Terminating a Desired Pregnancy for Medical Reasons or Poor Prognosis

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In the second trimester, doctors typically conduct a number of prenatal screening tests that can detect a variety of different chromosomal and congenital conditions in the fetus. The conditions being screened for can vary heavily in their prognosis. Children with some of these conditions, such as Down syndrome and mild to moderate neural tube defects, can be born alive and live a normal lifespan—although they may have developmental, physical, or cognitive disabilities.

Other conditions detected in prenatal screening can be fatal or carry a profoundly poor prognosis. For example, half of the babies born with anencephaly will not survive birth and the other half die within hours or days. A chromosomal condition such as trisomy 13 or trisomy 18 can result in a baby with a short lifespan; 90 percent of babies with either of these conditions do not survive past one year old and are frequently afflicted with health problems and medical interventions throughout their lives.

Medically Indicated Termination

When prenatal screening and subsequent diagnostic tests return a definitive diagnosis of a condition with a poor prognosis, parents may face the decision of whether to continue the pregnancy. A pregnancy termination under these conditions is sometimes called medically based or medically indicated termination. Parents may also end up considering a medically based termination when rare pregnancy or other health complications pose a notable threat to the mother's life if she continues the pregnancy.

Your options for medical termination may depend on the state you live in. Some healthcare providers in some states may not be able to counsel you on medical termination. You can find a list of each state's medical abortion laws here.

When parents choose to terminate a pregnancy because of severe medical conditions in the baby, the medical procedure is technically a second-trimester abortion or a "late-term" abortion—and it is technically elective because parents can choose whether to let nature take its course or to end the pregnancy. As opposed to most elective terminations, however, most babies aborted late in pregnancy for medical reasons were very much wanted and the parents may deeply grieve the loss of the baby.

Politics and Emotions

Pregnancy termination of any type tends to be a divisive and emotional issue, both personally and politically. People who are philosophically or religiously opposed to abortion may view all abortions as wrong—no matter the circumstances. Activist groups are sometimes deeply opposed to even medically based terminations, and numerous online sites make a case that every baby should be brought to term. People who have a pro-choice stance usually have no objections to medically based terminations.

In cases when the diagnosed condition is not necessarily fatal, some opponents to selective abortion after a prenatal diagnosis have fears that parents may not receive full information. Outcomes have improved over the years for some conditions, such as Down syndrome, and they fear that parents may receive an inaccurate and dismal view of what it is like to raise a child with a physical or developmental disability.

As of June 24, 2022, the Supreme Court has overturned Roe v. Wade, the law that guaranteed constitutional access to abortion, including medical abortion. This means that each state will now have different laws regulating abortion. This may impact how you can plan for a medically indicated abortion, depending on which state you live in.

Outside the context of politics, and more important in these situations, are the feelings of the parents. Rather than being black and white (as political views tend to be), parents' emotions often fall somewhere on a spectrum. Some cannot fathom the idea of having a late-term abortion at all even after a diagnosis of fatal birth defects, while others wrestle with the idea but ultimately opt for the termination, and still, others do not struggle with the decision even though they grieve the loss of the baby. In all cases, it is a tremendously difficult decision for parents to make and is often accompanied by significant sadness and grief.

Deciding In Favor of Medically Indicated Abortion

When parents decide to terminate for medical reasons, the decision may have a number of factors. In nonfatal conditions, parents may feel they are ill-equipped to handle a child with lifelong special needs. Sometimes the decision to terminate involves concern for the baby's suffering. For example, in the context of a condition like a ​trisomy 18 that involves potentially severe medical problems as well as a very short life expectancy, parents may want to avoid putting the child through unnecessary pain when there is no hope for a good outcome. These parents may feel that termination is the lesser of two evils.

Terminating for medical indications may involve concerns for the mother's emotional health as well. When receiving the news of a devastating medical diagnosis, mothers may not want to face additional months of pregnancy only to see their much-wanted baby die in the hospital. These mothers may need to end the physical process so they can begin grieving and healing in the way that is best for themselves and their families.

Finally, some situations may involve serious risk to a mother's life, such as the rare condition of a twin pregnancy involving one normal fetus and one hydatidiform mole (in which the mother faces a 60 percent risk of developing the malignant gestational trophoblastic disease by the end of the pregnancy if she opts to continue). In these cases, the mother's life and health may be protected by the termination—even if the baby was very much wanted.

Deciding Against Medically Indicated Abortion

For diagnoses of nonfatal conditions, such as Down syndrome, parents may decide that they are ready and willing to accept a child with special needs. And in situations even with a very poor prognosis for either the baby or the mother, some parents may opt against termination because of religious convictions or deep philosophical convictions against abortion.

Still, other parents may feel solace in letting nature take its course and in having a chance to hold the baby before it passes away, perhaps not being able to bear the idea of terminating the life of a baby.

A few parents may continue a pregnancy because of a slim hope that the diagnosis was wrong and that everything will turn out fine. (Diagnostic errors are extremely rare for conditions that would raise the question of medically based termination; chromosomal studies obtained through amniocentesis, for example, have 100 percent accuracy barring the also rare case of lab error.)

It is important to note that these decisions can be impacted by where you live. Some states may have outlawed medically indicated abortions. Check your state's laws here.

A Personal and Individual Decision

The decision of whether or not to terminate a pregnancy affected by a serious medical condition is highly personal. Some parents take a middle ground, opting to terminate if the condition is one that would be fatal at birth or shortly thereafter, but choose to continue pregnancies in which the baby is expected to have a physical or developmental condition but also a reasonable life expectancy.

Some states do have laws on the books that can make a termination difficult if the condition does not threaten the mother's life, in which case women may be forced to travel a long distance for the procedure or to continue the pregnancy.

Second-trimester terminations for medical reasons usually involve a D&E (dilation and evacuation) or a D&X (dilation and extraction) procedure—often with an injection beforehand to stop the baby's heartbeat. The D&X procedure, which is used for some of these terminations, is highly controversial. Legislators have targeted this procedure, sometimes termed "partial-birth abortion" by conservative media, in recent years and the future of the procedure remains uncertain.

By Krissi Danielsson
Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage.