Dr Jennifer Gunter explains about late-term abortions.

The third and final Presidential debate focused very quickly on abortion. Clinton defended choice and Trump, not one to be bothered with facts, countered with this doozy of line:

“I think it’s terrible if you go with what Hillary is saying in the ninth month you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby. Now, you can say that that’s okay, and Hillary can say that that’s okay, but it’s not okay with me. Because based on what she’s saying and based on where she’s going and where she’s been, you can take the baby and rip the baby out of the womb in the ninth month, on the final day. And that’s not acceptable.”

They don’t rip, she says with cold politeness. There is no ripping. Ripping is not what they do.

Perhaps we can forgive Donald Trump for not knowing this as it is hard to believe that a man who bragged that he doesn’t change diapers and said he wouldn’t have had a baby if his wife had wanted him to actually physically participate in its care would have attended the birth of his own children. It’s certainly not for the faint of heart as there is, after all, lots of blood coming out the “wherever.”

Ah, what a “nasty woman,” thank you baby Jesus.

Talking about abortion from a medical perspective is challenging when you are not a health care provider. Even someone familiar with the laws can get confused. For example, Mrs. Clinton made an error speaking about late-term abortion when she said it was a health of the mother issue. Typically it is not (it’s almost always fetal anomalies). However, this error on Clinton’s part only underscores how important it is for politicians to not practice medicine.

To put it in perspective  1.3% of abortions happen at or after 21 weeks and 80% are for birth defects.

Very rare, and mostly because of birth defects. Not done because the pregnant woman suddenly got bored.

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?

Note that c-sections are major surgery.

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 abortions happen earlier.

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.

Nobody involved needs any help or advice from Donald Trump.