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September 29, 1999
Chicago Tribune, front page

RARE ABORTIONS BY INDUCED LABOR PROBED BY STATE

By Jeremy Manier, Tribune Staff Writer.
Published: Wednesday, September 29, 1999

A long-standing but rarely used abortion procedure that can result in fetuses surviving outside the womb for an hour or more has spurred a state inquiry into abortion practices at Christ Hospital and Medical Center in Oak Lawn, in the wake of complaints by anti-abortion groups.

Christ Hospital officials said investigators are examining the care of such fetuses to see if state laws or regulations are being violated. In the most extreme case, a fetus survived some six hours after delivery.

The procedure, in which physicians induce premature labor, has been an option for decades at hospitals around the country--including several in Chicago--when the fetus has a severe genetic defect or the mother's life is in danger.

But complaints by a delivery ward nurse at Christ and by anti-abortion groups earlier this month were enough for Atty. Gen. Jim Ryan's office to ask the Illinois Department of Public Health to perform a review of the hospital.

Officials at Christ said the procedure is perfectly legal and is used at the hospital only when doctors determine the fetus has serious problems, such as lack of a brain, that would prevent long-term survival. They said many couples faced with wrenching choices opt for a therapeutic abortion rather than wait for a miscarriage or the natural birth of a short-lived child--options that can bring medical and emotional costs.

In cases when the couple choose premature induced labor, doctors at Christ said they prefer not to deliver drugs that would kill the fetus inside the womb--as most centers do--because doing so would force them to play a more active role in ending a human life.

Yet performing an abortion on a fetus that may survive for even a short time after delivery raises ethical concerns that are absent in the first months of gestation, said George Annas, a professor of health law at the Boston University School of Public Health.

"Once a fetus is born, it's no longer a fetus, it's a child," Annas said. "And you have to treat it that way."

The Illinois Department of Public Health visited the hospital late last week to review abortion procedures in the wake of complaints by Jill Stanek, a delivery ward nurse.

Conclusions from the ongoing review will be sent to the attorney general's office and the federal Health Care Financing Administration, according to state officials.

Hospital officials said that investigators gathered information concerning sanitary conditions in the ward and the quality of care given to aborted fetuses before they died.

Doctors at Illinois Masonic Medical Center try to avoid the dilemma of what to do with aborted fetuses that may survive. After the 20th week of gestation, doctors there give an injection of potassium chloride or some other substance that stops the fetus' heart, said Dr. Charles Strom, director of medical genetics at Illinois Masonic.

"Our feeling is that if we're doing a pregnancy termination, we make sure the fetus demises in utero," Strom said.

One of the complications, Strom said, is that ultrasound tests have grown more sensitive in recent years, picking up signs of defects that might otherwise have gone unnoticed.

Yet even advanced ultrasound cannot detect some problems until relatively late in a pregnancy, Strom said.

By the time physicians can confirm the outcome through amniocentesis and genetic tests, the fetus may already be in the 22nd week of gestation--just two weeks short of the point when many hospitals will try to save a premature baby.

"For most parents who get in that situation, it's a completely unexpected problem," Strom said.

At Christ, where doctors perform about 20 labor induction abortions each year, nurses give "comfort care" to babies who survive labor. Stanek, who describes herself as pro-life, said she once held a baby boy slightly larger than her hand who survived for about 45 minutes.

"Their skin is so thin you can see the heart beating through their chest," Stanek said. "It's not like they kick a lot and fight for air. They're weak."

In some cases, Stanek said, parents name and even baptize the premature baby.

Dr. John Weitzner, an attending physician in obstetrics and gynecology at Rush-Presbyterian-St. Luke's Medical Center, said he does not give heart-stopping drugs in such abortions because they are not necessary for the health of the mother.

"You get into a gray zone when the baby is born with signs of life," said Weitzner, who estimates his unit performs about 100 labor-induction abortions each year. "By giving a potassium chloride injection, you avoid the controversy. The question is, is there any medical advantage if you're just doing it to prevent the controversy?"

Administering such drugs before labor can bring other ethical problems, Annas said, especially if there's a chance the fetus could live outside the womb.

Aborting a viable fetus is against the law in most states unless the mother's life or health is in danger.

"If you're not sure, you can't do it," Annas said.

Labor induction accounts for just one-tenth of one percent of all abortions, according to the Centers for Disease Control and Prevention.

Experts say most centers that use the technique deliver drugs that kill the fetus in utero--including Women's Health Care Services in Wichita, Kan., a national center for second and third trimester abortions.

Maureen Britell of Washington, D.C., had a labor induction abortion five years ago after she learned in the 25th week of pregnancy that her fetus had no brain. Although her doctors did not give drugs to kill the fetus, her baby girl died after getting lodged in the birth canal.

Britell, now director of government relations for the National Abortion Federation, said the choice was a difficult one.

"One of our options was to start the grieving process early by terminating the pregnancy," said Britell, a practicing Roman Catholic. "After counseling with our priest, we decided that would be best for us.

"To a certain extent, you're allowing nature to take its course. But this allowed us the opportunity to push the clock forward."

Many religious abortion opponents say they are offended that any abortions are performed at a place called Christ Hospital. The hospital is affiliated with the United Church of Christ and the Evangelical Lutheran Church in America--both of which have a permissive view toward therapeutic abortions, hospital officials said.

Abortion opponents have been holding prayer vigils at the hospital for months, calling for an end to all therapeutic abortions there. One of the protesters has been state Sen. Patrick O'Malley (R--Palos Park), who sits on the hospital's local governing council.

"I just don't think we're in a position to play God," O'Malley said in an interview.

Copyright© 1999, The Tribune Company. Unauthorized reproduction prohibited.

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