Hot-button abortion practices

By Susan Ruel

Abortions in high-risk pregnancies, late-term abortions, births of newborns with fatal abnormalities — Dr. Glenn Herman weighed in on key issues that frequently come up in abortion debates.

High-risk pregnancies

For five years Herman practiced as an OB-GYN, and then he began a fellowship in the sub-specialty of Maternal and Fetal Medicine at the University of Pennsylvania. Afterwards, he worked only with high-risk pregnancies that involved maternal or fetal complications. “For the remainder of my career, I relied on abortion to deal with severe fetal abnormalities,” he said.

Herman remembered problems he encountered in certain cases and the role that abortion played.

“It was difficult to take care of a diabetic pregnancy and far harder to care for a diabetic woman who did not want to be pregnant. This problem was mostly solved by the availability of abortion,” he recalled. In at least one case, Herman said, a mother and her unborn child died when the medical treatment plan was not followed.

“Although I did relatively few abortions in maternal and fetal medicine, about half my work was related to the possibility of abortion. Without abortion, the whole field of fetal diagnosis would lose much of its relevance,” he said.

Herman said his practice had “rigorous criteria for offering an abortion in the presence of birth defects.” A fetus was aborted “only when the parents requested it after being fully informed of the fetal condition.”

In some cases involving couples at significant risk of genetic disease, the legalization of abortion enabled women who had not dared to become pregnant to do so. With prenatal diagnosis and selective abortion, these women “could go on to have the families they had always wanted,” Herman said.

Late-term abortions

Herman said that based on his experience treating high-risk pregnancies, late-term abortion, or abortion in the third trimester, will “always have at least a limited benefit in maternal care.” He recalled a married couple who consulted him years ago. The fetus was at 28 weeks’ gestation, and an ultrasound showed it was small – and had no bones.

“The fetus had hypophosphatasia, and although all the natural cartilage scaffolding was there, there was no `mineralization’ of the cartilage. There was no hope that it would ever mineralize, and we had no way of inducing that mineralization,” Herman said.

“The fetus didn’t need bones to survive in the uterus, but once the fetus was born, the absence of some rigidity within the ribs and the spine would really limit the ability of the lungs to expand to take in air,” he said. Death would occur at birth or within days or weeks afterward.

“The parents were horrified and saw no reason to extend their horror while awaiting natural birth. We arranged for a third-trimester abortion, and they were very relieved,” Herman said. “They returned after the abortion just to thank us. It’s hard to accept that anybody would have objected to that procedure. “ 

Newborns with “lethal anomalies”

Herman practiced in several U.S. states, giving him a broad perspective on regional differences.

“Very early in my career, we sometimes delivered babies with terrible deformities. We became used to seeing this as just a part of being an obstetrician/gynecologist,” he said. Later, once ultrasound and abortion were available, Herman did not often encounter such cases — until he practiced in San Antonio, Texas, in 2008-09.

Abortion was legal in Texas but “heavily stigmatized,” he said. “People did not generally seek out termination of pregnancy. These very anomalous newborns would, of course, reappear everywhere if abortion became illegal,” Herman said.

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Hot-button abortion practices