The Virginia abortion ultrasound law is still wrong, but there is a silver lining

Gov. Bob McDonnell backed off on the Virginia abortion ultrasound bill. His requested amendments to the House of Delegates took vaginal ultrasound off the table and the bill passed in a vote of 65-32.

It is important to put this change in perspective.

The initial wording of the bill did not mention vaginal ultrasound, it specified an ultrasound  most “appropriate” for determining gestational age. For many women that would have meant a vaginal probe, as a vaginal ultrasound is often the most accurate way to determine gestational age in the 1rst trimester. While some women will avoid a vaginal probe because of these changes, many women getting a 1rst trimester will get a vaginal ultrasound as part of their routine pre-abortion care. So, it is hard to know how many vaginal ultrasounds will actually be avoided by the changes.

In my opinion, changing the bill to expressly exclude transvaginal ultrasound doesn’t improve it much and all the focus on the potential increase in vaginal ultrasounds detracted from other egregious aspects:

  • Politicians are still stipulating how a medical procedure should be performed (the ultrasound requirement). That’s wrong. Medical care should be between a patient and her provider.
  • The added cost that a potentially unnecessary ultrasound imparts. Studies tells us that many 1rst trimester ultrasounds could actually be avoided.
  • The 24 hour delay between getting the ultrasound and having the abortion. Unless of course you live 100 miles a way, then a 2 hour window between ultrasound and procedure is acceptable. The cost and inconvenience of taking an extra day off of work or arranging another day of childcare, never mind the cost of gas for women living 30 or more miles from their provider is obscene. Most counties (88%) have no abortion provider and 97% of non-metropolitan areas are without an abortion provider. This bill unfairly disadvantages women based on geography.

The medical evidence indicates that cost and geographic location do not affect choice with regards to abortion, they only delay the procedure until funds and transportation can be secured. Therefore, this bill can serve no other purpose other than one or all of the following:

  • Punishment of women who choose abortion
  • Imposing the religious beliefs of one group on another
  • Political posturing in an election year
  • Legislation (and rather poor legislation at that) of the practice of medicine

There is one silver lining. People made a lot of noise and it clearly had some impact. Not enough, but some.

And the people who made that noise vote.

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  1. I question whether everyone that disagrees with abortion does so because of religious beliefs.

    I know that is a motivation for many, however, I think one can be pro-life and nonreligious at the same time.
    I agree with all of your other bullet points other than the second one.

      1. Your link does not prove anything, it is only a group of opinions. You can believe that life, as we know it, begins at conception or not. I choose to believe that life as we know it does not begin with one cell, it may be life in that the cell is alive but it is not human life…no heart, brain, consciousness, awareness, ability to feel pain, think, reason, etc.

      2. Unfortunatley, it is not simply a “group of opinions” it is how our Medical Doctors are trained! Those references are from the fetology text books they utilize.

        Re: “it is not human life” of course not! How silly, of me. It is a duck, or whale. Please stop justifying your opinion with facts that cannot be followed to a logical conclusion. i.e. if that one cell grows–does it grow into a tree? A chicken? No. Following the logic to its natural conclusion tells us, yes-even you, that it grows into a human being-Just like you and I.

        There have been many excuse for the murder of our babies and it is time to face the facts, and stop denying that no matter how many cells the baby has, she is still a baby human.

        As a matter of fact, when you qualify your case with “no heart, brain etc” you disprove your own point. The moment a sperm penetrates an ovum a completley new set of DNA is created–One that is NOT the moms nor the fathers. Nor is is whale or tree. It is a completely new human being at the earliest stages of her develpment–just like a newborn grows into a toddler, into a teen, into an adult into an elderly person. Again, still not a tree or whale or chicken.

      3. You are simply taking my comments and twisting them to suit your own agenda. Of course I take responsibility. Think what you will about abortion, I still think it is a woman’s right to do with her body as she sees fit. The problem with abortion will go down when more people have access to contraception and when more young girls understand what they are doing when they have unprotected sex.

      4. I did not take out of context and twist anything. I simply used your logic.

        Pregnancy, abortion and STD rates have gone up with the onset of the sexual revolution, now we are giving away free condoms to 12 year old boys! (MA & CA) We claim we can’t understand why sexual issues keep getting worse so we attempt to solve the problem by giving them access to BC at younger and younger ages when they are less capable, less mature and less knowledgable to understand and take responsiblity. Makes sense, heh?

        How about we teach abstinence, instead. No sex = no pregnancy, no STD and no abortions. But that method doesn’t make anyone, any money.

    1. It should not have anything to do with religion. However for many people it does. Many people think it is a woman’s choice regardless of religious beliefs. As a man I firmly believe only a woman should decide what goes on within her own body. It is her decision and congress, the Supreme Court and anyone else should not take that right away from her.

      1. That sounds like a cop out for a man that doesn’t want to take responsiblity. Or want to have any rights to his children. If you truly believe that, then you must believe that the Gov’t stays out of health care and have women pay for thier own birth control and abortions and men for their own sterilizations.

        Here is an amazing quote from a truly amazing man:

        “I was thinking more about the general population of men. I know there are many men who speak out against abortion, but the average guy seems wholly uninterested in the issue, which I think is very sad. The women’s movement doesn’t want to educate men on the issue for fear that these men may see abortion for what it is and then develop a backbone.

        More specifically, men need to speak-out against the women in the women’s movement who are pro-choice, and not let these women push them into silenece and submission. Too many men feel that they have no say on the topic of abortion. They have sheepishly accepted the “My body/My choice” argument out of fear of being labelled a misoygnist. This fear causes them to be pro-choice. Ironically, howver, this fear and pro-choice perspective leads many of these men to be misoygnists!! Their fear creates a downward spiral into greater and greater immorality for themselves.

        Men need to be taught to no just think of babies, but to think of pre-born babies.

        If we convince men that abortion is wrong, and to be more responsibile sexually the problem of abortion will go down dramatically. This is a challenge for men, which can even be tracked by statistics in order to see how good men are doing.

        Educating men on this issue of taking control of their bodies will perhaps show the pro-choice women that they should respect their own body and the body inside their womb. Right now the North American culture has little respect for the human body, let alone human beings!”

        —Tyler (used with permission)

      2. It is not human life is until it is and that is not at conception. A single cell does a human make. At the time we have a single cell we do not have a human and we may never have a human. Only time will tell. In the meantime, before it becomes able to live outside the womb make a decision.

      3. Abstinence is pie in the sky thinking. Kids will not abstain from sex, but if they are educated about the consequences they might use contraception to prevent an unwanted pregnancy. Glad to see we are giving away condoms to young boys, I was sexually active at age 12. She was my age and initiated it. Sex will not go away and to think it will is not rational. The only hope we have is through education regarding contraception.

      4. When they are raised with morals and values, respect for their bodies they do. There is a natural orde to things whether you admit to it or not.No one said to make it go away, but to abstain until you can pay for your own consequences, and emotionally mature enough to be responsible. pay for your own bc, etc. When you demand that the public pays for your private affairs then demand that the gov’t stays out of your bedroom–you have a double edged sword don’t we. Which way to you really want it? Can’t be both.

        I’d be ashamed to admit what you did–to me it says that you were definately lacking parental involvement, and the girl had no self respect or guidance. If I had to be brutally blunt, I’d guess that there is sexual deviation in your history as well.

      5. Sexual deviation in my history……..are you nuts? Well yes you probably are. I was using that as a point to show that giving boys condoms at age 12 was not a bad idea. Regardless how children are raised they still have interests and desires and they need to know at a young age the consequences of their acts. I don’t want the goven. to pay for anything. Too govern. as is. But if a woman cannot pay for contraception then the govern needs to provide for it in some manner.

  2. Thank you, thank you, thank you for writing this post and your previous one on this bill. As a health sciences librarian, the amount of disinformation about this issue is really quite disheartening. Even (especially!) from mainstream news sources.

  3. The ultrasound laws reflect a particular distrust between the public and abortion providers that is seemingly unique in the healthcare sector. This distrust is not simply predicated on the moral dispute between what constitutes a person and when human life begins or the rights of a person to do what they what with their body. It is far from bumper sticker philosophy simple 40 years after Roe.

    The cash-on-delivery healthcare sector (abortion, elective plastics to name two) have a way of attracting predatory physicians who are in general, not qualified for the procedures that they do, do not have surgical admitting privileges at hospitals and have a tendency to become indicted felons. You do not see this in ortho, peds, general surgery or podiatry.

    Regular abortion providers are unique in that this population routinely include physicians who (1) “Dump” the expected end of their incompetency on E.Rs. (2) Are sometimes one procedure family practice physicians, not residency trained gyn surgeons with surgical admitting privileges (3) Employ non-physicians and non-RNs to perform abortions and administer narcotics. The Gosnell’s indictment is a shocking 281 pages horror and his office was in the middle of Philadelphia. With a 30 year career, he was undoubtedly known in the Ob/Gyn community as one who was a “bit loose” with fetal dating. (4) In 2010 one doc was jailed for manslaughter (5) in January 2012 two physicians were indicted for one and five counts of manslaughter respectively. One doc curiously started an abortion in NJ and attempted to complete it in MD. – a routine practice of his. I will leave it to competent ob-gyn physicians to explain if this accepted practice. (6) Strangely both Brigham and Gosnell had a habit of freezing dozens of aborted fetuses and Gosnell had a jar of preserved fetal feet on his desk. This screams for a high level regulatory oversight and reveals a strange psychology. The fact that Gosnell worked for 30 years and Brigham 15 suggests knowledge of their practices in the medical community. (6) Just this week, Ann Kristen Neuhaus, M.D. lost her license to practice medicine for failing to meet the standard of care 11 times in vulnerable patients between the ages of 11 and 18.

    The distrust between the public and the abortion provider appears legitimate and the ultrasound law, parental notification law, waiting period law, etc., is in part a reflection of that distrust. It is also a transparent strategy to limit access but that strategy is only effective because practices like the above exist for decades and the ob-gyn community – the experts could care less.

    It seems that for the abortion sector of ob-gyn the norm is to ignore problems and to have no standards of care; not even something as simple and as routine as ultrasound, or real surgeons or inspected clinics. It is either the standard of care to ultrasound a woman who is having a uterine surgical procedure or it is not. If not, great, let’s publish a paper and send it to Blue Cross. I am certain that they would be thrilled to disallow any ultrasounds until the 12th week. Maybe a non-continuing pregnancy is not an indication for ultrasound, but I cannot see how one can say in 2012 that it is the standard of care to determine uterine anatomy by physical exam alone or the presence of an ectopic pregnancy by labs and exam alone. In fact, I am yet to see any Ob-Gyn say that ultrasound is not standard, reasonable or necessary in a pregnant patient at virtually any time.

    But when it comes to abortion, no standard of care is fine – and that is distressing.

    In no circumstance would you see family practice docs doing any other surgery. In no ob-gyn practice would you observe intrauterine surgery performed or RU-486 administered without an ultrasound. In no circumstance would you have a surgical procedure started in NJ and completed in MD. In no circumstance would you find a physician dropping off his critical patient to an ER and leave, refusing to offer a history or even his name. In no circumstance would you find a medical practice and an oxcycontin distributorship. In no surgical procedure would you have an imaging procedure that is not reviewed by the surgeon and patient together. But in abortion, this is the stated norm.

    This aspect of healthcare screams for regulatory oversight because leaving it between a patient and her paid in cash doctor is not working very well. Many “good” docs are not interested and woe to the woman who lives in a state that lacks aggressive oversight she may die or be maimed, be treated by a non-physician or have anesthesia administered by a teen. The surgical suite my reek of cat urine and the halls and clinic may not meet code; as was the case in Philly. The above links are not events from the bad old days but widely reported events from within the last year.

    It has little to do with the right to choose or not, it has to do with an unregulated surgical practice that seems to attract a disproportionate number of felons and bottom feeding doctors. Roe was 40 years ago and women continue to actually die. The only recourse is for the public to exercise their right to self-govern because mainstream medicine and accredited physicians have abandoned the oversight of abortion patient decades ago. The standard is “whatever” and in 2012 that is not good enough.

    1. You are incorrect. Many studies show that an ultrasound is not needed is the woman is sure of her last menstrual period and the size of the uterus is in agreement. It depends on training to some extent, but the sad reality is a lot of imaging happens in the U.S. because of medicolegal concerns. A recent study indicates that mifepristone could be administered to 98% of women without an ultrasound.

      There are physicians doing procedures they should not be doing in every medical field in the United States. The difference with abortion is that the women who have abortions are marginalized and therefore not empowered to speak up.

      Abortion should not be regulated any differently than any other surgical or medical procedure. Abortion in the United States is far safer than pregnancy (I refer you to a recent article in he journal Obstetrics and Gynecology).

      1. Dr. Jen,

        Peer reviewed or not that study is terribly sourced and extremely flawed. Abortion is not safer than birth.

        First, as I am sure that you are aware, the true consequences regarding ER visits and maiming that occur in the US is deplorably underreported. The causes of death within an ER setting might be “vaginal bleeding” or “sepsis” as secondary to the abortion. Abortion is rarely, if ever, deemed the cause of death. In the research study you cited Guttmacher is definately a biased source. Even though they claim to have withdrawn as the research arm of Planned Parenthood, one must question their objectivity on this topic.

        Also the CDC does NOT mandate abortion reporting in the US, it is voluntary. With that said, do you really think that in all of those cases that Daniel (above) cited –that those abortionist reported anything? You, yourself recently wrote an article where you protected a Dr. that injured an woman during an abortion.

        Further, the CDC does not have a specific enough classification/coding system for reasons of death for maternal mortality…again, as I am sure that you are aware. I trust that You MUST be aware of this inforamtion because I am merely a stay at home mom and I am aware of this, so you being a Dr., must know.

        That research study does not account for:
        1) suicides
        2) depression
        3) infertility issues
        4) premature births following an abortion
        5) substance and alochol abuse issues
        6) increased risk of breast cancer
        etc. that follow an abortion and especially multiple abortions.

        When one takes in the “big” picture of abortion safety vs. birth, the facts are obvious.

        Besides, medical intelligence aside, it makes common sense that something natural like pregnancy and birth would be much safer than an invasive, violent procedure such as abortion. Especially, when one truly understands the complex dance of pregnancy and how each hormone compliments one system while another prepares the baby for entry into the birth canal, how every single biomechanical system has a purpose in every single stage of pregnancy and birth and that when that natural flow is interrupted we end up with “stalled” labor or “Fetal distress”–or in the case of abortion how the sudden disruption of the pregnancy, where the body has not prepared for it throws all systems into chaos–again, medical intelligence aside, it just makes common sense that that cannot be healthy for the mother aborting…actually, I am sure the body receives the “attack” as traumatic.

        Common sense tells us, too, that there is such a stigma around abortion that most people get angry and/or feel guilty about abortion. Why? Because people know that it is taking a life. For humans to still have faith in humanity and compassion we must believe that if a mom is killing her child that at the very least, she suffers some kind of emotional distress. So for reports to deny that, says nothing about our medical intelligence. It only serves to dehumanize and demoralize and belittle women. “Hey, I had an abortion and I Feel great about it!” It is trying to pretend you are heartless when you really aren’t. What does that say about a woman?

      2. You are incorrect. There is no link with abortion and and of the following: depression, breast cancer, premature delivery. substance abuse, suicide, and infertility. There are multiple studies to show this. Hop on over to PubMed and do the research.

      3. That is a pretty tight ultrasound exclusion criteria – good dates from the patient and good hands from the clinician. I do not think that intersection occurs very often. I have little doubt that ob-gyns with hospital privileges have great hands (they are also prudent enough to use ultrasound liberally). I have less confidence in a family practice doc or advanced practice nurse that rotated thorugh ob-gyn and it has to do with the fundamental mindset of surgeons who own their errors and others who refer their errors.

        The well understood fact that abortion is safer than pregnancy has nothing to do with potential procedures consistent with the era and the state of the art that may increase its safety. Abortion should be benchmarked against abortion, not pregnancy.

        Office visits, medical and surgical procedures are indeed regulated with respect to content and context – except when the payment is in cash. Otherwise, there are criteria that must be documented for routine, new and complex office visits.Many office and hospital based interventions typically include pre and post procedural activities and documentation for payment. It is far from unheard of to regulate the content and content of medical acts – what is rare is to have them legislated as opposed to executive branch regulatory rulings (like HHS rulings).

        While there have always been physicians working outside of their competency, crimes co-incident with the practice of medicine with fatal endpoints are particular and unique to abortion providers. In 2010 – 2011 one can identify 14 alleged incidents of manslaughter traced directly to physicians practicing in the context of abortion.

        When it takes district attorneys to shut down medical practices that injure and kill (I am speaking legally here and not the “abortion is murder” line) women and children over decades, you can expect “the law” to fill the void that medicine abandoned.

        At the end of the day, it is a matter of trust and more and more of the public distrusts the abortion sector of healthcare. Even with the outcry over transvaginal ultrasound as invasive, they lose the thinking middle when they are outraged over a t/v probe and accept, speculums, dilators, sounds, and the provider’s hands without question. It seems disconnected to the thinking observer.

        I appreciate your evidence based approach as I like to apply evidence and reason to these disputed points.

  4. As a woman, I am in total agreement with this law. I am in disagreement with Hugh.

    Except for the “we don’t even begin to understand what a woman goes through”. Fact is, we DO know. We know that they are scared, they don’t feel capable of taking care of a child or being a mom, they feel pressured etc. So instead of packing her off to do something that hurts another and breaks her soul–why not offer support and help for an alternative?

    In today’s day and age–there is absolutly NO reason for an abortion anymore. NONE. There are so many medical resources, social resources, educational resources etc. etc. There are, in fact, so many resources for today’s pregnant woman that it makes the decision to abort a purely selfish one. And for those who are going to throw out the “hardship” medical cases, they are such a tiny fraction of the number of abortions we perform in the US that the argument is invalid. Not to mention that there is TRUE medical care to save baby and mom.

    For some reason, women are choosing to believe that abortion is not ending a life.They have been duped into thinking it is “medical care”. Medical care: 1) Heals 2) Saves Lives. Abortion 1) Wounds 2) Destroys lives. Medical care is giving you heart medicine so that it doesn’t stop beating. Medical care is sewing up an artery.

    The Sono law will help to minimize abortions. That is what angers people. Fact is, most women who see the truth, the beating heart, the baby moving will opt to carry the baby. That is what really angers people. Any sensible “pro-choice” person would be grateful to have common sense preventative measure in place–unless one is NOT really for choice. It is common knowledge that most women who do get an abortion do NOT Have all the information they need to make a real informed choice.

    Most abortion clinics are not regulated as ambulatory surgery places, so when a gurney needs to fit in the door for an emergency case and it can’t-it is a problem but the pro-choice community fights every single regulation, even if it is common sense. So, if one is really prochoice, then it is essential that a person have ALL the information to make a well informed choice.

    Besides, you are missing this point: How many abortionists have been accused of illegal abortions in the last year? This sonogram law will help save mom’s lives too–there are too many botched abortions and illegal late term abortions. Yes, every day in this nation. Maybe the sonolaw will help prevent some of these “errors”

    Way too many people are stuck on outdated, false information and it is time to bring the U.S up-to-date.

  5. I totally agree with Dr. Gunter, we need to take medical procedures out of the hands of politicians. Politicians are mostly men and we don’t even begin to understand what a women goes through when facing a pregnancy or wanting an abortion. The emotional toll that government is extracting on women in the name of religious beliefs is huge and this must change. I hope that more women enter congress on a State and Federal level and then perhaps a women’s medical needs can be left to doctors and not politicians.

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