The abortion conflict; what it does to one doctor



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THE ABORTION CONFLICT; WHAT IT DOES TO ONE DOCTOR

By Dudley Clendinen; Dudley Clendinen is a New York Times correspondent based in Atlanta.
Published: August 11, 1985

ONE FRIDAY AT NOON, AFTER FOUR gray days of rain, the leaden clouds over northwestern Oregon drew apart and the sun filled the operating room of Dr. Peter Bours's clinic in Forest Grove. The winter light came through clerestory windows set in the peak of the cathedral ceiling, filtering through the glossy leaves of the palms and ferns in the loft, falling gently on Dr. Bours, his nurse and the pregnant woman lying on the operating table.

The woman looked older than her 32 years - her broad forehead was pale, her cheeks slack, her eyelids heavily veined. She had three children, no spare money, and wished no fourth child. She had come to Dr. Bours for an abortion.

In other rooms of the clinic, on other days, women gave birth to children they want to raise and love, and babies delivered by Dr. Bours returned, bringing their earaches and their colds for treatment. But Tuesday and Friday mornings were set aside for abortions, and on those days, out of sight of the doctor and his staff, but never far from mind, a small grim band of men and women guarded the entrance of the clinic's driveway. Armed with signs and literature, old Life Magazine pictures of healthy fetuses and sad pictures of aborted ones, they stood outside in the damp cold of that Friday morning.

Some knelt on the chill, gritty pavement, heads bowed, rosary beads threading through their fingers. Others shouted at patients making their way in and out of the clinic. ''Do you know that little babies are dying in there?'' Rosemary Young called to a young woman with a little girl. ''I don't want to hear it,'' the woman shot back. April Dauenhauer, another protestor, raised her eyes imploringly: ''If somebody was murdering me on the sidewalk right now, would you ignore it?'' ''You bet, because you asked for it!'' the woman snapped, and the clinic door closed behind her.

The protests started more than two years ago. Since then, on those days when Dr. Bours performs abortions, a loose coalition of Roman Catholics and evangelical Christians has set up a gauntlet at the driveway entrance. On Mother's Day weekend, 1984, two primitive firebombs ignited against a wall of the clinic. Several death threats have been made against the doctor and his family, his staff, and even some of the young mothers whose babies he has delivered.

None of that has dissuaded Dr. Bours from doing abortions, but the violence and the protests at his office did reduce the number of expectant mothers who came to him for care. Now, caught in the same insurance squeeze that has led other doctors to leave the field of obstetrics, he has decided to stop delivering babies, devoting himself almost entirely to family planning, including the practice of abortion.

Inside the clinic, on this Friday noon, the woman who wanted no more children had been prepared for an abortion and for a tubal ligation.

When all was ready, Dr. Bours - a bearded 41-year-old with sandy hair and intense blue eyes - began the procedure. Ten or 11 weeks before, a sperm loosed inside the woman had joined with an egg in that space medical science knows as the uterus, but which antiabortionists call the womb. Out of that union came what medicine terms an embryo - to antiabortionists, it is a baby. Now, Dr. Bours reversed the process, suctioning the tiny form into a clear glass jar.

It took only a few minutes, this procedure sanctioned by law and repeated hundreds of thousands of times each year across the nation. For Dr. Bours, it is part of a modern family practice; to those men and women outside the clinic, it is murder. And the conflict at the driveway has spread through the small college and farming town, booming out on the evening news, turning the letters page of the local newspaper into a polemical battleground, inspiring opposing petitions circulated among the town's 11,500 residents.

In one form or another, the confrontation over abortion has found its echoes in dozens of communities across the nation.

There have been some 30 cases of bombing, firebombing and arson at clinics during the last three years. In Alabama, a Roman Catholic priest smashed up a clinic with a sledgehammer. The operator of an Illinois clinic and his wife were kidnapped. Patients at a clinic in the state of Washington had their phones tied up by as many as 700 anonymous callers. In Texas, an arsonist's work at a clinic spread to and burned down a small shopping center. Pickets march outside scores of doctors' offices and clinics, and more and more doctors report personal threats. The public anger and conflict grow.

Just last month, the Justice

Department asked the Supreme Court to overturn its 1973 decision that established a constitutional right to abortion.

If the Court did that, the legality of abortion would again become a matter of state law, and in many states at the time of the decision abortion was still a crime.

Like other standard medical procedures, abortion is normally a private matter, quietly practiced, seldom discussed by the either the women or the doctors involved. But now, to meet the attacks of the antiabortionists, women are being urged to speak out - Eleanor Smeal, the newly elected president of the National Organization for Women has vowed that defending a woman's right to abortion will be a top priority for her. And Peter Bours, who once felt reluctant to enter the public debate, has changed his mind. ''I think we have to,'' he says. ''Being low-key hasn't helped.''

THE COURSE OF PETER BOURS'S life in many ways seems to have led him inex (Page 2 of 6)

He grew up in the graceful countryside populated by executives and family members of the Du Pont Company outside Wilmington, Del. Peter's father, William Alsop Bours III, joined the company after graduating from Princeton and Columbia, and eventually became a vice president. His son was christened William Alsop Bours IV, but the family called him Pete, and as an adult he chose to be known as Peter.

It was a milieu of handsome homes and pools and tennis courts, of affection for Wyeth paintings, Oldsmobiles and the Republican Party. Like many of his neighbors, Peter Bours went to private schools, and then to college. At Stanford University, he made Phi Beta Kappa his junior year.

That year was 1965, which also marked a political turning point for Peter Bours. ''I remember William Sloan Coffin coming out and speaking,'' he says, recalling the antiwar chaplain of Yale University, now the senior minister at Manhattan's Riverside Church. ''And I remember after that a whole generation of students in protest.'' He became fervently opposed to the Vietnam War, and critical of the society that supported it.

An economics major, Peter Bours did his senior thesis on population control and economic development in third-world countries. It was an interest he brought from home, where his parents had long been active in Planned Parenthood.

At the end of his senior year, the subject of birth control became suddenly personal. ''I was heading off to Boston'' - to Harvard University Medical School - ''and my girlfriend of all four years was heading off to law school at Berkeley. That was the first month we had sex, and she got pregnant.''

In 1966, most abortions were illegal in the United States. It had not always been so. In fact, through most of history, they had been freely practiced. In early common law, abortion performed before ''quickening'' - defined as that point when the fetus begins to move in the uterus at 16 or 18 weeks - was not an indictable offense. In the mid-19th century, as Kristin Luker, a professor of sociology at the University of California at San Diego, points out, a survey showed that between 17 percent and 34 percent of all pregnancies in Michigan ended in abortion. It was not until after the Civil War, in the sway of the Victorian era and at the urging of the recently formed American Medical Association, that the states began passing laws making abortion illegal. The only exception was when a physician determined that an abortion was necessary ''to save the life of the mother.''

In California that spring of 1966, Dr. Bours recalls, ''after some clandestine arrangements, all these furtive plans'' -made through a doctor across the border in Mexico - ''we had to meet these guys in the Los Angeles airport. I had to give them $700, cash.'' His girlfriend flew off to Guadalajara for the abortion, and Peter Bours, with no money for his own airfare, had to wait for her return.

But even then, the abortion picture was changing. Some years before, in Arizona, Sherri Finkbine had discovered that her sleeping pills contained strong doses of thalidomide. Although her life was not at risk, her doctor urged her to abort her fetus, which he felt certain was deformed. Her story, as Kristin Luker puts it, ''forced people to define exactly what circumstances in principle constituted legitimate grounds for abortion.''

Then, in California, came an outbreak of rubella, or German measles, also a danger to a fetus. Many doctors considered it reason for an abortion, but the California State Board of Medical Examiners, for one, did not. Seven prominent physicians were charged by the board with performing illegal abortions. In 1967 -urged on by the American Medical Association, the American Bar Association and the American Academy of Pediatrics - Gov. Ronald Reagan signed a law that made abortion legal in California when done by a registered physician in an accredited hospital to prevent physical or mental damage to the woman.

Meanwhile, Peter Bours had settled in at Harvard. His political activism continued, centered on opposition to the war. ''I'm sure I was considered part of the left-wing element of the medical school,'' he says. He also organized a symposium on abortion. ''But that was all from the political end,'' Dr. Bours recalls. ''It wasn't like I ever saw myself being involved in it.''

In 1968, Dr. Bours married his girlfriend from Berkeley days, who had moved to Boston, but the marriage lasted only two years. Then he moved back West, signing on as an intern at the University of California in San Diego.

By then, more than 99 percent of all California women who applied for abortions were being granted them. Abortion on demand had become a reality in California, and a number of other states had enacted similar laws.

Peter Bours had planned to become an orthopedic surgeon, but during his internship and residency in San Diego, he changed his mind. He had married again, and fathered a daughter, Emma, and the experience left him more interested in children, in families and family care, than in bones. When he began to practice, it would be in family and maternity care.

(Page 3 of 6)

In 1973, the Supreme Court issued its landmark abortion ruling. Henceforth, no state could make abortion unlawful except in those instances when the fetus was old enough to sustain life outside the uterus. Before that age -thought to be between 24 and 28 weeks - the decision would rest with the woman and her physician.

F OREST GROVE, some 25 miles west of Portland, is one of a string of small communities clustered along Highway 8 as it strikes through woods and farmlands toward the Pacific Coast. Founded by Congregationalists in the 1840's, washed by a tide of Dutch Roman Catholics who migrated from Wisconsin about a century ago, it is a town of churches. And increasingly, in recent years, the new congregations have been evangelical and fundamentalist. The signs at each intersection along the highway tell the story, pointing the way to the Assembly of God, Central Baptist, First Life Ministries, Hillside Bible, Foursquare Church.

The town's population is layered, too, with lawyers and architects who commute from Portland, students and professors from the town's Pacific University, and farmers. There is also a community of several hundred people, now middle-aged, who split with traditional society during the radical years of the 1960's and 1970's, and settled in Forest Grove to find a simpler life.

Peter Bours, too, was drawn by the uncomplicated beauty of the place. He bought a piece of farmland and an old frame house outside town in 1974 and went into practice. By this time, Dr. Bours was once again single. ''If I weren't such a social traditionalist,'' he says in wry reflection, ''I wouldn't have married so many times.'' And within a few years, he did it again, marrying his nurse, Joan Moss.

Together, they built a family practice based on delivering babies - often, in that era, to couples who wanted their children born at home or in one of the birthing cabins that Dr. Bours fashioned from outbuildings on his property. It was an effort to take obstetrical medicine out of cold, institutional hospital delivery rooms and return it to the home - and it fit with the ideas he had developed during the war years, the search for a redefinition of personal and social relationships.

Few doctors in the area were offering that kind of care. ''So we had a lot of highly educated 30- to 40-year-olds in Portland coming out to have their babies with us,'' Dr. Bours says. For his wife, it was an idyllic time. ''In one year,'' she recalls, ''we did 350 deliveries, and that was in just 365 days. I remember thinking, 'I have the most wonderful job in the world.' '' In time, the couple had their own children, a daughter, Heidi, and a son, William Alsop Bours V. Peter Bours had his own style. He wore loose shirts and comfortable pants and knockaround shoes, almost never a coat and tie. His patients called him by his first name. And he kept his rates low, paying himself less than $50,000 a year, sinking the rest of his income into the new clinic which he built in town, next to the community hospital.

Says the Rev. Richard E. Osburn, pastor of the United Church of Christ, whose congregation supports the right to abortion, ''A lot of people considered Peter a strange duck. Different.'' When the town police would stop Dr. Bours for speeding on the way to a delivery, recalls the minister, a former chaplain of the police force, the doctor would inform them that he would meet them the next morning if they wanted to give him a ticket, but that at the moment he was in a rush. ''I know that a lot of the officers think of Peter as thinking he's above things,'' the minister says.

Dr. Bours's practice flourished. His new office and patient rooms were bright and cheerful, crammed with snapshots of pink new babies and their beaming parents. And at the top of the building he hung a bell, to ring out the news of birth.

From time to time, women would come to him seeking an abortion. He decided that women who wished to terminate their pregnancies deserved the same guilt-free atmosphere of professional care that women who brought their pregnancies to term enjoyed. ''Then,'' he recalls, ''the Portland Women's Clinic started referring me a regular group of patients each week. Suddenly, I had an abortion practice.'' With its low fees and cheerful atmosphere, it became one of the largest in the state.

Reflecting Dr. Bours's philosophy, the clinic offered women the options of birth control, giving birth, putting the baby up for adoption, or, as a last resort, abortion. One day, he stood quietly at the counter in his outer office with a young father and his son, whom Dr. Bours had delivered six years before. Just now, he had performed the third abortion for the boy's mother. Dr. Bours turned to the father and said, ''I think we need to get you on some kind of effective birth control.''

A doctor who performs abortions confronts a host of personal decisions. The law, for example, permits abortion until the fetus is about six months of age, leaving doctors to decide how late in life's evolution they are willing to terminate a pregnancy.

(Page 4 of 6)

''I don't know where you can draw the line,'' Dr. Bours said at his home one night as he moved about the kitchen, building a casserole. ''I say 12 weeks. Others might say 14, 16 or 18 weeks. When you get beyond 18 or 20 weeks, you get into trouble. I have a practicable kind of morality. The technique changes a lot between 12 and 13 weeks. The complications increase. The amount of pain to the patient goes up.''

And an abortion on an advanced fetus, which has taken on more of a recognizable human form, takes a greater emotional toll on a doctor and his staff. Earlier that day, performing the procedure on the woman who wished no fourth child, Dr. Bours finished vacuuming her uterus, funneling the remains of the fetus into a sock of white gauze, suspended in a jar.

After an abortion, the doctor must inspect these remains to make sure that all the fetal parts and the placenta have been removed. Any tissue left inside the uterus can start an infection. Dr. Bours squeezed the contents of the sock into a shallow dish, and poked about with a finger. ''You can see a teeny-tiny hand,'' he said.

At the sink and sterilizer, where the surgical instruments are cleaned, a nurse stood and turned on the faucet. ''I've been cleaning up after him for four years,'' she said. ''We all wish it were formless, but it's not. It has a form. And it's painful. There's a lot of emotional pain.''

W HEN DR. BOURS began performing substantial numbers of abortions in 1977, there were no organized protests. Most of the women who came to him for deliveries were unaware that he did abortions. But even back then, there were passionate antiabortionists in Forest Grove. They only lacked a target.

Then, in May 1983, the parish priest at Rosemary Young's church invited one of the founders of Catholics United for Life to speak to his congregation. As the visitor talked of the need to save lives by counseling women against abortion, the words tugged hard at Mrs. Young.

At the University of Oregon at Eugene a decade earlier, Mrs. Young and her then-boyfriend, Randy Young, a Southern Baptist, had - like Peter Bours - been part of the student reaction against the Vietnam War, involved in what was then known as the counterculture. They helped collect food to supply the Indian radicals rebelling on the reservation at Wounded Knee, and for a time considered going to live with friends in a commune.

In their junior year they married, and five months later, the 20-year-old student was pregnant. ''I considered abortion, myself,'' she confesses - she had been raised in the Catholic Church, which holds that human life begins at the moment of conception, but her faith had slipped. ''I thought seriously about it. But I knew that I couldn't do that.'' So she bore her child, dedicating herself to house and family while her husband went to work.

Then, Mr. Young decided to take instruction in Catholicism. Mrs. Young went along. ''We had a really nice old Irish priest who answered all our questions,'' she recalls. ''So often you find that so many churches give no absolutes. They gave us absolutes. That's what we wanted. We were sick of searching, and they gave us absolutes.''

Thus, when in May 1983 the priest suggested that the women of the parish might want to meet with the speaker from Catholics United for Life, to discuss what was called ''sidewalk counseling,'' Mrs. Young offered her home as a meeting place. Among those who attended were Jamie Nibbler and Maria Vandecoevering.

''Before I knew it,'' Mrs. Young recalls, ''Jamie and Maria said, 'We'll go and do it - and there's a doctor right here in Forest Grove.' ''

So the picketing outside Peter Bours's office began, pitting the doctor who had hewed to the liberal ideas of his college years against many of his neighbors who had abandoned those same ideas. The protests have had strong support from the Roman Catholic Church. Twice, on the anniversary date of the Supreme Court decision, the Most Rev. Kenneth D. Steiner, Auxiliary Bishop of the Archdiocese of Portland in Oregon, has arrived on the scene to bless the effort. And gradually Protestant fundamentalists joined in the picketing.

Both groups are fiercely single-minded. ''One day,'' Peter Bours recalls, ''they had a 20-week fetus in a bottle. There were some first-graders walking down the street, and they showed it to the first-graders and said, 'This is a baby, and the doctor in there is killing them for $1,000 a baby.' '' (In fact, Dr. Bours's fee is $140.) The most vociferous of the demonstrators has been Michael Thomas Story, who began conducting his own campaign on the days when abortions were not performed. He carried a sign likening the clinic to Auschwitz. He paraded with a cross on which he had crucified a doll splattered with blood-red paint.

Because of Mr. Story, Dr. Bours's children no longer drop by the clinic after school. ''You wouldn't either,'' Dr. Bours says, ''if you had Michael Story yelling at you. Would you want to be a child brought to the doctor's office for an earache and have this man yelling at you that the doctor is a murderer?'' He stopped, his disgust evident. ''I've had a hard time not getting into a fist fight with the guy,'' he said. ''And I haven't been in a fight since I was seven years old.'' In fact, late last month, the two did get into a scuffle.

(Page 5 of 6)

The battle over abortion in Forest Grove has taken a variety of forms. At one point, the antiabortionists started to flood the local weekly, The News-Times, with letters to the editor attacking Dr. Bours and his clinic. Some of his friends got up a petition of support. It drew several hundred signatures. Then the fundamentalist owner of a fast-food store started an opposing petition. It gathered even more names.

The attacks on Dr. Bours in the letters columns grew ever more graphic and angry. Finally, says David H. Baker, the managing editor at the time, ''this elderly lady called me and said, 'Look, I love your paper and I've read it for years and years, but I just can't take this anymore.' And she was crying and sobbing. And I said, 'Oh, God, you're right.' '' When, in May 1984, the clinic was bombed, Mr. Baker, fearing that the letters had become inflammatory, announced a temporary moratorium on them.

The first firebomb attempt came the Friday of Mother's Day weekend; the second, that Saturday. In each case, a plastic 7-Up bottle filled with gasoline was connected to a propane tank and attached to the clinic's outer wall. Each time, the gasoline flamed but the propane failed to explode; the cedar wall was badly scorched.

''The bombings were somewhat upsetting,'' says Dr. Bours's wife, Joan Moss, ''but it was the death threats that changed my feeling -and how we lived.'' The first letter, handwritten on plain paper and then machine-copied, was signed ''The Firebomber,'' and the writer provided exact details of the firebombs' construction.

''In case you haven't noticed,'' the letter read, ''there is an ever-growing militaristic movement against babykillers. You will be stopped. Unless you stop voluntarily upon receipt of this letter, you and your staff will be killed to save the lives of those you would kill. Terrorism? No more than the American revolution was terrorism or the civil war.''

Emma, Dr. Bours's daughter by his second marriage, had just arrived to spend the summer, but her alarmed mother insisted that Emma could not stay in Forest Grove. So the Bourses rented a house 50 miles away on the Oregon coast, and Joan Moss took Emma and her own two children to stay there. ''It was very stressful,'' she says. ''I was very upset.'' Then the second letter from ''The Firebomber'' arrived. This time, Dr. Bours did not tell his wife the details. The letter - describing the story of David and Goliath - promised that since Dr. Bours had not ceased doing abortions, he would be decapitated, and his head would be left in a public place to be urinated on by his enemies.

Peter Bours was with his family in their refuge on the coast, celebrating his 40th birthday, when the next threat came, delivered in person to the Bourses' house in town. As the neighbors described it, ''Someone pulled up in a pickup truck in front of the house at 4 or 5 in the morning,'' Dr. Bours said, ''and revved up a chain saw, and said they were going to kill the whole family.''

Forest Grove's police force of 17 has been unable to find the person or persons who placed the firebombs, sent the letters or showed up with a chain saw. Gary Tyler, the police chief, says that his investigation has been hampered because the antiabortionists will not cooperate; they take offense at being questioned, he says.

Joan Moss's fear for her children lasted until the end of summer, when the family moved back to town. ''And then after two weeks, I had my cancer diagnosed,'' she says. It was breast cancer, the same disease that had killed Dr. Bours's sister Mary Anne in 1980.

The family's focus shifted to the new threat. Joan Moss had a mastectomy, and began chemotherapy treatments. She lost her hair and bought a wig; she rested at home on the days the chemicals made her ill, but continued working in the clinic when she felt well. As the months passed, each Tuesday and Friday brought the antiabortionists back to the clinic, but the family was preoccupied by the more immediate threat. ''The crisis that they are all dealing with, that they know about,'' Joan Moss says simply, ''is my cancer.''

January of this year brought another anniversary of the Supreme Court decision. Peter Bours closed the clinic for the day, but at home that night, on the television news, he saw Bishop Steiner blessing the protest effort. And he saw John David Ott, a new doctor in town, the product of Catholic schools, a former Marine who for a time prepared for the priesthood, standing over a tiny, makeshift coffin with a bugle -blowing Taps.

Says Peter Bours: ''It was gross.'' He called Dr. Ott, a man he saw every day at the community hospital or the community pool where both men swim at noon. They talked, and now Dr. Ott, though still a firm antiabortionist, seems sorry about his performance. Of Peter Bours, Dr. Ott remarks: ''I think he's been the fall guy. I think there's been a witch hunt, and most of the people here are tired of that.''

If anything, Dr. Bours says, the people he sees each day ''seem to know that we're going through a hard time, and most of them seem to go out of their way to be friendly.'' In restaurants and stores around town, friends remain friends, and abortion, Dr. Bours says, ''seems an issue that most people would rather not bring up - which is fine with us because we talk about it plenty anyway.''

(Page 6 of 6)

He is glad that he followed his family's pattern, placing his children in private schools. In public schools, he says, they might be thrown in with the children of the antiabortionists, who ''really do teach their kids that I'm a murderer.'' He has seen the change this message can bring. ''There's a 6-year-old boy that I delivered that I say hello to,'' Dr. Bours says, ''and after the last newspaper article came out, he wouldn't look at me. That's the hardest thing for me, because I've always prided myself on my relationship with kids. It hurts me.''

Dr. Bours's practice has been affected. Not his abortion practice, he says -''That doesn't seem to have been affected at all.'' But deliveries fell from about 300 cases a year to 150 or fewer. ''The major dropoff,'' he is convinced, ''was because of the protest and the controversy. About half are people who are against abortions and didn't realize I was doing them all that time. And the others simply worried that someone was going to try to blow the place up while they were in there.''

Meanwhile, the controversy goes on. The protestors picket. The newspaper again prints letters of protest. And the threat of violence remains.

The Rev. Stan Doland, until recently the pastor of the Foursquare Church and now a missionary, said: ''The Marines, that's what I call them. I don't think the Marines around here will let up until he goes out of business, or quits doing abortions, or -God forbid - something violent happens.'' The church is against abortion, but the minister - whose son was delivered by Peter Bours before the pastor knew the doctor performed abortions - cannot bring himself to call it murder. ''Peter honestly believes what he is doing is right,'' the minister says.

O NE AFTERNOON, Rosemary Young spread across her kitchen table snapshots of a handful of women who had been persuaded not to have abortions. She pointed to a photograph of Kimberly Crutsinger, 19 years of age. ''She comes over quite frequently,'' Mrs. Young said. ''She'll probably need our help for quite some time.''

Then Kim Crutsinger arrived, carrying her baby, Amber Christina. She has a 3-year-old son as well. Her husband, who was furious that she chose to have Amber, left, returned, left again. He had no job. Neither did she, and she was pregnant again. ''Everything seems so dark, now, but I don't regret having them at all. It's a responsibility,'' she said, her eyes shining, ''but it's a joy, too.''

She is living on welfare, in an apartment of her own. ''For the two children, I get $386 a month, plus food stamps. And I have car insurance to pay.'' It wasn't enough. She smiled uncertainly, and turned to give Mrs. Young some news: ''They are coming to get the furniture today.''

Mrs. Crutsinger's fortunes have since changed again - her husband is back, the new baby has arrived and the furniture is safe. But it is the kind of case history she represents that supports Peter Bours in his conviction that abortion serves a moral need. He sees women every day, he says, for whom ''unwanted pregnancies are a real disaster. So for me the continuing experience of being involved in this area further reinforces my feeling that this is right.''

For a time, under the pressures of his day-and-night practice and the protests and the worry about his wife's cancer, he considered going into industrial medicine or some other kind of private employment, or simply moving his practice to a high-rise building in downtown Portland. But this is home. ''We couldn't replace the friends we have here,'' he says.

He could, however, change his practice, and he did. After 2,200 births, he decided to stop delivering babies.

Since April 1, he has accepted no more pregnant women for obstetrical care. Dr. Bours will confine himself to the other elements of family practice, specializing in ''women's health care, family planning, birth control, and the main business we have been doing, abortions and tubal ligations and vasectomies.''

The reason for the change is grounded in a national trend - the huge increase in malpractice suits and, as a result, an enormous rise in the cost of malpractice insurance. ''For a doctor doing the work of an OB-GYN in Oregon in the last three years,'' Dr. Bours says, ''malpractice premiums have gone from $6,000 to $30,000 this year. And it's expected to continue to go up.''

In fact, for many doctors -particularly those who do large numbers of procedures, as Dr. Bours does, and for those who deliver babies - it has become more and more difficult to obtain malpractice insurance at all.

In the first week of July, Dr. Bours went to court to defend himself against a three-year-old lawsuit brought by the parents of a child whose scalp had been scarred in a difficult delivery. ''The estimated cost of repairing the scar was $4,000,'' Dr. Bours says, but the parents had sued him for $450,000. The jury found him blameless, but the case made it more difficult for him to get malpractice insurance.

To deal with the problem, Dr. Bours established a new maternity care practice in his clinic, under the direction of a nurse-midwife, who could more easily obtain malpractice insurance. But now midwives are experiencing the same insurance problems. The new maternity center has received a 60-day cancellation notice from its insurance carrier, ''and if a new form of coverage cannot be found,'' Dr. Bours said last month, ''then we'll be out of that business altogether.''

On July 6, Dr. Bours turned 41. ''At about midnight,'' he says, as they were celebrating at home, ''I got called off and had to go deliver a baby.''

Now he has only a few more expectant mothers left in his care. But the prospect that he will deliver no more babies beneath the bell he erected years ago to ring out the news of birth does not dismay him as it would have once.



''I have a certain sense of relief at this point,'' Peter Bours says. ''We need time to focus on the family.''

Photo of Protestors outside Peter Bour's clinic (Paul Fusco/Magnum); Photo of Clasping hands of a women and a nurse; Photo of the doctor performing a tubal ligation (page 20); Photo of the doctor visiting with a family (page 21); Photo of an antiabotion activist praying outside his clinic (page 22)


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