American College of Obstetrics and Gynecology
Intact D & X is not some macabre procedure designed to kill children. It's a product of rational thinking about how to terminate pregnancies. You can argue all day about the morality of abortion but as long as abortions are legal . . . the only people who should be involved in the decision to do it . . . is the mother, father (spouse), and whatever moral/legal authority they choose to consult. The only people qualified to determine HOW to do it are obstetricians and gynecologists.
The policy statement noted that although a select panel convened by ACOG could identify no circumstances under which intact D&X would be the only option to protect the life or health of a woman, intact D&X "may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman's particular circumstances, can make this decision."
I really recommend you try the ACOG website for detailed explanations but I will give your question a whack. Let's start with the assumption the intact D & X is fully elective. It sounds harsh but once a couple decides to abort a fetus . . . regardless of reason . . . there's only ONE patient . . . the mother. The focus of the surgical team is how to best serve the patient which is very different calculus from balancing mother/fetus issues during a wanted/viable pregnancy.
During my tour of obstetrics I was always amazed at how such a large entity could exit such a small opening . . . it ain't pretty. During my third delivery I spent an hour sewing up a birth canal . . . which can have lacerations all the way up to the cervix (opening to uterus) during NORMAL deliveries.
A condition of increasing prevalence in America is diabetes. Diabetes greatly increases the risk of macrosomia (big damn baby) . . . the larger the baby the greater the mismatch between the package (baby) and the pathway (birth canal) . . . which dramatically increases the risk of birth injury to child and mother. During a normal delivery blood loss is minimal. Macrosomics are given a limited opportunity to progress but OBs have a low threshold for moving on to Ceasarian section. C-section entails cutting open the abdomen, physically removing the uterus (it's freaky pulling it out and plopping it on the mother's abdomen), cutting open the uterus, squeezing the kid out, sewing the uterus back up (if you do it with a running/locking stitch you can make the uterus look like a face), stuffing the uterus back into the mom, sewing up the layers of fascia, muscle, and subcutaneous tissue, and then top her off with some staples. Blood loss would be expected to be less than 500mL (pint).
A macrosomic (which is typically normal) versus a macrocephalic (big head) is a significant issue. Again the assumption is the family chooses an elective abortion . . . if their choice is based on amniocentesis or chorionic villus sampling for abnormalities then this decision may not come until 16wks. Vaginal passage is accomodated by dilating the cervix (passage) AND reducing the size of the fetus (package). A macrosomic may require dismemberment while a macrocephalic must be reduced to facilitate removal.
I'm not an OB/GYN but we had an open debate between OBs at our medical school. Medical necessity depends on how you define necessity. Every OB will tell you that intact D & X is NOT the ONLY method available. Experienced OBs will tell you that for a given patient under given circumstances intact D & X is the best option.
Fragile X and Down Syndrome are NOT sufficient reasons IMHO to abort a fetus. Other trisomies like 16 and 18 are rarely born live and never survive to the first birthday. There are a myriad of genetic conditions which guarantee lifelong morbidity and early mortality. It's up the parents and their support group to decide if giving every one of Nature's gifts a chance even in the face of short (or long) term suffering of the child.
Medicine cannot answer the question about the morality of abortion but it can evaluate reasonable and unreasonable means of performing abortions. I didn't bother with emergency intact D & X (maternal health condition like eclampsia) b/c there's little doubt the Congress has absolutely no business trying to dictate how physicians should treat patients during a medical emergency. The Pro-Life/Anti-Choice people have attempted to create a tempest by giving graphic descriptions of a medical procedure that they are unqualified to assess. They aren't offering alternatives they are just saying don't do this one. Dilatation and Curettage (D&C) is the typical elective abortion (or clean up after a spontaneous abortion/miscarriage). It's graphic as well but won't be banned b/c the Supreme Court has granted women the right to choose their procreative destiny.