procedure. The goal is a dead baby.
At our hospital a fetal death before 20 weeks it is considered a spontaneous abortion or miscarriage. After that time it is considered a stillbirth and a death certificate must be filled out and the baby must be sent to the funeral home. If a baby of any gestation is born alive and exhibits definite signs of life, it is considered a birth and a birth certificate is filled out.
Unlike D&E, which is limited to about 20-22 weeks by the toughness of the tissue, D&X allows a surgical delivery of the fetus through term. Unlike induction and C-section, however, the fetus has no possibility of survival with D&X.
Even ACOG, a staunch supporter of abortion rights states in its Abortion Statement of Policy, "The College continues to affirm the legal right of a woman to obtain an abortion prior to fetal viability. ACOG is opposed to abortion of the healthy fetus that has attained viability in a healthy woman."
When I reviewed Dr. McMahon’s testimony given to the House Subcommittee on the Constitution June 23,1995 I found that the maternal indications he listed for D&Xs he had performed were generally not serious and the vast majority were actually done for fetal indications, many of which were minor. Depression accounted for 39, Induction failure 14, Sexual Assault 19, Down's Syndrome 175, and cleft lip 9.
Dr. Haskell admitted that he did the vast majority of his D&Xs on normal fetuses and pregnancies. During the course of this debate I received a letter from an abortionist in Orlando offering termination of pregnancy up to 28 weeks for fetal indications. He went on to say that, "To obtain a pregnancy termination beyond 24 weeks gestation, Florida State Law requires that a patient receive a written statement from her personal physician indicating it would be a threat to her health to continue her pregnancy." (Letter from Dr. James S. Pendergraft dated April 14, 1999) As the court currently defines health, even continuing a normal pregnancy threatens a woman’s health.
I am concerned that some of the effort to preserve this technique is being fueled by the fetal organ trade in addition to the abortion industries desire to have no restrictions on abortion.
As a moral people there are some things that just should not be allowed and the killing of an infant in the process of birth is one of them. Although the courts have given a woman the right to empty her womb they have not given her the right to a dead child. As technology and Induction techniques improve we will hopefully be able to give a woman the right to terminate her pregnancy without the necessity of terminating her child.
When Dr. McMahon first testified regarding D&X he claimed that the fetus was killed by the anesthetic given the mother. That was soundly refuted by several prominent anesthesiologists. We also now know that the fetus feels pain, which makes this procedure even more ghastly.
I have been accused of being anti-abortion because of my religious beliefs but actually I stopped doing abortions while I was an atheist.
When I started my OB/GYN Residency I was very pro-abortion. I felt no woman should have go through a pregnancy she didn't want. I felt abortion was a necessary evil and I was determined to provide women with the best abortion care possible. I perfected my D&C with suction technique and then convinced one of our local abortionists to teach me to do D&Es. I moonlighted at an abortion clinic in Gainesville as much as I could. The only time I felt uneasy was when I was on my neonatal rotation and I realized that the babies I was trying to save were the same size as the babies I had been aborting.
I continued to do abortions almost the entire time I was pregnant (with my eldest daughter) without it bothering me. It wasn't until I delivered my daughter and made the connection between fetus and baby that I stopped doing abortions. I found out later that few doctors are able to do abortions for very long. OB/GYNs especially, often experience a conflict of interest because they normally are concerned about the welfare of both their patients but in an abortion they are killing one of them. It's hard for most doctors to deliver babies and do abortions. It also has to do with the fact that to almost everyone else the pregnancy is just a blob of tissue, but the abortionist knows exactly what he is doing because he has to count all the parts after each abortion. I never had any doubt that I was killing little people but somehow I was able to justify and compartmentalize that.
Even though I later became a Christian, I continued to be a staunch supporter of abortion rights. I just couldn't stomach doing them myself anymore. It wasn't until I read an article that compared abortion to the Holocaust that I changed my opinion. I had always wondered how the German Doctors could do what they did to people. I realized that I was no better than they were. I had dehumanized the fetus and therefor felt no moral responsibility towards it.
I joined the fight to ban this procedure only because I felt we were no longer really dealing with abortion but rather a form of infanticide. This bill safeguards women and does not unduly interfere with their ability to obtain an abortion. It clearly does not cover D&E or other commonly performed abortion techniques. It reestablishes a bright line between abortion and infanticide and it bans a procedure that is abhorrent to most Americans.
I urge you to pass HR 4965 "The Partial-Birth Abortion Act of 2002".
Thank you.