The 'Scream' of Bernard Nathanson

He is calm, controlled, a man at home.

And a man at the center of the rising storm of debate over abortion.

Nathanson originated the idea for and narrates the grisly antiabortion film "The Silent Scream," which shows an abortion-in-progress by means of ultrasound photography, a relatively new technology. It has been seen by millions on "Donahue," the Rev. Jerry Falwell's weekly cable television program and elsewhere. At President Reagan's suggestion, copies of the film are being given to every member of Congress. Critics call it propaganda, and inaccurate at that, but the film's emotional megatonnage has hit "pro-choice" forces hard.

"For the first time," Nathanson narrates flatly in the film, his words a slow, sepulchral march, "we are going to watch a child being torn apart, dismembered, disarticulated, crushed and destroyed by the unfeeling steel instruments of the abortionist."

Words spoken with the intensity of a convert.

Nathanson was formerly a leading advocate of abortion on demand. His change of mind has given new ammunition to "pro-life" forces, who also point to his self-proclaimed atheism as evidence that the appeal of their movement reaches beyond the hard religious right.

As the head of a major clinic here in the early 1970s, Nathanson by his own count presided over 60,000 abortions. He himself performed thousands. He helped lead the pro-choice movement that preceded the 1973 Supreme Court approval of abortion on demand, which opened the way for an estimated 18 million abortions since.

He was dubbed the Abortion King.

Now, on a pleasant Saturday morning in his home, Nathanson leads the way upstairs to his library, a sanctum of dark wood and comfortable old furniture, of brandy snifters on the coffee table. An entire section is devoted to Joyce.

He settles into a deep armchair, touches his fingertips together.

He says, among other things, that he must confine his antiabortion work to weekends because his life centers on his practice here in obstetrics and gynecology, and he has no partners.

He smiles warmly.

"I'm just a practicing doc."

Nathanson's patients sometimes come to him wanting to end pregnancies.

He tailors his response to each case.

"You really have to try and read your patient carefully," he says, "and understand, and really get some sort of a visceral nexus with the patient. If I feel this woman has made up her mind after turmoil, and she's there only to have me carry it out, I just say, 'No, I don't do abortions, you'll have to find somebody who does. I want to reassure you that the moment the abortion's finished you can come right back to me, because if there's any complications . . . I want to see you. Don't worry about my feelings on it . . .' I do not try to persuade such women from abortions. I know that they have gone through a terrible turmoil and it's a very private thing and I don't want to interfere."

But if a patient appears undecided:

"I will try to draw out her feelings . . . counsel her against the abortion . . . tell her that it does involve another human being, and that the human being is being torn apart . . . that there is enough support out there to help her through this . . . No obstetrician practices with only one patient in mind, and you have to tell the one patient about the other patient and balance their needs. If her situation is so extreme that it justifies the destruction of a human being, well then, that's the way she thinks. But you have to understand that this is . . . not at all dissimilar to infanticide . . . If I begin to counsel them and I notice they're beginning to pull away from me, I will not pursue it."

Bernard Nathanson, 58, has now stood publicly and vociferously on both sides of one of the great issues of contemporary life, each time investing, he says, his entire moral being in the effort.

Each time seen as a pariah.

Critics accuse him of grandstanding, but he says he must speak loudly now because he spoke loudly before.

Accused of making money on both sides, he says he lost income doing abortions and is not paid for pro-life activities now.

"It is extremely telling that this man, who is a doctor and who has performed by his own account at least 5,000 abortions, can claim to say he never knew what was there in the womb , that he didn't know what the fetus was, and now he does," says Judy Goldsmith, president of the National Organization for Women.

Recently in a speech she said, "It was only 15 years ago that a woman who had to terminate a pregnancy risked fear, pain, injury and even death."

Nathanson says he saw these kinds of horrors as a young doctor and that they helped prompt his early activism. In his 1979 book, "Aborting America," he tells of a harrowing experience as a student at McGill University Medical College in Montreal. Nathanson got his girl pregnant and sent her for a back-alley abortion; she returned with "a pool of clotting blood on the floor of the cab. She was ashen and trembling violently."

It poisoned the relationship and eventually they broke up.

Barbara Radford, director of the National Abortion Federation, a group of clinics, says Nathanson fails to grasp what abortion means for women. "Any woman who's faced with an unplanned, and often unwanted, pregnancy goes through a lot of pain . . . We're not saying that abortion is an easy decision . . . but one that must remain available and safe."

The criticism can get personal.

"Bernie Nathanson from the beginning had seemed willing to be more radical than radical," says feminist Betty Friedan, recalling the late 1960s when she, Nathanson and others started the National Abortion Rights Action League (NARAL). "He seemed to be a really avid supporter . . . but there were things . . . that began to make me uneasy."

One night after dinner at Nathanson's house, she says he took a saber or knife "and he sticks it at my throat. I said, 'Bernie, what's wrong with you?' . . . He ran it up and down on his thumb . . . gloating in the sharpness of the knife . . . I began to wonder, 'God, where are some of these men coming from?' Any movement is going to attract all kinds."

Says Nathanson: "That's purely a figment of her imagination . . . I don't fool around with such instruments. I don't think it's funny at all. I don't know where she got this."

Nathanson's sense of humor can be a bit macabre. On ABC's "Nightline" Dr. Hart Peterson of Cornell University Medical School attacked "the notion that the fetus is being tortured" during abortion and Nathanson said: "If pro-choice advocates think that they're going to see the fetus happily sliding down the suction tube waving and smiling as it goes by, they're in for a truly paralyzing shock."

"I don't understand why people castigate my husband for, in good conscience, having a change of mind," says Nathanson's wife of 20 years, Adelle. (They have an 18-year-old son.) "He didn't just wake up and say, 'Hey, I'm not in the limelight any more, I've got to change!' That's outrageous. I know, I was there. He is a man of the utmost conscientiousness."

She always hated the idea of abortion.

They would argue, and she remembers that he once said the difference between a fetus and a baby was like the difference between a set of blueprints and a building.

"I believe in the sanctity of human life," she says, "so I'm quite delighted and, really, very very proud of my husband."

Nathanson's Odyssey.

The son of a New York obstetrician, he was destined for a medical career. His father was a religious skeptic, and after Bernard was bar mitzvahed he didn't attend synagogue. His family had no direct experience with the Holocaust. Pro-life leaders call abortion a silent holocaust, but Nathanson avoids the term, saying it trivializes what happened under the Nazis.

In 1952, Nathanson became a resident in obstetrics and gynecology in a Manhattan hospital and "began to see for the first time the harvest of illegal abortions. Women . . . very ill, and often requiring major surgery."

He doesn't remember his first abortion but by 1965 was performing "legal psychiatric abortions" regularly. "Every abortion I ever did was legal. We would submit letters to the therapeutic abortion committees and indicate that the woman was suicidal."

In 1967 Nathanson, then in his mid-thirties and with two marriages behind him, met radical activist Larry Lader, who had written a book advocating abortion on demand. After that, Nathanson says, he was "swept up."

"Those were years in which the passions were roiling around in the country, and I suppose the overriding theme of it all was anti-authoritarianism." He took part in antiwar activities, "and this idea with Lader of striking down all abortion laws seemed to me not only good medicine but in the spirit of the times, the Zeitgeist. The appeal was powerful to get rid of all this garbage and let's really set women free."

In 1971 Nathanson agreed to direct the Center for Reproductive and Sexual Health here. By the time he left a year and a half later, more than 100 abortions a day were being performed at the center.

He then took a job as chief of obstetrics at New York's St. Luke's Hospital, and soon began to have doubts about abortion.

The doubts, he says, were not of heart or spirit, but were intellectual, scientific.

"It was about that time that we were moving in all this new equipment and technology. The ultrasound machines came in and the electronic heart-monitoring machines and fetascopes . . . which I began to work with . . . beginning to look at this child in the uterus. And then, again, as in the pro-abortion time of my life, when it seemed that a confluence of events just pulled me on . . . in the middle '70s another concatenation of events swept me along including the increasing emphasis on the welfare of the fetus, or child."

A recent edition of "Williams' Obstetrics," a textbook, puts it this way: "Happily, we have entered an era in which the fetus can be rightfully considered and treated as our second patient." Dr. Nancy W. Dickey, chairman of the American Medical Association's judicial council, says two new specialties developed in the 1970s: neonatology, the care of newborn problem babies; and perinatology, the care of high-risk pregnancies. Perinatologists, Dickey says, "most emphasize the two-patient concept. They go in and operate on the fetus sometimes. It's almost Buck Rogers stuff."

Nathanson began to change.

"I began to look at this. I began to say, 'Wait a minute, what is going on here? I mean, we are wiping out this creature that I am charged to take care of.' "

In 1974, while still performing abortions, Nathanson confessed in the New England Journal of Medicine to being "deeply troubled by my own increasing certainty that I had in fact presided over 60,000 deaths . . . There is no longer serious doubt in my mind that human life exists within the womb from the very onset of pregnancy."

It caused a big stir.

Nathanson wrote that he still believed abortion should be "unregulated by law," but wanted somehow to end the "moral evasiveness."

As the years passed, he wrestled with the problem.

He discussed with his wife and close friends the "accumulating weight of evidence," gradually "breaking down the mechanism of denial."

He continued to do abortions, but "more and more reluctantly."

Finally in 1977 when Nathanson was temporarily in charge of obstetrics at a large Manhattan hospital, he was told that a woman 33 weeks pregnant was about to be admitted for an abortion.

"And I said no way would I sanction that. I said, 'I am literally going to stand in the door and prevent this.' By this time the weight of evidence was beginning to just drag me down . . . The woman had what is called a thanatophoric dwarf she was carrying. They had diagnosed it by ultrasound. Thanatophoric dwarfs are misshapen and they live a very short time, but I said, 'There can be no abortion at 33 weeks while I am here.' "

There was a furor.

Nathanson was ousted and the abortion performed.

But he had made his stand.

How could he have performed so many abortions without feeling, thinking, seeing what seems so clear to him now?

"Because I didn't see it, didn't see it! I didn't know what it was about. I mean, I hadn't seen that fetus. Oh, I'd listened to its heartbeat . . ."

When you take them out, you don't see them?

"Naw, you don't see anything."

What about in "The Silent Scream," all those abortion clinic tubs filled with recognizable dead human forms?

"You mean the second-trimester abortions? First-trimester abortions are suction, where this child comes out all chopped up and you don't see anything. All you see is just bloody meat . . . These second-trimester abortions, you have to understand this, we would inject the saline and then we would leave his voice grows soft , and the women would deliver these fetuses in the bed with the nurse in attendance. We never saw them."

Never?

"Naw. They'd be sent right to the pathology lab. I don't think I saw, of all the hundreds, maybe thousands, of second-trimester abortions I did, I don't think I saw half a dozen fetuses."

And it never bothered you when you did?

"Not particularly, no. I mean, this was the end product. This was a lifeless, limp thing lying there."

But it had a human form?

"Oh, absolutely."

You looked, but you didn't see?

"Naw, I was busy denying it. You could not continue to do this unless you were busy denying it . . . We were shielded from it. The nurses took the brunt of it."

They didn't say anything to you?

"Well, no, but we could not escape the fact that a nurse's tenure on such a unit was pretty short."

On "Nightline," Nathanson said he thought the Supreme Court would reverse Roe v. Wade, the 1973 decision legalizing abortion on demand.

What he really wants, however, is not a legal but a technological solution.

A medical miracle that will make the whole problem go poof! Gone. Everybody happy.

"Ten years from now," he says, "we are going to be able to take that pregnancy out of the uterus of a woman who doesn't want it, put it into either somebody else's uterus, or into a life support system, and let it just grow to maturity."See NATHANSON, B6, Col. 1

Not likely soon, if ever, says Prof. LeRoy Walters, director of the Center for Bioethics at Georgetown University.

"It's possible to keep earlier and earlier premature infants alive at the newborn end," says Walters. " . . . At the other end, with in vitro fertilization, embryos are cultured for several days before being transferred to the uterus. But there is that long period between four days and, say, 22 or 24 weeks where there simply is not any technology that comes close."

Nathanson, however, has "not the slightest doubt" of an eventual breakthrough.

He says: "Until then, my feeling is we must declare a moratorium on what's going on now. I think as history looks back on this era, it will be contemptuous of us, because we have been contemptible."

"The Silent Scream" is about pain.

Do the unborn "often feel pain -- pain that is long and agonizing" during an abortion, as President Reagan said in his Jan. 30, 1984, speech before the National Religious Broadcasters, kicking off his reelection campaign?

Nathanson got the idea for the film after the president made the assertion.

"I thought, well, listen, there's only one way to answer this question," he says. "Let's just do an ultrasound of an abortion and see what we come up with."

Ultrasound is a system using sound waves and computers to project an image of a fetus moving within its mother's womb. In hospitals today, parents watch the movements on TV screens as a doctor studies the same images for possible problems.

Through acquaintances, Nathanson arranged to film ultrasound images of an abortion at 12 weeks, the end of the first trimester.

Statistics kept by the Alan Guttmacher Institute, a research organization, show that slightly more than half of the roughly 1.5 million abortions done each year occur at eight weeks or less, and 91 percent occur by the end of the first trimester. About 130,000, or 8.7 percent, are in the second trimester.

Using the ultrasound film and Nathanson's narration, American Portrait Films produced the 28-minute "Scream."

The title is drawn from Nathanson's statement in the narration that, "The child's mouth is wide open in a silent scream."

Nathanson also says that, as the abortion instruments approach, "the child will rear away . . . is extremely agitated . . . the heart rate has speeded up dramatically . . . it does sense aggression . . . is moving away . . . to escape . . . "

This is, critics say, propaganda.

"Emotional pornography," says NOW's Goldsmith. "There are gross lies."

"Leading doctors have said that the movement is just a reaction to stimulus," says NARAL spokeswoman Emily Tynes.

Critics say the ultrasound film is so unclear that, without the narration, one couldn't tell what is happening. One can generally, however, discern a small babylike image -- its two-inch size magnified on the television screen -- that moves, appears to suck its thumb, and then becomes a swirl of movement after the abortion instruments enter the picture.

Controversy over the pain question began in the medical community shortly after Reagan's statement last year. The American College of Obstetricians and Gynecologists issued a statement saying there was no scientific evidence "that a fetus experiences pain early in pregnancy."

A dissident group of college members, including Nathanson, issued a statement saying the unborn "do respond to stimuli."

The official college statement itself left open the possibility that a fetus might be well enough developed to "perceive pain" at some point in the third trimester. (Asked about this recently, a college spokesman said: "It would be ludicrous for us to say in the ninth month a baby isn't going to feel pain.")

In a recent telephone interview, Dr. Jennifer Niebyl, director of maternal and fetal medicine at Johns Hopkins Hospital, says a fetus at 12 weeks that moves in response to stimulus "is exhibiting reflex behavior" and doesn't feel anything "on a conscious level."

"The nervous system is so undeveloped it doesn't feel pain as we know it," she says. She says one can stick a needle in a fetus and get a "reflex from the spinal cord, but that message may not be communicated to the brain as conscious awareness."

At some point between seven months and term, she says, a fetus may feel pain.

"Nobody really knows for sure."

Niebyl has seen "The Silent Scream," and says that what Nathanson describes as the fetus recoiling from pain and seeking to escape may be, in fact, simply the kind of movements fetuses make all the time.

"They have periods of quiet and periods of violent activity," she says. " . . . That was what you might see in a baby at 12 weeks" that was not being aborted but simply moving about in the womb.

Niebyl also says suction abortions aren't as drawn out as appears on the film, but are "almost instantaneous . . . It takes maybe a couple of minutes."

The particularly disturbing scene in the film where the fetal skull is crushed with forceps to make it small enough for extraction is not typical of a 12-week abortion, Niebyl says.

The film, she says, "has parts that are accurate, but it has exaggerations of the parts that are unpleasant, statements that have no factual documentation. We can't say that the baby feels pain, and he acts like he knows it does."

"You have to understand that this is a mute creature," responds Nathanson during the interview in his home. "Incommunicado, like an animal, and all we can do with animals is infer that they are in pain from response. They cannot tell you, 'I am in pain.' But you look, and you see . . . the grimacing here and the violent churning and the agitation . . . And you must infer from this that this is a creature in pain."

The Practicing Doc settles deep into his chair.

Says he didn't particularly like obstetrics and gynecology in medical school. He tried, when young, general surgery and other specialties.

"I liked it surgery , but it didn't speak to me. I don't know, I just can't tell you, but on some . . . level it didn't speak to me, and the same with urology."

He came around, finally, to his old man's specialty.

"If you want a real paean of praise about obstetrics, talk to my father. He just adores obstetrics."

Nathanson thinks.

"It's joyous."

Laughter wells up, burbling into his words.

"It is incredible, and even at 4 o'clock in the morning, tired, hungry, you do this, you help this woman, you see, in whatever small way you can. And I am not any longer so young and so egocentric as to think that I deliver the baby. I mean, no, the doctor is there to just oversee it a little bit, guide it along, but the women do it . . . "

He laughs happily.

" . . . Women really have put the doctor in the proper perspective. I was one of the early boosters of Lamaze a "natural" birth procedure . Twenty years ago I did that, I love it. I thought it was just tremendous. No more did we take over the delivery rooms! . . . My father, unfortunately, never agreed, because he was brought up in the era when you really were an authoritarian, patriarchal figure."

Birth.

"Oh, it's great. I mean, you look at the baby, and it's really a remarkable . . . "

He searches for the word.

" . . . Miracle! I mean, I am not a religious man, I'm an atheist. But I must tell you that probably I get as close to, uhhh, accepting some beneficent order in the universe when I look at a baby as I ever do . . . "

As if in some crazy confirmation, the little antique clock on the mantlepiece begins chiming 2.

" . . . It's at that instant that I know that there is some kind of elliptical poetry in the universe . . . "

His voice softens.

" . . . And, for a moment, my mind snaps onto it, you see. And then I think, 'Aw, wait a minute, I'm gettin' carried away here.' "

Pause.

He laughs suddenly, explosively, his face bunching into a great wreath of a smile.

"But it is such a compelling sight! Such a compelling experience!"