Birth Defects
This could range from Down syndrome to anomalies incompatible with life. The generally accepted limit of viability is 24 weeks so before that gestational age abortions can happen for any reason. After 18 or so weeks the options are an induction of labor or a dilation or an evacuation (or D and E), which is a surgery. With induction it can take a few days as labor can be hard to trigger so early. If all goes well the cervix dilates and the fetus delivers. Sometimes indictions fail because you can’t always get such a premature uterus to contract. With a D and E the cervix is dilated, with the help of medication, instruments or both, and the fetus is removed. The fetus is essentially taken apart with a D and E to fit through the dilated cervix (the cervix is dilated less with a D and E than for an induction). This is no secret to the women having the procedure. This is also no ripping, there is simply surgical technique. Women know they were pregnant before the procedure and that they were not after and trust me they don’t think their doctor waved a magic wand or had a time turner.
After 24 weeks birth defects that lead to abortion are very severe and typically considered incompatible with life. These procedures are either a traditional induction, just like labor, or something that requires instrumentation. Because of
the nonsensical partial birth abortion law women who wish to have a dilation and extraction (a modified technique for more advanced procedures) need to have fetal cardiac activity stopped with an injection into the uterus. Either way it’s a 2 or 3 day or even 4 process to get the cervix to dilate enough. The further along in the pregnancy, the more likely the procedure will be an induction of labor, but a skilled practitoner can do a dilation and extraction at 32 or 34 weeks. I’ve never heard of a dilation and extraction for any other reason than severe birth defects and often it is for a woman who has had two or three c-sections for whom inducing labor might pose other health hazards, like uterine rupture. Are we to force women to have c-sections for a pregnancy that is not compatible with life?
Why do some women end up with these procedures later on in their pregnancy? Sometimes it can take weeks or even longer to fully understand what is going on with the fetus. Some patients might think they can make it to term and then at 34 weeks cave and ask to be delivered because they just can’t bear one more person asking them about their baby. Do they just smile and walk away or say, “Well, actually, my baby has no brain and will die at birth?” Some women go to term and others can’t. To judge these women for requesting an early delivery is cruel on so many levels.
I wrote more about it here if you are interested. Regardless, terminations for birth defects isn’t ripping “the baby out of the womb in the ninth month.” At 38 or 39 weeks it’s always an induction and is simply called a delivery.
Health of the Mother
This definitely happens between 20 and 24 weeks. The most likely scenario is ruptured membranes and an infection in the uterus. The treatment of this is delivery or
the infection will spread and kill the mother, however, someone with lupus or renal disease or heart disease (for example) could have a deterioration of their health and with their providers make the decision to have a termination. After 25 weeks this would simply be a c-section or an induction of labor and the baby would go to the neonatal intensive care unit. Between 24-25 weeks there could be some leeway as conditions that are serious enough to require delivery at 24 weeks often also have devastating effects on the fetus. For example, the fetus could be so severely growth restricted making viability at 24 weeks unlikely and a woman with a severe heart condition may not elect to risk her health with a c-section for a likely non viable pregnancy and choose a termination. These are difficult and nuanced decisions and everyone is simply working together to make the best decision for the pregnant person. I don’t know where Mrs. Clinton got this “bad news at the end” of the pregnancy being about maternal health. I have only ever heard of one very late abortion for maternal health and that was for the rape of a minor by her brother and that was still not at term.
So no one is performing health of the mother abortions at 38 or 39 weeks we just do deliveries. It’s called obstetrics.
Other
Some of the 0.3% of abortions after 21 weeks will be for personal reasons. Often these are called elective abortions, but I don’t like that term. Usually this happens when it took too long to find a clinic and raise the money. These abortions happen before 24 weeks. There is no ninth month action here either.