Late term abortionist Warren M. Hern wrote a textbook on how to do abortions. He describes different ways to abort babies:
“Once the tissue is grasped, the forceps is withdrawn gently with a rotating motion to permit easier passage. If any doubt is entertained about the kind of tissue being grasped, the rotation should occur before withdrawal.
If uterine wall or viscera is between the forceps blades, it will not rotate easily and the patient will experience discomfort. The tissue can be released and damage minimized. The forceps should be applied with extreme caution to avoid the latter calamity.
The probability of difficulty in removing the 1calvaria [human skull] is greater at 15 weeks than at any other time.
Continuing to search or attempt to grasp without success is increasingly dangerous with time, because the uterine wall is more and more likely to become the tissue that is grasped. As the calvaria [human skull] is grasped, a sensation that it is collapsing is almost always accompanied by the extrusion of white 2cerebral material…This calvaria sign [white cerebral material] may not be much in evidence with the 13-week procedure, but it is more likely to appear at 14 weeks.”
… At 16 to 17 weeks, 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…
At 18-19 menstrual weeks… fetal parts are significantly larger and more difficult to morcellate (tear into pieces)… [Abortion after] 20-week gestation… can be 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…
The procedure changes significantly at 21 weeks 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.
The calvaria is no longer the principal problem; it can be collapsed. A long curved Mayo scissors may be necessary to decapitate and dismember the fetus.
After the bimanual examination, the physician removes the basin from beneath the patient’s perineum and replaces her feet on the pull-out leg support.
At this point, I move around the table to face the patient, to inform her that she is no longer pregnant and to reassure her. Many patients are prepared to cry.
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 calvaria 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.”
Warren M. Hern. Abortion Practice (Philadelphia: J.B. Lippincott Company, 1990), 150-154
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