DATE: Monday, May 12, 1997                  TAG: 9705120051

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY MARIE JOYCE, STAFF WRITER 

                                            LENGTH:  297 lines

``PARTIAL-BIRTH'' ABORTION IT'S A LATE-TERM PROCEDURE RARELY PERFORMED IN VA., BUT DEBATE RAGES OVER A POSSIBLE BAN.

It has been compared to infanticide. Called ``horrendous,'' ``macabre,'' ``gruesome,'' ``barbaric.''

The so-called ``partial-birth'' abortion - a type of late-term procedure - has generated such an outcry that many states, including Virginia, have moved to ban it.

The debate has been ferocious. At a U.S. House and Senate committee hearing in March, lobbyists and politicians hurled insults at each other, with a congressman calling abortion-rights supporters ``very hardened, very cold and very callous.''

This week, the U.S. Senate is expected to vote on a bill to ban the procedure nationwide. The House has already passed its own version. President Clinton vetoed similar legislation last year, saying the lives and health of women would be endangered if the procedure weren't available.

But the fiery rhetoric, in the halls of government and in the media, hides a statistical reality: The law would have little, if any, effect on abortions in Virginia.

Why? Because, according to a Virginian-Pilot analysis of a state database and interviews with doctors, the procedure that has provoked so much rancor is rarely, if ever, done in the state.

Said Dr. Robert Vermillion, a Roanoke obstetrician: ``I have never spoken with anyone who has done one or knows anyone who had done one. . . . I'm talking the whole southeastern United States.''

What is a partial-birth abortion?

The bill before Congress targets a procedure more typically called intact dilation and extraction, or D&X. The term ``partial-birth abortion'' is a political label, not a medical one.

In a D&X, the cervix, the opening to the uterus, is dilated slightly. The doctor pulls the fetus out partway. He drains brain tissue from the skull, so the skull will compress as it passes the cervix, and the fetus is pulled out.

The bill bans any abortion in which ``the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.''

Although critics these days use words like ``atrocity'' to describe D&X, the method was devised to reduce risks to women, say doctors familiar with the subject.

Some believe it is safer than a common method of late-term abortion, inducing early labor. The cervix doesn't have to be dilated as much for a D&X, so there may be less risk of complications like bleeding and infection.

And some believe it is better than methods that break up the fetus in the uterus because it may lower the chance of clotting problems. All these contentions are disputed by doctors who oppose abortion.

In cases where the abortion is done because of a fatal defect, D&X might be used so the body comes out intact and can be held by the parents.

The numbers are very small.

Numbers have been critical in the ``partial-birth'' debate, especially since abortion-rights lobbyist Ron Fitzsimmons recently said he had lied when he claimed the procedure was done only a few hundred times a year nationwide.

Unfortunately, there are no reliable national numbers. Some estimates put the number nationwide at several thousand annually.

State numbers, collected by the Virginia Health Department, don't say directly how often D&X is done. For years, state policy has lumped D&Xs together with a procedure called ``dilation and evacuation,'' or D&E, in which a fetus is broken up in the womb with a grasping instrument and removed in pieces.

Overall, just 603 abortions - out of 103,026 done in Virginia from 1992 through 1995 - were listed as D&Es. That's about half of 1 percent. By far, the most common method was suction curettage, which uses a vacuum process to remove the fetus.

How many abortions marked as D&E were actually the D&X procedure? Very few, based on when in the pregnancy they were done.

D&X is a late-term procedure. A national authority on the abortion-rights side, Dr. Mitchell Creinin of Pennsylvania, said D&X is used starting at about the 24th week of pregnancy. An opponent, Dr. Curtis Cook of Michigan, said the D&X procedure becomes feasible after the 20th week.

Using the more conservative figure of 20 weeks, The Pilot found that 565 of 603 D&Es were done at or before 20 weeks and so almost certainly were not the ``partial-birth'' procedure.

Of the rest, just eight abortions in four years were marked as D&Es done beyond 20 weeks; only three of those were later than 22 weeks. Records of the remaining 30 noted the age of the fetus as unknown.

The point at which a baby could survive outside the womb is not easy to define. It depends on a lot of things, including the baby's condition and the skill and technology at the center caring for him.

Generally, said Cook, those born at 23 weeks are considered viable; they have about a 30 percent chance of survival. Those born 22 weeks and below aren't considered viable.

Using this number, from 1992 through 1995 in Virginia, only three D&Es were done at a point where the baby, in theory, could have lived outside of the womb.

State Sen. Mark L. Earley, a Republican from Chesapeake who supports a ban, points out that some abortions were marked as ``other'' in the state records. Some or all of those may be D&Xs, Earley said.

The procedure may be marked as ``unknown'' in some instances. And in some cases, the age of the fetus isn't marked. Those may be late-term procedures, too.

But even assuming that all of those are ``partial-birth'' abortions - an unlikely scenario - they still bring the total of possible D&Xs to 130 - one-tenth of 1 percent of all abortions done in Virginia during those four years. The number is such a small fraction, say doctors, that it could be explained by reporting errors and very unusual cases.

The state records don't note why the abortions were done.

However, the database may include some cases that most people wouldn't consider bona fide abortions.

For example, if a fetus is killed as a result of treating the mother for a serious injury or illness, state reporting policies are somewhat ambiguous on whether the death should be marked as an abortion or a miscarriage.

The same is true for cases in which fetuses die in the womb of natural causes and are removed.

Doctors say they don't do D&X

Doctors familiar with how abortions are done in Virginia say they don't know of anyone who does D&X.

When the debate erupted a few years ago, Willette L. LeHew, a Hampton Roads obstetrician and gynecologist, decided to investigate. LeHew, who heads the Virginia chapter of the American College of Obstetricians and Gynecologists, sent out a confidential survey to members.

While the results aren't scientifically valid, they are revealing.

No one said they did D&X. Since then, LeHew has asked around. No one, he said, knows of an obstetrician who does the procedure.

Other doctors say the same thing.

``I have never done it. I don't know anyone who does it,'' said Dr. R. Nathan Slotnick, a Norfolk obstetrician who specializes in high-risk pregnancies.

Slotnick does abortions only in cases of genetic defect, and only until the 24th week. Between 20 and 24 weeks, he induces early labor. The massive contractions shear the placenta from the wall of the uterus and kill the fetus. A mother can choose labor induction earlier in the pregnancy, too.

Similar policies seem to be favored elsewhere in Virginia. For abortions after 22 weeks, labor induction is the procedure most often used.

``To my knowledge, nobody uses the (D&X) method'' in Virginia, said Dr. Herbert C. Jones, a Charlottesville doctor who serves on the National Abortion Federation's executive committee.

Why is this issue a lightning rod?

Even though there's no evidence that D&X is done here, anti-abortion advocates in Virginia have lobbied for a ban. Doctors and abortion-rights activists are worried about it.

Why has there been attention in Virginia over something that happens, at most, very rarely?

It changes the debate.

With this controversy, the focus shifts from who has the right to decide to what is being decided, Earley said.

``It helps people understand what we're talking about here is a baby,'' he said.

Earley, a candidate for attorney general, sponsored a ``partial-birth'' ban that failed in the General Assembly earlier this year.

The procedure is easy to describe in graphic terms.

``It is grotesque,'' said Louise Hartz, president of the Virginia Society for Human Life.

However, it's hard to say that there is something especially grim or graphic about this procedure compared to others, such as the suction method.

But those methods are hard for people to visualize, says Earley. Most people can visualize the D&X procedure because many have experienced or witnessed childbirth. ``This is something people can see. This is something they understand,'' he said.

Anti-abortion groups have emphasized their point by circulating a series of line drawings showing a baby being pulled feet-first from the womb. A pair of adult hands stab the baby in the back of the head with scissors. The baby slumps.

Abortion-rights groups have said the drawings are misleading because they depict a perfectly formed baby, which is rarely the case in late-term procedures. People picture a baby like those in a neonatal intensive care unit, said Creinin, the Pittsburgh doctor, but many of these fetuses have genetic defects and are terribly deformed.

It could be a first step toward outlawing other procedures.

By keeping the public's attention focused on the grim details of this procedure, abortion rights advocates hope to gain a moral victory, they say.

The technique seems to be working. Last year, some pro-choice members of Congress switched sides and agreed to support a ``partial-birth'' ban.

And some political observers believe a ban could be the first in a string of victories for the anti-abortion side, and losses for the abortion-rights side.

``People are worried . . .that this is just a step in outlawing any,'' said Jones, the Charlottesville doctor.

Other procedures could be threatened by this law, because the wording is so vague, say abortion-rights advocates

For example, someone might interpret the law to include labor induction methods, said Vermillion, the obstetrician from Roanoke. ``Would that fall under this definition? Maybe.''

Bad statistics make good political fodder.

No one knows the national numbers. Like Virginia, most states don't keep records on the number of D&Xs.

This may give a boost to abortion foes because they can keep the arguments about numbers in the public eye, said Karen Raschke, a lobbyist for Planned Parenthood in Richmond.

The numbers aren't the only issue.

If one believes that every abortion is a murder, then stopping even one procedure is a victory, Earley points out.

Said Cook, the Michigan doctor who opposes the procedure, ``I don't think people are interested in the percentage.''

The medical benefits and risks are unknown.

There has been no comprehensive research comparing D&X to other late-term procedures, said Creinin.

Creinin says D&X may be safer than labor induction. There is less chance of infection, because the uterus acts like a bellows during childbirth, drawing material in from the vagina. Also, because the cervix isn't dilated as much, there is less risk of bleeding.

Creinin does not use the procedure himself - he was not trained in it, and Pennsylvania doesn't allow abortions beyond 24 weeks. But earlier in the pregnancy, he prefers D&E to labor induction.

Cook, on the other hand, believes the D&X is more dangerous because the process of dilating the cervix takes longer than the labor induction process. The cervix is dilated by inserting sticks of seaweed in the opening of the uterus. The sticks swell as they absorb moisture, gradually opening the cervix. Cook says this could weaken the cervix and endanger future pregnancies.

In the absence of good information, he said, the procedure can't be justified.

But Creinin said that without good studies, women are best served by allowing doctors to chose whichever procedure best fits the case, based on their judgment and experience.

The debate is no longer a grass-roots issue.

``Look, both sides of the abortion debate now have enormous public relations bureaucracies developed to defend their sides,'' said Larry Sabato, a University of Virginia political scientist.

``This is not a citizen's movement anymore, on either side.''

One time-honored strategy of the professional is to find the most horrific case possible to make the point. ``Once you get the public's attention, you get to make your argument,'' he said.

``The media - and circuses - look for the exceptional.'' ILLUSTRATION: AT ISSUE

The procedure: The cervix, the opening to the uterus, is dilated

slightly. The doctor pulls the fetus out partway. He drains brain

tissue from the skull, so the skull will compress as it passes the

cervix, and the fetus is pulled out.

In Congress: The House has passed a bill to ban the procedure.

The Senate is to vote on it this week. Last year, President Clinton

banned a similar bill.

In Virginia: Statistics don't say directly how often

``partial-birth'' abortions are done. But the number is about half

of 1 percent of the 103,026 abortions in the state from 1992 through

1995.

LEGISLATION

Last year, a ban on ``partial-birth abortions'' passed the U.S.

House and Senate but was vetoed by President Clinton, who said he

wanted to include exceptions that take a woman's health into

account. Abortion opponents couldn't muster enough votes to override

the veto.

In the wake of that, many states moved to adopt their own laws.

In Virginia, several bills that would have outlawed the procedure

died in committee during the General Assembly session in January and

February this year.

Now, the issue is back on the federal playing field. A measure

now before Congress, if passed, will do what the state bill would

have done.

The House has passed the bill, with enough of a margin to

override a veto.

In the Senate, sponsors of the measure were predicting it would

pass, The Associated Press reported Friday. However, it's not

certain they will have the two-thirds majority needed to override a

threatened veto.

ABORTION

VP GRAPHIC

HAMPTON ROADS

Here's the break-down for 22,052 abortions done during 1992-95:

Suction curettage 98.9%

All others 1.1%

VIRGINIA

1992-95

Suction curettage 97.9%

All others 2.1%

Ninety-nine percent of all abortions in South Hampton Roads are

done with a procedure called suction curettage, in which a tube

about as wide as a pencil is used to vacuum out the contents of the

uterus. An instrument like a spoon, called a curette, may be used to

scrape the lining of the uterus for any remaining tissue.

The rest, accounting for just 1 percent of all abortions,

include:

Dilation and evacuation, in which the doctor uses a grasping

instrument to remove the fetus.

Labor induction.

Dilation and curettage, in which the doctor uses a curette to

scrape the lining of the uterus for fetal tissue. This method was

the most common early term method before the introduction of vacuum

aspiration, but now is almost never used on its own.

Hysterectomy, removal of the uterus and hysterotomy, surgical

opening of the uterus to remove the contents.

A handful of procedures were marked as ``other'' or ``unknown.''

Source: Va. Health Department's Center for Health Statistics KEYWORDS: PARTIAL BIRTH ABORTION COMPUTER ASSISTED REPORTING

DATABASE

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