Not to split semantic hairs, but whereas I am <em>PRO-CHOICE</em>, I am <em>not</em> <em>PRO-ABORTION</em>. I personally do not know any “pro-abortion” people–only people who feel that this decision should rest with a woman and her doctor, not the legislators or the courts.</p>
<p>By the same token, I don’t know anyone who is “rallying around” PBA, certainly not me. It is a procedure I find disturbing and disconcerting, but no more so than I find women bearing children they do not want and will not care for. Like the bumper sticker says, “If you can’t trust a woman with a choice, how can you trust her with a baby?”</p>
<p>My great fear regarding his court decision lies not so much with the banning of a certain procedure as it does with the chipping away of a woman’s reproductive rights. Also, I shudder at the sentiments expressed by Kennedy and also at the thought that the mother’s health should not be a consideration in this decision, only her life. </p>
<p>Berurah, I meant that it is still legal for a woman to have this procedure in order to save her life. I would personally find that to be an impossible choice. On the one hand, if a woman has other children at home, isn’t she obligated to save her life to take care of them? But how could someone choose to end a human life in this way – and I don’t think anyone could view a late term fetus as anything other than a human life? I am just grateful that I haven’t faced that choice. But it’s also hard for me to imagine a medical situation where the only way to preserve the mother’s life is to undergo a late term abortion. I could see inducing labor early, or an emergency c-section solving whatever medical issue exists.</p>
Okay, gotcha…you were referring to the legality.</p>
<p>As far as whether or not a woman is obligated to to save her life to care for her other children—this is a very tough ethical question, and the reason I brought it up is because I believe that it is perfectly legitimate for different people to hold different, but equally valid, answsers to this question. And therein lies the problem with courts making these decisions. Some questions are ones that each and every individual must answer for themselves and on behalf of their own families.</p>
<p>I’ve seen several posters question why something that would be deemed illegal to do with the babe on the outside should be legal to do with the small time/space difference while the babe is in utero. This same question could be asked about putting the life of the mother first. I don’t know any loving, committed mother who would not sacrifce her life for the life of her baby, no matter how tiny or young that baby is. And yet, our society seems, at least right now, to feel that it is perfectly appropriate to put the life of the mother ABOVE her baby while the child is in utero. So, what’s to prevent this view from changing legally when we start chipping away at women’s reproductive rights? Who’s to say that down the line, it won’t be mandated that a woman must carry a pregnancy to term, even if her life is threatened? </p>
<p>These are the types of questions which lie on the slippery slope when the courts start deciding on behalf of women. Whose views will be represented? </p>
<p>As I said in a post way back on this thread, sometimes there is <em>NO</em> good choice. Sometimes, it’s an agonizing choice between bad, worse, or worst. And, IMHO, choices such as these should <em>always</em> be left in the hands of a woman, her doctor, and her family (dh).</p>
<p>In the US, women die everyday from the complications of childbirth and pregnancy, despite the availability of C-sections and early induction.</p>
<p>The maternal death rate for the US is 17 per 100,000, or about 700 women a year. (This is only women who die from complications of pregnancy and childbirth; it doesn’t include pregnant women who die from other causes). </p>
<p>While certainly better than the rate for developing countries, it’s not particularly good compared to other industrialized nations. It’s double Iceland’s rate and four times Austria’s rate. </p>
<p>I know a family who, when there was a life-threatening situation, wasn’t told by their hospital that the hospital’s policy was always to save the child instead of the mother, regardless of other considerations, including viability. Had they known, they would have transferred to another hospital where they had the option to save the mother. She died during the C-section, and the father was left with a preschooler and an infant with profound disabilities and health problems. He’s so shattered he isn’t much help to either child, and the grandparents are now raising both children as best they can.</p>
<p>I’m not going to claim that the life of a normally healthy adult woman is worth more than the life of a profoundly physically and intellectually disabled child. It’s not my call. But the hospital had a policy to call it the other way.</p>
<p>“During 1991–1999, a total of 4,200 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 11.8 deaths per 100,000 live births and ranged from 10.3 in 1991 to 13.2 in 1999. The pregnancy-related mortality ratio for black women was consistently higher than that for white women for every characteristic examined. Older women, particularly women aged >35 years and women who received no prenatal care, were at increased risk for pregnancy-related death. The distribution of the causes of death differed by pregnancy outcome. Among women who died after a live birth (i.e., 60% of the deaths), the leading causes of death were embolism and pregnancy-induced hypertension.” (MMWR, 2003)</p>
<p>These are the statistics to which you were referring.</p>
<p>As to your case presentation, I don’t understand why the above referenced woman died during a c -section, and what would have made a vaginal delivery safer in her case? Usually an emergency c-section is very safe. I am not saying that there are not risks, but generally many pregnancy-related complications are resolved post-section. Do you have more details about her case, and what her medical problems were?</p>
<p>Collegialmom, the rate was up to 17 per 100,000 by 2000, the most recent year I’ve been able to find statistics on. At 4,000,000+ births that year, it worked out to 690 women for that year, or more than 1.5 women per day.</p>
<p>I do know the medical complication in the case, and it was rare enough that if I said it, that coupled with my location, it could possibly identify the family, which I will not do.</p>
<p>I don’t know specifically what treatment option it was that might have saved her life over the infant’s; I only know that an option did exist and hospital policy prohibited the family from being informed about it. </p>
<p>But I doubt that the other option was a vaginal delivery. That’s a false dichotomy. No one said that a vaginal delivery would be safer than a C-section, only that a C-section cleary wasn’t adequate to save her life.</p>
<p>Isn’t that the point of the procedure the Supreme Court just ruled on? To provide a safety net in cases when neither vaginal delivery nor a C-section can be done without serious risk of lasting injury or death to the mother? </p>
<p>The Court didn’t decide that partial birth abortion didn’t improve survival rates for women in life-threatening situations where no other option would. What they decided was that the safety net should be available only to women who would die without it–and not to women who would simply suffer long term health injury or incapacitation. </p>
<p>Even if we accept that that decision is appropriate, as another poster pointed out, the next question is where do you draw the line? How much risk of death is acceptable for a woman before her doctor can legally recommend the procedure?</p>
<p>"In the US, women die everyday from the complications of childbirth and pregnancy, despite the availability of C-sections and early induction.</p>
<p>The maternal death rate for the US is 17 per 100,000, or about 700 women a year. (This is only women who die from complications of pregnancy and childbirth; it doesn’t include pregnant women who die from other causes).</p>
<p>While certainly better than the rate for developing countries, it’s not particularly good compared to other industrialized nations. It’s double Iceland’s rate and four times Austria’s rate."</p>
<p>Break it out by race, and you’ll find that for white folks it is about the best in the world. For everyone else, developing country status.</p>
<p>That’s awful, mini, I didn’t realise that, though I guess it does fit with what we know about differential access to health care in this country.</p>
<p>As a point of reference, the woman whose family I know, who died despite a C-section, was white and upper middle class. She was well insured, and had access to what normally would be considered good health care.</p>
<p>Part and parcel of the same thing I guess: differential access to health care results in increased maternal mortality, whether the lack of access is generalized and limited due to social stratification or is specific to certain treatments and limited for ideological reasons.</p>
<p>When it’s all said and done, this decision by the Litmus Test Court is simply another example of the Republican commitment to large, overbearing, instrusive government with activist courts medling in people’s lives, based on the government’s prefered religious beliefs. It’s kind of like Shi’a Law.</p>
<p>Conyat: Really, I cannot think of a pregnancy complication where there would be an option that an emergency c-section would not cover. The fetus can be removed within about 10 minutes. That generally solves the complications. </p>
<p>I realize that you do not want to give yourself away to the local folks, but this has to be incredibly unusual, and it would seem only fair to be able to substantiate that such a condition of pregnancy exists.</p>
<p>Therefore I can only conclude that it cannot be germane to this discussion.</p>
<p>mini: You are right, the MMWR really emphasizes the racial disparity. Also that the rate is higher for those who do not get prenantal care. </p>
<p>“Among women aged >20 years, higher levels of education were associated with decreasing pregnancy-related mortality ratios; however, pregnancy-related deaths for black women were 3–4 times higher than that for white women at any education level. Although the overall risk for pregnancy-related death was higher among unmarried women than among married women, this association varied by race. Black married women had a higher mortality ratio than black unmarried women, and the inverse was observed for white women.” (MMWR 2003) </p>
<p>“When it’s all said and done, this decision by the Litmus Test Court is simply another example of the Republican commitment to large, overbearing, instrusive government with activist courts medling in people’s lives, based on the government’s prefered religious beliefs. It’s kind of like Shi’a Law.”</p>
<p>But yet the Republicans were voted in for the presidency. I assume they will get another round in the next election. The Democrats in Congress are running around without much direction, and the candidates aren’t acting too impressively. Actually on either side, but the Republicans seem to have a better machine.</p>
<p>There have been three studies published in the last year, two in JAMA, one in the New England Journal of Medicine, that indicate that African-Americans, WITH THE SAME INCOME, and WITH THE SAME INSURANCE PLANS, and (in one study) WITH THE SAME PHYSICIANS, getter poorer quality health care. Physicians spend less time with them, they get fewer tests that are given as the standard of care to Caucasians, they are provided less counseling about “life style” issues such as smoking, they are less likely to be provided with needed referrals. </p>
<p>It’s called institutionalized racism - nothing necessarily to do with any individual doc - no explicit effort to reduce health status of minorities - but the weight of institutionalized racism is borne throughout the entire health care system. Coupled with lower income and education, and we find the best or second or third best health care system in the world for white folk, and one that doesn’t break the top 30 for everyone else.</p>
<p>It’s a sad commentary, and a painful one. Most of us - including health care providers - would like it to be different.</p>
<p>Were they? I seem to recall a Republican Litmus Test Court ruling that counting all the votes in Florida would do irreparable harm to George W. Bush.</p>
<p>That’s OK. Bush got everything he wanted, including a kangaroo court and a rubber stamp Congress for six years. No excuses. He was the Decider. We’ll let the American voters judge the results.</p>
<p>I would suspect that an obsetrician who deals with high-risk pregnancies could indeed think of such complications. But if you have peer-reviewed medical journal articles to suggest otherwise–that C-section is a safe alternative for 100% of women with any and all complications, let’s see them. </p>
<p>You do realise that an emergency C-section is major abdominal surgery? That it requires general anethesia and so forth? That is has the same risk of complications as any other major surgery?</p>
<p>Do you really feel qualified to say that 100% of the pregnant women in this country, no matter what medical complications they have, are healthy enough to live through a major surgery lasting even 10 minutes?</p>
<p>Women die in childbirth, despite having C-sections. I fail to see how we can fairly excluse these women from the discussion–even if it’s politically expedient to pretend they don’t exist.</p>
<p>I did not say that a c-section is 100% safe, and I am well aware of the potential complications. I just cannot think of a late pregnancy complication where there would be a safer route than a c-section for a mother in the situation that you are alluding to. Unless you are saying that a third trimester abortion or a vaginal delivery would have been safer. Maybe I missed that point, that the hospital should have done an abortion. How many weeks gestation was the baby?</p>
<p>If the mother was so ill that she could unfortunately not survive an emergency c-section, then what alternative care could she have received that then would favor her over the fetus? What would have been safer for her? There are only 2 ways to get a fetus out, vaginally or by a c-section. So are you saying that a vaginal delivery or an abortion would have been safer for the mother? Maybe so since this is a thread about late pregnancy abortion. But you also said that you doubted a vaginal delivery was the other option. So option #3 was???</p>
<p>OK so you have determined that it would have been safer for the mother to have had a quick partial birth abortion than an emergency c-section, because her lying there with her medical condition having a pregnancy terminated by abortion was safer for her? Sorry, I don’t buy it. Partial birth abortion is a messier procedure for a very sick woman, and would have the risks of DIC and excessive bleeding, that late in pregnancy.</p>
<p>I didn’t say that. You’re attacking a straw man.</p>
<p>What I said was the family was told that she might have lived had the hospital gone another route, but that the hospital didn’t tell them about the other route, or that they could get it at another facility.</p>
<p>I don’t personally know what the other route was. But I do know that it’s not accurate to say that C-section will always save a woman’s life or that there’s no difference in risk between vaginal delivery and intact D&X. Or as you claim, that there’s no situation where an intact D&X is more likely to result in the woman’s survival than vaginal delivery or C-section. </p>
<p>I find it hard to believe that you think intact D&X would have resulted in worse complications for this woman, given that she already didn’t survive a C-section.</p>
<p>Maybe for you. Sure. But I don’t buy that it’s impossible for doctors who know the situation to decide which is safer. And that’s what you’re saying with your constant insistence that such conditions don’t exist even though doctors say they do.</p>
<p>But if you have peer-reviewed medical journal articles to say that these conditions don’t exist, or that intact D&X is always more risky for the mother than the alternatives–let’s see them.</p>