In preparing a script for the next video in Abort73's Case Against Abortion (Abortion Procedures), I've spent the better part of the last three days reading Warren Hern's Abortion Practice. It's been on my shelf for years, and you'll find references to it on a few of our pages (Abortion Risks, Profit or Principle? and Who Cares About Morality?), but this is the first time I've read it from cover to cover. It is both insightful and disturbing. Warren Hern is one of the most well-known and influential abortionists in the world, and this book has long been seen as a crowning achievement by those in the abortion industry. Originally published in 1984, the 1990 update remains the only single-author abortion textbook in publication.

If there is a central philosophic premise to Dr. Hern's book, it is the notion that pregnancy should be understood and treated as though it were a disease. "Many, if not all, aspects of pregnancy," he says, "can be understood best in terms of the cognitive framework of illness." (4) Why does he say this? From a practical standpoint, he points to the discomfort and sickness-like symptoms often experienced by pregnant women. From a philosophical standpoint, he recognizes that it is the only way to justify abortion in the broader context of established medical protocol. "It is important to remember," Hern tells the reader, "that the first principle of medical practice is to do no harm." (188) If you visit Abort73's Abortion Procedures web page, you'll find the same principle, Primum non nicer, at the heart of our condemnation of abortion. It's ironic that Hern points to the very same thing as a justification for abortion, and his basic argument is this: Pregnancy brings disease-like symptoms and is statistically more likely to kill a woman than full-term pregnancy. So, "unless pregnancy is desired for the purpose of reproduction," he argues, "abortion is the indicated treatment of choice." (46) Along the way, Hern compares pregnancy to smallpox and tuberculosis, and says, "the distinction between elective and therapeutic abortions is false; all abortions are therapeutic." (46)

There are three things missing in Dr. Hern's assessment. First, no consideration is given to the severe emotional trauma that often follows on the heels of abortion. He simply states that there is "no strong evidence either way concerning the adverse or positive psychological effects of abortion." (289) His argument that abortion is "healthier" than pregnancy is limited strictly to reported mortality rates. Second, no mention is made of the potential causal connection between abortion and breast cancer. If abortion does increase a woman's likelihood of contracting breast cancer, then abortion presents a far more serious threat to her life than does a full-term pregnancy. And even if there is not a positive causal connection between abortion and breast cancer, it is well established that pregnancy itself reduces a woman's risk of breast cancer. Therefore, even if the average post-abortal woman is no more likely to contract breast cancer than a woman who was never pregnant, the abortion still cancels out the health benefits that would have ensued from a full-term pregnancy. Third, and most significantly, Dr. Hern never addresses the harm done to the innocent human beings who are killed through the process of abortion. He says in the introduction that abortion involves a woman and her physician. No mention is made of the baby (or the father). In the book's 340 pages, not a single reference is made to the question that is at the heart of the abortion debate.

Near the book's close, Dr. Hern recommends that all abortion practitioners follow his own pattern of silence on the issue of fetal rights. It is both calculated and strategic. "With public support of the right to choose reaching nearly 80% among the general public," Hern says, "debates are of limited value." (325) He notes that in Colorado, the pro-choice community blankly refuses all requests to participate in public debates. While they're happy to make presentations in schools, if both sides of the debate are to be presented, Hern requires that "the presentations must be made on different occasions [and] visual aid materials (must) not be presented by either side." He only agrees to TV interviews if the station agrees to "[focus] on the public issue involved (right to confidential and professional medical care, freedom of choice, and so forth) and not on the specific details of the abortion procedures." (323) According to Dr. Hern, this is the only message that should be communicated in a TV interview: "Abortion is safe; it is legal; it ought to stay that way; people who think otherwise are interfering with your private business and trying to ruin your life." (324)

The closest Dr. Hern gets to a moral rationale for abortion is this: "We as abortion-service providers, cannot place moral judgments on the motives or actions of our patients… the counselor cannot know whether the reason given for the abortion is a good one or even if it is the real reason." (85) In other words, Hern sees abortionists as amoral agents who have no place or responsibility in deciding whether abortion is right or wrong. In his mind, any reason to abort is just as good as the next one, so long as it's what the woman wants. To illustrate, he shares of an experience he had with a well-educated and affluent woman in her 30's who came in for a second-trimester abortion after finding out she was having another boy. Hern writes: "(If she had the boy,) she felt she would inflict psychological damage on the child and … be miserable and resentful for the rest of her life. Even though I had begun by being totally opposed to an abortion for this reason, she persuaded me that, in her mind, abortion was the only choice she could accept for this pregnancy for her own mental health as well as the welfare of her family." (85) Dr. Hern performed the abortion, and I suppose we should commend him for at least realizing that there is no moral distinction between a sex-selection abortion and a health-selection abortion. If he's willing to do the one, he has to be willing to do the other.

Though Warren Hern realizes how damaging public debates and pictures of abortion can be to the "pro-choice" cause, there is plenty in the book itself that can and must be used to publicly expose abortion. That is my main intention in commenting on this book at all. The descriptions Hern provides of the abortion process are shocking (to say the least) and have reignited my anger and outrage that this continues to happen in America—while those on both sides of the debate are largely indifferent to its practice. We simply go on with business as usual. I pray that after reading the following descriptions, our opposition to abortion will become far more intentional. And I pray that as we rightly condemn the myriad of lesser injustices happening around the globe, we will stop shying away from the one massive injustice that is happening right here at home. In the words of Dr. Hern, this is abortion:

Evacuation of fetal parts through the less dilated but softened cervix may produce uneven pressure on the internal os and result in serious laceration… Even though 2 cm to 2.3 cm of dilatation are obtained by laminaria alone… fetal parts such as the pelvis and collapsed calvaria (skull) may measure 2.5 cm to 3 cm or more in width. (128)

Collapse and dismemberment of fetal tissues become difficult, adding to the discomfort, duration, and danger of the procedure. (129)

As the forceps is closed, a solid feel will relay the information that fetal parts are grasped. The forceps is gently withdrawn in a rotating motion. The reason for the rotation is principally that it will disclose whether the material grasped is uterine wall instead of uterine contents. (139)

After the cervix is entered, force [should not be] applied to push the curet through… It must be remembered that the edge of the curet is sharp and the uterine artery may be less than a centimeter away. (149)

If labor is not established, 5 hours or more should elapse from the injection time to the time the D & E procedure is performed… Ideally, the fetus is presenting in the lower uterine segment and can be delivered quickly with little discomfort to the patient. Fetal tissues are significantly softened, permitting easy dismemberment. (145)

Fetal weight doubles from 13 to 14 weeks (11-12 weeks from fertilization), and total tissue weight almost doubles. The fetus is significantly larger than at 12 weeks and the [skull] may not easily enter or pass a large (12-mm) suction cannula. The [skull] can easily become trapped… At 14 weeks' fetal age (12 weeks from fertilization), tissue is more likely to become lodged in the cannula. When this happens, it is a good procedure to put the suction tip aside and proceed with the forceps. (146-47)

It is better to use smaller forceps and take smaller amounts of tissue each time than to deliver fetal parts intact while traumatizing the cervix… If both the fetus and the placenta have been delivered but the [skull] has not, the Barrett is also an excellent instrument for exploration [because] grasping the uterine wall accidentally with the Bierer could be catastrophic. (150)

At 16 to 17 weeks (14-15 weeks from fertilization), fetal tissue is much more easily identifiable with the forceps and in some ways is easier to grasp and remove than in earlier gestations. The [skull] is about the size of a Ping-Pong ball and usually can be grasped readily with the Bierer. Collapsing it gives a definite sensation… (151)

[At 18-19 weeks (16-17 weeks from fertilization),] fetal parts are significantly larger and more difficult to morcellate (tear into pieces). (152)

[A 20-week abortion (18 weeks from fertilization) is] a significantly more difficult procedure accompanied by unnerving hemorrhage. Forceps use must be sure and relatively rapid. There is frequently not much time for exploring the nuances of different tissue sensations. Grasping and collapsing the [skull is] often difficult. Stripping the [skull] of soft tissue is sometimes the first step in successful delivery of this part, followed by dislocation of parietal bones. In this case, care must be taken in removal because ossification is occurring and the edges are sharp… Regardless of the amount of dilatation, delivery of the [skull] and pelvis is sometimes difficult… The advantage obtained by having a softened cervix could become a disaster if a laceration develops at the level of the internal os as the result of too much force. (153)

The procedure changes significantly at 21 weeks (19 weeks from fertilization) because the fetal tissues become much more cohesive and difficult to dismember. This problem is accentuated by the fact that the fetal pelvis may be as much as 5 cm in width… [the skull] can be collapsed. Other structures, such as the pelvis, present more difficulty… A long curved Mayo scissors may be necessary to decapitate and dismember the fetus, since it may be impossible to apply forceps or to do so while avoiding the thinned-out cervix. (154)

After a second-trimester dilatation and evacuation (D & E) procedure, fetal tissue is carefully separated from placenta and membranes… The aggregate fetal tissue is weighed, then the following fetal parts are measured: foot length, knee-to-heel length, and biparietal diameter. In most cases the [skull] has been collapsed but is basically intact. It is placed under running water and, as the water fills the cranium, a biparietal measurement is taken by sight with a clear plastic ruler… All observations should be carefully noted in the patient's chart. Tissue specimens are placed in formalin and disposed of. (164)

A trapped [skull] is one of the most common, frustrating, and disconcerting complications, but it is one of the most innocuous when it is managed properly… When the [skull] cannot be grasped with the [forceps], the next step is to explore with a [curet]. Sometimes the curet can move the [skull] out of the cornu into the midline, where it can be grasped… Once the [skull] can be felt, it should be possible to collapse and deliver it. (194)

Cervical obstruction by the [skull] is a paradoxical problem, since it is the opposite of having difficulty in recovering tissue… Small instruments cannot encompass it; large instruments… either push it away, cannot be closed once the [skull] is grasped, or, having grasped the [skull], cannot be withdrawn. Unless the [skull] can be collapsed and delivered, however, the procedure cannot be completed… and the risk of complications begin to increase. The most useful maneuver in this case is to grasp the presenting of the [skull] with the cervical tenaculum, stripping away the soft tissue (skin). When the skull bones are visible, they are grasped also with the tenaculum. A long curved Mayo scissors is then used to dissect the [skull] to the point that it is opened and decompressed. At this time, a forceps with a very strong blade and firm grasp… may be used to grasp the tentorium and skull plates, sometimes dismembering by torsion and sometimes by sharp dissection with the Mayo (scissors)… Once some dismemberment has taken place, the operator may take a somewhat larger forceps…  As the tissue is pushed slightly up in to the uterine cavity, the forceps blade is opened and a moderate amount of tissue is grasped… With good dilatation and effacement, the entire fetus may be delivered. More likely, however, it will be necessary once again to dissect the portion grasped using the Mayo scissors. This procedure is repeated until it is finally possible to deliver the smaller portions of the fetus, particularly extremities, intact. (199-200)

Dr. Hern's website offers abortion through 26 weeks. Since he ages from the last menstrual period, that's approximately 24 weeks from fertilization. You can see what a 24-week baby looks like on Abort73's Prenatal Development page, and you can see what abortion does to a 24-week baby on Abort73's Abortion Pictures page (though the 24-week baby pictured there was killed in a saline abortion). The method Dr. Hern prefers (D & E) dismembers the baby before delivery. And lest you argue that the procedures described above have no bearing on the ethics of first-trimester abortion, consider the fact that Dr. Hern makes no moral distinctions between first and second-trimester abortions. They are all the same in his eyes, save for the fact that second-trimester abortions are technically more difficult to perform. The only reason second-trimester procedures sound more gruesome is because the abortionist has to manually dismember the baby, whereas machines do it for them in the first-trimester. Describing a first-trimester suction abortion, Dr. Hern says the abortionist will "first notice a quantity of amniotic fluid followed by placenta and fetal parts, which may be more or less identifiable." (114) If the parts cannot be identified as they're being sucked through the cannula, it is only because they've been so thoroughly torn apart. After the abortion is complete, Hern instructs that the gauze bag must be emptied into a flat receptacle and the fetal parts accounted for. This is the only way to ensure that a complete and "successful" abortion has taken place. Make no mistake. First-trimester abortions are no less violent than second-trimester abortions, and the pictures certainly bear this out. Is it any wonder that Dr. Hern refuses to engage in public debate where abortion photographs are included?! Abortion is much easier to justify when you don't have to look at what it's actually doing.