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PARTIAL-BIRTH ABORTION TRIAL UPDATE April 7, 2004 Information Compiled by: Secretariat for Pro-Life Activities, U.S. Conference of Catholic Bishops For extended excerpts from all trials, as well as full transcripts, visit: www.usccb.org/prolife/index.htm NEW YORK. DAY EIGHT: Wednesday, April 7, 2004 Excerpts from direct examination of Dr. Gerson Weiss: THE COURT: Do you, when you tell them the various procedures available, say that in an intact D&E, if you choose to call it, or partial-birth abortion, that you take a pair of scissors and make an incision in the base of the skull? THE WITNESS: I say that we take the fluid and material out of the skull. THE COURT: No, Doctor. The question is simple. Don't turn it around. Just do you tell them that if you do that procedure you're going to take a pair of scissors and make an incision at the base of their baby's skull? THE WITNESS: I do not use that language. THE COURT: Do you discuss with them whether or not this inflicts pain on the fetus or the baby? THE WITNESS: No, I do not. THE COURT: Do you tell them that you are going to use a suction device and suck the brain out of the baby? THE WITNESS: Yes. THE COURT: You use simple words and tell them that? THE WITNESS: Yes. THE COURT: Next question. ~ Q. Doctor, when you remove the fetus in a procedure involving dismemberment, are the fetus's bones covered by soft tissue? A. Excuse me? When you? Q. Remove the fetus in a dismemberment procedure, are the pieces of the fetus covered by soft tissue? A. Frequently much of the bone is covered. It is quite likely that the ends of the bone in the area that is broken are uncovered and sharp. ~ Q. Can you eliminate the risks of retained fetal tissue in a D&E involving dismemberment by counting the fetal parts at the end of the procedure? A. No, you can't. You can count roughly. You can count there is a limb here, I can see feet and hands, I can see skull fragments, I can see trunk. But when you see little pieces, if there are small pieces left behind that are torn off, you can't fully reconstruct and you cannot fully count the small pieces. Another way of looking at that is if you have a long bone that is broken into six parts, you are only going to say I see long bone parts. You will not be able to reconstruct to a point of that accuracy. ~ Q. Is your ability to bring the fetus out intact affected by the fetal tissue at that gestational age that you perform D&Es? A. The earlier the pregnancy the more fragile the fetus. So, grasping a fetus early on is more likely to tear it and less likely to allow you to bring it out whole. If the fetus were older its condition would be tougher enough that it could take, you could move it into an appropriate position easier. Q. And you also testified that you have, when you were speaking with the Judge, that you have used suction to remove the brain of the fetus, is that right? A. Yes. Q. Is there another way that you have removed the head in the D&E procedures that you have performed? A. Yes. Q. What is that? A. You can in a, before 18 weeks, sometimes grab the head with one instrument, with a grasping instrument in one hand and use a grasping instrument in the other hand to grab the rest of the head. Usually with a twist you can deflate the head enough to bring it through. So, it's a crush -- THE COURT: Do you crush the head? THE WITNESS: Yes, it could be a crushing; yes, early on. ~ Q. Why not? A. Because this statement says -- let me find it. Blindly forcing the sharp instrument. There is nothing blind about it. Visualize in your mind this. The cervix has to be dilated enough to allow the entire trunk of the fetus to pass through it. The neck of the fetus is much smaller than the shoulders and the trunk but a larger thing, the shoulders and the trunk have passed through. So, not only is the neck through but a portion of the skull which is vividly, you know, exactly where it is and you see it, it's above the neck -- THE COURT: Do you always see it, Doctor? THE WITNESS: Almost always, yes. THE COURT: Not always then. THE WITNESS: I can't think of anything that I always -- THE COURT: You do it by feel, don't you? THE WITNESS: You always feel it. It's right there where your finger is. THE COURT: If you feel it you can't see it. THE WITNESS: Usually you see it. So, when it's right there you can usually, under direct vision, insert a sharp instrument into the skull or, at worst, by feel, not blindly, because you know exactly where it is and you feel it with your finger. ~ Q. What is it that you are using to bring the cervix down in your description? A. You are using a grasping instrument called a tenaculum. Usually they have several opposing teeth which grasp the cervix and allow you to hold it without tearing. Q. In the example you just gave, I think you said that there were several things you might do that would be an act that would kill the fetus. What might those things be? A. One thing would be to simply pull the fetus out. Having done that, it is likely that the fetal head would remain inside, and in pulling it would have separated the head from the body, and that would have resulted in the fetal death and later delivery. Another possibility is that you would grasp the head under those circumstances and either crush it or hold it and then puncture it to deliver the head. In either case, you have done an overt act after delivering the fetus to the trunk. Q. In the example you gave where you delivered the fetus up to the head, is any part of the trunk past the navel outside the woman's body? A. Yes, certainly. Q. What part? A. Depending on the anatomy of the woman, most of the cervix is dilated, so it is usually a good part of the fetus, probably from the navel down in the situation when the vagina and the cervix are in the same plane or close to the same vertical plane. Q. In that example is any part of the trunk above the navel outside? A. It is possible that, depending on the situation, a part of the fetus above the navel would be outside. It depends only on the geometry of the cervix and how far the cervix is brought down. Q. In the example you gave where the head separates, is that an act that you know will kill the fetus? A. It is. Q. Is that an act that completes the delivery of the fetus. A. No, it is not. Q. Why not? A. Because you would then have to remove the head. Q. You would have to go back -- A. You would have to go back, grasp the head, and remove it. Q. Dr. Weiss, what is your purpose, in the example you just gave, in delivering a fetus up to the head after removing an arm? What is your purpose in doing that? A. Your purpose in doing the procedure is overall to terminate the pregnancy, to make the woman no longer pregnant… Excerpts from cross-examination of Dr. Weiss: Q. You were on the board of directors of Planned Parenthood of Essex County from 1992 through 1997, is that right? A. That is correct. Q. You are still a member of Planned Parenthood? A. I don't know if I am a member. Q. Would it surprise you to learn that your CV lists you as a member of Planned Parenthood? A. No. I am not sure what the dates are. I would be continuing a member if I sent them a check this year, and I don't recall doing so. Q. As soon as the law on abortion changed in 1971, you were part of a group that established a Planned Parenthood-sponsored abortion facility in Pittsburgh, is that correct? A. That is correct. Q. And you have provided testimony -- THE COURT: What year was that? MR. LANE: Excuse me, your Honor? THE COURT: What year was that? MR. LANE: 1971, your Honor. THE WITNESS: Excuse me, sir. I misspoke. On recollection, it was after the law was changed, and that was January 22, 1973. So I believe it was 1973. THE COURT: A date that sticks in your mind, is it, Doctor? THE WITNESS: Vividly. ~ Q. Doctor, in your view, you don't set out to do a specific abortion procedure, but instead set out to make a woman unpregnant, isn't that right? A. That's correct. Q. The word "unpregnant" is your term, right, Doctor? A. That's correct. Q. That is a term you used here this morning as well as in your deposition? A. Yes. Q. That is not a medical term, is it, Doctor? A. No. It is a term in English. THE COURT: It is a what term? THE WITNESS: A term in English.
DAY SEVEN: Thursday, April 8, 2004. Excerpts from direct examination of Dr. Stephen T. Chasen: THE COURT: Yes. Do you tell them straight out what you are doing? No sugar coating, just you tear it off and remove it in pieces?
THE COURT: I didn't ask you that, Doctor. I know it is not pleasant. I want to know whether or not these people know, have a fully-educated discussion with you what you are going to do. THE WITNESS: We have a full and complete discussion about the fact that in most cases the fetus will not pass intact through the cervix and in many cases -- THE COURT: No, let's go back. I asked you a simple question. Do you tell them you are going to tear limbs off? THE WITNESS: I don't have simple discussions with my patients. I have involved discussions. I can share with you what I tell my patients. THE COURT: Go ahead. I am asking you, do you tell them you tear it off? THE WITNESS: I initiate the discussion in general terms, and they always include the possibility that destructive procedures will be done to facilitate removal of the fetus. THE COURT: Do you do it in nice sugar-coated words like that? THE WITNESS: My patients are under no illusions and they don't regard that as sugar-coating and they are usually devastated- THE COURT: How do you know, Doctor, do you see into their minds?
THE COURT: Oh, you can tell. Do you ever use the word you are going to tear the limb off? THE WITNESS: Yes, I do, I use that terms sometimes. THE COURT: You do? THE WITNESS: That is not an option I give them. Their option is to have a D&E or to continue the pregnancy or to have a medical induction of labor. When I am telling them D&E, again, in general terms that some destruction of the fetus will be necessary and -- THE COURT: No, Doctor, let's get back. [Do you tell] them that if it comes to that procedure, you will take a pair of scissors and insert them in the base of the skull? THE WITNESS: I don't use those terms, but, again, they know that the brain has to be removed so allow -- THE COURT: You don't use those terms? THE WITNESS: I don't talk about the specific instruments that I use to accomplish this. THE COURT: Do you tell them that you're going to suck the brain out of the skull? THE WITNESS: I don't use the term "suck" but I say the brain has to be removed so that the skull will fit through the cervix without injuring them. THE COURT: Do you ever discuss with them whether or not in the D&E, the dismemberment, when you tear limbs off, do they ask you, does it hurt? THE WITNESS: Patients have asked about if -- THE COURT: What do you tell them? THE WITNESS: I tell them that neither I nor anybody knows for sure whether it does. ~ Q. Doctor, in earlier answer, again I think in response to a question put to you by his honor, you made reference to certain observations you have made concerning fetal response to stimuli and response to anesthesia; what were those observations?
~ Q. Yes. Just describe for us if you can how you perform a D&E? A. …Once they're under anesthesia I do an examination and based on the dilation of the cervix, based on the proximity of the cervix to the opening of the vagina, based on the fetal position that I can determine by palpation or with ultrasound that I have there, I determine the, what I feel will be the most appropriate way to evacuate the fetus from the uterus. Q. And what might those appropriate ways be? A. ....And in most cases the degree of cervical dilation will not accommodate passage of the fetal head through the cervix. And in this case my practice is to make an incision at the base of the skull with the scissors which I can do really under direct visualization, place a suction device within the skull, the brain tissue is aspirate and typically the head then delivers easily. Q. And what do you do in the event that you are not able to -- THE COURT: Excuse me. Does that mean because the skull collapsed. THE WITNESS: Yes. THE COURT: That it delivers easily. THE WITNESS: Once the skull has collapsed. ~ Q. In your experience, Dr. Chasen, are there ever cases in which, to your knowledge, the fetus dies during the course of an induction abortion? A. Yes. Q. Based on your experience, Dr. Chasen, how long does the process of fetal death [by] asphyxiation take from the onset of contractions and induction abortion? A. It could take many minutes. ~ Q. Dr. Chasen, in your experience, how is the fetal head extracted in a dismemberment D&E? A. The fetal head is extracted by placing the forceps around it and crushing it. Q. How readily is that -- how easy is that to accomplish? A. In some cases it is relatively easily accomplished and in other cases it is very difficult. THE COURT: Does it hurt the baby? THE WITNESS: I don't know. THE COURT: But you go ahead and do it anyway, is that right? THE WITNESS: I am taking care of my patients, and in that process, yes, I go ahead and do it. THE COURT: Does that mean you take care of your patient and the baby be damned, is that the approach you have? THE WITNESS: These women who are having [abortions] at gestational ages they are legally entitled to it -- THE COURT: I didn't ask you that, Doctor. I asked you if you had any caring or concern for the fetus whose head you were crushing. THE WITNESS: No. ~ Q. You mentioned direct visualization. What does that mean? A. That means when the skull is obstructed at the level of the cervix, at that point I place a clamp on the front part of the cervix and, applying mild traction to this, it exposes the skin at the back of the fetal neck at the site through which I place the scissors. So I can in almost all cases actually visualize the spot through which I place the scissors. ~ Q. Which ones [referring to earlier question about use of KCl or digoxin to effect fetal demise before starting to evacuate the uterus in a D&E]? A. These are women that, because they are choosing to undergo abortion, do not want to experience a live birth, and I let them know that there is a small possibility but a possibility that they will go into labor, by laminaria insertion and that they could deliver a live baby, and that one way to preclude that if we are successful is to induce fetal death prior to that. Q. How long does it take, Doctor, in your experience, for the fetus to die after the umbilical cord has been cut? A. It's not instantaneous. Q. What effect, if any, can that delay have on the woman? A. In waiting -- if you're asking if we would wait until we could confirm a fetal demise that the heart wasn't beating in this woman who is already being subject to risks of anesthesia and in which prolonged operative times could increase the risk of bleeding an infection, then that could have an adverse effect on the patient. THE COURT: Despite all of those reasons, Doctor, can you finally give an answer at how long does it take? THE WITNESS: I don't know exactly how long it fakes. THE COURT: Could you give us an approximation? THE WITNESS: During most D&Es I perform I'm not watching the fetal heartbeat while I am doing it. THE COURT: I didn't ask you that, Doctor. Do you know how long it would take approximately for the fetus to die if the umbilical cord is cut? THE WITNESS: I would -- I -- I think it would take several minutes, at least. THE COURT: Under 10? THE WITNESS: I don't know. THE COURT: Under five? THE WITNESS: I don't know. Excerpts from cross-examination of Dr. Chasen: Q. You would agree, Doctor, wouldn't you, that at 20 weeks' gestational age the fetus is more likely to disarticulate with traction than to deliver intact? A. I would agree. Q. Traction is used in D&E by dismemberment, correct? A. Traction with forceps is used. Q. When it is feasible for you to perform the intact procedure, you generally start with the delivery of one leg of the fetus, correct? A. Correct. Q. You gently pull on the one leg with your hands, and when it is almost out, the other leg is swept out, correct? A. Yes. Q. You wrap a small sterile towel around the fetus, because it is slippery, and after the legs are out you pull on the sacrum, or the lower portion of the spine, to continue to remove the fetus, right? A. Right. Q. When the fetus is out to the level of the breech, you place another, larger towel around the first small towel, right ? A. Right. Q. You gently pull downward on the sacrum until the shoulder blades appear, right? A. Right. Q. Then, with your hand on the fetus's back, holding it with the towel, you twist in a clockwise or counterclockwise motion to rotate the shoulder, right? A. Right. Q. The shoulder in front or the arm in front is swept out with your fingers, and then you rotate the other side of the fetus to sweep out the other arm, right? A. Right. Q. Then the fetus is at a point where only the head remains in the cervix, correct? A. That's correct. Q. That is when you make the decision based on the gestational age and the amount of cervical dilation, whether the head will fit out intact, whether you can tuck the head of the fetus to its chest, or whether you have to decompress the skull to remove the fetus's head, right? A. It is based on the size of the fetal head and the cervical dilation. I don't directly consider the gestational age. Q. If you are able to deliver the head by flexing the chin against the fetal chest -- and you have been able to do this several times…Doctor? A. There have been a few occasions, yes. Q. Then you remove the fetus with the towel, you put it on the table, and you turn back to the woman to deal with the placenta, right? A. That's right. Q. If you can't do that, you know you are going to have to crush the head, and so you take a clamp and you grasp the cervix to elevate it, and then your assistant there in the operating room will pull down on the fetus's legs or back, gently lowering the fetus's head toward the opening of the vagina, right? A. Right. Q. That is when you put two fingers at the back of the fetus's neck at the base of the skull where you can feel the base of the skull, and then you puncture the skull with the scissors, right? A. I usually can see it as well as feel it. But yes. Q. At that point you see some brain tissue come out, and you are 100 percent certain that you are in the brain, so you open the scissors to expand the hole, remove the scissors, and put the suction device in the skull, right? A. Correct. Q. You turn on the suction, and typically the fetus comes right out with the suction device still in its skull, right? A. Right. Q. You would agree, wouldn't you, that the maneuvers that you perform are very similar to an assisted breech delivery after viability? A. With the exception of the decompression of the skull, yes. Q. Your paper included in the intact group some cases where the fetus was delivered in the vertex presentation, right? A. Yes. Q. That's a head-first delivery, isn't it? A. Yes, it is. Q. In those cases an incision with scissors is first made in the fetus's head, suction is placed in the skull, and then the fetus is delivered, correct? A. Correct. Q. The incision with the scissors is made while the fetus's head is still in the uterus but flush against the internal cervical os, right? A. Yes. Q. Then the suction curette is placed in the head to drain the brain, correct? A. Correct. Q. Similarly, you typically find that with the suction curette still in the head, the fetus will descend through the cervix and easily come out of the woman's body, right? A. Yes.
NEBRASKA.
Excerpts from Government's direct examination of Dr. Curtis Cook: Q. When a pregnancy has to be ended prematurely, because of a maternal health condition of the kind that you treat, is it ever necessary to take a destructive act against the fetus directly, in order to protect the health interests of the mother? A. No, all that is required for recovery of the mother is for separation of the fetus and placenta from her system so that she can start the recovery process. There is nothing inherent in the destruction of the fetus that starts to facilitate that process. ~ Q. What is your response to the assertion that medical inductions are a more painful and physiologically stressful procedure than a surgical termination such as D&E? A. Well, I think surgery is decidedly nonphysiologic as opposed to labor. So a labor induction is a much more physiological process or utilizes a natural process more than surgery would. But it also is a more controlled and monitored situation, as opposed to the D&X procedure, meaning that patients are constantly monitored for pain control, analgesia is constantly available to them in various forms, including patient controlled IV anesthesia or epidural, as opposed to having a handful of Motrin or Ibuprofen, going to a motel room somewhere for a couple of days while the cramping and contracting is taking place. ~ Q. Doctor, the question was, in inductions, you have never used Digoxin or KCL to induce fetal demise in performing inductions, because you always considered it unnecessary; is that right? A. That is not correct. I have not utilized those techniques but not because I consider them unnecessary ever. They haven't been necessary for my clinical situations, because the people that utilize those techniques utilize it so they can guarantee that there is not a live born baby at time of delivery. And, if possible, I want a live born baby at time of delivery.
DAY EIGHT: Thursday, April 8, 2004 Excerpts from Government's direct examination of Dr. Elizabeth Shadigian: Q. ....What is your opinion, with respect to assertions that the D&X procedure is intuitively safe, based on the experience of practitioners who are performing it? A. Well, I know those practitioners have their best intellectual judgment in mind. And I know they want to be honest and truthful in what they are saying, but really it's just anecdotal evidence they have that they think it's safe. They don't have any long-term studies or even a comparison of the D&X to another kind of procedure. So I don't question that they really believe that, but really without data, we can believe a lot of things, but medicine is based on evidence. It's based on doing studies. It's based on comparison of what we know to what we don't know. And in the absence of that, those are just anecdotal thoughts or feelings that a physician may have. ~ Q. What's your basis for that last assertion as to the follow-up of the abortion practitioners with their patients? A. Well, there have been several studies. One, I quote specifically which is the Picker study from 1999, and they actually asked women about the quality of their abortion care, because this is such an important issue. And, in fact, it turns out that only about 29% of women actually follow up with their abortion provider afterwards. So it's hard for me to understand how abortion providers, in quotes, know their complications, if they don't even see their patients back later. Excerpts from cross-examination of Dr. Shadigian: Q. And it's your opinion, Doctor, that this ACOG statement of policy is simply a compilation of the personal opinions of several physicians who sat on the executive board at the time this statement was issued; isn't that correct? A. It is correct that it was just approved by the executive board, which is a small number of physicians, but they didn't talk to any of the rest of the body of ACOG about any of these issues. Q. And so it's your feeling that this is simply a statement of their personal opinions; isn't that correct? A. It's a statement of their personal/medical, anecdotal opinions, yes. ~ COURT: Doctor, I have a few questions. The first has to do with the 17th week of gestation. . ... the doctor does an intact, or pardon me, typically a D&E, but there are a fair number of his or her practice of circumstances at which at the 17th week, the doctor reaches up and he has the fetus delivered to the point where the cervix, where the calvarium lodges against the cervix. Okay. WITNESS: Yes. COURT: Now, I realize, do we have the facts pretty well. Do you understand the facts as I have given them to you? WITNESS: I think so. COURT: Okay. What does the physician do at that point? WITNESS: Do you mean to try to get the rest of the baby to deliver at that point? COURT: Well, the physician's intent is to do an abortion.
CALIFORNIA.
Excerpts from Government’s direct examination of Dr. Watson Bowes: Q. Doctor, I am showing you what has been marked as plaintiffs’ learned treatise 11. Is this the study by Dr. Grimes, et al, that I was just referencing? A. Yes. Q. And can you briefly summarize what the article is about? A. This is a study which Dr. Grimes described as a feasibility study. He set out to compare two abortion procedures, one which was a labor induction procedure using these two drugs called mifepristone and misoprostol used together to induce abortion through a labor induction method. Compare that with the abortion procedure called D&E. And his objective was to randomize patients to one of those procedures or the other, as we have described, in a randomized controlled trial. ~ Q. Doctor, did Dr. Grimes and his colleagues explain some of the reasons why it was difficult to enroll sufficient number of women for the study? A. Yes, I believe they did. ~ Q. Doctor, continuing on, what was the fourth reason given by Dr. Grimes and his colleagues for the slow enrollment in the study? A. Then they limited their population to women who were 19 weeks or less gestation. And they did that, as Dr. Grimes says here, because the nursing service didn’t want to take the risk of their being a live baby born after the abortion procedure. So that further restricts his population down to the limits that we have described. DAY SEVEN: Friday, April 9, 2004 Excerpts from Government’s direct examination of Dr. M. Leroy Sprang: Q. . . . Now, could you tell us, please, why it is your opinion that intact D&X presents a risk of infection? A. Several reasons. One, that normally in the vagina, just like on the skin in the mouth we have numerous bacteria present. But particularly in the vagina there are generally five to nine organisms that occur in very large numbers, like 10 to the ninth. And that is where they belong, and they don’t do any harm there. If you add a foreign body, twigs, stick seaweed, you are going a get a certain amount of trauma to the tissue which enhances the bacterial growth. And the way the laminaria work, their length is such that you are taking them from the outside of the vagina, placing them through the cervical canal. For them to be effective, they have to cover the entire length of the cervical canal with a portion of them remaining in the vagina so you can retrieve them, and the other portion going right up against the amniotic sac. If you don’t do that, you are not going to completely dilate the cervix the entire length, and it will lead to major problems. So what happens in the first day, a certain amount of trauma from the little sticks, as they dilate, even more trauma. But then the bacteria in the vagina work their way up those little sticks and are then at the level of the internal os and sitting right next to the amniotic sac. So that it is moving them from the normal position to an abnormal position, which increases the risk of infection. Q. Does the length of time over which the dilation for intact D&X occurs, do you think that also increases the risk of infection? A. It increases the risk because the length of time a foreign body is there, the greater the risk of bringing bacteria from the vagina to the cervix, either on the first application or on the subsequent applications of the laminaria. Sometimes the actual little sticks will break the amniotic sac, too, which significantly increases the risk of infection because then you have the bacteria going from the vagina to the uterine cavity. And I know that happens just obviously intuitively it happens, but the different authors, including Haskell, describes it in his paper that sometimes it breaks and sometimes it doesn’t. And the next day when they remove them and proceed to the next step of the procedure, if it has -- his comment is "if it hasn’t already ruptured," which obviously tells you sometimes it does, then he ruptures the membranes. So you have another significant risk of infection there, especially if it broke. You inserted them on day two, and you waited to day three to do the procedure, you’ve got a ruptured bag of waters with foreign bodies sitting in the cervix for potentially 24 hours. Q. Doctor, you said something a few minutes ago about the amount of bacteria in the vagina. What I think you said was: "10 to the ninth"? A. Yes. It is a mathematical term. And you add 10, and add nine zeros. That is the number. Q. Doctor, I think you also mentioned the internal podalic version as presenting a risk to the patient. Why is it your opinion that that maneuver presents a risk to the patient? A. Having done it as well, there is a strong mechanical force in taking the fetus and basically forcing it to do a summersault within the uterine cavity. These are not little things that you just kind of push gently, and it just turns. It doesn’t work that way. You are using a great deal of force in turning it upside-down that does trauma to the uterine cavity and could disrupt the placenta and cause bleeding. And rarely things like amniotic fluid embolus. Those are not common things that could happen, but rarely they could. And, in fact, in Williams’ textbook of obstetrics, which is one of the most premiere, respected obstetrical textbooks for teaching medical students, when I was a student was the primary textbook, it specifically says that there are very few, if any, indications to do internal podalic version other than the second twin. And in various editions he actually says it is potentially harmful. He says that it is the most common cause of traumatic uterine rupture. Q. Doctor, if I can ask a few follow-up questions on those things. You mentioned disrupting -- the potential for disrupting the placenta. What can that lead to? A. Again, these are rare situations, but there is potential trauma if you disrupt the placenta at that point. There will be bleeding. And you are also -- you have got vernix parts, white stuff on the fetus. There is not as much that early in pregnancy. You have still got some amniotic fluid around. When you disrupt the placenta, some of that material can get into the maternal circulation, which could cause an amniotic fluid embolism in the mother, which is a very serious situation. Q. Is there any risk in that internal podalic version of causing maternal bleeding? A. Because if you do separate the placenta, all the blood supply to the uterus goes to the surface of the placenta and stops there. If the placenta starts to separate, you, in fact, have an abruption of a placenta, and there would be internal hemorrhage. ~ Q. So you have never encountered a situation where the pregnancy had to be terminated before viability because of a maternal health condition? A. I have not. ~ Q. Doctor, are you aware of any maternal health conditions that would require terminating pregnancy by the intact D&X method? A. And after careful review and after sitting on both the ACOG -- correction -- AMA task force, we could not find any medical conditions that would require an intact D&X. The ACOG panel could not come up with any situations that would require an intact D&X. And, in fact, in reading each of the numerous declarations and depositions I haven’t seen any physician [here a hearsay objection was sustained] Q. Doctor, in your practice have you seen a need for the use of the intact D&X method? A. I have never seen a situation where an intact D&X method was necessary to be performed.
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