Terminating a Desired Pregnancy for Medical Reasons or Poor Prognosis

In the second trimester, doctors typically conduct a number of prenatal screening tests that can detect a variety of different chromosomal and congenital conditions. The conditions being screened for can vary heavily in their prognosis. Children with some of these conditions, such as Down syndrome and mild to moderate neural tube defects, can be born alive and live a regular lifespan -- although they may have developmental, physical, or cognitive disabilities.

Other conditions detected in prenatal screening can be fatal or can have a profoundly poor prognosis. In anencephaly, for example, half of babies with the condition will not survive birth and the other half die within hours or days. Chromosomal condition such as trisomy 13 and trisomy 18 can result in a baby with a short lifespan; 90% of babies with either of these conditions do not survive past age 1, and during their lives are frequently afflicted with health problems and medical interventions.

When prenatal screening and subsequent diagnostic tests return a definitive verdict of a condition with a less than optimal prognosis, parents may face the decision of whether or not to continue the pregnancy. These terminations are sometimes called medically based or medically indicated termination.

Parents may also end up considering a medically based termination when rare pregnancy or other health complications pose a notable threat to the mother's life if she continues the pregnancy.

Current Status

What's all the Fuss About?

When parents choose to terminate a pregnancy because of severe medical conditions in the baby, the medical procedure is technically a second-trimester abortion or a "late-term" abortion -- and it is technically elective because parents can choose whether to let nature take its course or to end the pregnancy.

As opposed to most elective terminations, however, most babies aborted late in pregnancy for medical reasons were very much wanted and the parents may deeply grieve the loss of the baby.

Abortion of any type tends to be a divisive and emotional issue, both personally and politically. People who are philosophically or religiously opposed to abortion may view all abortions as wrong -- no matter the circumstances. Activist groups are sometimes deeply opposed to these medically based terminations, and numerous online sites make a case that every baby should be brought to term. People who have a pro-choice stance usually have no objections to medically based terminations.

Looking more importantly at the feelings of the parents, most people fall somewhere on a spectrum. Some cannot fathom the idea of having a late-term abortion at all even after a diagnosis of fatal birth defects, while others wrestle with the idea but ultimately opt for the termination, and still others do not struggle with the decision even though they grieve the loss of the baby.

In cases when the condition being diagnosed is not fatal, some opponents to selective abortion after a prenatal diagnosis have fears that parents may not receive full information. Outcomes have improved over the years for some conditions, such as Down syndrome, and they fear that parents may receive an inaccurate and dismal view of what it is like to raise a child with a physical or developmental disability.

Pros

When parents decide to terminate for medical reasons, the decision may have a number of factors. In nonfatal conditions, parents may feel they are ill equipped to handle a child with lifelong special needs, such as a baby with Down syndrome.

Sometimes the decision to terminate involves concern for the baby's suffering. In the event of a condition like trisomy 18 that involves potentially severe medical problems as well as a very short life expectancy, parents may want to avoid putting the child through unnecessary pain when there is no hope for a good outcome.

These parents may feel that termination is the lesser of two evils.

Terminating for medical indications may involve concerns for the mother's physical and emotional health. When receiving the news of a devastating medical diagnosis, moms may not want to face additional months of pregnancy only to see the much-wanted baby die in the hospital. They may need the physical process over with so that they can begin grieving and move on.

Finally, some situations may involve serious risk to a mother's life, such as the rare condition of a twin pregnancy involving one normal fetus and one hydatidiform mole (in which the mother faces a 60% risk of developing malignant gestational trophoblastic disease by the end of the pregnancy if she opts to continue). In these cases, the mother's life and health may be protected by the termination -- even if the baby was very much wanted.

Cons

For diagnoses of nonfatal conditions, such as Down syndrome, parents may decide that they are ready and willing to accept a child with special needs.

In situations with a poor prognosis, some parents may opt against termination because of religious convictions or deep philosophical convictions against abortion.

Other parents prefer not end the pregnancy through medical or surgical intervention when the condition does not threaten the mother's life.

Some of these parents may make every effort to avoid medical interventions when possible because of philosophical or religious beliefs, especially invasive procedures.

Still other parents may feel solace in letting nature take its course and in having a chance to hold the baby before it passes away, perhaps not being able to bear the idea of terminating a baby that is alive.

A few parents may continue a pregnancy because of a slim hope that the diagnosis was wrong and that everything will turn out fine. (Diagnostic errors are extremely rare for conditions that would raise the question of medically based termination; chromosomal studies obtained through amniocentesis, for example, have 100% accuracy barring the also rare case of lab error.)

Where It Stands

The decision of whether or not to terminate a pregnancy affected by a serious medical condition is highly personal. Some parents take a middle ground, opting to terminate if the condition is one that would be fatal at birth or shortly thereafter, but choosing to continue pregnancies in which the baby is expected to have a physical or developmental condition but also a reasonable life expectancy.

Some states do have laws on the books that can make a termination difficult if the condition does not threaten the mother's life, in which case women may be forced to travel a long distance for the procedure or to continue the pregnancy.

Second-trimester terminations for medical reasons usually involve a D & E or a D & X (dilation and extraction) procedure -- often with an injection beforehand to stop the baby's heartbeat. The D & X procedure, which is used for some of these terminations, is highly controversial. Legislators have targeted this procedure, known as "partial-birth abortion" in mass media, in recent years and the future of the procedure remains uncertain.

Sources:

National Institute of Neurological Disorders and Stroke, "Anencephaly Information Page." 13 Nov 2007. Accessed 7 Feb 2008.

University of Virginia Health System, "Trisomy 18 and 13." Medical Genetics. 28 Jan 2008. Accessed 3 Feb 2008.

Wertz, D.C. "How parents of affected children view selective abortion." Issues in Reproductive Technology I: An Anthology Garland Publishing, 1992. New York. Accessed 7 Feb 2008.

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