By publishing in full the video Carly Fiorina described in the last Republican presidential debate, Gregg Cunningham hoped to finally put to rest any questions about whether the footage showed an abortion and mistreatment of the fetus, which appears on camera to have both a pulse and a moving leg.
“We have incontestably laid to rest the question of whether this is an authentic abortion because we show the abortion,” Cunningham, the founder of the Center for Bio-Ethical Reform, told Fox News Tuesday.
But medical experts who reviewed the video are not so sure. “It’s possible it could be an abortion and it could be a miscarriage,” said Jeffrey Perlman, a neonatologist at Weill Cornell Medical College, after watching the extremely graphic footage on YouTube.
The video shows the vaginal delivery of the fetus, which is approximately 17 or 18 weeks old, according to Cunningham. It is placed in a metal bowl, where it is moved by medical instruments and handled by someone in the room. There is no sound on the video. Cunningham has declined to say when the footage was shot, where it came from, or how he acquired it, citing a confidentiality agreement with his sources.
In an interview with TIME on Monday night, Cunningham said the fact that the fetus was not offered any medical treatment following the birth was evidence that the procedure was an abortion. But three leading neonatal doctors and an obstetrician who has studied premature births interviewed by TIME on Tuesday said that medical guidelines do not indicate a need for resuscitating a fetus born so young.
Paul Holtrop, a neonatologist at Beaumont Health System in Michigan, who has published research on the survival rates for infants who have been resuscitated as early as 22 weeks, agreed that doctors would not attempt to intubate or ventilate a baby born at such an early gestational stage. “Nobody would resuscitate a baby at 17 and a half weeks,” he said. “The future is a certain death.”
Perlman, who co-chaired a report for the American Academy of Pediatrics on the guidelines for resuscitating infants after birth, also said there would be no expectation of medical care. “The lower edge of viability is approximately 23 weeks,” Perlman explained. “Fetal heart rate is present from very early on. If you deliver and you have a heartbeat that is not inconsistent with a miscarriage.”
Jennifer Gunter, an obstetrician who wrote a book, The Preemie Primer, a guide for parents about premature birth, agreed. “If you resuscitate before 22 weeks, it’s because you thought the fetus was older,” she said. “The survival odds are so dismal.”
John Kattwinkel, a professor emeritus of pediatrics at the University of Virginia, who co-chaired the Academy of Pediatrics report with Perlman, also said there is nothing that can be done for a fetus at 17 weeks, though like Holtrop he said he had not seen the video. “There is nothing that the medical team should do to prolong the baby’s clearly non-viable life,” he wrote in an email. “Fetuses will move and kick and have an audible heartbeat from midway through the first trimester, as any woman who has carried a baby in her uterus knows. And those activities will continue for a time if the fetus is born alive. But no one has ever saved the extrauterine life of a 17 week fetus. We have been able to move the threshold down to 23 weeks in some cases, and some will argue that 22 weeks may rarely be possible. But the chance of survival below that gestation is simply so remote that application of aggressive neonatal resuscitation and intensive care would be not only futile, but cruel.“
In the last Republican debate, Fiorina inaccurately described a clip from the video Cunningham published in full on Tuesday. “Anyone who has watched this videotape, I dare Hillary Clinton, Barack Obama to watch these tapes,” Fiorina said. “Watch a fully-formed fetus on the table, its heart beating, its legs kicking, while someone says ‘We have to keep it alive to harvest its brain.’ This is about the character of our nation.”
The footage Fiorina described does not exist. Another anti-abortion activist, David Daleiden, had taken a clip of the Cunningham footage and cut it together with a voiceover from a medical worker describing a separate event, when fetal tissue was acquired for medical research. Cunningham and Daleiden have not claimed that the footage was taken from a Planned Parenthood facility, as Fiorina suggested. “I am neither confirming or denying the affiliation of the clinic who did this abortion,” Cunningham said.
In an interview Tuesday, Cunningham maintained that it was preposterous for anyone to suggest a fetus at 17 and a half weeks should not get medical treatment, if it showed signs of life outside the womb. “It’s just nonsensical that any OBGYN would not provide any neonatal intensive care,” he said.
He also argued that a woman facing a possible miscarriage would go to a hospital, not an abortion clinic. “I absolutely know for certain that this was an abortion clinic, not a hospital setting,” he said.
Several experts TIME interviewed Tuesday said miscarriages do sometimes occur at abortion clinics.