Abortion expansion bill gasps for life

April 27, 2012

By Dave Roberts

California women abort their unborn children at a significantly higher rate than the rest of the country, accounting for nearly one in five abortions in the United States. But for many Democratic politicians and abortion providers there aren’t enough abortions in the Golden State. Rather than keeping it safe, legal and rare, as the slogan goes, they are determined to expand abortion access, even if it might result in more injuries to women.

State Sen. Christine Kehoe, D-San Diego, has authored SB 1338, which expands the professions that are allowed to perform surgical abortions. Currently only licensed physicians and surgeons are allowed to do so. Anyone else would be subject to a $10,000 fine and imprisonment. SB 1338 would allow registered nurses, nurse practitioners and certified midwives who have received training by the end of the year also to perform aspiration abortions.

Aspiration is the most common type of abortion, primarily done in the first trimester, in which the baby is vacuumed out of the uterus. The technique is considered the safest abortion method — provided, of course, that you’re not the one being aborted. But it’s still an invasive procedure with sharp instruments, and complications can arise.

Those complications and whether they will increase when less skilled, less educated and less experienced people are allowed to vacuum uteruses were at the heart of the debate on SB 1338 in the Senate Business, Professions and Economic Development Committee meeting on Thursday.

“A rigorous, state-approved pilot project has demonstrated that clinicians can perform with high rates of patient safety and satisfaction,” Kehoe told the committee. “Advanced clinicians already perform surgical and non-surgical procedures: IUD insertion and removal, biopsies and some forms of insemination.”

Kehoe’s bill originally applied to all nurses, practitioners and midwives. But she watered it down to apply to those 41 people in the state who have received aspiration abortion training through a University of California, San Francisco study. It’s possible that more people could be trained, however, by the January deadline. Representatives of the California Nurses Association said there are 16,000 nurse practitioners in the state who might also want to perform abortions.

The more the better, as far as Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California, is concerned. “Over half the counties do not have  providers who will perform abortions for Medi-Cal patients,” said Kneer. “That requires women to drive long distances. We believe it’s very important that patients have access to early, safe abortion procedures. We believe that practitioners who they see for their regular routine care should also be able to offer this so they can provide continuity of care.”

Abortion study

Also leading the drumbeat for more abortions is Tracy Weitz, a UCSF associate professor in obstetrics, gynecology and reproductive science, who led the abortion study.

“We know that two things make abortion safer: making it legal, and doing it as early as possible in the pregnancy,” Weitz told the committee. “The widespread use of aspiration abortion technique as a preferred method for ending pregnancies in the first trimester is what has made abortion incredibly safe. The question of who can safely perform those procedures can now be answered by scientific evidence.”

During her four-year demonstration project, 41 clinicians performed nearly 8,000 abortions. It took about seven days and 45 abortions for each clinician to gain sufficient competency. Only 1.6 percent of the procedures resulted in complications, according to the study, with only six women requiring hospital care. All recovered “without any long-term physical harm,” Weitz said.

But the reliability of those numbers and the ethics of the study’s procedure came under assault by Assemblywoman Linda Halderman, R-Fresno, who is also a licensed surgeon. She has witnessed aspiration abortions, and said that the procedure can include the use of extremely sharp instruments in the blood-filled cervix to scrape its fetal contents.

“Incomplete abortion means that some of the fetal parts are left inside,” she said. “And that is in fact a known complication that is uncommon, but it’s reported in this procedure. However, there are additional complications that are reported. These are associated normally with surgical procedures done by board-certified obstetricians and gynecologists. The published rates (of complications) are between 3 and 5 percent. And they consist of incomplete abortions, failed abortions, hemorrhaging, excessive bleeding, anesthesia-related complications, bleeding within the uterus walls themselves, infections, cervical injury including cervical tear, and uterine injury which rarely requires hysterectomy.”

‘Disturbing’

Given all of those possibilities of something going wrong, Halderman said she found it “disturbing” that, in data published by pro-choice ob-gyn organizations, there is a 3-5 percent rate of complications when abortions are done by experienced doctors and surgeons, but Weitz’s study asserts that there was only a 1.6 percent rate of complications in abortions performed by nurses and midwives learning the procedure.

Halderman is concerned that there was not adequate follow-up about potential problems. Less than 10 percent of the women were interviewed in person after their abortion. Most interviews were done by phone or a mailed survey and some women were not contacted at all. She pointed out that the study has yet to be published in a medical journal, undergoing peer review.

“This is so outside the standard of research care that I am concerned that there may be violations here that may be of a legal magnitude,” said Halderman. “In particular, locations that were chosen for these pilot projects have substantial portions of minority women. And if the purpose is to increase access to early abortion, I don’t think the way we want to do that is to compromise women’s safety.”

Informed consent?

Halderman is also concerned that the women who participated in the study were not all provided with informed consent forms in their native languages (only English and Spanish forms were provided).

“It is for these reasons that I regretfully ask that you must vote no on this project until we have some data, until we have some proof and until we have some real answers on whether or not protocols of research were actually followed,” Halderman concluded.

Also speaking against SB 1338 was Carol Hogan, communications director for the California Catholic Conference. She said that a majority of Californians oppose allowing nurse practitioners and physician assistants to perform first trimester abortions, citing a poll of 778 people conducted in late March by Smith Johnson Research.

“The author’s rationale is to increase access to abortion, thereby increasing the actual number of abortions performed in California,” said Hogan. “For almost any medical procedure, people with either private or government health insurance have to schedule their appointments well in advance and may well have to travel some distance. Even toenail surgery or earwax removal is not available on the same day or the same week that the patient desires it. To have an abortion is a serious decision, one that ends the life of an unborn child and may change the life of the woman. Does it need to be as available as an aspirin at the corner drug store? They claim that abortions should be safe, legal and rare. This law would make abortion less safe and less rare.”

Wynette Sills, a Sacramento pro-life activist, said, “They are increasing the certification for pet groomers to ensure the health of our pets. So why would we turn around and lower the health standards of women? Women deserve better. In this pilot study with 8,000 women hurt and 8,000 human lives killed, it was found to be fairly safe for the women. Yet the intent is to expand abortion throughout the state. While it might have been found safe under rigorous research conditions, as you move away from UCSF and out into the Central and Imperial Valley, I don’t think we can ensure the same level of supervision and safety for women.”

Although the committee has a 6-3 Democrat majority, surprisingly it deadlocked 4-4 on SB 1338 with two Democrats voting against it. One of those Democrats, Juan Vargas, who represents Chula Vista, said he could not support a policy affecting women’s health based on a study that had yet to be published and peer reviewed.

Mark Wyland, R- San Juan Capistrano, agreed that the committee had insufficient information to make an informed decision on such a technical issue. “It seems to me, given what we know, that it’s a big leap to say people who have had a few days’ training and a few supervised procedures should be doing something like this,” he said. “I just think that’s an awfully big leap.”

Although the bill failed to make it out of the committee, it has not been, well, aborted. Kehoe’s representative said she plans to bring it back to the same committee on May 7 for a vote only, no testimony allowed.