Intact dilation and extraction

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Intact dilation and extraction
(IDX, intact D&X, et al.)
Abortion type Surgical
First use 1983
Gestation >16 weeks
United States 0.17% (2000)
Infobox references

Intact dilation and extraction (IDX) is an extraction procedure used for a fetus where dilation is done so it can be removed intact. The procedure is used both after late-term miscarriages and in late-term abortions.

It is also known as intact dilation and evacuation, dilation and extraction (D&X, or DNX), intrauterine cranial decompression and, in some cases, as the legal term in the United States, as "partial-birth abortion". The procedure may also be used to remove a fetus that is developed enough to require dilation of the cervix for its extraction.[1]

Though the procedure has had a low rate of use, representing 0.17% (2,232 of 1,313,000) of all abortions in the United States in the year 2000 according to voluntary responses to an Alan Guttmacher Institute survey,[2] it has developed into a focal point of the abortion debate. In the United States, intact dilation and extraction of a live fetus was made illegal in most circumstances by the Partial-Birth Abortion Ban Act in 2003, which the U.S. Supreme Court upheld in the case of Gonzales v. Carhart.

Intact D&X surgery[edit]

Under the Intact D&X method, the largest part of the fetus (the head) is reduced in diameter to allow ease of passage through the uterine cervix and vagina. According to the American Medical Association, this procedure has four main elements.[3] Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using laminaria tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such as pitocin, a synthetic form of oxytocin, are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus's leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the cervix, which some refer to as "partial birth" of the fetus. The doctor subsequently extracts the rest of the fetus, leaving only the head still inside the uterus. An incision is made at the base of the skull, a blunt dissector (such as a Kelly clamp) is inserted into the incision and opened to widen the opening,[4] and then a suction catheter is inserted into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass more easily through the cervix. The placenta is removed and the uterine wall is vacuum aspirated using a cannula.[5]

"Partial-birth abortion"[edit]

The term "partial-birth abortion" is primarily used in political discourse—chiefly regarding the legality of abortion in the United States.[6] The term is not recognized as a medical term by the American Medical Association[7] nor the American Congress of Obstetricians and Gynecologists.[8] This term was first suggested in 1995 by Congressman Charles T. Canady, while developing the original proposed Partial-Birth Abortion Ban.[9][10] According to Keri Folmar, the lawyer responsible for the bill's language, the term was developed in early 1995 in a meeting among herself, Charles T. Canady, and National Right to Life Committee lobbyist Douglas Johnson.[11] Canady could not find this particular abortion practice named in any medical textbook, and therefore he and his aides named it.[12] "Partial-birth abortion" was first used in the media on 4 June 1995 in a Washington Times article covering the bill.[citation needed]

The signing of the Partial-Birth Abortion Ban Act'

In the U.S., a federal statute defines "partial-birth abortion" as any abortion in which a living fetus is extracted "past the navel [of the fetus]... outside the body of the mother," or "in the case of head-first presentation, the entire fetal head is outside the body of the mother," if the fetus has already passed. The U.S. Supreme Court has held that the terms "partial-birth abortion" and "intact dilation and extraction" are basically synonymous.[4] However, there are cases where these overlapping terms do not coincide. For example, the IDX procedure may be used to remove a deceased fetus (e.g. due to a miscarriage or feticide) that is developed enough to require dilation of the cervix for its extraction.[1] Removing a dead fetus does not meet the federal legal definition of "partial-birth abortion," which specifies that partial live delivery must precede "the overt act, other than completion of delivery, that kills the partially delivered, living fetus."[13] Additionally, a doctor may extract a fetus past the navel and then cut through the neck of the fetus. This could fall within the terms of the statute, even though it would not result in an intact body and therefore would not be an intact dilation and extraction.[11]




IDX is a target of pro-life advocates who believe the procedure illustrates their contention that abortion, and especially late-term abortion, is immoral. Critics consider the procedure to be infanticide,[16] a position which many in the pro-life movement extend to cover all abortions.[17] Some advocates, both for and against abortion rights, see the IDX issue as a central battleground in the wider abortion debate, attempting to set a legal precedent so as to either gradually reduce or gradually increase access to all abortion methods.[18]

Dr. Martin Haskell has called the IDX procedure "a quick, surgical outpatient method" for late second-trimester and early third-trimester abortions.[19] The Partial-Birth Abortion Ban Act of 2003 describes it as "a gruesome and inhumane procedure that is never medically necessary."[20]

According to a BBC report about the U.S. Supreme Court's decision in Gonzales v. Carhart, "government lawyers and others who favour the ban, have said there are alternative and more widely used procedures that are still legal - which involves dismembering the fetus in the uterus."[21] An article in Harper's magazine stated that, "Defending the Partial-Birth Abortion Ban... requires arguing to judges that pulling a fetus from a woman's body in dismembered pieces is legal, medically acceptable, and safe; but that pulling a fetus out intact, so that if the woman wishes the fetus can be wrapped in a blanket and handed to her, is appropriately punishable by a fine, or up to two years' imprisonment, or both."[11] The U.S. Supreme Court has stated that intact D&X remains legal as long as there is first an "injection that kills the fetus."[1]

There is also controversy about why this procedure is used. Although prominent defenders of the method asserted during 1995 and 1996 that it was used only or mostly in acute medical circumstances, lobbyist Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers (a trade association of abortion providers), told the New York Times (February 26, 1997): "In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along."[22] Some prominent pro-life advocates quickly defended the accuracy of Fitzsimmons's statements,[23] whilst others condemned Fitzsimmons as self-serving.[24]




In the United States[edit]

Federal law[edit]






State law[edit]




Since the Stenberg v. Carhart decision, Virginia, Michigan, and Utah have adopted legislation very similar to the Nebraska law overturned as unconstitutional. The Michigan law was similarly struck down for broadness and failure to provide a health exemption. Utah's law remains on the books, pending trial, but is unenforceable under a court-ordered preliminary injunction. Virginia's Law was initially ruled invalid, but was reversed and remanded to the District Court in the wake of the Gonzales v. Carhart decision, where it was upheld as constitutional. This is despite the fact the Virginia law criminalizes abortions for accidental D & X procedures, as well as intentional D & X.



Clinical response to legal bans on the procedure[edit]

Since the passage of the Partial-Birth Abortion Ban Act in the United States and similar state laws, providers of late-term abortions typically induce and document fetal demise before beginning any late-term abortion procedure. Since the bans only apply to abortions of living fetuses, this protects the abortion providers from prosecution. The most common method of inducing fetal demise is to inject the fetal heart with concentrated potassium chloride or digoxin using a long needle guided by ultrasound.[29]

In other countries[edit]

Questioned about United Kingdom government policy on the issue in Parliament, Baroness Andrews stated that



  1. ^ a b c Gonzales v. Carhart, 550 U.S. ____ (2007). Retrieved 2007-04-30. ("If the intact D&E procedure is truly necessary in some circumstances, it appears likely an injection that kills the fetus is an alternative under the Act that allows the doctor to perform the procedure.")
  2. ^ Abortion Incidence and Services in the United States in 2000
  3. ^ Late-Term Pregnancy Termination Techniques American Medical Association. H-5.982 Retrieved April 24, 2007.
  4. ^ a b c Gonzales v. Carhart, 550 U.S. ____ (2007). Retrieved 2007-04-19.
  5. ^ "Surgical Abortion Procedures" American Pregnancy Association. Accessed April 14, 2006.
    Haskell, Martin. "Dilation and Extraction for Late Second Trimester Abortion." Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992
  6. ^ D & X/PBA Procedures: Introduction. Accessed April 14, 2006.
  8. ^ ACOG Files Amicus Brief in Gonzales v. Carhart and Gonzales v. PPFA September 22, 2006 The American College of Obstetricians and Gynecologists. Retrieved April 25, 2007.
  9. ^ Alex Gordon. "The Partial-Birth Abortion Ban Act of 2003". Harvard Journal on Legislation. Volume 41, Number 2, Summer 2004. (see footnote 15)
  11. ^ a b c Gorney, Cynthia. Gambling With Abortion. Harper's Magazine, November 2004.
  12. ^ Adam Simon, “Elite Discourse, Programming and Survey Response in the Partial Birth Abortion Debate” (March 2003).
  13. ^ U.S. Code, Title 18, Part I, Chapter 74, Section 1531, "Partial-birth abortions prohibited."
  14. ^ Abortion Bans: Myths and Facts. American Civil Liberties Union. Accessed April 14, 2006.
    Stenberg v. Carhart, 530 U.S. 914 (2000)
  15. ^ Miranda Kennedy (March–April 2000). "Partial Truth Abortion Coverage". Fairness and Accuracy in Reporting. Retrieved 2006-09-14. 
  16. ^ Koukl, Gregory. Partial-Birth Abortion Is Not About Abortion. Stand to Reason. Accessed April 25, 2006.
    White, Deborah. Pros & Cons of Partial Birth Abortions Accessed April 25, 2006.
  17. ^ The Official Point of View of the Romanian Orthodox Church on Abortion (summary). The Romanian Patriarchate. Accessed April 25, 2006.
    Achacoso, Jaime B. A Sin and a Crime Accessed April 25, 2006.
    Gonzalez, Ramon. Pro-life teens challenged Western Catholic Reporter. October 23, 2000. Accessed April 25, 2006.
  18. ^ Slippery Slope: Democratic Wavering in the Battle for Reproductive Rights. February 25, 2004. Accessed April 25, 2006.
    Strategic Initiatives The Rockridge Institute. Accessed April 25, 2006.
  19. ^ Haskell, Martin. Dilation and Extraction for Late Second Trimester Abortion. Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992.
  20. ^ 108th Congress, 1st Session, S.3. Partial Birth Abortion Ban Act of 2003.
  21. ^ "US top court backs abortion ban". BBC. 2007-04-18. Retrieved 2007-04-18. 
  22. ^ Stout, David (1997-02-26). "An abortion rights advocate says he lied about procedure". The New York Times. p. A11. Retrieved 2009-06-08. 
  23. ^ Ruth Padawer, "Pro-choice advocates admit to deception", Bergen Record, February 27, 1997.
  24. ^ Melanie Conklin, "Whatever happened to the abortion lobbyist who repented?", The Progressive, September, 1997.
  25. ^ Testimony of Brenda Pratt Shafer, R.N. Committee on the Judiciary, Subcommittee On The Constitution, U.S. House Of Representatives, March 21, 1996. Retrieved May 2, 2007.
  26. ^ Woodbury, Margaret A. (2002-07-24). "A doctor's right to choose". Retrieved 2007-04-29. 
  27. ^ Hern, Warren. "Did I Violate the Partial-Birth Abortion Ban?" (Slate, October 22, 2003).
  28. ^ Sherman, Mark (April 18, 2007). "Court Backs ban on abortion procedure". SFGate. Archived from the original on November 14, 2007. Retrieved 2007-04-18. 
  29. ^
  30. ^ Text of a written answer to a parliamentary question at The House of Lords Hansard. Accessed 7 September 2006

External links[edit]

Legal documents[edit]