By Rob Stein
Washington Post Staff Writer
Friday, June 5, 2009; A03
When Susan Fitzgerald went in for a routine ultrasound near the end of her pregnancy, she was expecting good news. Instead, she was stunned to learn that the fetus had a rare condition that left his bones so brittle he would live less than a day.
"It was unbelievable," Fitzgerald said. "You think by the third trimester you're home free. It was devastating."
Desperate to end the pregnancy, she flew from her home in New England to Wichita, where George Tiller was one of the few doctors in the country willing to perform an abortion so late in a pregnancy.
"It was very difficult, but I knew it was the most humane thing I could do for my baby," Fitzgerald said. "It was absolutely the right thing to do. I'm just so grateful that Dr. Tiller was there for me."
Her story is one of dozens that have surfaced in the past week during candlelight vigils, at memorials and on blog postings since the shooting death of Tiller. An antiabortion activist has been charged in his slaying.
Tiller's death has focused attention on abortions late in pregnancy. While it is clear that they account for a tiny fraction of the 1.2 million U.S. abortions each year, much about the procedures is unclear, including exactly how many are done, by whom and under what circumstances. The government does not collect detailed data, and doctors who perform them publish little information.
"This is an area that we just don't know much about," said Stanley K. Henshaw, a senior fellow at the Guttmacher Institute, a reproductive health research group that has the best available data. "The information just isn't available."
More than 88 percent of abortions are done in the first trimester, and most doctors will not perform them beyond 22 or 24 weeks because of moral qualms, social stigma, legal concerns, inadequate training or lack of experience. Barely 1 percent of procedures are done after 21 weeks. At 37 weeks, a baby is generally considered full-term.
But 2001 data from 15 states and New York City indicate that perhaps as many as 2,400 abortions were performed after 24 weeks in the United States that year, Henshaw said, most of them probably in the 25th or 26th week.
A survey of 1,819 providers found that at the time, 18 clinics and 12 hospitals performed abortions at 26 weeks. Because the overall number of abortion providers has dropped since 2001, the number offering procedures that late has probably fallen, too, and the number performing abortions even further along in the pregnancy is probably much smaller, Henshaw said.'Targeted for Violence'
"We know it's a very small handful," said Vicki Saporta, president of the National Abortion Federation, the largest group of abortion providers, who would not be more specific. "Given the fact that these people are targeted for violence, I don't necessarily want to name other providers that we know are providing necessary reproductive health care in these circumstances."
Abortion rights activists argue that late-term procedures are performed only when absolutely necessary -- often when devastating abnormalities in the fetus or life-threatening problems in the woman are discovered.
"What made Dr. Tiller unusual was that he specialized in seeing women who found out late in very wanted pregnancies that they were carrying fetuses with anomalies that were incompatible with life," Saporta said. "For them, there was really no good choice. They needed to terminate their pregnancies to protect their own health, and he provided both the emotional and physical care for women in that situation."
Abortion opponents condemn the procedures, regardless of the circumstances.
"They're homicide," said Troy Newman, president of Operation Rescue. "It's the taking of an innocent human life."
Under Kansas law, an abortion can be performed after a fetus is viable only if the doctor performing the procedure and an independent physician agree that the woman's life is at risk or that continuing the pregnancy would cause "substantial and irreversible impairment of a major bodily function."
Many are performed in cases such as Fitzgerald's, where a major abnormality in the fetus is discovered late, Saporta and others said.
"The latest patient was a case where the fetus had no brain at all, would never take a breath on its own. That was probably just a few weeks before delivery," said LeRoy Carhart, a Bellevue, Neb., doctor who worked with Tiller, in an interview this week. "Her doctor knew the problem all along but just never told her."
In other cases, late-term abortions are performed for women who develop a life-threatening condition related to the pregnancy or need to terminate it for cancer treatment. But the procedures are sometimes done in other circumstances, including cases when the woman suffers serious emotional problems.
"There was a woman who tried to commit suicide three times. She was pregnant because she had been raped. She said every time she felt the baby move, it was the rape all over again. She could not live with that," said Carhart, who estimated that 400 procedures a year were performed beyond 24 weeks at Tiller's clinic.
Carhart and another physician said they are also willing to perform late-term procedures for some incest victims, especially very young girls for whom the pregnancy could pose physical and emotional risks.
"If someone calls me up, and she's 32 weeks pregnant and knew she was pregnant for six months and says, 'I want an abortion, because I just broke up with my boyfriend,' I won't do that," said Warren M. Hern, a Boulder, Colo., doctor who is one of the very few physicians who perform the procedures and are willing to speak publicly. "But a 13-year-old teenybopper clutching a pink teddy bear who has been raped by her stepfather -- I'll do that."First Comes Counseling
Hern and Carhart said their patients must first undergo intensive counseling and evaluation.
"Many of these women are truly desperate. Many have a desired pregnancy that is terribly complicated by a lethal fetal anomaly. The baby is totally impaired, may die in delivery or after terrible struggle and pain. There is no justification for forcing the woman to carry this baby to term," Hern said.
While most of the late-term procedures involve physical health problems, neither Hern nor Carhart would specify what proportion falls into those categories.
"The antiabortion people take any facts and use them as a bludgeon," Hern said.
Newman disputed the contention that the procedures are commonly performed to save a woman's life, and condemned doing them for genetic defects or in cases or rape or incest.
"Performing these for fetal anomaly -- that's the same as going into a hospital and killing everyone in the hospital with a handicap," Newman said. "In the case of incest, prosecute the father. Don't punish the child for the crime of the father."
Fitzgerald wondered what happened to couples who might have flown to Wichita that day to see Tiller.
"I think of all the poor couples, knowing they made this heartbreaking choice," Fitzgerald said. "What did they do?"