More Observations from Abortion Practice

As it turns out, a single blog post didn't offer nearly enough room to comment on everything worth noting in Warren Hern's Abortion Practice – not by a long shot. Consider this volume two. I've already disclosed Hern's underlying philosophy: pregnancy is a disease; abortion is the cure. This time through, I'm going to focus on some of the statements that struck me for their implications to common pro-abortion perceptions. I've broken them down into a few categories, marked below in bold.

Abortion Risks

Writing a single-author, medical textbook is a massive undertaking, and the reason Hern did so was to "remedy" what he saw as an overall lack of proper abortion training. (x) Though he believes abortion is safer for (born) women than childbirth (when performed correctly), he also suggests that plenty of abortion providers and advocates are too cavalier in their risk assessment. "In medical practice," Hern writes, "there are few surgical procedures given so little attention and so underrated in its potential hazard as abortion." (101) Hern revisits this theme throughout the book, and you'll find some of his parallel assertions on Abort73's Abortion Risks page. What particularly struck me this time through were Hern's assertions regarding anesthesia and laminaria (a thin piece of sterile seaweed used to gradually dilate the cervix). He writes:

There are some surgical operations that absolutely require general anesthesia… Operative abortion is not. (120)

…the use of general anesthesia is associated with a two to four times greater risk of death in abortion than the use of local anesthesia. (182)

Patient comfort and physician convenience appear to be highly marginal indications for general anesthesia considering the risks involved. The degree of bleeding experienced under general anesthesia is greater, the risk of perforation is greater, and the risk of death due to aspiration of vomitus, among other things, appears to be greater. I believe it is preferable to have a patient who is uncomfortable but able to tell me what she is feeling and if she feels a strange new abdominal pain than to have a patient who is quite comfortable because she is dead. (119)

While the National Abortion Federation (NAF) website states that general anesthesia is not commonly used during the first trimester, I've read plenty of abortion testimonies from women who were knocked out during their abortion. And many of the risks Hern describes would also be true of conscious sedation. Since the abortion industry positions itself as a champion of women's health, why make general anesthesia and sedation available at all? As Dr. Hern asserts, "comfort" and "convenience" are not sufficient rationales – though these same factors seem to be influencing the use of laminaria as well. Hern writes:

I favor the use of laminaria for cervical dilatation as a means of minimizing complications… The need for local anesthesia is reduced… The pain resulting from from cervical dilatation is usually minimal, the procedure time is rapid… blood loss is usually insignificant [and] careful preoperative evaluation of the patient's emotional status [can be made]… The principal disadvantage include the necessity for two clinical visits [and] the risk of mild to severe overnight cramping. (108)

Without going into the details of cervical dilation, the point here is that Hern believes the use of laminaria makes for a much safer first-trimester abortion. He calls it a "safe and natural way" to open the entrance to the uterus. As an aside, how is it natural to stick seaweed into a woman's cervix so that it's forced to open up before the appointed time?! More to the point, Hern's Colorado abortion clinic may be the only one in the country following his recommended procedure. Why? It almost certainly owes to a general unwillingness to make abortion a two-day procedure. If Hern's assessment is correct, safety is being compromised for convenience. He further states that the "common complications" of abortion are rarely serious. Rather, it is the mismanagement of these complications that can prove fatal:

The most common complications of first-trimester abortion cut across the major categories of complications. They include uterine hypotonia, or postabortal syndrome (PAS), retained tissue, infection, perforation, and vasovagal reaction… Major complications are rare, but they usually flow from one of these common complications that has progressed or is inappropriately managed. (176)

Towards the end of the book, Hern recommends that every abortion clinic should be located "within 5 minutes of a full-service hospital" and have "a ground-floor entrance… for the management of emergencies." (224)

Abortion Perception

One of the ways abortion advocates try to "normalize" abortion is by arguing that it has always existed, and it is only the backwards or prudish who object to it. The following statements from Dr. Hern reference the historic stigmatism of abortion and demonstrate that it has never enjoyed broad, public support or acceptance:

…a surprising number (of women) feel that the abortion has been a rather positive experience." (63) - If there is nothing abnormal abortion, why does Hern express surprise that some women react to it positively?

The woman who is considering abortion or who has decided to terminate a pregnancy is going against the grain of our cultural history. (63)

Abortion has been considered a stigmatized operation by the medical profession for centuries… In some programs, assignment to the abortion rotation is considered a kind of academic and surgical purgatory. (101)

The reputation for danger that abortion acquired in the United States, at least in the first half of the century, was due to the high incidence of incomplete abortions resulting in sepsis (a severe illness in which the bloodstream is overwhelmed by bacteria) and death. (107)

In the United States, abortion is one of the most significant social controversies of the 20th century… abortion has been stigmatized in the medical profession… the public and large segments of the medical profession considered abortion to be an unethical medical act regardless of its legal status. (317)

Communities do not like to be reminded that abortions are occurring within their boundaries… very few abortion clinics or physicians providing abortion services include the word abortion in the title identifying the activity. (317)

Abortion Counseling

Dr Hern writes, "It is essential that each patient be given full information concerning the abortion procedure," and he labels those abortion clinics that provide no counseling as "seriously deficient." (67, 301) I agree. In fact, that is the very reason Abort73 exists. It was built upon the conviction that pregnant women are not being given the full story when they enter the abortion clinic. What do I make of Hern's assertion then? I think its genuine so far as it goes, but clearly he has a very narrow view of what full disclosure looks like. He advises:

[Counselors should be trained in] reproductive anatomy and physiology, gynecologic diseases, venereal disease, breast and cervical cancer, sterilization, medical aspects of abortion, theory and case studies of oral contraceptives and intrauterine devices, and conventional contraceptive methods." (311)

[Counseling should include:] social history relevant to abortion. Explanation of reproductive anatomy and physiology. Explanation of the abortion procedure. Explanation of birth control methods. Presentation of consent form. (312)

Notice that nothing is mentioned about prenatal development. Nothing is communicated to the effect that abortion kills an innocent, genetically distinct human being. To Dr. Hern, these considerations do not even exist. And despite his willingness to be more objective than most abortion advocates, he still makes conscious decisions to conceal key aspects of the truth:

the waiting room should not be located next to the procedure room: waiting patients should not be subjected to the sounds of the operating room. If physical layout requires such an arrangement, the dividing wall should be insulated to make it soundproof. (220)

It is not advisable for patients to view the products of conception, to be told the sex of the fetus, or to be informed of a multiple pregnancy. (304)

I also found these counseling-related statements telling:

It is common to find that a woman has presented herself for an abortion even though she does not really want one; her partner or her parents want her to have one. (81) Dr. Hern then goes on to tell of a situation where  he was able to convince a 15-year-old girl who didn't want abortion (but was brought in by her parents) that it was in her best interest to have the abortion.

For religious women, "frequently, fear of discovery of their pregnancy if they continue it outweighs their fear of going against religious precepts." (83) He doesn't come right out and say it, but I wonder if counselors are encouraged to play upon this fear of discovery?

"…the abortion counselor should recognize that the emotional trauma experienced by the rape or incest victim cannot be treated adequately, if at all, in the abortion clinic setting."

I found this last statement interesting for two reasons. First, Hern gives no directive to counselors to report a rape to authorities when it is disclosed to them and advises them to not mention it in future. He suggests many of these stories are fabricated. Secondly, notice that he says that the trauma of rape cannot be treated adequately, if at all, in the abortion clinic! In other words, having an abortion does nothing to minimize the trauma and misery of rape. And yet over and over, we hear that abortion is an essential, therapeutic response to rape. Don't miss the significance of Dr. Hern's assertion.

I have a few more observations to share, but I'm going to wrap this post up here. Stay tuned for volume three...