Understanding The Implications and Provisions Set in Place by the NY Reproductive Health Act

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Perell, AP

2019-5-3

DISCLAIMER: THIS ARTICLE CONTAINS IMAGES OF REAL FETUSES AT DIFFERENT STAGES OF FETAL DEVELOPMENT AND CONTENT THAT MAY DISTURB SOME  VIEWERS. VIEWER DISCRETION IS ADVISED.

 

    A new abortion law in New York is causing sparks to fly throughout the country, as many detest the newly passed law approved by the NY State Senate. With many bashing Governor Andrew Cuomo and the Democratic majority of the state senate committee for their support of the bill, it is needless to say that it did not have a quiet entry into law. Those who support the new law call it a step forward for women’s reproductive rights and an additional protective measure to ensure the autonomy of the mother. Opposition calls it a barbaric overstep of the state legislature and a moral crisis. With all this chatter from both sides of the aisle it is easy to find ourselves lost in all the commotion and talking points, especially with the further agitation and polarization by the media. Today, instead of discussing the ethics of abortion itself, we will be taking a look at the raw facts of the procedure and this new law. Breaking down the changes to the code itself, as well as the implications that result and further comparing them to the laws throughout the rest of the country to gain a better understanding of why this particular law has caused so much controversy.

 

Section 1: Understanding Abortion

    The first stop on the train of understanding, is to gain adequate knowledge on what exactly abortion entails at different stages of gestation. It is no secret that the term “abortion” is used to describe the termination of a pregnancy, however often politicians and organizations like to sugar coat the actual procedure by using misleading vocabulary and avoiding certain details that might make their supporters uneasy. Let’s take a realistic look at what a fetus and the associated medical procedures look like during each trimester of development.

    First Trimester Development: The first trimester of pregnancy begins on the first day of the mother’s last menstruation and continues twelve weeks (3 months) past that date. Within the first 4 weeks the developing embryo is around the size of a poppy seed (only .04 inches long). It is here that the heartbeat begins, the liver, pancreas, spleen, and gallbladder begins to form (see Figure A). By week 12, the hair follicles, arms, legs, bodily organs as well as the facial features have all developed and the heartbeat becomes audible with a doppler (see Figure B). Within the 8 week span the baby’s size will increase to six inches and the rate of miscarriage will drop from 25% to 1.7% as the embryo begins to pass its vital stages of development. This twelfth week marks the end of the first trimester.

 

    First Trimester Complications: During this stage of development there are a few potential complications that can be dangerous for both the developing fetus and the life of the mother. Primary issues include ectopic pregnancies which is a pregnancy in which the fetus develops outside of the uterus for example, in the fallopian tubes. Ectopic pregnancies account for 1-2% of total pregnancies and are almost always identifiable within the first 12 weeks. It is also worth noting that most ectopic pregnancies can be treated with surgery or medication however, if left untreated ectopic pregnancies can lead to internal bleeding and death of the mother. The other first trimester developmental complication is placenta previa which occurs when the placenta of the embryo attaches either too low or directly to the cervix. It typically does not pose a problem until later in gestation but in the 1 in 200 chance that the placenta does not adjust itself later in the pregnancy, the baby will be unable to be born naturally. Instead the fetus will have to be born by way of a cesarean section. Secondary issues that can result from pregnancy are rare but include iron anemia, severe gestational diabetes, and heart or liver problems that are indirectly escalated by the additional strain on the mother’s body by the pregnancy.

Figure A. 4 week old fetus.png
Figure B. 12 week old fetus.png

Figure B. 12 week old fetus

Figure A. 4 week old fetus

    Second Trimester Development: The second trimester is the second stage of fetal development from week 13 to week 28. At five months the fetus has developed muscles and begins to exercise them, this is typically when a mother will first feel the fetus kick. It’s nervous system is nearly a month old by this point and well developed. At this point the developing fetus will have reached about 10 inches and would weigh between half a pound and a pound. By the end of month five at about 23 weeks, the fetus would be able to survive outside the womb with proper medical care. There have even been a few cases of infants being born as early as 21 weeks surviving with medical assistance (see Figures C and D). By the end of month 7 (about 28 weeks into pregnancy) the fetus would be able to live outside of the womb with minimal medical support although they would most likely be placed under strict medical surveillance. At the end of the second trimester the fetus is anywhere from 2-4 pounds and fully developed.

 

    Second Trimester Complications: The second trimester is commonly considered to be most enjoyable segment of pregnancy with women reporting higher energy levels, subsiding of morning sickness, and an overall more pleasant experience than the first trimester. Reported complications in the second trimester are very few, however, they typically include further progression of first trimester issues such as placenta previa, gestational diabetes, rare cases of autoimmune diseases such as lupus, as well as vitamin deficiencies and other secondary conditions. Placental abruption can occur although unlikely, in which the placenta will detach from the uterine wall and the fetus will either have to be born prematurely or the physician will hurry the fetal lung development along with the aid of special hormones. None of these, with the exception of autoimmune diseases are untreatable and life threatening to the mother.

Figure C. 21 week birth.png
Figure D. healthy 4 year old.png

Figure C and D. Lyla Stensrud born at 21 weeks is now a healthy 4 year old girl.

​    Third Trimester Development: During the third trimester the fetus nears full development and begins to rapidly gain weight. At twenty eight weeks the fetus will reach about two and a half pounds and between six to nine pounds by the fortieth week with the accumulation of fat deposits. The bones of the fetus begin to fully calcify during this trimester and all five of its senses are fully functional. It will gain the ability to see, feel, taste, hear, and even dream by the thirty first week. The typical gestation period for a human female is 40 weeks and by this time the fetus is fully developed and ready to be delivered.

    Third Trimester Complications: Many complications that may occur in the third trimester involve similar issues as second trimester and similarly require the delivery of the fetus through Cesarean section. Other conditions that may prove fatal for the mother is preeclampsia which occurs in the twentieth week and beyond and includes symptoms such as swelling of the hands and feet, high blood pressure, and sudden weight gain. If left untreated this illness can cause seizures, kidney failure, and loss of life for both mother and fetus. Preeclampsia can be treated with either blood pressure medication and or immediate birthing of the fetus as deemed appropriate by medical professionals. Placenta Previa, PROM (premature rupture of membranes or “water breaking” early), and placental abruption are treated in similar fashion, typically through cesarean section to extract the fetus. Other issues that can occur are usually from secondary and underlying deficiencies and may be treated by again premature birth of the fetus followed by intensive care at a hospital.

   

    Abortions: The methods of abortion vary depending on the stage of the pregnancy. There are three common methods of abortions performed during the first trimester in the U.S, mifepristone and misoprostol, manual vacuum aspiration, and aspiration. Mifepristone and misoprostol, commonly known as “the abortion pill”, is a medication given to terminate a pregnancy within the first seven to nine weeks and is 95% effective. Manual vacuum aspiration is the removal of a fetus using a handheld, syringe like suction tool called an aspirator pictured below (see Figure E). It is typically used 3-12 weeks after the last recorded menstruation with the goal of removing the developing embryo by means of suction. The final procedure that is performed is surgical aspiration using a clamp and a curette (see figure F) to scrape the walls of uterus and remove any developing fetus. After the first trimester the available procedures change as the fetus becomes too large to use prior methods. After 16 weeks the abortionist will use a method known as dilation and evacuation in which the fetus is broken down for extraction from the uterus using a pair of uterine forceps (see figures G and H). This is the most common and widely used method of abortion after 16 weeks, after the fetus’ bones have calcified, however a second method called Induction abortion is also utilized past 16 weeks and up until birth if deemed appropriate. In this method, saline, urea, or potassium chloride is injected into the amniotic sack of the fetus and a prostaglandin (drug used to induce uterine contractions) is used to induce the mother’s expulsion of the fetus. New studies show that some fetuses are injected intracardially with potassium chloride to prevent the accidental resuscitation of the fetus. During the third trimester both this method as well as another method are employed to carry out abortions. This second procedure is known as dilation and extraction in which the fetus is grabbed by the physicians forceps and removed up to the fetus’ head. The head is then compressed by creating an incision in the base of the head and inserting a vacuum into the incision to remove the contents of the skull, allowing it passage through the vaginal canal (See figure J WARNING GRAPHIC). This is the final method of abortion that is used up until birth.

Figure E. MVA device.png

Figure E: MVA device used by physicians

Figure F. Surgical Curette.png

​​​​​​​​​​​​Figure F: Surgical Curette used in surgical aspiration

Figure G. Uterine forceps.png

Figure G: A pair of Clemetson Uterine forceps used for break down of fetus

Figure F..png

Figure H: Dilation and Evacuation procedure

Figure I.png

Figure I: Dilation and Extraction procedure (partial birth abortion)

​​​​​​​​​​​​​​​Section 2: Comparing the New Law and the old law.

    In order to understand how this new law, deemed “The Reproductive Health Act”, has changed NY abortion laws, we must look now at the original law. The original NY law on abortion was passed in 1970 and stunned the nation by being one of the most progressive laws in the country. According to a written study by doctors Davis Harris M.D, Donna O’Hare M.D, Jean Pakter M.D, and Frida G Nelson B.A, the (at that time) new law allowed for an abortion “only if, in the physician's judgment, the life of the expected mother was in Jeopardy.”(Harris 409). It is important to remember here that not only did this mean that abortions were legal under a specific circumstance, but also that a registered physician had to make the judgment on whether or not the patient's life was in danger. The law went on to declare abortion as a legal act “if the woman consented and if the abortion was performed by a licensed physician within 24 weeks (6 months) of the commencement of the pregnancy” (Harris 409). As a result, abortion still remained a criminal offense. No mention was made on the issue of residency requirements and this consequently became a highly debated topic after the initial law’s passing.

    The Reproductive Health Act was originally introduced by governor Eliot Spitzer back in 2007 but has been blocked by the republican held Senate until recently. This law therefore is not new and has been being processed and voted on for over a decade. The first change to the NY state law shown is that, “A health care practitioner licensed, certified, or authorized under title eight of the education law, acting within his or her lawful scope of practice, may perform  an abortion when, according to the practitioner's reasonable and good faith professional judgment based on the facts of the patient's case: the patient is within twenty-four weeks from the commencement of pregnancy, or there is an absence of fetal viability, or the abortion is necessary to protect the patient's life or health.”.  This is without a doubt a massive chunk of information but in essence this provision allows for the execution of abortion related medical procedures by any licensed healthcare providers, whereas previous law stated that only licensed physicians could perform the procedure. The second point made by this provision is that it allows for a requested termination of pregnancy within 24 weeks (6 months or halfway through second trimester). After this time period the mother could not receive an abortion unless she met the requirements further stated. These requirements have changed from whether or not her life was in danger as stated in the previous law, to whether or not her health was in danger as deemed by a physician.

    Critics complain that the document does not include a definite explanation of what “health” entails. Does the health of the mother also include mental health? Can an expecting mother abuse the provision to acquire an abortion after the legal timeframe has passed? Are minor medical complications that can be remedied with medication or an emergency medical procedure also be appropriate reason to acquire such a late term abortion? Others suggest that if a fetus can survive outside the womb by 21 weeks with modern medical technology there is no need at all for an abortion past that time period to save the life or benefit the health of the mother. Does the abortion allow mental and physical relief from a pregnancy that a cesarean section and adoption cannot? Supporters argue that the choice to give birth to the child resides with the mother alone and that this law will protect women’s access to an abortion if the supreme court decides to repeal the Roe v. Wade court decision. Dissenters call it a blatant disregard for fetal life and a push toward infanticide. On both sides the debate has turned red hot and does not appear to have any clear end in sight.

    The second issue addressed by the document is the decriminalization of the abortion procedure after 24 weeks. This revision was necessary in order to stay true with the new law as prior to the adoption of it, it was illegal to have an abortion after 24 weeks unless a physician determined that the life of the mother was in jeopardy. Many have used this part of the law to call out the archaically primitive nature law regarding the criminalization of abortion. However, sorting through the over-politicalization of the issue it is self evident that the law was actually aimed toward the criminalization of illegal abortions, those performed after 24 weeks without the approval and performance by a physician when the mother’s life was deemed endangered. It did not criminalize all abortions as suggested by many on both sides of the political spectrum. Instead it regarded illegal abortions past 24 weeks as homicide. One can argue the validity of the homicide charge as applied to abortion as valid or not however, it goes without saying that any abortion performed in an illegal manner is a criminal offense and not a medical procedure because it is not performed by legal means. This statute is around to actually protect the mother as the guidelines define where an abortion can be performed and requires the most qualified medical professional to perform the procedure, making it a criminal offense to do otherwise.

 

Section 3: How this law affects the future of abortion

    The implications of this new law and it’s influence around the country is where the heart of this issue lies. The new New York abortion laws are already creating ripples around the country with states both hopping on board and loosening their abortion policies, as well as making their policies more strict. Connecticut state legislature for example, is working on a proposal that would allow abortions to be covered by private insurance without copay, and regulate faith based pregnancy centers. The state of Virginia has decide to take a route similar to New York by pushing legislation that would allow for third trimester abortions to take place within a hospital if the mother’s life or mental health was in danger and allow for second trimester abortions to be performed outside of a hospital. This law was brought especially to light due to the governor’s response to the law which was considered by many to endorse the termination of an infant after birth. Many states that are highly in favor of abortion, like New York and Virginia, claim that their new proposals are additional protections if the Roe v. Wade Supreme Court decision is overturned. Does this mark a battle line being drawn by the states against the federal government and a hypothetical declaration of war if such a line is crossed? How far will these states go to defend these laws if the federal law is overturned and replaced by one that is more strict and limiting of the procedure? And most importantly, how much support around the country is there for these types of laws by other state legislatures?  

    Despite the very public loosenings of abortion laws in New York and Virginia there has also been many other states that are tightening their abortion policies and using this latest controversy to propel their proposals. Louisiana has been in the spotlight recently for attempting to pass law that would restrict access to abortions in the state although this law was blocked by the supreme court. Other states have brought up proposals that would make abortions illegal after fetal cardiac activity (a heartbeat) was detected. States in favor of such a  proposal include Florida, Tennessee, Kentucky, South Carolina, and Ohio. Many view these laws as an infringement of a woman's right to chose, others claim it a necessary limitation to abortion laws. The direction of the morality of our nation is once again in question as these types of laws become increasingly progressive. As abortion once again takes center stage as an important issue of the day it will be interesting to see how it impacts the 2020 election and the future of our nation.






 

Sources

 

Articles

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The Reproductive Health Act official document

https://nyassembly.gov/leg/?default_fld=&leg_video=&bn=A01748&term=2017&Summary=Y&Text=Y

 

Connecticut Law Proposal

https://www.courant.com/politics/hc-pol-abortion-connecticut-20190101-weuyiv34ibhffh5en57tzt4ygm-story.html

 

Virginia Law Proposal

https://www.cbsnews.com/news/virginia-abortion-bill-proposed-by-kathy-tran-third-trimester-today-2019-01-30/

 

Louisiana Proposal

https://www.wbur.org/onpoint/2019/02/11/abortion-law-louisiana-health-clinics-fetal-heartbeat

 

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https://www.ncbi.nlm.nih.gov/pubmed/1635748