Contents

1. Publications concerning medical aspects of abortion by Dr. Warren Hern as sole or lead author in peer-reviewed medical journals. These include clinical research papers. [Go To]

2. Publications concerning the medical, social, or administrative aspects of abortion by Dr. Warren Hern as sole author or co-author in peer-review journals, edited volumes (books) or monographs (single subject issues). Invited contributions.[Go To]

3. Publications concerning abortion by Dr. Warren Hern as sole author in general publications (newspapers, magazines, academic books). This category includes editorials and op-ed articles in major newspapers such as the New York Times, Washington Post, The Denver Post, Rocky Mountain News.[Go To]

4. Abortion Practice, the standard medical textbook on abortion written by Dr. Warren Hern and published by J.B. Lippincott Company in 1984; frequently cited in medical and legal publications and in legal briefs before U.S. Supreme Court. This section contains content and ordering information for obtaining copies of Abortion Practice, softcover edition, now published by Alpenglo Graphics (1990).[Go To]

5. Abortion Services Handbook, by Dr. Warren Hern, first published in 1977. Contents, ordering information. Abortion In The Seventies, Dr. Warren Hern and Bonnie Andrikopoulos (eds.). Proceedings of the 1976 Western Regional Conference on Abortion. Published by the National Abortion Federation in 1977 (paperback). Contents, ordering information.[Go To]

6. Complete bibliography of all publications by Dr. Warren M. Hern (does not include letters to editor) by date of publication 1971 - 1997.[Go To]

7. Research Publications Summary; 7a.: Annotated Bibliography of Research Publications.[Go To]

8. Testimony before legislative/Congressional committees. Contains Dr. Hern's submitted testimony before the US Senate Judiciary Committee on the "Partial Birth Abortion Act of 1995," November 17, 1995.[Go To]

Publications.1
Bibliography #1
Medical publications in peer-review journals

Laminaria in abortion: use in 1368 patients in first trimester. Rocky Mountain Medical Journal 72:390-395, 1975.

Multiple laminaria treatment in early midtrimester outpatient suction abortion. W. Hern and A. Oakes. Advances in Planned Parenthood 12:93-97, 1977.

Correlation of sonographic cephalometry with clinical assessment of fetal age following early midtrimester D & E abortion. W.M. Hern, W.A. Miller, L. Paine, and K.D. Moorhead. Advances in Planned Parenthood 13:14-20, 1978.

Outpatient second-trimester D & E abortion through 24 menstrual weeks' gestation. Advances in Planned Parenthood 16:7-13, 1981.

Dilatation and evacuation abortion. Letter to the editor, Obstetrics and Gynecology 60:667, 1982.

Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstetrics and Gynecology 63:26-32, 1984.

Serial multiple laminaria and adjunctive urea in late out patient dilatation and evacuation abortion. Obstetrics and Gynecology 63:543-549, 1984.

Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: Techniques and clinical management. Obstetrics and Gynecology 81:301-306, 1993.

Cervical treatment with DilapanTM prior to second trimester dilation and evacuation abortion: A pilot study of 64 patients. American Journal of Gynecologic Health 7(1):15-18, 1993.

Dilapan vs. laminaria in second trimester abortion: Randomized controlled cohort of 1001 patients. American Journal of Obstetrics and Gynecology 171(5):1324-1328, 1994.

• Ortho Award, Best Scientific Paper, National Abortion Federation Annual Meeting, 1993
• Ortho Award, Best Scientific Paper, Association of Reproductive Health Professionals, 1994

[Return to List]

Publications.2
Bibliography #2

Is pregnancy really normal? Family Planning Perspectives 3(1), January 1971.

U.S Government policy on abortion. G. Contis and W.M. Hern. American Journal of Public Health 61:1038, May, 1971.

The illness parameters of pregnancy. Social Science and Medicine 9:365-372, 1975 (England).

Administrative incongruence and authority conflict in four abortion clinics. W.M Hern, M. Gold, and A. Oakes. Human Organization 36:376-383, 1977.

The concept of quality care in abortion services. Advances in Planned Parenthood 13:63-74, 1978.

What about us? Staff reactions to D & E. Advances in Planned Parenthood 15:3-8, 1980.

Midtrimester abortion. In Obstetrics and Gynecology Annual, 1981, Ralph M. Wynn, (Ed.), Appleton-Century-Crofts, New York, 1981.

Long-term risks of induced abortion. In Gynecology and Obstetrics, Chapter 63, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott, 1982.

First trimester abortion: complications and their management. In Gynecology and Obstetrics, Chapter 59, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott, 1982.

First and second trimester abortion techniques. Current Problems in Obstetrics and Gynecology 6, No. 11: July 1983.

Discussion remarks. In Shaw, M.W, Doudera, A.E, (eds): Defining Human Life: Medical, Legal, and Ethical Implications. Ann Arbor, AUPHA Press, 1983. Proceedings of the conference entitled Human Life Symposium: An Interdisciplinary Approach to the Concept of Person, Houston, Texas, March 1982.

Use of prostaglandins as abortifacients. In Gynecology and Obstetrics, Chapter 58, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott Co, 1982. Published in 1988.

Evolution of second trimester abortion techniques. In Prevention and Treatment of Contraceptive Failure, U. Landy and S.S. Ratnam, eds. New York: Plenum Press, 1986.

The Politics of Choice: Abortion as Insurrection. In Births and Power: Social Change and the Politics of Reproduction, W. Penn Handwerker, (Ed.), Boulder, Westview Press, 1990.

Proxemics in the abortion debate: the use of anthropological theory in conflict arising from antiabortion demonstrations. Population and Environment 12(4): 379 -388, 1991. Life on the Front Lines. Women's Health Issues 4(1):48-54,1994.

Surgical abortion: Management, complications, and long-term risks. In Gynecology and Obstetrics, John J. Sciarra (Ed.) and Preston V. Dilts, Jr (Assoc. Ed.) Revised edition, 1994. Philadelphia: J.B. Lippincott Company, 1994. Chapter 59.

First trimester abortion: Principles, Techniques, and Clinical Management. In Fertility Control, Stephen L. Corson, Richard J. Derman, and Louise B. Tyrer (Eds.). Second edition. London, Ontario, Canada: Goldin Publishers, 1994.

Abortion. Chapter I in Encyclopedia of Marriage and the Family, MacMillan Publishing Company, New York, 1995.

Life on the front lines. In Abortion Wars: 1950-2000, by Rickie Solinger (ed.). Univ. of Calif. Press, 1997.

How Roe vs. Wade has affected my life and work. Conscience 18(4):26, 1998. Special issue on 25th Anniversary of Roe vs. Wade; invited essay.

[Return to List]

Publications.3
Bibliography #3
General publications concerning abortion

The politics of abortion. The Progressive, November, 1972.

Abortion: the need for rational policy and safe standards. The Denver Post, May 27, 1973.

Single pregnancies: are they really accidental? Denver Singles Guide, April, 1975.

Abortion issue muddles presidential politics. The Denver Post, October 31, 1976.

New attack on abortion under way in Colorado. The Denver Post, February 27, 1977.

The human life statute: will it protect life or power? The Denver Post, June 21, 1981.

Helms' abortion amendment unenforceable. Daily Tar Heel, February 18, 1981 (University of North Carolina).

Reagan's war on abortion. The Sunday Camera, December 9, 1984.

Reagan turning abortion into crime against state. The Rocky Mountain News, December 14, 1984.

The antiabortion vigilantes. The New York Times, Op-Ed Page, Friday, December 21, 1984.

Abortion `compromise' flawed. The Denver Post, April 27, 1985.

`Silent Scream' is propaganda. The Denver Post, July 6, 1985.

Drug won't end abortion dilemma. The Daily Camera, April 5, 1986.

Must Mr. Reagan tolerate abortion clinic violence? The New York Times, Op-Ed page, June 14, 1986.

Reagan faces anti-abortion terrorists‹and winks. The Rocky Mountain News, Commentary, June 17, 1986

Protect Abortion Rights. New York Times, Op-Ed page, January 22, 1987.

Protect Abortion Rights. Rocky Mountain News, January 23, 1987.

Anti-abortion campaign rhetoric prompts attacks on clinics. Sunday Camera, September 4, 1988.

Abortion clinics under siege. The Denver Post, November 1, 1988.

Abortion as Insurrection. The Humanist 49(2):18, March/April, 1989.

Voters sent a clear pro-choice message. The Daily Camera, December 21, 1992.

Hunted by the Right, Forgotten by the Left. The New York Times Op-Ed page, March 13, 1993.

Doctors disparaged in abortion debate. The Daily Camera, March 19, 1993.

Florida doctor's death resulted from 20 years of inciting violence. The Denver Post, March 20, 1993.

The Pope and my right to life. The New York Times Op-Ed page, August 12, 1993.

Anti-abortion movement put weapon in slayer's hand. Daily Camera, Guest Opinion, March 20, 1994.

Anti-abortion zealots' grasp for power. The Rocky Mountain News, Guest Opinion ("Speakout") Column. December 19, 1994.

An electronic demon stalks clinic workers. The Daily Camera, Commentary. January 9, 1995.

How it feels to be on anti-abortion hit list. Letter to the editor, The New York Times, February 4, 1995.

Parental notice is bad legislation. Commentary, The Colorado Statesman, March 10, 1995.

Parental notice law should be rejected. Editorial, The Rocky Mountain News, March 19, 1995.

'Killing for Life' is senseless. Op-ed piece, The Denver Post, April 8, 1995.

Who wanted to ban 'partial birth abortion'? The Daily Camera, December 16, 1995.

Abortion and the numbers game. Op-Ed page, The Washington Post, October, 1996.

Abortion bill skips the fine print. Op-Ed page, The New York Times, May 17, 1997.

[Return to List]

Publications.4
ABORTION PRACTICE
(Medical textbook)

Abortion Practice. J.B. Lippincott Company, Philadelphia, 1984. Reviewed in Family Planning Perspectives, New England Journal of Medicine, Journal of the American Medical Association, American Journal of Reproductive Health.

Abortion Practice. Softcover reprint. Alpenglo Graphics, 1990, 368 pages, 59 illustrations, 3 color plates, 16 tables.

Available from Alpenglo Graphics, 1130 Alpine, Boulder, CO 80304.

U.S. orders: $35.00 includes postage & handling
Canada: $50.00 U.S. includes postage & handling
Other: $75.00 U.S. includes international courier service (FedEx, DHL, etc.)
Colorado residents add 7.41% sales tax

[Return to List]

Publications.5

ABORTION IN THE SEVENTIES
Abortion in the Seventies. Proceedings of the Western Regional Conference on Abortion. W.M. Hern and B. Andrikopoulos (Eds.), National Abortion Federation, New York, 1977.

Available from Alpenglo Graphics, 1130 Alpine, Boulder, Colorado 80304.

U.S. orders $15.00 includes postage & handling
Canada $25.00 U.S. includings shipping
Other foreign $40.00 U.S. intn'l courier service

ABORTION SERVICES HANDBOOK
Abortion Services Handbook. Interfacia, Chicago, 1978.

Available from Alpenglo Graphics, 1130 Alpine, Boulder, CO 80304.

U.S. orders: $10, includes shipping & handling
Canada: $15 U.S.; International: $25.00 U.S.

[Return to List]

Publications.6
COMPLETE BIBLIOGRAPHY OF PUBLICATIONS BY WARREN M. HERN
Abortion-related publications by Warren M. Hern, M.D., M.P.H., Ph.D.

U.S Government policy on abortion. G. Contis and W.M. Hern. American Journal of Public Health 61:1038, May, 1971.

The politics of abortion. The Progressive, November, 1972.

Abortion: the need for rational policy and safe standards. The Denver Post, May 27, 1973.

Single pregnancies: are they really accidental? Denver Singles Guide, April, 1975.

Laminaria in abortion: use in 1368 patients in first trimester. Rocky Mountain Medical Journal 72:390-395, 1975.

Abortion issue muddles presidential politics. The Denver Post, October 31, 1976.

Administrative incongruence and authority conflict in four abortion clinics. W.M Hern, M. Gold, and A. Oakes. Human Organization 36:376-383, 1977.

Having an Abortion. Office pamphlet © 1975, Warren M. Hern, M.D., M.P.H.

Boulder Abortion Clinic. Office pamphlet © 1976, Warren M. Hern, M.D., M.P.H.

Abortion in the Seventies. Proceedings of the Western Regional Conference on Abortion. W.M. Hern and B. Andrikopoulos (Eds.), National Abortion Federation, New York, 1977.

Multiple laminaria treatment in early midtrimester outpatient suction abortion. W. Hern and A. Oakes. Advances in Planned Parenthood 12:93-97, 1977.

New attack on abortion under way in Colorado. The Denver Post, February 27, 1977.

Abortion Services Handbook. Interfacia, Chicago, 1978. Available from Alpenglo Graphics, 1130 Alpine, Boulder, CO 80304.

The concept of quality care in abortion services. Advances in Planned Parenthood 13:63-74, 1978.

Correlation of sonographic cephalometry with clinical assessment of fetal age following early midtrimester D & E abortion. W.M. Hern, W.A. Miller, L. Paine, and K.D. Moorhead. Advances in Planned Parenthood 13:14-20, 1978.

Program Standards for Abortion Services. Standards Committee, National Abortion Federation. National Abortion Federation, Washington, D.C.

What about us? Staff reactions to D & E. Advances in Planned Parenthood 15:3-8, 1980.

The human life statute: will it protect life or power? The Denver Post, June 21, 1981. Helms' abortion amendment unenforceable. Daily Tar Heel, February 18, 1981 (University of North Carolina).

Outpatient second-trimester D & E abortion through 24 menstrual weeks' gestation. Advances in Planned Parenthood 16:7-13, 1981.

Midtrimester abortion. In Obstetrics and Gynecology Annual, 1981, Ralph M. Wynn, (Ed.), Appleton-Century-Crofts, New York, 1981.

Long-term risks of induced abortion. In Gynecology and Obstetrics, Chapter 63, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott, 1982.

First trimester abortion: complications and their management. In Gynecology and Obstetrics, Chapter 59, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott, 1982.

Dilatation and evacuation abortion. Letter to the editor, Obstetrics and Gynecology 60:667, 1982.

First and second trimester abortion techniques. Current Problems in Obstetrics and Gynecology 6, No. 11: July 1983.

Discussion remarks. In Shaw, M.W, Doudera, A.E, (eds): Defining Human Life: Medical, Legal, and Ethical Implications. Ann Arbor, AUPHA Press, 1983. Proceedings of the conference entitled Human Life Symposium: An Interdisciplinary Approach to the Concept of Person, Houston, Texas, March 1982.

Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstetrics and Gynecology 63:26-32, 1984.

Serial multiple laminaria and adjunctive urea in late out patient dilatation and evacuation abortion. Obstetrics and Gynecology 63:543-549, 1984.

Abortion Practice. J.B. Lippincott Company, Philadelphia, 1984. Reviewed in Family Planning Perspectives, New England Journal of Medicine, Journal of the American Medical Association.

Reagan's war on abortion. The Sunday Camera, December 9, 1984.

Reagan turning abortion into crime against state. The Rocky Mountain News, December 14, 1984.

The antiabortion vigilantes. The New York Times, Op-Ed Page, Friday, December 21, 1984.

Abortion `compromise' flawed. The Denver Post, April 27, 1985.

`Silent Scream' is propaganda. The Denver Post, July 6, 1985.

Drug won't end abortion dilemma. The Daily Camera, April 5, 1986.

Use of prostaglandins as abortifacients. In Gynecology and Obstetrics, Chapter 58, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott Co, 1982. Published in 1988.

Must Mr. Reagan tolerate abortion clinic violence? The New York Times, Op-Ed page, June 14, 1986.

Reagan faces anti-abortion terrorists‹and winks. The Rocky Mountain News, Commentary, June 17, 1986

Evolution of second trimester abortion techniques. In Prevention and Treatment of Contraceptive Failure, U. Landy and S.S. Ratnam, eds. New York: Plenum Press, 1986.

Protect Abortion Rights. New York Times, Op-Ed page, January 22, 1987.

Protect Abortion Rights. Rocky Mountain News, January 23, 1987.

Anti-abortion campaign rhetoric prompts attacks on clinics. Sunday Camera, September 4, 1988.

Abortion clinics under siege. The Denver Post, November 1, 1988.

Abortion as Insurrection. The Humanist 49(2):18, March/April, 1989.

The Politics of Choice: Abortion as Insurrection. In Births and Power: Social Change and the Politics of Reproduction, W. Penn Handwerker, (Ed.), Boulder, Westview Press, 1990.

Abortion Practice. Softcover reprint. Alpenglo Graphics, 1990, 368 pages, 59 illustrations, 3 color plates, 16 tables. Available from Alpenglo Graphics, 1130 Alpine, Boulder, CO 80304.

Proxemics in the abortion debate: the use of anthropological theory in conflict arising from antiabortion demonstrations. Population and Environment 12(4): 379-388, 1991.

Voters sent a clear pro-choice message. The Daily Camera, December 21, 1992.

Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: Techniques and clinical management. Obstetrics and Gynecology 81:301-306, 1993.

Cervical treatment with DilapanTM prior to second trimester dilation and evacuation abortion: A pilot study of 64 patients. American Journal of Gynecologic Health 7(1):15-18, 1993.

Hunted by the Right, Forgotten by the Left. The New York Times Op-Ed page, March 13, 1993.

Doctors disparaged in abortion debate. The Daily Camera, March 19, 1993.

Florida doctor's death resulted from 20 years of inciting violence. The Denver Post, March 20, 1993.

The Pope and my right to life. The New York Times Op-Ed page, August 12, 1993.

Anti-abortion movement put weapon in slayer's hand. Daily Camera, Guest Opinion, March 20, 1994.

Life on the Front Lines. Women's Health Issues 4(1):48-54,1994.

Surgical abortion: Management, complications, and long-term risks. In Gynecology and Obstetrics, John J. Sciarra (Ed.) and Preston V. Dilts, Jr. (Assoc. Ed.) Revised edition, 1994. Philadelphia: J.B. Lippincott Company, 1994. Chapter 59.

First trimester abortion: Principles, Techniques, and Clinical Management. In Fertility Control, Stephen L. Corson, Richard J. Derman, and Louise B. Tyrer (Eds.). Second edition. London, Ontario, Canada: Goldin Publishers, 1994.

Dilapan vs. Laminaria in second trimester abortion: Randomized controlled cohort of 1001 patients. American Journal of Obstetrics and Gynecology 171(5):1324-1328, 1994.

• Ortho Award, Best Scientific Paper, National Abortion Federation Annual Meeting, 1993
• Ortho Award, Best Scientific Paper, Association of Reproductive Health Professionals, 1994

Abortion: Medical and Social Aspects. In Encyclopedia of Marriage and the Family, David Levinson, Ed. New York: Simon & Schuster MacMillan, 1995. Chapter 1, pp 1-7.

Who wanted to ban 'partial birth abortion'? The Daily Camera, December 16, 1995.

Abortion and the numbers game. Op-Ed page, The Washington Post, October, 1996

Abortion bill skips the fine print. Op-Ed page, The New York Times, May 17, 1997.

Life on the front lines. In Abortion Wars: 1950 - 2000, Rickie Solinger (ed.). Los Angeles: University of California Press, 1997.

How Roe vs. Wade has affected my life and work. Conscience, 18(4):26, 1998.

Publications related to Fertility/Family Planning/Population by W.M. Hern

Family Planning and the Poor. The New Republic, November 14, 1970.

Is pregnancy really normal? Family Planning Perspectives 3(1), January 1971.

Biological Tyranny. The New Republic, February 27, 1971.

The illness parameters of pregnancy. Social Science and Medicine 9:365-372, 1975 (England).

Knowledge and use of herbal contraceptives in a Peruvian Amazon village. Human Organization 35:9-19, 1976.

High fertility in a Peruvian Amazon Indian village. Human Ecology 5:355-368, 1977.

Water sets the limits on exponential growth. The Denver Post, January 10, 1982.

Secretary Schweiker's flawed plan to curb teenage sex. New York Times, Letter, February 26, 1982.

Alta fecundidad en una comunidad nativa del Río Ucayali. Ginecologia y Obstetricia (Lima) 28:20-25, 1983.

Population growth: the real reason behind the peril to the planet. Colorado Daily, February 3, 1989.

Why are there so many of us? Description and diagnosis of a planetary ecopathological process. Population and Environment 12(1), 1990. [News Brief, Science, March 15, 1991, p 1311].

Individual Fertility Rate: A new measure of fertility for small populations. Social Biology 37(1-2), 1990.

Book review: The Population Dynamics of the Mucajai Yanomama, J. Early, and J. Peters, San Diego, Academic Press, 1990. Population Studies 45:359-360, 1991.

Effects of cultural change on health and fertility in Amazonian Indian societies: Recent research and projections. Population and Environment 13(1):23-43, 1991.

Polygyny and fertility among the Shipibo of the Peruvian Amazon. Population Studies 46:53-64, 1992

Shipibo polygyny and patrilocality. American Ethnologist 19(3):501-522, 1992.

Family planning, Amazon style. Natural History 101(12):30-37, 1992, December.

Is human culture carcinogenic for uncontrolled population growth and ecological destruction? BioScience 43(11):768-773, 1993.

Has the human species become a cancer on the planet? A theoretical view of population growth as a sign of pathology. Current World Leaders 36(6):1089-1124, 1993 (Special issue Featuring: World Population Issues).

Cultural change, polygyny, and fertility among the Shipibo of the Peruvian Amazon. In Demography of Lowland South American Indians: Case Studies from Lowland South America, Kathleen Adams and David Price (Eds.). South American Indian Studies 4:77-86, 1994.

The impact of cultural change and population growth on the Shipibo of the Peruvian Amazon. Latin American Anthropology Review 4(1):3-8, 1992 (published 5/94).

Alta fecundidad en una comunidad nativa de la Amazonia Peruana. Amazonia Peruana 24:125-142, 1994.

Conocimiento y uso de anticonceptivos herbales en una comunidad Shipibo. Amazonia Peruana 24:143- 160, 1994.

Poliginía y fecundidad de los Shipibo de la Amazonía Peruana. Amazonia Peruana 24:161-184.

Microethnodemographic techniques for field workers studying small groups. In The Comparative Analysis of Human Societies, Emilio Moran (Ed.). Boulder: Lynn Reiner Publishers, 1995.

Health and demography of Native Amazonians: Historical perspective and current status. In Amazonian Indians from Prehistory to the Present, Anna C. Roosevelt (Ed.), Tuscon: University of Arizona Press, 1994. pp. 123-149

Publications related to Health/Economics/Politics/Ecology by W.M. Hern

Health and economics in West Africa. Rocky Mountain Medical Journal, October 1962.

Brazil's rulers crack down on foes. The Denver Post Perspective section, January 26, 1969.

Could we have a killer smog in Denver? The Denver Post Perspective section, September 13, 1970.

History shows us how to get it all wrong in Central America. The Sunday Camera, May 19, 1985.

Questions about Homestake II. The Denver Post, Op-Ed page, October 24, 1987.

All Latin America will hate the U.S. for invasion of Panama. The Sunday Camera, January 7, 1990.

Values clash over wild waters. Rocky Mountain News, Op-Ed Page, August 22, 1990 (concerning the Homestake II project).

Informe sobre la epidemia del colera en los rios Pisqui y Bajo Ucayali, Peru: 8 a 20 de junio de 1991. Boletin de Lima (78):29-31, 1991.

Book review: Anthropogenic Climatic Change, M.I. Budyko and Yu A. Izrael, Eds., Tucson, University of Arizona Press, 1990. National Geographic Research and Exploration 8(1):125-126, 1992.

Upper Pisqui River, Peruvian Amazon: July to August 1991. National Geographic Research and Exploration 8(2):234-236, 1992.

Book review: Environmental Evolution: Effects of The Origin and Evolution of Life on Planet Earth., L. Margulis and L. Olendzenski, Eds., Cambridge, MA, MIT Press, 1992. National Geographic Research and Exploration 10(1):132, 1994.

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Publications.7
RESEARCH PUBLICATIONS SUMMARY

Dr. Warren Hern, Director of Boulder Abortion Clinic, is the author of ten research papers published in peer-review journals concerning the medical and surgical aspects of surgical abortion. He is the author of numerous other abortion-related publications in scientific, professional, and academic journals and monographs concerning some aspect of abortion. Some of these were prepared as invited book chapters.

The ten abortion research papers published to date represent specific aspects of clinical observation and research conducted over twenty-five years; they reflect the experience with some 35,000 patients and over 40,000 abortion procedures ranging from 4 menstrual weeks to 34 menstrual weeks.

Most of these research papers are concerned with the clinical results for second trimester and later abortions (15 - 34 menstrual weeks gestation).

Although all the research papers have specific case series included for analysis, one paper (Laminaria vs. dilapan; AJOG 1994) utilizes rigorous statistical and comparative methodology for comparing the results of a particular strategy for cervical dilation using two different materials.

Another research paper with rigorous comparative methodology is the 1984 paper concerning the correlation of fetal age and measurements (Obstet Gynecol 1984). This is the first publication since Streeter's in 1920 which utilizes a rigorous methodologic and statistical approach to this subject in a way that gives highly reliable and applicable results for the practitioner.

Of the various case series presented by Dr. Hern in these publications, the major complication rates range from 0.0 to 0.3%, up to 3 per 1000. Blood loss and procedure times are also studied and presented.

For first trimester patients under Dr. Hern's care, there have been no primary uterine perforations (during the abortion procedure) in approximately 30,000 patients. This is to be compared to a national average of 0.1 - 0.2%.

For most second and third trimester patients under Dr. Hern's care, the major complication rate has been approximately 0.2% overall (2/1000), with slightly higher major complication rates of up to 0.5% (5/1000) in smaller, more advanced series.

Publications.7a
ANNOTATED BIBLIOGRAPHY - ABORTION RESEARCH PUBLICATIONS

* Laminaria in abortion: use in 1368 patients in first trimester. Rocky Mountain Medical Journal 72:390-395, 1975.

In this study, 1368 patients received vacuum aspiration abortion following overnight cervical dilation with Laminaria japonicum. There were no uterine perforations or major complications.

* Multiple laminaria treatment in early midtrimester outpatient suction abortion. W. Hern and A. Oakes. Advances in Planned Parenthood 12:93-97, 1977.

In this study, a serial multiple laminaria technique of dilating the cervix in second trimester abortion was used in 162 patients experiencing abortion in a private outpatient office. Blood loss, procc. time. There were no uterine perforations or major complications. This paper is the first description in the American literature of the Serial multiple laminaria technique in second trimester D & E abortion.

* Correlation of sonographic cephalometry with clinical assessment of fetal age following early midtrimester D & E abortion. W.M. Hern, W.A. Miller, L. Paine, and K.D. Moorhead. Advances in Planned Parenthood 13:14-20, 1978.

* Outpatient second-trimester D & E abortion through 24 menstrual weeks' gestation. Advances in Planned Parenthood 16:7-13, 1981.

* Dilatation and evacuation abortion. Letter to the editor, Obstetrics and Gynecology 60:667, 1982.

* Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstetrics and Gynecology 63:26-32, 1984.

* Serial multiple laminaria and adjunctive urea in late out patient dilatation and evacuation abortion. Obstetrics and Gynecology 63:543-549, 1984.

* Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: Techniques and clinical management. Obstetrics and Gynecology 81:301-306, 1993.

* Cervical treatment with DilapanTM prior to second trimester dilation and evacuation abortion: A pilot study of 64 patients. American Journal of Gynecologic Health 7(1):15-18, 1993.

* Dilapan vs. Laminaria in second trimester abortion: Randomized controlled cohort of 1001 patients. American Journal of Obstetrics and Gynecology 171(5):1324-1328, 1994.

In this study, 1001 patients receiving DilapanTM and Laminaria japonicum for cervical dilation for second-trimester dilation & evacuation were compared for various outcome variables. A cohort comparison of 1001 patients receiving alternate preoperative treatment with either osmotic dilator after initial randomization until this number had been reached in the series. Results: Few significant differences were found in the two cohorts with respect to blood loss, procedure times, and overall complication rates. However, patients receiving DilapanTM were at least twice as likely to experience problems in cervical dilation or problems resulting from poor dilation and/or disintegration of the device than patients receiving Laminaria japonicum. While more patients receiving Laminaria experienced amniotic fluid embolism and/or disseminated intravascular coagulation syndrome, these problems could not be attributed to the type of osmotic dilator used.

Conclusions: Both osmotic dilators are acceptable for use in overnight dilation in this procedure, but the DilapanTM is more likely to disintegrate, retract, or present minor problems associated with poor dilation.

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Publications.8

My name is Warren Martin Hern. I am a physician engaged in private medical practice in Boulder, Colorado, where I specialize in outpatient abortion services. My formal medical training includes graduation from the University of Colorado School of Medicine in 1965 followed by a one-year rotating internship at Gorgas Hospital in the Panama Canal Zone. I subsequently served for two years as a commissioned officer in the United States Public Health Service assigned as a Peace Corps physician in Brazil. Following that, I studied public health and epidemiology at the University of North Carolina School of Public Health in Chapel Hill, receiving my Master of Public Health degree in 1971. In March, 1970, I began service as Chief, Program Development and Evaluation Branch, Family Planning Division, Office of Health Affairs in the Office of Economic Opportunity, Executive Office of the President in Washington, D.C. I served in this capacity as a federal official until June, 1972.

Since 1973, I have provided abortion services in Boulder, Colorado. I have provided these services in my private practice, Boulder Abortion Clinic, since 1975.

In 1980, while continuing my medical practice, I resumed my graduate work in Chapel Hill, and in 1988, I received my Ph.D. in Epidemiology from the University of North Carolina School of Public Health. My dissertation research studied the health effects of cultural change among the Shipibo Indians of the Peruvian Amazon.

My publications since 1975 include three books and some 40 professional papers concerning abortion and other aspects of fertility.1 My medical textbook, Abortion Practice, was published by J.B. Lippincott Company of Philadelphia in 1984. It remains in print as the principal textbook concerning abortion and is used internationally.

In addition to my private medical practice, I hold several academic appointments. I am Assistant Clinical Professor of Obstetrics and Gynecology at the University of Colorado Health Sciences Center and Professor Adjunct in the Department of Anthropology, University of Colorado at Boulder. I also hold appointments in the USHSC Department of Preventive Medicine and Biometrics, Department of Family Medicine and at the University of Colorado at Denver, Department of Anthropology.

Senate Bill 939
The bill under consideration, S. 939, is called the "Partial Birth Abortion Ban Act," but there is no such thing as a "partial birth abortion." This is an operation which has never been described in the medical literature, and as far as I know, it does not exist. The bill's sponsors describe some procedures which have been performed for many generations in the case of obstetrical emergency. The operation mentioned in the Senate bill contains some elements of a procedure called an "Intact D & E," or "Intact Dilation and Evacuation" by some physicians during the course of scientific discussions of late abortions, but I have never heard the term, "partial birth abortion" in these discussions. As written, the bill describes aspects of an operation which is performed routinely by some physicians currently, but they are procedures with a long history and wide application by other physicians on a sporadic and unpredictable basis. The bill's language could be interpreted to refer to virtually any second trimester or later abortion. If made more specific, it has the potential to single out and discriminate against specific doctors, some of whose procedures may be alleged to be consistent with the language of the bill. Doctors are poor judges of these subtleties when presented with the exigencies of patient needs. These circumstances mean that the bill can produce a "witch hunt" atmosphere that chills medical practice and interferes with good patient care by conscientious doctors.

History of Intact D & E
Evidence from the ancient city of Pompeii indicates that an operation like this may have been performed by physicians and surgeons during that era, approximately 1,950 years or more before the present time. Breech extraction followed by perforation of the fetal skull by surgical instruments to allow delivery of the aftercoming head in an obstetrical emergency has been practiced by physicians and midwives for hundreds if not thousands of years. It has been practiced in the South American Amazon for a similar period. This is not a new idea.

The specific operation described by the bill's sponsors involves routine version of a 20-week or later fetus into a breech (feet first) position, followed by extraction of the fetus up to the neck, when the base of the fetal skull is perforated with surgical instruments. At that point, the contents of the fetal skull are removed by vacuum aspiration using a hollow cannula. Since the fetus is usually dead by this point, whether due to an induced abortion or miscarriage, and since the head is under great pressure, the cerebral contents are often extruded without any intervention by the surgeon. The head collapses, permitting delivery of the more or less intact fetus.

A variation of this procedure, which is usually preceded by several days of treatment to open the uterus so as to permit passage of the fetus, is decompression of the fetal skull as it presents first in the sequence of expulsion or delivery of the fetus. Again, the fetus is usually dead at the point at which this occurs. I think fetal death is often brought about by infarction (death) of the placenta as the result of other kinds of treatment such as those that cause uterine irritability.

A common approach to abortion by some obstetricians who have discovered a severe fetal anomaly in an advanced pregnancy is to place prostaglandin suppositories in the vagina followed by induction of labor and expulsion of the fetus. It is my understanding that the maneuvers described by the sponsors of S. 939 are followed by attending physicians throughout the nation when the safety of the woman having the abortion is at issue.

Another approach, which I favor and which is followed by some other physicians, is to induce fetal death on the first or second day of treatment of the cervix. This requires an injection of a medication into the fetus under (usually) ultrasound guidance. This is the procedure which I and one or two other physicians follow. It is accompanied by other forms of treatment, but these vary according to the physician. In the case of a breech presentation of a dead fetus, the procedure described by sponsors of S. 939 is routinely followed.

Advantages of Intact D & E
The principal purpose of an abortion is to end a pregnancy which threatens a woman's life or which she wants terminated. The manner of ending the pregnancy must be determined by safety factors for the woman and acceptability of the methods used. The considerations for the fetus are secondary to the safety and welfare of the woman seeking the abortion.

The possible advantages of Intact D & E procedure include a reduction of the risk of perforation of the uterus. Since most women seeking abortions are young women who hope to reproduce in the future, having a safe abortion technique for late abortion is of paramount importance, aside from the prevention of complications. Another advantage of the Intact D & E is that it eliminates the risk of embolism of cerebral tissue into the woman's blood stream. This catastrophe can be almost immediately fatal.

I support the right of my medical colleagues to use whatever methods they deem appropriate to protect the woman's safety during this difficult procedure. It is simply not possible for others to second guess the surgeon's judgment in the operating room. That would be dangerous and unacceptable.

Fetal Considerations
According to biologist Clifford Grobstein and others, fetal neurological development well into the early part of the third trimester is insufficient for the fetus to experience what we regard as "pain." In Professor Grobstein's book, Science and the Unborn (1988, Basic Books, New York), "...an adequate neural substrate for experienced pain does not exist until about the seventh month of pregnancy (thirty weeks), well into the period when prematurely born fetuses are viable with intensive life support." Like any other mammalian organism, fetuses have enough neurological development to permit certain reflexes, but this is not the same as pain. Interpretation of these reflexes as "pain" is highly misleading.

Duration of pregnancy and reasons for late abortion
While about 1% of all abortions are performed after about 20 weeks of pregnancy, only about .03%, or fewer than 500, are performed after 26 weeks. The majority of these are now performed by me or one of my medical colleagues. These abortions are almost always performed for the most tragic reasons of severe fetal anomaly, genetic disorder, or immediate risk to the woman's life. They are not performed for frivolous reasons, contrary to statements by those opposed to abortion.

For example, one woman was recently brought to me by air ambulance from Rapid City, South Dakota for an abortion because she was about to die from her pregnancy, which was desired. She was a diabetic and had developed hyperemesis gravidarum (uncontrollable vomiting from pregnancy). She was starving to death. Her doctors were having difficulty keeping her alive. Her blood chemical balance was severely altered to the point that her heart could stop at any time. She was profoundly dehydrated. She was critically ill and could barely speak. Since she and her husband wanted the pregnancy, they tried everything to get her through it, but she was finally advised that she must have the abortion. While being flown to Boulder so that I could see her, she almost died in the airplane. I began her treatment immediately and performed the abortion by one the techniques I have described here two days later. She recovered completely and felt healthy again the next day. Without this operation, she would have died.

Another woman with an advanced pregnancy was referred to me by a colleague in northern Colorado because her fetus had been found to have a severe genetic disorder. She and her husband both wanted the pregnancy to continue. The fetal disorder also caused a serious disease of the placenta, which, in turn, caused the woman's blood pressure to go up. When she arrived at my office, her blood pressure was starting to go up at an alarming rate. I put her in the hospital as I continued my treatment. Her urine output diminished. She became edematous. Her electrolytes (blood chemicals) were out of balance because she was not excreting urine. She developed pulmonary edema (water on the lungs) and began having difficulty breathing. Meanwhile, I was trying to prepare her for the abortion, which promised to be extremely dangerous because of a large placenta that obstructed the opening of the uterus and threatened to cause catastrophic bleeding. We crossmatched blood for her. At 2 AM on the second night, before her cervix was completely prepared for the abortion I needed to perform, I had to act. She was deteriorating rapidly and it was clear that she would die before morning if I did not perform the abortion. This operation took every bit of my skill and experience as a surgeon and everything I have learned in 22 years of performing abortions. Although she was ill for some days from the effects of the pregnancy, the patient recovered fully.

On another occasion, a woman had been referred to me from Michigan for a late abortion because the fetus had a severe anomaly. The pregnancy was complicated by polyhydramnios (too much amniotic fluid surrounding the fetus), which was the result of one of the fetal anomalies. She was resting in my recovery room in preparation for her abortion, accompanied by her husband, when suddenly, without warning, the woman developed signs of shock, and I made a diagnosis of placental abruption. The placenta had torn away from the wall of the uterus and she was bleeding to death into the uterus. I carried her into my operating room without waiting for assistance, placed her on the operating table, and assembled my surgical team. My nurse held her fist on the patients aorta to keep her from bleeding to death while I did the abortion. As I began the procedure, two units of blood (about a quart) spurted out of her uterus, and she lost another unit during the operation. Without our preparations and my skill and experience, that woman would have died within minutes.

Mr. Chairman, I did not have time with any of these cases to consult the United States Senate on the proper method of performing the abortions.

Comparative risk of abortion and term birth
Without medical treatment, the risk of death due to pregnancy and childbirth is in the range of 1%. This is measured by the maternal mortality ratio, which is the proportion of women dying from pregnancy or its effects to the number of live births. For example, in 1920, the maternal mortality ratio was 680 per 100,000 live births. 680 women died for each 100,000 live births. In the Peruvian Amazon, where I conduct medical research from time to time, the maternal mortality ratio is about 1000 deaths of women per 100,000 live births, or about 1%.

By 1960, the U.S. maternal mortality ratio had dropped to about 38 per 100,000 live births. It is now about 8 per 100,000 live births for term pregnancy.

By contrast, the death rate in abortion is about 2 or 3 per 1,000,000 procedures, or about .2-.3 per 100,000 abortions. For early abortion, the abortion mortality rate is less than 1 per million procedures.

This means that a woman is ten or more times likely to die if she carries a pregnancy to term than if she has an abortion. For women at high risk of pregnancy complications, the risk of death may be 100 times greater for carrying the pregnancy to term.

Late abortion is a more dangerous procedure than early abortion, but the evidence is that it is still much safer in terms of mortality risk than carrying a pregnancy to term. The risk of a major complication is about 25-30% with term pregnancy, but it is much lower in late abortion. In a recent medical article of mine published in the journal Obstetrics and Gynecology in February, 1993, I described the experience of 124 patients for whom I performed abortions in pregnancies complicated by severe fetal anomaly, diagnosed genetic disorder, or fetal death. The average length of pregnancy was 23 weeks with a few over 30 weeks. The major complication rate was less than 1% (one patient). In another comparative study of mine published one year ago in the American Journal of Obstetrics and Gynecology, 1001 patients whose pregnancies ranged from 13 to 25 weeks in duration experienced a major complication rate of 0.3%. Only 3 of these patients experienced a major complication.

Implications of S. 939 for medical practice
Late abortion as currently practiced in the United States is a safe procedure that saves women's lives. The medical community has not determined the very best way to perform these procedures, and that cannot be determined by any legislature. That is a matter for scientific study and medical judgment.

If S. 939 is passed into law, any physician performing any second trimester or later abortion could be prosecuted by an aggressive public prosecutor. It would cause each physician to have to make a legal and political judgment with each patient as to whether prosecution would follow the exercise of the physician's judgment. It is an unwarranted and unacceptable intrusion into the practice of medicine.

The women who seek late abortion always do so for serious reasons. My experience has been that the women who seek my services are experiencing great pain and anguish, along with their family members, as the result of a very difficult decision. Even those who have all the information in a particular case have difficulty in determining the best thing to do. As a practicing physician, I do not see how any governmental body can effectively or rationally control these decisions.

S. 939 is an irretrievably bad piece of legislation that cannot be made acceptable by any means, and I urge the Senate to defeat it at the first opportunity.

References
1. Hern, W.M.: Laminaria in abortion: use in 1368 patients in first trimester. Rocky Mountain Medical Journal 72:390-395, 1975.

Hern, W.M. and A. Oakes: Multiple laminaria treatment in early midtrimester outpatient suction abortion. Advances in Planned Parenthood 12:93-97, 1977.

Hern, W.M.: The concept of quality care in abortion services. Advances in Planned Parenthood 13:63-74, 1978.

Hern, W.M., W.A. Miller, L. Paine, and K.D. Moorhead: Correlation of sonographic cephalometry with clinical assessment of fetal age following early midtrimester D & E abortion. Advances in Planned Parenthood 13:14-20, 1978.

Hern, W.M. and B. Corrigan: What about us? Staff reactions to D & E. Advances in Planned Parenthood 15:3-8, 1980.

Hern, W.M.: Outpatient second-trimester D & E abortion through 24 menstrual weeks' gestation. Advances in Planned Parenthood 16:7-13, 1981.

Hern, W.M.: Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstetrics and Gynecology 63:26-32, 1984.

Hern, W.M.: Serial multiple laminaria and adjunctive urea in late out patient dilatation and evacuation abortion. Obstetrics and Gynecology 63:543-549, 1984.

Hern, W.M.: Abortion Practice. J.B. Lippincott Company, Philadelphia, 1984. Reviewed in Family Planning Perspectives, New England Journal of Medicine, Journal of the American Medical Association.

Hern, W.M.: Evolution of second trimester abortion techniques. In Prevention and Treatment of Contraceptive Failure, U. Landy and S.S. Ratnam, eds. New York: Plenum Press, 1986.

Hern, W.M.: Use of prostaglandins as abortifacients. In Gynecology and Obstetrics, Chapter 58, J.W. Sciarra, Ed., Philadelphia, J.B. Lippincott Co, 1982. Published in 1988.

Hern, W.M.: Abortion Practice. Softcover reprint. Alpenglo Graphics, 1990, 368 pages, 59 illustrations, 3 color plates, 16 tables. Available from Alpenglo Graphics, 1130 Alpine, Boulder, CO 80304.

Hern, W.M., C. Zen, K.A. Ferguson, V. Hart, and M.V. Haseman: Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: Techniques and clinical management. Obstetrics and Gynecology 81:301-306, 1993.

Hern, W.M.: Cervical treatment with DilapanTM prior to second trimester dilation and evacuation abortion: A pilot study of 64 patients. American Journal of Gynecologic Health 7(1):15-18, 1993.

Hern, W.M: Laminaria versus Dilapan osmotic cervical dilators for outpatient dilation and evacuation abortion: Randomized cohort comparison of 1001 patients. American Journal of Obstetrics and Gynecology 171:1324-1328, 1994.

Hern, W.M.: Abortion: Medical and Social Aspects. In Encyclopedia of Marriage and the Family, David Levinson, Ed. New York: Simon & Schuster MacMillan, 1995. pp 1-7.

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