The Abortions of Last Resort : The Question of Ending Pregnancy in Its Later Stages May Be the Most Anguishing of the Entire Abortion Debate

FROM THE BUSY street, it is easy to miss the little building hidden behind a high stucco wall and a locked gate. Its courtyard is a sculpture garden, where the soothing burble of a fountain smothers the din of the Santa Monica Freeway. Inside, the pastel-washed waiting room could be the lobby of a fancy small hotel. Vivaldi and Chopin play softly from hidden speakers; tropical fish make neon streaks in an oversized tank.

This tranquil spot is where thousands of women have brought their anguish and their desperation. Those who could afford it have sought this place out from Kansas City, Philadelphia, even the Philippines. For here they find an abortionist of last resort--one who will take the cases that others turn down.

The last of the morning’s patients has gone. Dr. James T. McMahon retreats to the chaos of his paper-strewn office to take a call from another physician hoping to refer a patient. “I would say she has no more than one week,” McMahon warns. “I wouldn’t start that case later than next Monday.”

McMahon is one of relatively few doctors in the country who specialize in performing abortions up to 24 weeks, or almost six months, into a pregnancy. He has, in dire circumstances, done them as far as 32 weeks from conception, just six weeks short of an average delivery date. For the most complicated procedures, he charges $8,000. For the easiest and earliest abortions, he charges $500, which is more than double the rate asked at most clinics.

“That’s my specialty,” this former altar boy says of abortion. “That’s my expertise. That’s my passion.”

McMahon, 51, performed his first abortion in 1972, when California was one of the few states where women could easily get a legal abortion. Fascinated by the technical aspects of the procedure, McMahon gradually began to specialize in it, abandoning plans for a family practice that would have included obstetrics. “I felt that you can’t do both. You do a delivery, and then you do a late abortion,” he says. “I couldn’t take the emotional roller-coaster ride.”

As more and more doctors have withdrawn from doing abortions, he has forged ahead, developing new techniques, particularly for the later abortions that now make up about one-third of the 1,200 he does each year. Among the 2,600 or so doctors, hospitals and clinics performing abortions in this country, McMahon is one of fewer than 200 who will take a patient nearing the end of her second trimester.

McMahon says that his conscience and his religious beliefs (he still attends Mass occasionally) have answered the basic questions that arise from later abortions. “I’ve always been a classic liberal. I believe in freedom in its broadest sense,” says the doctor, whose office is decorated with photographs of his own two children. “I frankly think the soul or personage comes in when the fetus is accepted by the mother.”

For all his self-assurance, McMahon is keenly aware that the morbid realities of his medical specialty would make him an especially good target for the militants of the anti-abortion movement--pickets, vandals, those who throw blood on women and plant bombs in clinics. If they could find him, that is. He does not advertise in the Yellow Pages, and he agreed to be interviewed on the condition that the name and exact location of his two offices not be used. He has outfitted his surgical center with hidden, Israeli-made steel shutters that drop over his plate-glass windows at the flip of a switch.

Abortion, no matter at what stage of pregnancy, is an issue that divides modern society as few others do. The vast majority of abortions in this country are performed well before 13 weeks of gestation. But about one in 10--around 141,000 a year--occur after that, according to the latest government statistics. A few thousand of these take place in the final three months--usually, doctors say, because the fetus is deformed or the pregnant woman’s health is at risk.

When a pregnancy is terminated in its later stages, after the fetus has taken a recognizably human shape, already-troubling questions intensify: When does humanity begin? At what point does a pregnant woman’s body become not one person, but two? With doctors struggling mightily to give one woman’s premature infant a fighting chance at 24 weeks of gestation, is it right to allow another woman to abort her fetus at 23 weeks?

Now that the U.S. Supreme Court is giving state legislatures leeway to rewrite their abortion laws, later abortions are coming under especially close scrutiny. But law and science--to which society looks for dispassionate judgment on difficult questions--are constantly shifting and only serve to tangle the issue further.

In the fourth month, a fetus averages 6 inches long and has developed such distinct features as fingerprints. During the fifth month, the pregnant woman may have felt it move inside her. In the sixth month, the fetus, averaging 12 inches in length and 1 1/2 pounds, nears viability, the point at which it is able to live outside the womb with intensive medical care. With each passing week of a pregnancy, biology erodes the comfortable middle ground from under those who insist that they support legal abortion but suppress the urge to add, “up to a point.”

“As much as I would prefer to avert my moral gaze, a late abortion forces me to confront the reality of abortion and my own incompletely suppressed doubts,” writes ethicist Daniel Callahan, director of the Hastings Center, a medical-ethics research institute in New York. “I suspect that for all but a small minority of those who, like myself, count themselves on the pro-choice side in the abortion debate, the matter of late abortions cannot help triggering distress. It stretches our commitment to the breaking point.”

IN THE 17 YEARS since the U.S. Supreme Court’s landmark Roe vs. Wade decision, the courts have fairly consistently protected abortion as an option through the first six months of a pregnancy. Now, the high court is moving in the opposite direction, and many on both sides of the debate believe that it is only a matter of time before the court’s new conservative majority overturns Roe altogether, throwing the entire matter of abortion back to the states. If it does, the issue of time limits is sure to be one of the most crucial, and possibly the most difficult, for legislatures to decide.

A difficult question, but not a new one. Techniques for abortion are described in medical books that date back more than 4,000 years. For almost as long, it seems, governments, philosophers and theologians have struggled with how to draw the line. Although the Roman Catholic Church now condemns abortion from conception, St. Augustine, whose thinking shaped Catholic dogma during the church’s early centuries, believed it was murder only after the fetus formed--which he defined as 40 days of gestation for a male and 80 for a female. Until 1869, the church held that the fetus was not formed until around 80 days.

The common law of England and its American colonies did not consider abortion an offense until after “quickening,” the point at which a woman feels a fetus move within her body. This country’s first law banning abortion from conception was an 1828 New York statute.

California’s 23-year-old law, unenforced but still on the books, prohibits abortion after 20 weeks. It was superseded by Roe vs. Wade, when the justices dealt with the time-limit question by dividing pregnancy into three-month trimesters. In the first three months, a woman would be allowed to decide whether to have an abortion, with virtually no state intervention. In the second trimester, the government could restrict abortion, but only to protect the woman--for instance, by requiring that a clinic have certain equipment, or that the doctor have special qualifications. In the third trimester, during which a fetus was presumed to have reached the point where it could survive outside the womb, states could go so far as to ban abortion in all but the rare cases where a woman’s life or health is at risk.

The court now seems to be paying less attention to those divisions. In a Missouri case last July, Webster vs. Reproductive Health Services, the court ruled that the state could require doctors to test for fetal viability before performing any abortion beyond 20 weeks, which is at least two weeks earlier than any premature infant has ever been known to have survived. Doctors say such tests are pointless at that gestational age, but the law’s clear intent is to discourage later abortions.

In November, Pennsylvania Gov. Robert P. Casey signed a law that would ban abortion after 24 weeks unless the pregnant woman’s life is clearly at risk, a significant tightening of the standard set by the Supreme Court in Roe. In coming weeks, other legislatures will begin to convene across the country, and Pennsylvania’s new statute seems certain to set the pattern for some of the dozen or so states where anti-abortion sentiment runs high.

Although polls consistently show that most Americans believe that abortion should not be banned entirely, abortion opponents believe that sentiment is on their side when it comes to later abortions.

“I think Americans still can stomach fourth-month abortion,” says Susan Carpenter-McMillan, who heads the Right to Life League of Southern California. “In the fifth month and up, it loses a lot of support. I don’t think that the majority of Americans realize that abortion after three months is allowed as freely as it is. When they’re really educated to learn (that later abortions) are being done for social and economic reasons, they leave their comfort zones.”

Abortion rights advocates argue that the truth, while not pretty, is not simple, either. The women who seek the latest abortions are often the saddest, most compelling cases: teen-agers who do not recognize the early signs of pregnancy, rape victims too ashamed to come forward, women who learn that they are carrying deformed fetuses, those whose lives and health are jeopardized, and--perhaps most frequently--the poor.

“Although these late abortions are infrequent, they are terribly important, because the women who need them need them desperately,” says Dr. David Grimes, a USC professor of obstetrics and gynecology who is a leading medical voice in the abortion-rights movement.

Abortion-rights groups agree with their opponents on one point: It is a terrible thing that one in three pregnancies now ends in abortion. (California has the nation’s highest abortion rate, 48 abortions for every 1,000 women aged 15 through 44 in 1985, the most recent year for which government statistics are available.)

But they insist that passing laws is not going to end abortion, just force it underground. Instead, they argue, opponents should look to the problems that are behind the more than 1.5 million abortions a year in the United States: contraception that is hard to use or hard to get, inadequate sex education and medical care, child abuse, and poverty that makes it all but impossible for some women to properly raise the children they already have.

IT IS EARLY, BUT already the graffiti-covered storefront office near downtown Los Angeles is almost full. At least 40 women and girls, some visibly pregnant, squeeze onto the hard benches in the stark reception area, waiting for their names to be called. Some struggle to quiet the fidgety babies and toddlers they have brought with them.

Poverty shows sharply here, in their faces, in their clothes and in their weariness. One middle-aged woman is called; a few minutes later, she returns. A sonogram has shown that she is 2 1/2 months pregnant, she tells the woman who is waiting for her. The news does not seem to surprise either of them. They talk about something else.

This Los Angeles clinic no longer schedules appointments because many of these women will not keep them. They come when they can. The people who work at inner-city abortion clinics hear the same frustrating stories over and over. They find that when catching a bus on time is too much to ask of a woman, regular contraceptive use is out of the question. Deadlines--whether to refill a birth-control prescription or to get an abortion early--are meaningless.

The administrator agrees to an interview, on the condition that neither her name nor that of the clinic be used. It is a private clinic, run by a former general practitioner, that does about 150 abortions a week. It accepts patients 26 weeks into their pregnancies. Asked the obvious question, the administrator sighs and says, “We have kind of gotten out of the habit of asking why they waited so long.”

A 1987 survey by the Alan Guttmacher Institute, a nonprofit research and policy analysis organization dealing with reproductive health issues, indicated that girls under 18, blacks, unemployed women and those covered by Medicaid were far more likely than others to delay their abortions beyond 16 weeks after their last menstrual period.

“This is a poverty issue. Don’t let anybody tell you any different. You don’t see a lot of middle-class women having second-trimester abortions,” says Anne Walshe, the blunt-spoken administrator of a Manhattan abortion clinic that she wants to remain anonymous. Her clinic, one of the nation’s busiest, does as many as 16,000 abortions a year. At least half are performed during the second trimester.

Walshe shows little patience for the idea that a later procedure somehow poses a more difficult moral judgment. “What’s the difference? Abortion is abortion. The nice folks who are debating this, who want to draw the line and put a limit on gestational age, will just be putting a restriction on poor women. Women who want abortions get them. It will just force the poor women back to unacceptable remedies.”

Most Americans, however, do not accept the idea that being poor is reason enough to justify an abortion, even an early one. In a Los Angeles Times poll last year, only 41% answered yes when asked, “Should a pregnant woman be able to obtain a legal abortion if the family has a very low income and cannot afford any more children?”

The realities that Walshe sees every day, she admits, can be unsettling. “These women know they are pregnant, but not until the 16th or 17th week, when the fetus is kicking and bothering them, do they say, ‘Oh, I have to deal with this,’ ” she says. “It’s not that these women are bad, or they’re wrong. They’re just poor. They don’t lead organized, routine lives.”

If there is any other single factor that inflates the number of late abortions, it is youth. Often, teen-agers do not recognize the first signs of pregnancy. Just as frequently, they put off telling anyone as long as they can. Anti-abortion groups talk a lot about adoption as an alternative to abortion, but the fact is that almost all the teen-agers who have babies keep them, springing a trap that could hold them in poverty for the rest of their lives.

“The doctor does abortions up to 26 weeks because he does not feel he can turn a 12- or 16-year-old away and send her to be a mother,” the administrator of the Los Angeles clinic says.

Joyce Strauss, who has worked for 17 years as a counselor and administrator in the offices of Los Angeles doctors who perform abortions, says: “I’ve literally bought coloring books for a 10-year-old and a teddy bear for an 11-year-old who were having second-trimester abortions because of child abuse. It was especially hard years ago when they were doing saline abortions”--a technique of inducing labor that is still used by some doctors. “I remember a 12-year-old going through full delivery virtually alone.”

21-YEAR-OLD woman who will be called Agnes had a second-trimester abortion at a San Fernando Valley hospital last April. It is still difficult for her to talk about it. As she sits uneasily at a coffee shop, trying to collect her thoughts, she crumples an empty pack of cigarettes and gives the waitress change to bring her another.

“I was strongly against abortions. I’m very strongly against them still, to this day. But why put my kid through it?” she demands, crying again, as she says she has every day for the past two years.

Doctors had diagnosed the 18-week fetus as having a bone deformity, the same one that had killed Agnes’ first baby, a boy, only 4 1/2 minutes after his premature birth in 1987. At best, the doctors said, this second one would have to endure numerous operations to rearrange its skeleton, with no guarantee of success. At worst, it, too, would die quickly after delivery. Some might have taken their chances, but Agnes knew right away that she did not want to.

“I thought about the baby. I’d love it, and it would die on me,” Agnes says. “Better (to lose it) now.”

The abortion itself was 8 1/2 hours of excruciating induced labor. When it was over, Agnes had asked to look at the aborted female fetus. She still sees it when she closes her eyes. “When I saw my little girl, she had eyes, and a nose, and her mouth. Everything looked fine, except her hands and her ears,” she says. In those features, Agnes saw the earliest subtle signs of the genetic abnormality.

Now Agnes is pregnant for a third time. It shows a bit under her black leather skirt, although she hasn’t told her family. At 18 weeks, she will again have a sonogram that will provide the first indication of whether this one has been twisted by the haywire recessive genes that she and her husband carry. She knows that it is a one-in-four chance, and she has lost with those odds twice before.

“I’m scared. My appointment’s coming up, and I’m scared to go,” Agnes says. “If they detect anything, that’s another abortion for me.” She has nonetheless bought stuffed animals, books and other toys, as if by force of sheer optimism she can will the baby to be normal. If it is a healthy girl, Agnes plans to name her Hope.

Some would call her irresponsible, even immoral for continuing this genetic trial and error. But she insists that this is the only way she can have the life she has always wanted. “Marriage is nothing without a family, without kids,” Agnes says. “If I could just see one kid healthy, it would be worth it to do it all over again.”

Many prospective parents view modern prenatal diagnostic techniques--now-routine tests such as sonograms and amniocentesis--as a godsend. Anti-abortion groups, however, say these tests are nothing more than “search-and-destroy missions.” “The only reason you are doing this is to weed out and kill those who are disabled or handicapped,” insists Dr. John Willke, who is president of the National Right to Life Committee. By that logic, he demands, why not round up and murder the retarded and deformed who are already among us?

California has moved more aggressively than other states to encourage prenatal testing. Since 1986, it has required prenatal-care providers to offer pregnant women a voluntary blood test that detects, through the study of a fetal substance called alpha fetoprotein, signs that a fetus may have certain defects of the nervous system. Officials estimate that this testing program led to about 240 abortions in 1988, out of about 325,000 statewide.

Alpha fetoprotein testing is best done 15 to 20 weeks into a pregnancy. So is amniocentesis, the technique by which the fluid surrounding the fetus is analyzed for signs of genetic problems. Medical science is working to develop tests that could warn of fetal deformity in the earliest stages of pregnancy. The increasingly popular procedure known as chorionic villus sampling, which tests tissue from the placenta, can do much of the work of amniocentesis in the first trimester.

Other methods under study offer hope of detecting abnormalities in the first days after conception, before the embryo plants itself in the uterus. But for the time being, “the most reliable time is in the second trimester,” says a leading fetal diagnostician, Dr. Lawrence D. Platt of County-USC Medical Center. “There are things on the horizon, but do I think it’s going to be there next week? No.”

Platt staunchly defends a woman’s right to use as much knowledge as she can obtain to decide whether she wants to continue a pregnancy. “There’s a sanctity of life that I respect,” he says, “but there’s a sanctity of choice, too.”

WHEN ROE VS. Wade was decided in 1973, medical science thought itself incapable of saving a baby born before 28 weeks of gestation. Therefore, it seemed that allowing abortion pretty freely up to 24 weeks carried little danger of destroying a viable fetus. Now, however, babies born at 26 weeks are given a 50-50 chance of survival, and a few are surviving at 24 weeks. Medical literature has even documented isolated cases of viable babies believed to have been born at 22 weeks of gestation. Such progress, Supreme Court Justice Sandra Day O’Connor wrote in 1983, has put Roe “on a collision course with itself.”

Abortion-rights advocates say that until medicine comes up with an artificial womb or some way of speeding fetal lung development, the chance of further progress is nothing more than science fiction. Their argument was bolstered last month with the publication of a study by Case Western Reserve University School of Medicine in Cleveland, which indicated that the survival rate of babies born before 25 weeks’ gestation has improved little over the past seven years. In a Supreme Court brief filed last March, a group of leading scientists and doctors asserted that 24 weeks is the “outer limit” of viability, and that there is “no reason to believe that a change in this outer limit is either imminent or inevitable.”

Still, science has come far enough to leave some doctors increasingly leery of later abortions. Dr. Phillip G. Stubblefield, chief of obstetrics and gynecology at Maine Medical Center in Portland and former president of the National Abortion Federation, an organization of providers, has suggested that physicians voluntarily limit themselves to doing abortion at no later than 22 weeks, except in cases where the fetus is doomed or the woman’s health is threatened.

“I personally will admit that I do find it difficult and painful (to do an abortion in the latter part of the second trimester),” Stubblefield says. “There is the feeling that one is close to viability, and this is something that at some point is wrong.”

When doctors have erred, the consequences have sometimes been horrific. Last June, Philadelphia-area obstetrician Joseph L. Melnick was convicted of infanticide for failing to care for a 3-pound, 9-ounce baby girl born alive after he attempted an abortion. The newborn died within an hour of birth. The doctor said he believed his patient, a 13-year-old, was only 18 weeks pregnant. An autopsy showed the gestational age as 32 weeks. Melnick is appealing his conviction.

In the late 1970s, jurors in Santa Ana deadlocked twice in the case of William B. Waddill, a Westminster obstetrician-gynecologist charged with murdering a 2 1/2-pound infant believed to have been born alive after an abortion attempt. During that sensational trial, the Westminster Community Hospital chief of pediatrics testified that he had seen the physician strangle the apparent abortion survivor--an accusation that Waddill denied. He was freed after the second failure to get a verdict.

Live births during later abortions occur very rarely, and few statistics on them are available. Technology makes it likely that the number has been drastically reduced these days, abortion-rights groups insist.

Increasingly, doctors are using sonograms to gauge gestational age of a fetus before abortion. It is a far more accurate measure than relying on a woman’s memory or the feel of the uterus. (Estimating gestational age has often been complicated by the fact that obstetricians speak in terms of the number of weeks since a woman’s last menstrual period. Conception usually occurs about two weeks after that, so actual gestational age is two weeks less. For the purposes of this article, references to weeks of gestation are the actual amounts, estimated as precisely as possible by doctors through sonograms and other means.) Still, Stubblefield says, ultrasound in the second trimester may be off by as many as 11 days.

Newer abortion techniques also have made the possibility of a fetus’s surviving more remote. However, abortion opponents say this does not lay to rest the basic issue--the idea that what is a fetus under one set of circumstances is a premature baby under another. Six years ago, several hospitals in the San Francisco Bay area began limiting second-trimester abortions because nurses were refusing to attend the procedures. The nurses said the aborted fetuses looked too much like the “preemies” they were tending elsewhere.

A woman’s health, too, is more at risk when an abortion is performed past the first trimester. Abortion opponents often cite cases of women maimed, killed and left infertile by the procedure. However, data compiled by the Guttmacher Institute suggests that abortion poses less than a 1% risk of such major complications as infection and hemorrhage.

The earliest abortions can be finished in five minutes. The patient is usually under only local anesthesia, as suction draws the fetus and surrounding placenta through a tube not much wider than a soda straw. In later pregnancies, the techniques are far more complex, and the risk of death, while still remote, rises sharply.

“There’s a great deal of craft to this procedure,” says James McMahon, who employs two staff doctors. He doesn’t allow doctors to work for him until they have performed at least 600. “Frankly,” he adds, “I don’t think I was any good at all until I had done 3,000 or 4,000.”

Years ago, the most common method of performing later abortions was to induce labor by injecting a woman with saline or the drug prostaglandin. This procedure was used to abort Agnes’ deformed fetus. The woman typically has to undergo long, lonely hours of painful labor, sometimes in rooms near those where other women are giving birth.

University of California at San Francisco researchers studied the experiences of doctors, patients and nurses in a 1979 survey of 250 second-trimester abortions done by various methods. “The woman who went through a prostaglandin amnio abortion had a long and painful experience, which made it generally impossible for her to turn away from the reality of her choice,” they wrote. “Most of the amnio subjects described the product of labor as a ‘baby’ and . . . found the unremitting quality of the labor pain more difficult than childbirth. Anger at the attending physician for being unavailable was prominent.”

Nurses also objected because they were left to tend to the patient during this ordeal and to the aborted fetus afterward. On the other hand, the researchers wrote, some doctors preferred these amnio abortions because they offer “relative noninvolvement.” One doctor who used only the prostaglandin amnio method told them: “Killing a baby is not a way I want to think about myself.”

These days, the most frequently used second-trimester abortion procedure is the least traumatic to many women, but also the bloodiest and most unpleasant for the doctor. It is known as dilatation and evacuation, or D and E.

The entire procedure may take as many as four days. A day or more before the surgery, a woman’s cervix is dilated. The patient is under light general anesthesia for the actual procedure, so she usually has little sense of what is happening as the fetus is dismembered inside the uterus and removed with forceps.

McMahon has developed his own method that he calls intrauterine cranial decompression. He arranges the fetus so that he can remove it feet first. Before the skull emerges, he “collapses” it by inserting a three-millimeter instrument known as a cannula and extracting its fluid. By keeping the fetus intact, he says, he runs less risk of internal injury to the woman.

“I want to deal with the head last, because that’s the biggest problem,” he adds levelly. “From my point of view, the fetus is a potential problem to the patient.”

WHEN CAROLINE got pregnant the first time at 15, she did not know she had any options. Her mother ordered her to go live with her boyfriend, so she did. Not that it bothered her much. “It was great to get out of the house,” she says, laughing.

A few years later that relationship was over and Caroline was struggling as a single mother of two in a drug-infested New York housing project. Determined that she would be out of that place before her son started school, she managed to get her high-school equivalency and two years of college. It was enough to land her a $23,000-year administrative job at one of Wall Street’s biggest financial firms and move her into a relatively safe apartment in Brooklyn.

It’s still tough, but at 25, Caroline is proud of her skill at handling millions of dollars for the firm’s customers. All around her are exhilarating opportunities and intoxicating possibilities. If she can only finish college, Caroline says, “In 10 years, I’ll be an executive. I’ll have my own secretary.”

But those plans could have been derailed last year, when Caroline discovered she was pregnant again--with twins this time. She had been off the pill for a few weeks and risked sex with her boyfriend “only once.” She tried to get to the clinic early, but the demands of work and motherhood forced her to cancel three appointments. “I was prolonging it so much, I was just desperate,” she says.

“I don’t feel guilty,” she says of her abortion at 18 weeks. “I feel that life begins when a baby is born.” She says that she doesn’t regret having had children, but she often wonders what her life would be like if she had not. If her daughter ever faces a similar choice, “I wouldn’t do what my mom did to me,” Caroline says. “I don’t want her to say, ‘What if?’ I want my children to dream.”

Does her attitude show a society where craven self-interest has obliterated any regard for human life? Should she have faced the consequences of what she admits was her own mistake? “No one understands unless they were in my position,” Caroline says. “I fell into a trap once. I won’t fall into another trap.”

And that, say those who support legal abortion, is what the entire debate is about: Whether a woman can control her own life, lay her own plans.

Still, the Hastings Center’s Callahan says, “at some point, the fetus does gain moral standing, and at that point, its rights take precedence over the right of a woman to destroy it.” He believes that this point lies somewhere in the second trimester, between 12 and 24 weeks.

And while others might draw the line differently, Callahan writes: “If the notion that abortion is a morally difficult issue is anything more than sheer rhetoric, it must be so because of a recognition, however inchoate, that such a point exists.”

The Development of a Fetus

4 WEEKS

The embryo is the size of a pinkie fingernail; the brain and the heart are beginning to differentiate. In the next two weeks, the digestive tract, sensory organs and arm and leg buds will begin to form.

8 WEEKS

Now measuring about 1 1/4 inches, the embryo weighs about 1/3 ounce and its heart beats. Its ears and eyes are developing quickly; fingers and toes start to appear. The skeleton begins to harden.

12 WEEKS

The embryo has doubled in length to about 3 inches since the eighth week and weighs about 1/2 ounce. Reproductive organs start to form, and sex can be distinguished. After the third month, it is called a fetus.

16 WEEKS

The fetus undergoes a rapid growth spurt. It is 6 inches long and weighs almost 4 ounces. Fingerprints appear, and it may suck its thumb. Its lungs are formed but collapsed and functionless.

20 WEEKS

Now 8 inches long, the fetus begins to form eyelashes and brows; its eyelids separate. The woman may feel the fetus move. Its lungs, skin and digestive tract are not ready for life outside the womb.

24 WEEKS

The fetus averages 12 inches in length and weighs 1 1/2 pounds; its skin is thin and shiny with no underlying fat. The hands develop a strong grip, fingernails are present and scalp hair begins to grow.

28 WEEKS

The fetus can breathe and swallow regularly, and its body temperature is regulated. Deposits of fat appear beneath its skin. It can perceive light and sweet tastes but remains unable to hear.

32 WEEKS

Its body becomes plumper and the skin pinkens; the fetus weighs 4 to 5 pounds and is 18 inches long. Movement becomes more frequent and pronounced. The digestive tract and lungs are still immature.

36 WEEKS

Movement diminishes in the final month because the fetus, at 20 inches long and 6 to 8 pounds, occupies all available space in the uterus. Its lungs mature, preparing it to live outside the womb.