Dear Donald Trump: I'm an OB-GYN. There are no 9-month abortions.

At the final presidential debate, Donald Trump said doctors do abortions in the “ninth month” of pregnancy, that they “rip the baby out of the womb in the ninth month, on the final day. And that’s not acceptable.”

I’m a doctor who was trained to do late-term abortions. I did them for five years in residency and for 10 years in practice and I have no idea what Trump is talking about. I have even practiced in states with no gestational age limit for abortions. So while I no longer perform abortions, I know much more about this subject than Donald Trump or any of his advisers can ever hope to know.

Focusing on late-term abortions is always an interesting strategy. And certainly, if one really wanted to reduce abortion, it is the wrong strategy, as only 1.3 percent of abortions happen at or after 21 weeks. We know this because the Centers for Disease Control (something you and I pay for with our federal tax dollars) conducts annual abortion surveillance. The majority of abortions, 91 percent in fact, happen before 13 weeks, and we know how to prevent most of them: easily accessible, free, long-acting reversible contraception.

Since we can’t and shouldn’t count on Trump for facts about abortion, let’s set the record straight on later-term abortions, meaning those at or after 21 weeks. There are three reasons women seek later-term abortions: health of the mother, personal reasons, and fetal anomalies (birth defects).

Late-term abortions are rare — and women tend to seek them for three reasons

Abortions for the health of the mother happen only happen before 24 weeks, which is the generally accepted cut-off for fetal viability. After 24 weeks, if a pregnant person is sick enough that she needs to deliver for her health, obstetricians either induce labor or perform a C-section, and the baby is attended by the neonatal intensive care unit.

Trump would apparently have you believe, and perhaps he believes himself, that in these situations doctors do a delivery and then commit infanticide. Health of the mother abortions absolutely do happen — in circumstances of ruptured membranes with an infection or deteriorating heart disease, for example — but they happen before 24 weeks. No OB-GYN is doing third-trimester abortions for the health of the mother. We simply just practice obstetrics and deliver the baby by the most appropriate method.

A small percentage of late-term abortions (i.e., at or after 21 weeks) are for personal reasons. These procedures also don’t happen in the “ninth month” or one or two days from delivery. When a woman presents for an abortion and she is past 24 weeks, she is told that she is too far along for the procedure. There is even a medical term for this — turnaways. It has been studied, so we know exactly why women present too late: difficulty finding a provider; difficulty getting to the provider, especially given that some states require multiple visits; and difficulty affording the procedure.

Only nine states and the District of Columbia allow abortions after 24 weeks without restrictions. Is it possible one or two women may have an abortion at 24 or 25 weeks in these states and it not be for the health of mother? Technically yes, but honestly I’ve never heard of it happening. People seem to forget when they talk about these theoretical post-24 week abortions for personal reasons that a pregnant person would need $15,000 or more in cash.

So, considering the cost of abortions, the fact that fewer than 0.3 percent occur at or after 21 weeks for non-genetic reasons, that most abortions will be before 24 weeks, and the expense of the procedure, it is simply ludicrous to insinuate that this happens regularly — never mind at all. And a “nine-month abortion” of an otherwise healthy fetus? That is just untrue.

The only type of abortion that happens anywhere near nine months is for fetal anomalies

The only type of abortion that does happen after 24 weeks is for fetal anomalies. Most abortions for fetal anomalies happen before 24 weeks, but a very small percentage happen later than that. The abortions that take place later do so because it takes time to do the ultrasounds and genetic testing. Sometimes a fetal MRI may even be needed.

Sadly, some women are lied to by anti-abortion doctors in states with gestational age limits and get their genetic testing done on the late side because the doctor wants to try to take the possibility of an abortion off the table. I have personally heard of this happening.

However, even with the most on-the-ball OB-GYN, it can still be a race to get all the information and give a pregnant person time to think it over before 24 weeks. Sometimes the drastic nature of the problem isn’t fully realized until the pregnancy progresses. Other times a woman is carrying a fetus incompatible with life and thought she would go to term and let nature take its course, but then she realizes she just can’t. Who among us should judge those women?

When these procedures do happen, they could be an induction of labor, or some highly skilled providers can perform dilation and extraction procedures past 24 weeks. The closer to term (40 weeks), the more likely the procedure will be an induction of labor. So at 36 or 37 weeks, in most situations, the doctor will simply induce labor and after delivery not resuscitate the baby. However, there are rare medical situations where that might not be advisable, so the option of a dilation and extraction allows women in these situations to avoid a C-section.

The facts are that 98.3 percent of abortions happen before 21 weeks. Most of the terminations at or after 21 weeks are very wanted pregnancies with serious fetal anomalies. Some are for the health of the mother and a very small percentage are for personal reasons. Almost all women who have later abortions for personal reason would have had the procedure sooner if they could have, so the very laws proposed by politicians who aim to restrict abortion (mostly under the false pretense of safety) actually lead to delays.

Donald Trump doesn’t understand women and abortion, at all

I’ve counseled women about later term abortions. I’ve met with them, listened to their heartbreak, and used every ounce of my being to hold back my tears. I’ve comforted women and their partners sobbing about the fact their baby has no brain or can never breathe as their lungs have not developed. I’ve helped women figure out how to get the body of what had been a wanted pregnancy back home for burial. I’ve cared for women ravaged with infection at 22 or 23 weeks and sat worried by their bedside in the intensive care unit hoping that I did the abortion in time to save their life.

If Donald Trump has spent any time learning the facts and hearing the stories of women, he would know what I do: There is no “ninth-month” abortion. It’s cruel to women who have walked the path of late-term abortion and it’s insulting.

Jennifer Gunter is an OB-GYN and a pain medicine physician. She is the author of the book The Preemie Primer, a guide for parents of premature babies. Her website is drjengunter.wordpress.com, and she is on Twitter @DrJenGunter.

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