How to respond to a question about “late-term abortion,” a procedure that doesn’t exist

There has been so much in the news these past few weeks about abortion. The misinformation, disinformation, and lies are overwhelming.

Language always matters, but in medicine it is especially important to be precise. Imagine if we didn’t use the term appendix and instead said a small chunk of bowel on the right? In very lay terms they sound similar, but medically they are not. You do not want a very lay procedure, you want a medical procedure. When imprecise or nonsensical medical terms become law they can hurt patients as doctors don’t know what to do. I have personally had to call a Kansas state legislator at home to ask him medically what his law meant? I’ve mentioned this story a few times. The fact that it is never big news stuns me. Then again, it was just about a woman who needed an abortion to save her life. Imagine if your heart surgeon had to call a politician at home to ask what he mean by the term floppy valve so they would not be criminally prosecuted for replacing the mitral valve in this situation?

And then there is the other layer. Inaccurate terminology about abortion isn’t just malignant lay talk meant to hamper what doctors can offer, it has another purpose — to invent definitions meant to color how people view abortion and sway public opinion with lies.

Term is a pregnancy between 37 0/7 weeks and 41 weeks 6/7 weeks. It is the time period in which we generally expect the pregnancy to deliver. It is a range, as delivering on the actual due date (40 weeks) is uncommon. Between 41 0/7 weeks and 41 6/7 weeks of gestation we say a pregnancy is late-term and from 42 0/7 weeks onwards we say it is postterm. These distinctions are important as late-term and postterm pregnancies are associated with an increasing risk of perinatal mortality (which is stillbirth or death in the first week of life). We have seen the tragedy of medically unattended postterm pregnancies play out on social media with women who refuse induction of labor and “free birth” (deliver without assistance).

Looking at this language you can see how late-term being falsely applied to abortion conjures up the image of an abortion either after the due date (meaning after 40 weeks or even 41 weeks) or shortly before. And of course this does not happen. Ever. I should know, I did abortions after 24 weeks for 3-4 years in a state with no gestational age limit and no one ever asked me for such a procedure. The latest procedure I did was at 34-35 weeks for severe fetal anomalies that would not have been compatible with life after delivery. There was some other mitigating maternal medical factor that prompted the intervention. A vaginal delivery was not an option for a variety of medical reasons and so the option was termination by the vaginal route or termination by c-section. This is an important point, if we do a c-section early for a pregnancy with anomalies that are not compatible with life that should also be considered an abortion if it is done before 37 weeks.

When a patient needs an abortion we discuss trimesters of pregnancy. In general, skill sets are divided into first, second, and third trimester. A patient who needs an 18 week abortion can’t be tended to by someone with first trimester skills. Although medically we usually say weeks of gestation. This informs us of the equipment we may need, the other medical staff we may require, and of course if we have the skill set.

If I were still doing abortions and someone called me to ask for a late-term abortion I would likely hang up on them as I would believe they were a forced birth operative. Which is of course what people who use late-term are. After all, they don’t seem keen on prosecuting women who go postterm with their pregnancies and have a perinatal death. Of course I am not advocating for women to ever be prosecuted for any negative outcome in pregnancy, but if they are so worried about fetal life after 40 weeks it seems somewhat hypocritical to ignore these cases. It simply proves the point that people who use the words late-term abortion are forced birth uniquely for women who want an abortion. If they were pro-fetal life they would care about the more than 700 pregnant women murdered every year (murder of the pregnant person often results in fetal demise — the opposite of fetal life), tobacco (cause of stillbirth — which is fetal death), vaccines (the flu vaccine in pregnancy reduces maternal complications hence improving fetal outcomes — meaning it improves fetal life) and be for free, accessible maternity care, which improved perinatal outcomes (meaning more fetal lives). If fetal life is your gig there are plenty of places to work constructively to improve outcomes.

The crickets in these areas is proof that there is no concern for fetal life. It is uniquely about punishing women for abortion.

When someone asks me about late-term abortion I tell them it isn’t a word and they need to ask me what specifically they mean. If they are someone confused by what they have read they usually rephrase the question in a way that it was clear they thought late-term was 20-24 weeks (effective propaganda, eh?). If they are an anti-abortion forced birther (AAFB) they change the subject and ask a different, but equal inflammatory question. I refuse to budge until they tell me what late-term abortion means. And they never do and thus the conversation ends. I do not put words into their mouths and help them. If they are so invested in fetal life they can figure out the right words. After all, people who have been confused by their propaganda do.

Late-term should never be applied to abortion. Ever. The press need to stop repeating it. Late-term abortion is like saying vaccines cause autism. It doesn’t happen. Repeating the lies that some politician or anti-abortion forced birth activist (AAFB activist) believes is not newsworthy and most certainly does not make them true. As repetition is easily confused with accuracy every one of us, but the press especially, needs to not only abandon the use of late-term abortion, but refuse to further the conversation until the person using this false definition offers an explanation.

There is no such thing as post-term abortion. I guess when you can’t use facts to sway people, all you have is lies.