Scary side of Virginia ultrasound law

[Witsec1]

The bill passed the House, but hasn't been approved by the Senate.

Since most abortions are performed early, the TV ultrasound would be required. The VA law would prevent doctors from practicing evidence-based medicine.

By Amy Norton

NEW YORK | Wed Dec 8, 2010 5:16pm EST

(Reuters Health) - Women seeking medical abortion, sometimes called the "abortion pill," often first undergo an ultrasound test, but a new study suggests that may be an unnecessary step.

In the U.S., medical abortions can be performed within nine weeks of the first day of a woman's last menstrual period. Most medical abortions involve taking the drug mifepristone (Mifeprex) followed by misoprostol, which causes the womb to contract.

There are no official guidelines stating that women should first receive an ultrasound. But because ultrasound is the most precise way to determine how far along a pregnancy is, it has become common practice for providers to perform one. Most women who seek the abortion pill at Planned Parenthood clinics, for instance, undergo ultrasound.

However, ultrasound adds to the cost of medical abortion, which in the U.S. ranges from $350 to $650, and may be more depending on what tests or exams are done, according to Planned Parenthood.

And ultrasound may not even be available in some parts of the world. So the common belief that women need an ultrasound may be a barrier to receiving a medical abortion, according to the researchers on the new study, led by Hillary Bracken of Gynuity Health Projects in New York City.

Gynuity is a non-profit research organization that focuses on reproductive health services.

Bracken and her colleagues tested whether a woman's estimate of her last menstrual period, along with a physical exam, is enough to judge her eligibility for an early abortion using mifepristone and misoprostol.

The study, published in the obstetrics journal BJOG, included 4,484 women seeking the abortion pill at any of 10 U.S. family planning clinics, including eight Planned Parenthood clinics.

Providers at the study sites -- most often nurse-midwives, nurse practitioners or physician assistants -- asked the women to give, or estimate, the date of their last menstrual period and performed physical exams. The women then underwent ultrasound.

Overall, only 1.6 percent of the women would have been given the abortion pill beyond the standard nine weeks if their providers had relied on their estimates and a physical exam alone.

And even in those cases, all of the women except for one were within the 11th week of their last menstrual period -- a point at which, studies show, the effectiveness of medical abortion is still high, without an increased risk of complications.

Overall, medical abortion is effective 97 percent of the time, with failed attempts followed up with a surgical abortion. After the ninth week of pregnancy, that effectiveness may begin to wane, "but it is not a steep drop-off," Bracken said in an interview. "Any reduction in efficacy would be gradual."

The findings, she said, indicate that doctors and other providers who lack ultrasound equipment can still "feel safe" in offering medical abortion. And that could help broaden access to medical abortion in rural parts of the U.S., as well as developing countries where ultrasound would be largely unavailable.

[smores]

I am sick over this, and while debating it on a mommy board, it makes me completely disgusted how many people cannot see that the real problem is the scope of government. You know what, fine, be against abortion if you want. Do NOT blindly support laws "for your side" to the point that government begins practicing medicine and changing the rights that people have for proper medical care.

This and the many blind supporters of this act disgust me.

[Witsec7]

http://www.nbcwashington.com/blogs/firs ... 37008.html

Someone will need to correct me if I'm wrong, but I had learned that pregnancy occurs after a fertilized ova implants on the uterine wall. So these folks are changing medical definitions as well?

[emmiedahl]

That is my impression as well; conception =/= pregnancy in most cases.

[chiccy]

The bill passed the House, but hasn't been approved by the Senate.

Since most abortions are performed early, the TV ultrasound would be required. The VA law would prevent doctors from practicing evidence-based medicine.

I'm a bit confused; some of these sources are saying that ALL abortions will now require a TV ultrasound. I thought that was what the part about "doctors not being allowed to determine if other methods could produce the images" was about.

[Witsec7]

So if this personhood law passes, will folks with fertilized ova in cryo storage be able to claim the blastocysts as dependents on their tax returns in VA? Include them on their health insurance policies?

[No Fun My Babe]

Would the fertilized eggs qualify for the Gerber Life Savings Plan? I should call and find out. I hope someone tries to claim their eggs on their tax return, I would love to see what happens.

And that was my understanding as well, regarding pregnancy. But we all know politicians know more than doctors and science.

[quiningseven]

I'm a bit confused; some of these sources are saying that ALL abortions will now require a TV ultrasound. I thought that was what the part about "doctors not being allowed to determine if other methods could produce the images" was about.

Yeah, I don't get that either... Not to mention traditional ultrasound can detect the yolk sac a week after a missed period and a fetus two weeks after, TV can detect about a week earlier so I don't buy that this is either forced, nor that tv would be the only option in the vast majority of cases.

[Austin]

Maybe I'm being too optimistic, but I think this legislature and others like it are shooting themselves in their collective feet. Americans do NOT want this personhood legislation. It has been voted down more than once, and in incredibly conservative states with lots of anti-choicers, like Mississippi. Legislators are supposed to be representing their constituencies. This is not what their constituencies want, if those failed referendums are any indication.

[Patsy]

It was my understanding that rape required lack of consent. By calling a vaginal ultrasound rapes when it is a prerequisite for abortion you are implying that women are either incapable of giving consent, that they are being held down and forcibly penetrated when they do not consent, or that not being able to procure an abortion is enough of a duress to constitue rape.

I definitely think it is. Some old back alley abortionists used to force women into oral sex or no abortion. You about to tell me that isn't rape, because they could have said "Nah, won't have an abortion, bye"? If a doctor genuinely determines it to be medically necessary and says "I'm sorry, but this procedure is required before I can do that one," that's entirely different to legislators who don't know a damn thing about the individual medical facts forcing every woman into the procedure, legally.

The idiotic conflation of conception and pregnancy by Bill 1 just shows that these people aren't medically literate. And shouldn't be making medical decisions for others.

[Witsec1]

I'm a bit confused; some of these sources are saying that ALL abortions will now require a TV ultrasound. I thought that was what the part about "doctors not being allowed to determine if other methods could produce the images" was about.

Here's my understanding - the law doesn't state what form of ultrasound should be used. Englin introduced an amendment that specifically required the TV probe not be used if the images could be obtained without it, and that written consent be obtained if the TV probe had to be used. So the legislature had a chance to specify the least invasive imagery be used, but they chose not to.

There was also some language in the bill about the level of detail in the imagery that is required, I don't know if that would affect the type of ultrasound.

I'm not going to try to sound like a medical expert because I'm not. It does sound like there is some research showing that medical abortion without ultrasound can be safe, and would allow women with less access to health care (poor/rural, etc) a safer, less invasive way to terminate a pregnancy.

And by the way, Geniebelle, you don't get to end with "agree to disagree" when you start out accusing others of not giving a damn about women's health.

[chiccy]

Here's my understanding - the law doesn't state what form of ultrasound should be used. Englin introduced an amendment that specifically required the TV probe not be used if the images could be obtained without it, and that written consent be obtained if the TV probe had to be used. So the legislature had a chance to specify the least invasive imagery be used, but they chose not to.

There was also some language in the bill about the level of detail in the imagery that is required, I don't know if that would affect the type of ultrasound.

Thanks. It is kind of confusing/misleading the way news outlets are saying "TV ultrasound will be required before [any] abortion." They shouldn't write that.

It just goes to show that Englin's amendment really was a minute (and, of course, entirely reasonable) change to the bill. The fact that the Republicans shot it down makes it really clear what the Republicans care about here: punishing women for getting abortions, and chipping away at Roe v. Wade absolutely anywhere they can.

[quiningseven]

I definitely think it is. Some old back alley abortionists used to force women into oral sex or no abortion. You about to tell me that isn't rape, because they could have said "Nah, won't have an abortion, bye"? If a doctor genuinely determines it to be medically necessary and says "I'm sorry, but this procedure is required before I can do that one," that's entirely different to legislators who don't know a damn thing about the individual medical facts forcing every woman into the procedure, legally.

The idiotic conflation of conception and pregnancy by Bill 1 just shows that these people aren't medically literate. And shouldn't be making medical decisions for others.

Then you are saying that clinics that require ultrasound before an abortion procedure are raping patients, (as at least some of those ultrasounds will be medically unnecessary) even if a client can refuse the procedure or return later for a less invasive ultrasound. Why not also say that clinics that don't offer medical abortion are also raping patients, since a more invasive d&e is often unnecessary? For that matter, clinics that require a pelvic exam could be said to be raping patients as there was a recent study that found only around 1% of self reported menstrual cycles were off enough to move pregnancy out of the appropriate window in patients given abortive drugs. Personally, I find that kind of silly, and think women are perfectly able to give consent to a medical procedure that may prove superfluous.

[Witsec1]

Then you are saying that clinics that require ultrasound before an abortion procedure are raping patients, (as at least some of those ultrasounds will be medically unnecessary) even if a client can refuse the procedure or return later for a less invasive ultrasound. Why not also say that clinics that don't offer medical abortion are also raping patients, since a more invasive d&e is often unnecessary? For that matter, clinics that require a pelvic exam could be said to be raping patients as there was a recent study that found only around 1% of self reported menstrual cycles were off enough to move pregnancy out of the appropriate window in patients given abortive drugs. Personally, I find that kind of silly, and think women are perfectly able to give consent to a medical procedure that may prove superfluous.

I think Patsy was responding to the second part of your statement, the part that I bolded.

Look, I think we all accept that there is some gray area on what tests are "medically necessary". When that decision is left open to doctors, I think there is more possibility that this determination will move in a direction that follows the scientific evidence. Without this law, a doctor would have the leeway to waive an ultrasound in the case of, for example, a very young rape victim. Without this law, the standards of medical practice could change so that ultrasound isn't required for most medical abortions (which even you agree the research shows)

[Witsec1]

around 1% of self reported menstrual cycles were off enough to move pregnancy out of the appropriate window in patients given abortive drugs.

Going back to this. You see nothing too get all upset about in a law that fixes this requirement and does not leave the medical profession the discretion to change their practice when the evidence points out that a procedure is unnecessary.

Personally, I find that kind of silly, and think women are perfectly able to give consent to a medical procedure that may prove superfluous. :oops:

And that's why we don't have to require their written consent! Makes perfect sense.

[heartmom]

I had an abortion, in Colorado, last July, and I had to have one to "date" the pregnancy. The Tech was nice apoligized but it was not something I wanted done. In my case, the fetus had a defect that was not conpatable to life. This law is another way to chip away at reproductive rights. :evil:

[Rosa]

Then you are saying that clinics that require ultrasound before an abortion procedure are raping patients, (as at least some of those ultrasounds will be medically unnecessary) even if a client can refuse the procedure or return later for a less invasive ultrasound. Why not also say that clinics that don't offer medical abortion are also raping patients, since a more invasive d&e is often unnecessary? For that matter, clinics that require a pelvic exam could be said to be raping patients as there was a recent study that found only around 1% of self reported menstrual cycles were off enough to move pregnancy out of the appropriate window in patients given abortive drugs. Personally, I find that kind of silly, and think women are perfectly able to give consent to a medical procedure that may prove superfluous.

My guess would be that, if a patient had a real problem with vaginal ultrasound, a clinic that requires ultrasounds as part of their standard of care would work with her to make it less traumatic, and possibly even waive the requirement - though they have to fear that any patient asking them to change any standard procedure is trying to run a pro-life "expose" (like "I was actually 13 weeks pregnant and they gave me an abortion as if I were only 12 weeks along! Close 'em down!!!!!") that they might tell the patient they had to find another provider.

But NO clinic is going to do a procedure on an unwilling patient. An abortion clinic, because they are so vulnerable to attack, is actually far, far, far less likely to do anything without specific consent than just about any other medical caregiver (such as a dentist, who are sometimes very high-pressure, or a regular OB/GYN, who I've experienced them wanting to do procedures like pinch biopsies without actually saying what they are or being willing to stop when I say to stop.)

[Patsy]

Then you are saying that clinics that require ultrasound before an abortion procedure are raping patients, (as at least some of those ultrasounds will be medically unnecessary) even if a client can refuse the procedure or return later for a less invasive ultrasound. Why not also say that clinics that don't offer medical abortion are also raping patients, since a more invasive d&e is often unnecessary? For that matter, clinics that require a pelvic exam could be said to be raping patients as there was a recent study that found only around 1% of self reported menstrual cycles were off enough to move pregnancy out of the appropriate window in patients given abortive drugs. Personally, I find that kind of silly, and think women are perfectly able to give consent to a medical procedure that may prove superfluous.

Yes, FloraPoste is right to say that I was responding to the decision being made under duress, due to the fact that any abortion would require it.

Of course, that can lead to questions of availability - what if you have a doctor who is the only effective possibility of abortion for a large number of a population, due to living in a small, conservative town, or working in the only clinic that is affordable?

I don't think it's rape if it's medically necessary and therefore consented to.

I don't think it's rape if it's medically necessary and therefore consented to: Even though people have expressed their wariness at terms like 'birth rape' in this thread itself, I think it's perfectly valid to refer to a non-consensual exam as rape. I'm aware that people use the term to mean other things, and I'm aware that people imply that it's somehow analogous to other rapes, but in the black-and-white basic view of it - yeah, I think that's rape. But a doctor saying "We're planning to do X procedure tomorrow, it's medically necessary to do this exam today" isn't the same as a law requiring all women to undergo a procedure for political reasons, regardless of what their doctor thinks.

I do understand that it's complicated. I've already mentioned two incredibly prickly discussions (economic/availability coercion, birth rape), and there are plenty more in there. But yeah, I think forcing women to undergo sexually penetrative procedures is rape, and I do think you can draw a line and be okay with some doctors saying "Unfortunately, sometimes it's medically necessary and you're not going to be able to receive the treatment you desire without that step" without saying it's okay to legally force women into such things for no good reason.

I guess my own personal feelings (which isn't a good way to frame the discussion, but might help explain where I'm coming from) are that my one pelvic exam/paps smear was painful and quite uncomfortable (in spite of the genius nurse and her expert ways), but I initiated it for health reasons and consented fully. If I was going in to get a repeat of my beloved The Pill and had to have one, not because my genius expert obgyn had good reason, but because some assholes were forcing him into it by law... I wouldn't be bracing myself beforehand and calmly capable during, and you could count my consent as true consent in the sense that I really did know what was going to happen and really did agree to it to get what I needed, but if that consent was necessary for untruthful, disrespectful and utterly irrelevant reasons, then yes, I think that consent was coerced. I think it's unfair. And I do think that forcing any woman into medically unnecessary ultrasounds is bullshit, and forcing all women into medically unnecessary internal ultrasounds is rape.

Which I hope helps to explain why I don't think it's rape if it's medically necessary and therefore consented to, as well.

[quiningseven]

Do you think requiring pap smears for birth control is also rape? It seems an analogous situation as it is coercive, and also unrelated to the safety and efficacy of the pill. It is not medically necessary, though it is recommended. I guess I don't really see the difference, though I really am trying to understand where you're coming from.

[Witsec7]

I had an abortion, in Colorado, last July, and I had to have one to "date" the pregnancy. The Tech was nice apoligized but it was not something I wanted done. In my case, the fetus had a defect that was not conpatable to life. This law is another way to chip away at reproductive rights. :evil:

In the way back dayz (1983) when I had my abortion, I never had an ultra sound. I was about 19 days pregnant.

[MadameX]

Do you think requiring pap smears for birth control is also rape? It seems an analogous situation as it is coercive, and also unrelated to the safety and efficacy of the pill. It is not medically necessary, though it is recommended. I guess I don't really see the difference, though I really am trying to understand where you're coming from.

This isn't a law that a bunch of non-doctors decided. It's a practice some doctors deem medically necessary, others don't and do not require it.

What sort of ultrasound, and whether one should be performed, should be between a woman and her doctor. End of discussion.

[Patsy]

Do you think requiring pap smears for birth control is also rape? It seems an analogous situation as it is coercive, and also unrelated to the safety and efficacy of the pill. It is not medically necessary, though it is recommended. I guess I don't really see the difference, though I really am trying to understand where you're coming from.

I appreciate that, because I don't seem to be explaining myself well on this one.

And in answer to your question: not quite.

Easy to miss in my wordy word words:

If I was going in to get a repeat of my beloved The Pill and had to have one, not because my genius expert obgyn had good reason, but because some assholes were forcing him into it by law... you could count my consent as true consent in the sense that I really did know what was going to happen and really did agree to it to get what I needed, but if that consent was necessary for untruthful, disrespectful and utterly irrelevant reasons, then yes, I think that consent was coerced. I think it's unfair. And I do think that forcing any woman into medically unnecessary ultrasounds is bullshit, and forcing all women into medically unnecessary internal ultrasounds is rape.

If a doctor refused to give out birth control unless it was consented to, I'd think it was skeevy as hell, because that's rather extreme. You'd need special reason for it to be medically necessary, especially so medically necessary that a doctor wouldn't be willing to waive it. If it wasn't the doctor's medical desire but some arbitrary ruling from on high that had nothing to do with the individual's health, then: more so. Or rather, yes.

I realise that it probably seems weird to be suggesting that motivation should be at all relevant to whether or not it's rape, but in this situation, where you're talking about pap smears/internal ultrasound that is medically necessary (and therefore pushed on someone, obviously), then I think whether or not it actually is medically necessary is definitely relevant.

I don't have a problem with any doctor thinking that ultrasounds and other diagnostic exams should be used in order to provide the best possible service. I do have a problem with idiots who have no clue what goes on in a general pregnancy or abortion, much less the indiviual patient's pregnancy or abortion, legislating for every single case, with no medical knowledge. They're not even a bunch of doctors deciding on recommendations in a hospital, they're a bunch of non-medical, seemingly clueless politicians who are not voting on this for medical reasons at all.

[quiningseven]

If a doctor refused to give out birth control unless it was consented to, I'd think it was skeevy as hell, because that's rather extreme. You'd need special reason for it to be medically necessary, especially so medically necessary that a doctor wouldn't be willing to waive it. If it wasn't the doctor's medical desire but some arbitrary ruling from on high that had nothing to do with the individual's health, then: more so. Or rather, yes.

Thank you for explaining it better, I do see better what you mean. I could potentially envision a case where a clinic might be rigid in requiring a recent pap in order to dispense oral contraceptives (perhaps for liability reason?), and I still wouldn't consider it coercion... But honestly I don't know that that would really happen in practice. The ability for a patient to opt out of a TV ultrasound, and still receive an abortion after a traditional ultrasound seems to remove some of that rigidity from this law as well.

I don't have a problem with any doctor thinking that ultrasounds and other diagnostic exams should be used in order to provide the best possible service. I do have a problem with idiots who have no clue what goes on in a general pregnancy or abortion, much less the indiviual patient's pregnancy or abortion, legislating for every single case, with no medical knowledge. They're not even a bunch of doctors deciding on recommendations in a hospital, they're a bunch of non-medical, seemingly clueless politicians who are not voting on this for medical reasons at all.

So much word to this.

[treemom]

In almos decade and a half that I have has an abortion and have spoken out about an abortion I have never encountered anyone who was not medically screened before their abortion. I am sure it happens, because if we can think of it it likely has happened at some point.

But you don't need to legislate doctors get medical history and do an exam before an abortion. Doctors do that. It is part of the standard of care. It seems like geniebelle's view of ob/gyns who perform abortions are of some back alley sadist.

Personally, because of the fact I had such a late term abortion I had to submit all my medical records before I even travelled to Kansas. And then I had an exam. No u/s (I had had...oh like 10 at this point) except for what was needed to stop the heart.

[treemom]

In the way back dayz (1983) when I had my abortion, I never had an ultra sound. I was about 19 days pregnant.

They rarely do them that early anymore because the risks of perforated uterus.