Abortion rights activists have long preferred to hold themselves at some remove from the practice they promote; rather than naming it, they speak of “choice” and “reproductive freedom.” But those who perform abortions have no such luxury. Instead, advances in ultrasound imaging and abortion procedures have forced providers ever closer to the nub of their work. Especially in abortions performed far enough along in gestation that the fetus is recognizably a tiny baby, this intimacy exacts an emotional toll, stirring sentiments for which doctors, nurses, and aides are sometimes unprepared. Most apparently have managed to reconcile their belief in the right to abortion with their revulsion at dying and dead fetuses, but a noteworthy number have found the conflict unbearable and have defected to the pro-life cause.
In the aftermath of Roe v. Wade, second-trimester abortions were usually performed by saline injection. The doctor simply replaced the amniotic fluid in the patient’s uterus with a saline solution and induced labor, leaving it to nurses to dispose of the expelled fetus. That changed in the late 1970s, when “dilation and evacuation” (D&E) emerged as a safer method. Today D&E is the most common second-trimester procedure. It has been performed millions of times in the United States.
But although D&E is better for the patient, it brings emotional distress for the abortionist, who, after inserting laminaria that cause the cervix to dilate, must dismember and remove the fetus with forceps. One early study, by abortionists Warren Hern and Billie Corrigan, found that although all of their staff members “approved of second trimester abortion in principle,” there “were few positive comments about D&E itself.” Reactions included “shock, dismay, amazement, disgust, fear, and sadness.” A more ambitious study published the following year, in the September 1979 issue of the American Journal of Obstetrics and Gynecology, confirmed Hern and Corrigan’s findings. It found “strong emotional reactions during or following the procedures and occasional disquieting dreams.”
Another study, published in the October 1989 issue of Social Science and Medicine noted that abortion providers were pained by encounters with the fetus regardless of how committed they were to abortion rights. It seems that no amount of ideological conviction can inoculate providers against negative emotional reactions to abortion.
Such studies are few. In general, abortion providers have censored their own emotional trauma out of concern to protect abortion rights. In 2008, however, abortionist Lisa Harris endeavored to begin “breaking the silence” in the pages of the journal Reproductive Health Matters. When she herself was 18 weeks pregnant, Dr. Harris performed a D&E abortion on an 18-week-old fetus. Harris felt her own child kick precisely at the moment that she ripped a fetal leg off with her forceps:
Instantly, tears were streaming from my eyes—without me—meaning my conscious brain—even being aware of what was going on. I felt as if my response had come entirely from my body, bypassing my usual cognitive processing completely. A message seemed to travel from my hand and my uterus to my tear ducts. It was an overwhelming feeling—a brutally visceral response—heartfelt and unmediated by my training or my feminist pro-choice politics. It was one of the more raw moments in my life.
Harris concluded her piece by lamenting that the pro-choice movement has left providers to suffer in silence because it has “not owned up to the reality of the fetus, or the reality of fetal parts.” Indeed, it often insists that images used by the pro-life movement are faked.
(Pro-choice advocates also falsely insist that second-trimester abortions are confined almost exclusively to tragic “hard” cases such as fetal malformation. Yet a review of the literature in the April 2009 issue of the American Journal of Obstetrics and Gynecology found that most abortions performed after the first trimester are sought for the same reasons as first-trimester abortions, they’re just delayed. This reality only intensifies the guilt pangs of abortion providers.)
Hern and Harris chose to stay in the abortion business; one of the first doctors to change his allegiance was Paul Jarrett, who quit after only 23 abortions. His turning point came in 1974, when he performed an abortion on a fetus at 14 weeks’ gestation: “As I brought out the rib cage, I looked and saw a tiny, beating heart,” he would recall. “And when I found the head of the baby, I looked squarely in the face of another human being—a human being that I just killed.”
In 1990 Judith Fetrow, an aide at a Planned Parenthood clinic, found that disposing of fetal bodies as medical waste was more than she could bear. Soon after she left her position, Fetrow described her experiences: “No one at Planned Parenthood wanted this job. . . . I had to look at the tiny hands and feet. There were times when I wanted to cry.” Finally persuaded to quit by a pro-life protester outside her clinic, Fetrow is now involved in the American Life League.
Kathy Sparks is another convert formerly responsible for disposing of fetal remains, this time at an Illinois abortion clinic. Her account of the experience that led her to exit the abortion industry (taken from the Pro-Life Action League website in 2004) reads in part:
The baby’s bones were far too developed to rip them up with [the doctor’s] curette, so he had to pull the baby out with forceps. He brought out three or four major pieces. . . . I took the baby to the clean up room, I set him down and I began weeping uncontrollably. . . . I cried and cried. This little face was perfectly formed.
A recovery nurse rebuked Sparks for her unprofessional behavior. She quit the next day. Sparks is now the director of a crisis pregnancy center with more than 20 pro-life volunteers.
Handling fetal remains can be especially difficult in late-term clinics. Until George Tiller was assassinated by a pro-life radical last summer, his clinic in Wichita specialized in third-trimester abortions. To handle the large volume of biological waste Tiller had a crematorium on the premises. One day when hauling a heavy container of fetal waste, Tiller asked his secretary, Luhra Tivis, to assist him. She found the experience devastating. The “most horrible thing,” Tivis later recounted, was that she “could smell those babies burning.” Tivis, a former NOW activist, soon left her secretarial position at the clinic to volunteer for Operation Rescue, a radical pro-life organization.
Other converts were driven into the pro-life movement by advances in ultrasound technology. The most recent example is Abby Johnson, the former director of Dallas-area Planned Parenthood. After watching, via ultrasound, an embryo “crumple” as it was suctioned out of its mother’s womb, Johnson reported a “conversion in my heart.” Likewise, Joan Appleton was the head nurse at a large abortion facility in Falls Church, Virginia, and a NOW activist. Appleton performed thousands of abortions with aplomb until a single ultrasound-assisted abortion rattled her. As Appleton remembers, “I was watching the screen. I saw the baby pull away. I saw the baby open his mouth. . . . After the procedure I was shaking, literally.”
The most famous abortion provider to be converted by ultrasound technology, decades ago, is Bernard Nathanson, cofounder of the National Association for the Repeal of Abortion Laws, the original NARAL. In the early 1970s, Nathanson was the largest abortion provider in the Western world. By his own reckoning he performed more than 60,000 abortions, including one on his own child. Nathanson’s exit from the industry was slow and tortured. In Aborting America (1979), he expressed anxiety over the possibility that he was complicit in a great evil. He was especially troubled by ultrasound images. When he finally left his profession for pro-life activism, he produced The Silent Scream (1984), a documentary of an ultrasound abortion that showed the fetus scrambling vainly to escape dismemberment.
This handful of stories is representative of many more. In fact, with the exception of communism, we can think of few other movements from which so many activists have defected to the opposition. Nonetheless, the vast majority of clinic workers remain committed to the pro-choice cause. Perhaps some of those who stay behind are haunted by their work. Most, however, find a way to cope with the dissonance.
Pro-choice advocates like to point out that abortion has existed in all times and places. Yet that observation tends to obscure the radicalism of the present abortion regime in the United States. Until very recently, no one in the history of the world has had the routine job of killing well-developed fetuses quite so up close and personal. It is an experiment that was bound to stir pro-life sentiments even in the hearts of those staunchly devoted to abortion rights. Ultrasound and D&E bring workers closer to the beings they destroy. Hern and Corrigan concluded their study by noting that D&E leaves “no possibility of denying an act of destruction.” As they wrote, “It is before one’s eyes. The sensations of dismemberment run through the forceps like an electric current.”
Jon A. Shields is assistant professor of government at Claremont McKenna College. David Daleiden is a student there.