Abortion ‘never medically necessary’ late in pregnancy? Doctors say that’s wrong

Health care is considered "medically necessary" when it is required to maintain or restore a patient’s health. And, despite posts on social media claiming otherwise, abortion can fall into that category in emergency situations — even in the third trimester.

"Abortion is never medically necessary in the last trimester. Literally never. They just do a C-section," a Nov. 6 Threads post said. 

The post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook,  Instagram and Threads.)

There are situations in which abortion would be medically necessary to preserve a woman’s health or save her life in any trimester, doctors and reproductive health experts say.

OB-GYNs told us the claim misunderstands how and when cesarean sections are used in abortion procedures, while oversimplifying the many complex conditions and interventions that can accompany pregnancy.

C-sections are considered a major invasive surgery that involves removing the fetus through an abdominal incision and can carry risks for health complications, such as hemorrhaging. They aren’t typically coded as abortions, and are usually done with the goal of delivering a live fetus that will survive. The American College of Obstetricians and Gynecologists doesn’t recommend performing this type of surgery in the context of abortion, because of the increased risks to the pregnant patient, which, besides hemorrhaging, can also include infection and damage to surrounding organs. 

"Abortion is not an easy medical issue," Dr. Deborah Bartz, an OB-GYN who provides abortion to medically complex patients in Boston wrote in an email. "Every pregnant person's individual health conditions are unique. This results in profound medical complexity (from) patient to patient that health care professionals are considering and balancing."

For a pregnant woman, severe complications from conditions can include placental abruption, bleeding from placenta previa, and preeclampsia or eclampsia, experts said. Pregnancy can also cause underlying conditions, such as chronic kidney disease and heart disease, to worsen.

"Pregnancy imposes significant physiological changes on a person’s body," the American College of Obstetricians and Gynecologists said in a 2019 statement when some of these claims first spread. "These changes can exacerbate underlying or preexisting conditions, like renal or cardiac disease, and can severely compromise health or even cause death." 

Determining the appropriate medical intervention depends on a patient’s specific condition, the organization said. This can lead to situations in which "pregnancy termination, in the form of an abortion, is the only medical intervention that can preserve a patient’s health or save their life."

Bartz said the post’s claim "would only be true if every pregnancy and fetus was healthy, and every pregnant person was fully healthy." That is not reality.

"Fetal anomalies and/or maternal health complications absolutely make third trimester abortion a medical necessity," Bartz said. "There are multiple methods for performing abortion, and a C-section can be one of those methods."

An abortion is a medical intervention designed to terminate a pregnancy before birth. Although a healthy fetus can typically reach viability — the ability to live outside the womb — around 24 weeks of pregnancy, some pregnancies are never viable, experts said. That means they aren’t able to survive outside the womb no matter how far along in pregnancy they are delivered.

Pregnancy is divided into three trimesters. The third — and last — trimester runs from around week 28 to week 40, when a pregnancy is considered full term. The vast majority of abortions in the U.S., about 91%, occur in the first trimester. Only about 1% take place after 21 weeks, and far less than 1% occur in the third trimester.

"The concept of ‘trimesters’ is more legal than medical; not everyone agrees on when the ‘last trimester’ begins," said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California-San Francisco. "A healthy fetus at 28 weeks may have a reasonable chance of survival, but a fetus with a serious medical condition or is not growing normally at 28 weeks may be unlikely to survive after delivery."

Fetal anomalies such as anencephaly, Trisomy 13, Trisomy 18 and renal agenesis are almost universally fatal outside the womb, Bartz said, and sometimes fetuses suffer from multiple less-severe conditions that, when taken together, may result in a worsened health scenario that leads to death with delivery.

"Think about anencephaly or acrania, problems where the fetal skull does not develop, and most of the head is absent. Those fetuses are not viable at any stage in pregnancy," Dr. Jonas Swartz, a North Carolina OB-GYN, wrote in an email. "If a patient presented at 32 weeks with a fetus with anencephaly, a C-section is not the best way to minimize risk for that woman. An abortion is lower risk. At that gestational age, it would probably be an induction termination with the goal of a vaginal delivery. The fetus might have an injection to stop the heart before starting the induction."

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In a twin pregnancy, for example, one twin can have an anomaly that means it will not live and potentially threaten the other twin’s well-being, Swartz said. Often, doctors will offer to perform an abortion by either providing a feticidal injection or severing the umbilical cord of the sick twin to save the life of the other.

"In some circumstances, this may be safer in the third trimester, he said. "Doing a cesarean at that point would threaten the life of the healthy twin because you’d be delivering it prematurely."

Although some patients get the chance to decide whether to end a nonviable pregnancy — with the other option often being carrying a fatally sick fetus to term — sometimes health risks develop for the pregnant woman. In these cases, Bartz said, a medical professional may need to intervene.

"If, for example, preeclampsia develops in the third trimester and the pregnant person's high blood pressures become life threatening, a delivery (and thus, abortion delivery) of a nonviable fetus is needed. If this induced delivery results in death, it is considered an abortion," Bartz said.

Grossman said a C-section in this situation would increase the risk of complications to the pregnant woman, with no benefit to the fetus, which would be expected to die. Other situations that may not allow for the fetus to be delivered vaginally, such as when a patient has large cervical fibroids, an abdominal cerclage or a placenta over the cervix, then a C-section may be the method of choice — if it’s considered safe for the pregnant patient.

A Threads post claimed that "abortion is never medically necessary in the last trimester. Literally never. They just do a C-section."

This is a misunderstanding and oversimplification of how abortion and reproductive care works throughout pregnancy, OB-GYNs and other reproductive health care experts said.

There are multiple complex medical situations that can affect a fetus or pregnant patient that — although rare — can result in medically necessary abortions later in pregnancy. Abortions can be performed in different ways, experts said, and although a C-section is typically not the preferred method, it may be used depending on the patient’s case.

We rate this claim False.