Abortionist call abortion after 24 weeks a 'labor of love'

A participant in a recently published study described offering later abortions as a "labor of love" while also acknowledging that working for a facility that commits later abortions "does [take a toll]."

Key Takeaways:

• A study published at ScienceDirect.com revealed that abortionists who commit abortions late into pregnancy call it a "labor of love."

• The study detailed which drugs are used in the process of a later abortion, including which works the fastest.

• Abortionists committing abortions as late as 28 weeks say it takes a toll, but they also think abortion is "great."

• Of the patients who had abortions at 24 weeks or later, 10% were under age 18.

• Some nurses complained about having to come to the facility in the middle of the night to manage excessive bleeding and quicker-than-expected dilation.

• Authors decided to stop using mifepristone for cervical preparation, and after that, patients stopped laboring in the middle of the night.

The Details:

The "mixed-methods study of expanding later abortion care at two U.S. facilities" published at ScienceDirect.com was based on anonymous online staff survey responses at two Illinois abortion facilities located near the state line. These facilities had expanded abortion to between 26 and 27 weeks during the study period.

Study Aim and Design

The study, funded by a research grant from the Society of Family Planning (SFP), examined "how two Illinois facilities expanded abortion services from the commonly accepted 24-week threshold to 28 weeks," authors Tracy A. Weitz, Adrian Davis, Malcolm Wilson Schwartz, and Julia E. Koh wrote.

They added:

"We employed a mixed methods design including an anonymous online staff survey, qualitative interviews with a purposive sample of clinical and non-clinical staff, and analysis of administrative patient data. We aimed to identify factors that enabled or constrained service expansion and to document staff experiences."

Participants in the study gave verbal consent to participate and to record interviews, and interviewees received a $75 gift card, or they could "donate their incentive to a regional abortion fund."

Authors identified "young people, people of color, and people from outside Illinois" as those who "benefited from the expansion" to later abortions. Of those who had abortions at 24 weeks or later, 10% of the patients were under age 18.

Later Abortion Described

"Regardless of the gestational duration of a pregnancy, clinicians may use medications to expel and/or instruments to remove the pregnancy via the cervix. In the U.S., this care is routinely provided in outpatient facilities that offer mostly abortion care or in combination with family planning services," the authors wrote.

"In this care model, after about 14 weeks (this differs by patients and clinicians), the cervix is gradually dilated before the abortion. Osmotic dilators and medications such as mifepristone and misoprostol are used either alone or in combination... With more advanced pregnancies, dilation may take more than one day," the authors added.

Authors Weitz, Davis, Wilson Schwartz, and Koh then described later abortion procedures:

"After 23 weeks and 6 days more dilation is required and may involve multiple facility visits to remove and insert new dilators, administer additional medications, and assess progress.

To ensure that the fetus is removed/delivered without signs of life, abortion providers inject the fetus with medication to stop the heart (“asystole”)... The medications used as feticide include digoxin, potassium chloride, and lidocaine...

Digoxin is typically easier to administer but takes longer to take effect, while potassium chloride and lidocaine require more training to administer but act immediately. After fetal asystole [cardiac arrest] and the cervical preparation, the patient may experience uterine contractions while adequate cervical dilation is being achieved, during which time additional medications may facilitate the process.

At this time, the physician uses instruments to remove the fetus (induction-evacuation) or lets the uterus expel the fetus and placenta (induction)."

2nd Trimester Abortion | Dilation and Evacuation (D&E) | What Is Abortion?

Later abortion: a 'labor of love'

The study authors also explained that based on prior research, abortion workers who participate in killing preborn babies "at a more advanced gestational [...age] experience both internal and external pressure to remain silent about their work."

They cited multiple studies about later abortion ambivalence:

"Crookston’s (2021) aptly titled article, 'This is my calling,' reflects the sentiment of many people working in abortion provision.

However, when studies specifically address abortion care later in pregnancy, people's feelings about participation sometimes differ based on the gestational duration of the abortion care provided.

Several studies with physicians, nurse midwives, and nurses find that support for participation in abortion care declines as the pregnancy gestation advances (Armour, Gilkison, and Hunter, 2021; Cignacco, 2002; Gallagher, Porock, and Edgley, 2010; Garel et al. 2007; Marek, 2004).

The result is that even when care could be provided, it is not."

Yet, while previous surveys have noted a high rate of staff ambivalence to participating in later abortions, this study found "minimal discussion among our interviewees about challenges with learning the new techniques to perform either the feticidal injection or the more complicated abortion procedure."

"Over 80 % of those who completed the full survey were positive or very positive about the gestational age limit of their facility," claimed the authors. These are facilities that kill babies at ages at which the baby can survive with medical care. This could indicate a more hardened view of abortion by facility workers post Dobbs, and possibly the influence of abortion training programs like the Ryan Residency.

According to the study:

"Many interviewees described it as a 'labor of love', citing that the patients are the reason they can overcome stress, burnout, and fatigue of everyday life.

One administrative staff member (318) summed it up: 'Well, it does [take a toll] because I am human, […] but at the same time, I have a lot of gratitude that I am able to assist them in this difficult time.'

The feeling was reiterated by other non-licensed clinical staff: 'that's what kept me going, helping these people'... and 'being able to offer that to someone, regardless of what state she was from, or what the laws are in her state, that's just. It’s great.'

Later abortion 'more complicated'

"[L]ater abortion care is more complicated, including how to schedule patients, manage clinic flow, and ensure 24-hour support," wrote the authors, adding:

"Many interviewees commented on how the care for people later in pregnancy was so different that it felt like an entirely separate service.

As one physician (921) explained: '[To me] that was the biggest learning curve is that, like, it takes a lot more physician time, it takes a lot more nursing time that, like, [all] while you're trying to also see other patients…it's almost like this whole other service.'"

An administrative staff member (734) explained how scheduling for later gestation patients was different from scheduling other abortion patients:

“They are more complex, and they require, I think, a little more care and attention in terms of medical history and complications. … So you have to be very careful when you're extracting all that information. And then the instructions are a little bit more complex. So the appointments, on average, do take longer. They can take anywhere from maybe 30 to 45 minutes to schedule.”

Costs over Safety

"Monitoring cervical dilation, checking for contractions, managing patient pain, and monitoring patient recovery after their procedures all required more time, heightened focus from staff, and separate spaces where later gestation patients could labor if needed," the authors wrote.

1). Deep Sedation which Reduces Risk, Costs More

According to the study, one abortionist explained that using deep sedation "greatly reduced the risk of certain complications." That doctor said, “I think the risks for, you know, cervical laceration, uterine perforation, bleeding from uterine atony, all of those things go way up without having deep sedation."

Yet, the cost of anesthesia, not safety, seemed to be a concern, the study said that one administrative staff member said, "We as a group have to recognize that's a barrier because CRNAs [certified registered nurse anesthetists] and anesthesiologists can get paid a lot more money in other facilities.” (emphasis added)

Yet, it continued, "So even given a preference for offering deep sedation, one physician ... summed up the sentiment: 'I certainly would never fault people for providing abortion care when they cannot provide anesthesia.'" (emphasis added)

2). Monitoring Multiple Day Procedure adds Costs

"In addition to the on-call nurse, the clinics have a physician and a clinical assistant who can come in during the night if needed, typically to manage excessive bleeding and quicker-than-expected dilation," claimed the authors. They added:

"Despite the staff commitment to the cause, the idea of around-the-clock care was initially resisted as one administrative staff member ... recalled: 'Some of the nurses still grumbled about the possibility of having to come in overnight because of the three-day procedure.'"

To address staff concerns, "facilities made some adaptations to clinical protocols to help reduce the need for overnight care." The study noted, "One physician ... explained: 'One of the changes we made was to stop using mifepristone [for cervical preparation]. And as soon as we did that, we stopped having patients go into labor overnight.' However, as an administrative staffer ... clarified, '[There are] things to try to, like, prevent, but you can't prevent [expelling the pregnancy early], like, 100 %.'"

Why it Matters:

There is never a reason to intentionally end the life of a preborn child by abortion. Yet, the abortion industry kills babies for any reason, even late into pregnancy, and even while knowingly putting women at risk — especially when violating the “standard of care” in late-term abortions.

Industry insiders, so-called 'experts" and insurance companies have all acknowledged these risks. Yet, committing later and later abortions seems to be something the industry is salivating to do.

Medical malpractice attorney Mike Seibel, who operates the AbortionInjury.com website with his co-counsel Justin Hall, was clear that late-term abortion "should be done in a hospital or hospital-like setting," that can properly monitor women for risks.

Seibel emphasized, "If they are going to commit these procedures outside the hospital setting, I will be suing more and more of them."