Michigan will very likely ban a type of abortion procedure within the next few months.
It’s called dilation and evacuation. It makes up about 7% of abortions in Michigan each year. And it’s the most common type of abortion performed during the second trimester of pregnancy.
“I think people will basically be unable to get second trimester abortions in this state if this passes”
When I visited Nicole Medina on a recent cold, sunny day, she was at home with her family. That included her smiley, boisterous, dinosaur-loving two-year-old son, who chattered away in the background as we talked. And a newborn addition, sleeping snugly in her rocker in the kitchen.
“Yep. My two little rainbows,” Medina said. “The rainbows after the storms. She’s three weeks old.”
The storms Medina is talking about is her first pregnancy about three years ago. She and her husband were elated about it — until their first ultrasound.
“They found that she had something called a cystic hygroma, which is fluid pretty much between the skin and the bones, like the skull and stuff,” Medina said. “And it was quite large.”
It took a few more weeks to get a definitive diagnosis, and it was a devastating one. The Medinas’ baby girl had a condition called trisomy 18. Basically, she had an extra copy of the 18th chromosome in every cell of her body.
Medina is an ICU nurse. Her husband is a doctor. They knew how bad this was.
“We both see suffering on a daily basis,” Medina said. “And we both knew that if she was born alive, how much she would suffer.”
They didn’t want that for their daughter. And it was an excruciating time for Medina. “I don’t know how I could have made it 40 weeks, if she would have made it that long,” she said.
So they made a decision to terminate the pregnancy. Because Medina was in the second trimester by that time, they had two options: to induce labor, or to have a dilation and evacuation abortion. They chose the abortion.
But abortion opponents want to make dilation and evacuation illegal in Michigan.
That would leave labor and delivery as the only option for women like Medina. Both procedures are considered very safe, medically speaking, said Dr. Jennifer Villavicencio, an obstetrician-gynecologist and lecturer at the University of Michigan.
But labor and delivery does have a higher risk of potential complications. It also requires hospitalization, and it’s more costly, in a state where health insurance plans generally do not cover abortions. And few doctors in Michigan provide that type of abortion.
For those reasons, “I think people will basically be unable to get second trimester abortions in this state if this [dilation and evacuation ban] passes,” Villavicencio said. “This makes it a crime to provide the safest, most evidence-based care. It pits doctors against patients, and doctors against medicine. Will I be considered a criminal for providing that care?”
The route to a ban: going around the governor
Dilation and evacuation involves a doctor dilating the woman’s cervix, and removing the fetus with forceps or other surgical instruments. In many cases, doctors administer a shot to stop the fetal heartbeat before the procedure. Opponents routinely call it “dismemberment abortion.”
Genevieve Marnon, legislative director for Right to Life of Michigan, said that’s why the group spearheaded a petition initiative to ban the procedure.
“We think that ripping living babies to pieces is not OK in a civilized society, and we think it’s high time to ban that particular abortion procedure,” Marnon said.
Governor Gretchen Whitmer had vowed to veto any legislation banning the procedure. So Right to Life gathered more than 380,000 petition signatures. Those are currently being vetted by the Michigan Bureau of Elections.
If they’re approved, that gets the proposal in front of the Republican-dominated state Legislature, which can pass it directly into law with simple majorities in both houses.
“In order to get around the governor’s veto, the only way to do that is through a petition initiative,” Marnon said. “And that’s what we’ve done.”
If the Legislature approves the law, as expected, it would make Michigan the 13th state to pass a law severely restricting second trimester abortions, said Elizabeth Nash, senior state issues manager with the pro-reproductive rights Guttmacher Institute. However, in ten of those states, court challenges blocked the laws from going into effect. In the other two states, no abortion providers did the procedure anyway.
Nash says women may seek second-trimester abortions for many reasons, like serious fetal abnormalities. But other factors, such as a lack of access to abortion services, cost, and legal restrictions can also force women to delay terminating a pregnancy.
“You’re looking at waiting periods. You’re looking at counseling requirements. You’re looking at limits on abortion coverage in health plans,” said Nash.
Nash says banning dilation and evacuation would be dangerous.
Michigan’s proposed law ban has just two exceptions: if the fetus is already dead, or if the mother’s life is in danger. But Nash says even in that situation, the ban could have a “chilling effect” on doctors — with grave consequences.
“A provider may not feel that they can meet the letter of the law, and provide the care that is appropriate for the patient, until the patient is in dire straits,” Nash said.
Court battle lies ahead
But Right to Life of Michigan’s Genevieve Marnon dismisses these concerns.
“I think the law is very clearly written, and I think doctors are really smart,” Marnon said. “They’ve had a lot of education. And I think they can figure this out.”
"If you limit any woman's choice, you're limiting my choice." --Nicole Medina
Marnon said dilation and evacuation is simply horrific, even in the case of very troubled pregnancies. “It just doesn’t make any sense that we would snuff them out through abortion because they’re not perfect,” she said.
But Nicole Medina said her abortion was about alleviating suffering, and she’s never regretted it.
She knows what it’s like to suffer judgment. A co-worker once called her a murderer. But Medina said no one should judge her unless they’ve had to make that choice themselves.
“The politicians, it’s black and white,” she said. “There’s no gray area. So if you limit any woman’s choice, you’re limiting my choice.”
“Don’t take away my right just because your choice might be different than mine. That’s just cruel. It’s cruel to think that you know what’s best for my family.”
But unless something unexpected and dramatic happens, Michigan’s proposed ban should become law within the next few months.
A court challenge will inevitably come next.
Update 2/24/2020: Updated with additional information about the common practice of ending the fetal heartbeat before a dilation and evacuation procedure.
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