Patients need 'the safest care'.(Letters)(Letter to the Editor)

Dr. Daniel J. Wechter may never have seen a woman die of a self-induced septic abortion, but I have ("Partial-Birth Abortion Ban," Letters, June 1, 2004, p. 9).

Not every woman can deliver vaginally and not every woman can safely undergo a cesarean section. I remember one case--a fetus with a huge hydrocephalus. By the time it was detected, there was essentially no brain tissue left. The debate was whether to deliver the woman abdominally or vaginally. We wanted to avoid c-section at all costs because she was at very high risk and we knew we would not have a viable child.

Vaginal delivery, or even c-section, without decompression of the fetal head would have been impossible, so this case involved needle drainage of the hydrocephalic fetus after delivering the body. That reduced the head from basketball size to virtually nothing, which allowed breech vaginal delivery. Had we done a cesarean we still would have had to decompress the same way and the fetal outcome would have been the same.

Does the vaginal delivery meet the definition of partial-birth abortion? This procedure was done in my residency in the U.S. Air Force and was thought to be appropriate and necessary, even though abortion was not legal in military facilities at that time.