Statement of Dr. Mark G. Neerhof
Legislative Hearing on H.R. 760
the “Partial-Birth Abortion Ban Act of 2003"
Committee on the Judiciary
Subcommittee on the Constitution
Tuesday, March 25, 2003
Mr. Chairman and committee members, Thank you for the opportunity to come and speak with you today.
My name is Mark Neerhof. I am an associate professor of Obstetrics and Gynecology at Northwestern University Medical School. I am an attending physician in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine at Evanston Northwestern Healthcare in Evanston, Illinois. I have been practicing Maternal-Fetal Medicine for 14 years. I am very familiar with fetal anomalies of all sorts, and am familiar with the options available for termination of pregnancy. I have done many deliveries at the gestational ages where an intact D&X is performed, and as a consequence, I am very familiar with the mechanism of delivery, including at these early gestational ages.
I came here today to express my support for a ban on intact D&X. I will divide my reasons into 3 categories: maternal, fetal, and ethical.
There exist no credible studies on intact D&X that evaluate or attest its safety. The procedure is not recognized in medical textbooks. Intact D&X poses serious medical risks to the mother. Patients who undergo an intact D&X are at risk for the potential complications associated with any surgical mid-trimester termination, including hemorrhage, infection, and uterine perforation. However, intact D&X places these patients at increased risk of 2 additional complications. First, the risk of uterine rupture may be increased. An integral part of the D&X procedure is an internal podalic version, during which the physician instrumentally reaches into the uterus, grasps the fetus’ feet, and pulls the feet down into the cervix, thus converting the lie to a footling breech. The internal version carries risk of uterine rupture, abruption, amniotic fluid embolus, and trauma to the uterus.
The second potential complication of intact D&X is the risk of iatrogenic laceration and secondary hemorrhage. Following internal version and partial breech extraction, scissors are forced into the base of the fetal skull while it is lodged in the birth canal. This blind procedure risks maternal injury from laceration of the uterus or cervix by the scissors and could result in severe bleeding and the threat of shock or even maternal death. These risks have not been adequately quantified.
None of these risks are medically necessary because other procedures are available to physicians who deem it necessary to perform an abortion late in pregnancy. As ACOG policy states clearly, intact D&X is never the only procedure available. Some clinicians have considered intact D&X necessary when hydrocephalus is present. However, a hydrocephalic fetus could be aborted by first draining the excess fluid from the fetal skull through ultrasound-guided cephalocentesis. Some physicians who perform abortions have been concerned that a ban on late abortions would affect their ability to provide other abortion services. Because of the proposed changes in federal legislation, it is clear that only intact D&X would be banned. It is my opinion that this legislation will not affect the total number of terminations done in this country, it will simply eliminate one of the procedures by which termination can be accomplished.
Intact D&X is an extremely painful procedure for the fetus. The majority of intact D&X are performed on periviable fetuses. Fetuses or newborns at these gestational ages are fully capable of experiencing pain. The scientific evidence supporting this is abundant. If one still has a question in one’s mind regarding this fact, one simply needs to visit a Neonatal Intensive Care Unit, and your remaining doubts will be short-lived. When infants of similar gestational ages are delivered, pain management is an important part of the care rendered to them in the intensive care nursery. However, with intact D&X, pain management is not provided for the fetus, who is literally within inches of being delivered. Forcibly incising the cranium with a scissors and then suctioning out the intracranial contents is certainly excruciatingly painful. I happen to serve as chairman of the Institutional Animal Care and Use Committee at my hospital. I am well aware of the federal standard regulating the use of animals in research. It is beyond ironic that the pain management practiced for an intact D&X on a human fetus would not meet federal standards for the humane care of animals used in medical research. The needlessly inhumane treatment of periviable fetuses argues against intact D&X as a means of pregnancy termination.
Intact D&X is most commonly performed between 20 and 24 weeks and thereby raises the question of the potential viability of the fetus. Recent unpublished data from my institution indicates an 88% survival rate at 24 weeks. These numbers will undoubtedly continue to improve over time.
Beyond the argument of potential viability, many pro-choice organizations and individuals assert that a woman should maintain control over that which is part of her own body (i.e., the autonomy argument). In this context, the physical position of the fetus with respect to the mother’s body becomes relevant. However, once the fetus is outside the woman’s body, the autonomy argument is invalid. The intact D&X procedure involves literally delivering the fetus so that only the head remains within the cervix. Based on my own experience, I can tell you that if the fetal head remains in the cervix, insertion of scissors into the base of the skull is, by necessity, a blind procedure, and consequently, potentially hazardous. If, as I suspect, the head is out of the cervix and in the vagina, that fetus is essentially delivered because there is nothing left to hold the fetal head in. At this juncture, the fetus is merely inches from being delivered and obtaining full legal rights of personhood under the US Constitution. What happens when, as must occasionally occur during the performance of an intact D&X, the fetal head inadvertently slips out of the mother and a live infant is fully delivered? For this reason, many otherwise pro-choice individuals have found intact D&X too close to infanticide to ethically justify its continued use.
In summary, the arguments for banning this procedure are based on maternal safety, fetal pain, and ethical considerations. I regret the necessity to support the development of legislation which will regulate medical care because, in general, that is not desirable. However, in this case, it is born out of the reluctance of the medical community to stand up for what is right.
Thank you for the opportunity to come and speak with you today.
Mr. Chairman, I’d like to request that a 1998 Journal of the American Medical Association article that I authored, in which I expand upon the subject of my testimony in front of you today, be submitted to the record.