Last year, 704 D & E abortions took place in Minnesota, according to the Minnesota Department of Health. It is the third most common abortion technique in the state and the main method during the second trimester. A total of 993 abortions occurred at 14 weeks gestation or later in 2014, including 174 at 20 weeks or later (the latest abortion took place at 27 weeks). These 20-week abortions are at least mostly D & E procedures.
In the U.S. Supreme Court's Stenberg v. Carhart decision (2000), Justice Anthony Kennedy (who in 1992 voted to uphold Roe v. Wade) summarizes the method:
As described by [well-known late-term abortion practitioner] Dr. [Leroy] Carhart, the D & E procedure requires the abortionist to use instruments to grasp a portion (such as a foot or hand) of a developed and living fetus and drag the grasped portion out of the uterus into the vagina. Dr. Carhart uses the traction created by the opening between the uterus and vagina to dismember the fetus, tearing the grasped portion away from the remainder of the body. ... The fetus, in many cases, dies just as a human adult or child would: It bleeds to death as it is torn limb from limb. The fetus can be alive at the beginning of the dismemberment process and can survive for a time while its limbs are being torn off. Dr. Carhart agreed that "[w]hen you pull out a piece of the fetus, let's say, an arm or a leg and remove that, at the time just prior to removal of the portion of the fetus, ... the fetus [is] alive." Dr. Carhart has observed fetal heartbeat via ultrasound with "extensive parts of the fetus removed," and testified that mere dismemberment of a limb does not always cause death because he knows of a physician who removed the arm of a fetus only to have the fetus go on to be born "as a living child with one arm." At the conclusion of a D & E abortion no intact fetus remains. In Dr. Carhart's words, the abortionist is left with "a tray full of pieces."In 2013 testimony before a U.S. House subcommittee, Dr. Anthony Levatino, a former practitioner of abortion, describes how he performed the procedure:
Imagine if you can that you are a pro-choice obstetrician/gynecologist like I once was. Your patient today is 24 weeks pregnant. At twenty-four weeks from last menstrual period, her uterus is two finger-breadths above the umbilicus. If you could see her baby, which is quite easy on an ultrasound, she would be as long as your hand plus a half from the top of her head to the bottom of her rump not counting the legs. Your patient has been feeling her baby kick for the last 2 month or more but now she is asleep on an operating room table and you are there to help her with her problem pregnancy.
The first task is remove the laminaria that had earlier been placed in the cervix to dilate it sufficiently to allow the procedure you are about to perform. With that accomplished, direct your attention to the surgical instruments arranged on a small table to your right. The first instrument you reach for is a 14-French suction catheter. It is clear plastic and about nine inches long. It has a bore through the center approximately 3/4 of an inch in diameter. Picture yourself introducing this catheter through the cervix and instructing the circulating nurse to turn on the suction machine which is connected through clear plastic tubing to the catheter. What you will see is a pale yellow fluid that looks a lot like urine coming through the catheter into a glass bottle on the suction machine. This is the amniotic fluid that surrounded the baby to protect her.
With suction complete, look for your Sopher clamp. This instrument is about thirteen inches long and made of stainless steel. At the business end are located jaws about 2 1/2 inches long and about 3/4 of an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go. A second trimester D & E abortion is a blind procedure. The baby can be in any orientation or position inside the uterus. Picture yourself reaching in with the Sopher clamp and grasping anything you can. At twenty-four weeks gestation, the uterus is thin and soft so be careful not to perforate or puncture the walls. Once you have grasped something inside, squeeze on the clamp to set the jaws and pull hard—really hard. You feel something let go and out pops a fully formed leg about six inches long. Reach in again and grasp whatever you can. Set the jaw and pull really hard once again and out pops an arm about the same length. Reach in again and again with that clamp and tear out the spine, intestines, heart and lungs.
The toughest part of a D & E abortion is extracting the baby's head. The head of a baby that age is about the size of a large plum and is now free floating inside the uterine cavity. You can be pretty sure you have hold of it if the Sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see white gelatinous material coming through the cervix. That was the baby's brains. You can then extract the skull pieces. Many times a little face will come out and stare back at you. ... If you refuse to believe that this procedure inflicts severe pain on that unborn child, please think again.
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Nucleus Medical Media offers a medical illustration of a D & E abortion of a 23-week-old fetus (right). The procedure is explained in clinical detail in the textbook Management of Unintended and Abnormal Pregnancy, published in 2009 by the National Abortion Federation.