Thin legal line separates two similar procedures

It is legal if the woman's life is in danger, but can't be done just to protect her health.

Physicians don't use the term "partial-birth abortion," which was coined in 1995 by the National Right to Life Committee, which seeks to outlaw abortion. "It doesn't exist as a medically defined procedure," says Dr. Eleanor Drey, an obstetrician/gynecologist and medical director of the Women's Options Clinic at UC San Francisco.

But, she says, because legislatures and courts have legally defined it, physicians have to determine what is meant by it.

A "partial-birth abortion" refers to a certain type of abortion after the first trimester, which extends from week one to 12. Most states ban all abortions after the fetus becomes "viable," or has a chance of living outside its mother's womb. This occurs around week 24.

Dr. Michael Ross, chairman of obstetrics and gynecology at Harbor-UCLA Medical Center in Torrance, says the law probably refers to a procedure called "intact dilation and extraction," or intact D&X. It differs from another procedure, D&E, or dilation and evacuation, which is not outlawed.

Both procedures start the same. The cervix is dilated via mechanical stimulation or a drug, which takes a day or two.

To perform a D&E (not banned), suction and forceps are then used to pull fetal tissue from the uterus. In the process, the fetus is broken up.

In an intact D&X (banned), the fetus is removed feet-first and mostly whole, except for the head, which is too big. Physicians then use suction to remove the brain and collapse the head. In either case, physicians sometimes inject the fetus with a drug to kill it before beginning dilation.

Drey says physicians are breaking the law if they start to remove an intact fetus while it is still alive but not if they remove a fetus intact when it is dead.

But D&E and intact D&X are closely related, and physicians might start with one and have to finish with the other. For example, physicians can't control precisely the right amount of time for the cervix to open. "If the cervix opens too much, the fetus might start to come out," Drey says.