They induce delivery or do a c section. You can't just vacuum it out or poison it or something - it's several pounds of flesh and bone, and (as always) the biggest issue is the skull. It's gotta come out, or the mother will die... Babies can die at any moment, and it will decompose. All that bacteria gets into the blood, and that bacteria poisons the blood... Sepsis is a death sentence - whether it's an organ or a fetus, it has to come out or your chances aren't good.

So you have to get the skull out - it's the widest part. So either induced delivery (the quicker, easier option), or it's surgery.

A C section is something that is extremely common and relatively safe - there's not really a third option unless the mother is likely to die from that or induced birth.

There's a whole approval process for non-standard procedures (or you'd lose your license and be begging for malpractice to drop you), and you'd need a specialist, probably a pediatric surgeon who does en-utero surgery. They'd also have to go through review and defend why it was medically necessary - they'd be risking their license and being dropped by malpractice insurance if they didn't have a very good argument.

It would be grueling too - it would be a long, physically intensive surgery for everyone involved. Extremely expensive too...

So you're doing an induced birth or a c section. It's also likely going to be automatically classified as a risky birth, because it's premature, so you'll be getting a more experienced surgeon and experienced nurses who have specialized in pre-mature births (possibly a special team, depending on the size of the hospital... But it'll be the most experienced people available).

These are going to be the people who devoted their life to giving babies every chance possible. I know several well... Let me share a couple stories I've heard.

An older couple was almost 9 months into the pregnancy, and very much wanted the child, especially knowing it was probably their last chance. It was an at risk pregnancy so they were watching closely, but seemed to be going along pretty well... They'd picked out a name and decorated the nursery, it could come any day now. Then suddenly, the woman felt pain, and they rushed in... The baby had died without warning. They were crushed, but they had to induce delivery. The nurse was delivering the corpse, and as the head came through it fell off.

The nurse blocked their view as she delivered the body, and took it over to the washing station. In cases like this, she'd clean and dress it, take a footprint and picture to give them something to keep, and let them hold their child once to give them a chance to say goodbye. So she did all that, bundled it in a blanket and covered the neck with a ribbon, and gave them that chance without them ever realizing.

In another case, a younger mother's health was going downhill midway through the pregnancy and she came in - the baby had died inside her some time ago, and she didn't realize. She was in bad shape because of sepsis, so immediately they induced delivery. It had rotted... The arms had already fallen off, and she delivered it in decomposing pieces. The nurse did a footprint, but didn't show the body.

But mostly, she delivered pre-mature births - babies that may or may not make it if she did everything she could. Even if it wasn't breathing or the heart wasn't beating, she put it on a ventilator and do infant CPR. Over the years she even learned to do weird things as a last ditch effort, like pricking the baby's foot with a needle or holding them at a certain angle... Giving dying babies every chance is what she's spent her life doing.

I did also ask about what they do in that situation, with a super late term abortion - they'd deliver the baby, and as soon as it was stable she'd whisk it away to the NICU. They then never mentioned it to the mother unless she directly asked... Apparently the mother usually doesn't, and so if it survives it goes up for whatever processes for adoption. If there's any kernel of truth in these stories, women might be leaving the hospital thinking their child is dead.

So I mentioned non-standard procedures risking everything - so there's a clear line here too. Part of the modern Hippocratic oath is to minimize harm... They can prioritize the mother's autonomy or health over the baby, but the baby has to come out. Maybe there's some crazy situation where killing the baby would improve the mothers chances, but without a pressing reason, the baby is going to get any chance they can give it.

But forget the laws. There's no way in hell they're killing babies just because the mother told them to... I've heard them talk shit about weird or stupid parents, but the only complaint I've ever heard about the babies is "it was really troublesome, it kept trying to die every time I looked away"