Virginia ultrasound bill at odds with medical standards

"Vaginal penetration" appeared in news headlines Wednesday, following the Virginia House's passage of a bill that mandates that all women seeking an abortion must first undergo a diagnostic examination using an ultrasound at least two hours before going forward with the scheduled abortion. The purpose of the proposed law as stated in the bill is "to determine gestation age" of the fetus.

During the floor debate, state Del. David Englin (D-District 45) said in the first trimester -- when most abortions occur --  the standard "jelly on the belly" ultrasound is not always effective. More invasive trans-vaginal ultrasounds, he said, might be necessary in order to satisfy the requirements in the bill, even though they are not recommended in the standards maintained by the country's primary network of the obstetrician-gynecologists.

Before the House passed House Bill 462, sponsored by Del. Kathy J. Byron (R-District 22), known as "Abortion; informed consent," Englin introduced an amendment stating that a medical professional "shall not perform an ultrasound requiring vaginal penetration without the prior written consent of the pregnant woman." The amendment also stated that if a "fetal ultrasound image can only be obtained with an ultrasound requiring vaginal penetration and the pregnant woman declines to provide written consent to an ultrasound requiring vaginal penetration, then ... fetal ultrasound imaging for the purpose of determining fetal age shall not be required."

The amendment failed. As the Richmond Times-Dispatch reported, Byron countered the argument against forced trans-vaginal sonograms with the argument that abortion itself is an invasive procedure.

Byron did not respond to repeated requests for comment.

The American Congress of Obstetricians and Gynecologists, a professional association of more than 55,000 doctors, has general standards for ultrasonography in pregnancy, including when it is appropriate to administer a trans-vaginal ultrasound versus a trans-abdominal ultrasound, i.e., the "jelly on the belly" ultrasound typically seen in movies.

In 2009, ACOG published a "practice bulletin" developed collaboratively with the American College of Radiology and the American Institute of Ultrasound in Medicine. For first-trimester ultrasound scanning, ACOG recommends trans-vaginal or trans-perineal scanning if the trans-abdominal exam is not definitive. ACOG offers a list of 12 "indications" for doing this type of scan, which include attempts to confirm a suspected ectopic pregnancy, to assess for fetal anomalies, to evaluate vaginal bleeding or pelvic pain, or to estimate gestational age. ACOG spokesperson Amanda Hall pointed out to The American Independent that abortion is not on the list of indications for a trans-vaginal sonogram.

On its website, ACOG has a patient education pamphlet on induced abortion, which notes that most abortions are performed in the first 12 weeks of pregnancy.

Before the procedure, a test is done to confirm the pregnancy. The doctor will ask questions about your health and perform a physical exam. Blood tests will be done. An ultrasound exam may be done to confirm the date of the pregnancy. In most cases, a counselor is available to answer any questions.

NARAL Pro-choice Virginia was among the abortion-rights groups that blasted the Virginia House decision, accusing state lawmakers of mixing medicine with politics.

"These politicians are effectively trying to enter the role of physician; they didn't go to school to become a gynecologist," NARAL spokesperson Sean Holihan said. "What we are opposed to is a woman getting an invasive procedure done with no exceptions, against her will."

Rose Codding, director of patient services at Falls Church Healthcare Center, an OB/GYN and abortion clinic in Falls Church, Va., told TAI that she thinks the new law is burdensome to low-income women or women who live far away from the closest abortion provider. A woman wanting an abortion will now have to make an extra appointment with her physician, she said, and depending on the circumstance, either she or her insurance company would have to pay for the appointment and the ultrasound.

Codding said at her clinic, ultrasounds are used in the case of abortion at the doctor's judgment or if a patient requests it.

"All practices should be patient-focused," she said. "This is absolutely an admission by the state legislature that they don't trust women."

In January, Codding mailed an open letter to legislators in Virginia asking them to reconsider the mandatory-ultrasound legislation. She provided TAI with a copy of the letter, which reads in part:

The Sono legislation being considered in Virginia is insulting to women. The law is offensive to physicians. These bills are not related to medical necessity nor to informed consent and they disregard women’s feelings and wishes. They are not related to good healthcare and disregards physician’s expertise and specialized training. The people who support these legislations need to stop pretending it is about informed consent and woman’s health and safety. Women who seek abortions know they are pregnant. Women do not choose abortion lightly. It is an emergency medical treatment – they have done everything right and yet have a pregnancy that is going wrong or may endanger her health or because of failed contraception or became pregnant from untoward circumstances. They know if they continue being pregnant the odds are that they will have a baby. Because they know this they are seeking an abortion. Women know the facts; 60% of our patients at FCHC [Falls Church Health Care] are mothers already. They have seen many ultrasounds; they know exactly what a developing embryo or fetus looks like; they know what a baby looks like. And because they know exactly what is involved in caring for a child, they are seeking to terminate their pregnancy.

Women have always had and needed abortions. Restricting access, cutting off insurance coverage, shaming and insulting women, and promulgating targeted regulations against abortion providers – none of it prevents abortion. It just threatens women’s lives and threatens their families. Making women see a sonogram and wait 24 hours (which may in fact be much longer)  is not going to change her mind about her abortion. All it can really do is add another obstacle for her to navigate, and in the process, make her feel devalued and disrespected.

Women will do whatever it takes to get an abortion when they want or need one. They already fly or drive hundreds of miles to get the care they need, they already borrow money to help pay for their abortion. They sign whatever paperwork they have to, they listen to whatever script they have to, they come in how ever many times they have to. And now they may have to make another trip, drive more, sign more forms, pay for more childcare, sign that they don’t want this as part of their informed consent.. (In fact this is an obvious misuse of informed consent which is to specify benefits, side effects and risks of a medical treatment…a sonogram does none of that).   But still, women will need abortions and women will do whatever it takes to terminate a pregnancy when they know in their hearts and minds, through their Faith and soul, that it is not time for them to bring a life into this world through their bodies. They always have, and they always will. Making a decision NOT to continue a pregnancy IS an ultimate act of motherhood.

Codding said she received no response from any of the legislators that sponsored or supported the ultrasound bill.

TAI reported recently that an ongoing study out of the University of California - San Francisco has found evidence that ultrasound images do not directly influence a woman’s whether or not to have an abortion, at least not in most cases.