Abortion In The Third Trimester: A Rare Decision Now In The Political Spotlight

Apr 30, 2019
Originally published on May 1, 2019 9:12 am

Dana Weinstein was 31 weeks into her second pregnancy, preparing to welcome a daughter, when she and her husband were given horrible news: A critical piece of the brain had not developed properly.

"[We were told] that our baby would have seizures 70% of the time — that was a best-case scenario; that when we delivered her, that we'd need to have a resuscitation order in place because she would most likely seize to death," Weinstein said.

Almost a decade later, Weinstein and her husband are the parents of three active children — a boy and two girls. She's 48, living in the suburbs of Washington, D.C., and working for a nonprofit.

She still tears up when she talks about that diagnosis and the difficult decisions that surrounded it. Fearing a short and painful life for their baby, Weinstein and her husband chose to travel to Boulder, Colo., to end the pregnancy, at one of the few clinics in the country that offer third-trimester abortions.

Weinstein has been speaking publicly about her experience for years. But she decided to tell her story again recently, amid renewed national debate over decisions like hers.

"I just don't understand why and how this is so front and center in the national debate," Weinstein said. "I would have given anything to have been able to help our baby live if she could have lived. But she was going to be incapable of that."

With two of President Trump's picks now on the U.S. Supreme Court, activists on both sides of the abortion debate have taken the fight to state legislatures this year.

Fearing a short and painful life for their unborn baby, Dana Weinstein and her husband chose to travel to Boulder, Colo., to end the pregnancy at one of the few clinics in the country that offer third-trimester abortions.
Sarah McCammon / NPR

Anti-abortion-rights activists are hoping the court will reconsider, and perhaps overturn, the 1973 Roe v. Wade decision that legalized abortion nationwide. In several states they've pushed through legislation banning the procedure from happening as early as six weeks into a pregnancy, hoping one of those bills will find its way to the Supreme Court.

In more liberal states — among them Vermont, Massachusetts and Illinois — lawmakers are pushing in the other direction, working to enshrine abortion rights in state law or remove existing bans. A failed proposal in Virginia to remove some restrictions on later abortions sparked heated rhetoric earlier this year, including claims that supporters were condoning infanticide.

"What we're seeing in some states is a complete overreach on the part of the abortion lobby," said Mallory Quigley, with the anti-abortion-rights group Susan B. Anthony List.

During his State of the Union address this year, President Trump weighed in on the issue, condemning a law passed in New York that removed some restrictions on the procedure, including later in pregnancy.

"These are living, feeling, beautiful babies who will never get the chance to share their love and their dreams with the world," Trump said.

At the federal level, abortion-rights opponents also are promoting proposals in Congress aimed at restricting later procedures. A recent bill sponsored by Republican Sen. Lindsey Graham of South Carolina, to ban the procedure nationwide after 20 weeks, appears unlikely to go very far — but it provided an opportunity for a Senate hearing on the issue.

Quigley said she believes opposition to abortion later in pregnancy will be a winning political issue for Republicans who oppose abortion rights.

"I think that the increased clarity that these types of debates are providing are going to help President Trump and pro-life senators, representatives, people on the ballot in 2020," she said.

Polling suggests that while a majority of Americans support access to abortion earlier, most oppose it by the third trimester.

The issue already is popping up on the 2020 campaign trail. At a recent campaign stop in Ohio, Democratic presidential hopeful Beto O'Rourke was asked for his views on third-trimester abortions. He responded that it "should be a decision the woman makes," before moving on.

However polarizing third-trimester abortions might be as a political issue, as a medical procedure, they are relatively rare. According to the Guttmacher Institute, which supports abortion rights, a little more than 1 percent occur sometime after 21 weeks, which is still well within the second trimester.

Dr. Warren Hern, who runs the clinic in Colorado where Weinstein traveled for her procedure, said many of the women he sees are in similar situations.

"These are tragic situations, and there's a tremendous sense of pain and loss and anguish for the woman and their family to end the pregnancy. So this is not something they want to do," Hern told NPR. "They want to have a baby; they don't want to have an abortion."

Some abortion-rights opponents argue that women facing life-ending fetal diagnoses should still go through with the pregnancy.

"If any other family member had a terminal diagnosis, there's no other circumstance where we would say, 'You know what, we should just kill them now; they don't have a chance for a meaningful life,' " said Dr. Ingrid Skop, an OB-GYN with the American Association of Pro-Life Obstetricians and Gynecologists. "And yet we do this with a fetus with a terminal diagnosis."

Skop acknowledged that these are difficult decisions for pregnant women and their families and said she still advocates giving birth.

"The woman would have the opportunity to hold the baby, to say her goodbyes to the baby. And I think that's a much more humane situation for that woman and for that baby," Skop said.

Skop said she worries that some women may seek abortions in the third trimester for other reasons, such as "coercion" by a former partner.

For Tara Mendola, the decision to end a third-trimester pregnancy after a devastating fetal diagnosis felt complicated — medically and morally.

"It was going to be bad enough for my children not to come home with a baby," Mendola said. "I really, really did not want to expose them to watching a sibling die immediately after they were born."

Mendola, 34, is a freelance writer and editor from Brookline, Mass. She has two children and is expecting another baby soon. In an essay for the website Rumpus last year, Mendola wrote about the moral complexity she felt around that decision in 2017, and how her Jewish faith guided her.

"I think the alternate viewpoint on this is you can't escape suffering; it's the easy way out to have an abortion," Mendola said in an interview with NPR. "It certainly was not easy ... but I think it was less traumatic for my family."

Whatever the circumstances surrounding the decision, women seeking the procedure in the late second or third trimester have few options, said Jen Villavicencio, an OB-GYN and fellow with the American College of Obstetricians and Gynecologists.

"She can't just show up at any clinic and decide to get an abortion. She's moving through tons and tons of barriers and hoops to be able to do this," Villavicencio said.

That was true for Beth Vial, a college student from Portland, Ore., who didn't learn she was pregnant until she was about 26 weeks along, in the summer of 2017. "I just [burst] out crying. I didn't believe them because I was told that wasn't a possibility for me," she said.

Vial has some health issues — including a condition that disrupts her menstrual cycles — which can make conception unlikely and a pregnancy harder to diagnose. Doctors in Portland told her she was too far along for an abortion there.

Vial was 22 at the time. She had recently ended her relationship and said she was sure she did not want to continue the pregnancy.

"I was already having a tough time in my life in a lot of other ways and it just felt like one more thing I really couldn't bear, or provide for, and I was panicked, I guess," Vial said.

Vial found a clinic in New Mexico that told her they would end her pregnancy up until 28 weeks — the beginning of the third trimester.

She scrambled, with the help of family, friends and a nonprofit that helps women pay for abortions, to pull together the fee of more than $10,000.

"[There were] a lot of people telling me how they felt about my situation without me asking — friends, family, strangers," Vial said. "I mean, you tell someone that you're seven months pregnant and having an abortion, they've got some things to say."

"People I thought were my friends made it clear to me that they disapproved," she said. "And that's fine. It wasn't changing my mind."

Copyright 2019 NPR. To see more, visit https://www.npr.org.

RACHEL MARTIN, HOST:

States across the country, including Ohio, Georgia and Mississippi, have recently pushed for bans on early abortions. It's part of an effort to challenge Roe v. Wade and to build support before the 2020 elections. But there's also a debate on the other end of the spectrum over very late abortions. Third-trimester abortions are rare and controversial. Women who seek them often are facing a devastating diagnosis or a personal crisis. But the issue has been coming up in state legislatures in Congress and in the presidential campaign. Here's NPR's Sarah McCammon.

SARAH MCCAMMON, BYLINE: These days, Dana Weinstein is the mother of three active children, a boy and two girls, who shower her with love as they burst through the door after school.

UNIDENTIFIED CHILD #1: Mommy, I missed you.

DANA WEINSTEIN: Hi, baby. Come on. Hi, baby.

UNIDENTIFIED CHILD #2: Mommy.

MCCAMMON: But Weinstein's path to this happy, healthy family has been difficult. Almost a decade ago, she and her husband found out they were expecting their second child, news that filled her with so much joy she documented her pregnancy in a journal written to her future baby.

WEINSTEIN: You moved. It's the first time I felt you move, and it was during a service Mommy was at that played music. I think you have a thing for live music. It was so great to feel you kick and move around.

MCCAMMON: Weinstein is now 48, living in the Washington, D.C., suburbs and working for a nonprofit. She still tears up when she talks about the diagnosis she received about 31 weeks into that pregnancy - that a critical piece of the brain had not developed properly. The prognosis was heartbreaking.

WEINSTEIN: That our baby would have seizures 70 percent of the time - that was a best-case scenario - that when we delivered her, that we would need to have a resuscitation order in place because she would most likely seize to death.

MCCAMMON: Fearing a short and painful life for her baby, Weinstein and her husband chose to travel to Colorado to end the pregnancy at one of the few clinics in the country that offers third-trimester abortions. She's been speaking publicly about her experience for years. But recently, decisions like hers have become the focus of national debate.

(SOUNDBITE OF 2019 STATE OF THE UNION ADDRESS)

PRESIDENT DONALD TRUMP: Lawmakers in New York cheered with delight.

MCCAMMON: Earlier this year, during the State of the Union address, President Trump weighed in on the issue of later abortion, condemning a law passed in New York that removed some restrictions.

(SOUNDBITE OF 2019 STATE OF THE UNION ADDRESS)

TRUMP: These are living, feeling, beautiful babies who will never get the chance to share their love and their dreams with the world.

MCCAMMON: With two of Trump's nominees now on the U.S. Supreme Court, anti-abortion rights activists are hoping the court will roll back or overturn the 1973 Roe v. Wade decision that legalized abortion nationwide. In several states, they've pushed through legislation banning the procedure as early as six weeks, hoping one of those bills will find its way to the Supreme Court.

In more liberal states - among them, Vermont, Massachusetts and Illinois - lawmakers have tried to push in the other direction, working to enshrine abortion rights in state law. A failed proposal in Virginia to remove some restrictions on later abortion sparked heated rhetoric earlier this year, including claims that supporters were condoning infanticide. Mallory Quigley is with the anti-abortion group the Susan B. Anthony List.

MALLORY QUIGLEY: What we're seeing in some states is a complete overreach on the part of the abortion lobby.

MCCAMMON: Abortion rights opponents are also promoting legislation at the federal level to restrict abortion later in pregnancy. They point to polling that suggests that while a majority of Americans support access to the procedure earlier, most oppose it by the third trimester. Quigley says she believes it's a winning political issue for Republicans who oppose abortion rights.

QUIGLEY: I think that the increased clarity that these types of debates are providing are going to help President Trump and pro-life senators, representatives, people on the ballot in 2020.

MCCAMMON: The issue already is popping up in the 2020 Democratic presidential primary. Former Texas congressman Beto O'Rourke was asked for his views on third-trimester abortions during a campaign stop in Ohio in March. And here's Vermont Senator Bernie Sanders responding to a question during a recent Fox News town hall.

(SOUNDBITE OF ARCHIVED RECORDING)

MARTHA MACCALLUM: With regard to abortion, do you believe that a woman should be able to terminate a pregnancy up until the moment of birth?

BERNIE SANDERS: Look, I think that that happens very, very rarely. And I think this is being made into a political issue.

MCCAMMON: Both Sanders and O'Rourke ultimately said they believe such decisions should be made by women and their doctors. However polarizing third-trimester abortions may be politically, as a medical procedure, they're very rare. According to the Guttmacher Institute, which supports abortion rights, a little over 1 percent occur sometime after 21 weeks, which is still well within the second trimester. Jen Villavicencio is an OB-GYN and fellow with the American College of Obstetricians and Gynecologists. She says a woman seeking an abortion in her final trimester has very few options.

JEN VILLAVICENCIO: She can't just show up at any clinic and decide to get an abortion. She's moving through tons and tons of barriers and hoops to be able to do this.

MCCAMMON: That was true for Beth Vial, a college student from Portland, Ore., who didn't learn she was pregnant until she was about 26 weeks along in the summer of 2017. Vial has some health issues that can make it hard to conceive and make a pregnancy harder to diagnose.

BETH VIAL: I just burst out crying. I didn't believe them because I was told that that wasn't a possibility for me.

MCCAMMON: Vial was just 22. She'd recently ended her relationship and says she knew she didn't want to be pregnant. Vial couldn't find a doctor who'd perform her abortion at that stage in Portland. But she was referred to a clinic in New Mexico that would do the procedure up until 28 weeks at a cost of more than $10,000. So Vial scrambled with the help of family and friends and a nonprofit group to get the money together.

VIAL: There was a lot of emotions I - because there's a lot of people telling me how they felt about my situation without me asking. I mean, you tell someone that you're seven months pregnant and having an abortion, they've got some things to say. People I thought were my friends made it clear to me that they disapproved. And that - I - that's fine. It wasn't changing my mind.

MCCAMMON: For Dana Weinstein, who ended her pregnancy in the third trimester because of a severe fetal diagnosis, the emotional public debate around the issue is sometimes difficult to hear.

WEINSTEIN: I would have given anything to have been able to help our baby live if she could have lived, but she was going to be incapable of that. I just don't understand why and how this is so front and center in the national debate.

MCCAMMON: It's a debate that's likely to continue in the coming months in the midst of new battles over who should be allowed to have an abortion and when. Sarah McCammon, NPR News.

(SOUNDBITE OF DYLAN AYCOCK'S "RED OAK BLACK") Transcript provided by NPR, Copyright NPR.