Good parents usually make their kids do their homework before they get to goof off, but the state shouldn't be making laws forbidding kids from goofing off until their homework is done.
It's a question of whose decision it should be.

If this is true, I want to know why the fuck all the people who have been screaming about this didn't know it. Haven't any of them had an abortion that involved this procedure? I'm guessing that some have, which is also making me question the validity of the response. Can someone verify this?

Isn't the issue WHO is doing the procedure? That you should be forced to have it done before you can even see the doctor about an abortion?

This requirement is political, not used for medical purposes.

When a doctor determines it is necessary they get the consent of the patient. When the state mandates it, it's rape. Simple.

@2: http://www.pittsburghcitypaper.ws/SlagHe…

I'm assuming that the "physician-in-training" aspect of the anonymous responder keeps her from being experienced enough to the separate the politics from the procedure.

@6: This pro-choicer still knows you have zero clue what you're talking about.

And most importantly, it is mandated whether or not the physician and patient deem it medically necessary, which is where the issues of State force stem from.

http://drjengunter.wordpress.com/2012/02…

Here's a more detailed explanation as well.

@9, thanks! Here's another one:
http://mobile.slate.com/articles/double_…

@10: Right, the waters are muddy to begin with, making excuses that these laws aren't a big deal because abortion providers may perform the ultrasounds on their own isn't helping anything, because it's removing the option of choice for reasons that have nothing to do with medical necessity.

From the Alabama proposal-

"It would require the ultrasound screen to face the woman while the doctor narrates the images, although the law states that it should not be “construed to prevent a pregnant woman from averting her eyes,” the bill reads. Doctors who do not follow the prescribed routines could face felony charges and could be sued by the potential father and grandparents."

I enjoy that this is also being used as a power-grab by "Mens' Rights Activists" to allow greater power for the father and his/her family to sue abortion providers over the choice of the mother.

Oh I may be part of the "cuntsia" (or, as we're known outside of right-wingnuttia misogyny, "women") but reading comprehension isn't my problem.

It would appear that the medical student may be ill-informed:

" there is a growing body of literature suggesting medical abortion can safety medical abortion can safety be accomplished without an ultrasound for 98% of women."

So we're back to some of the original intent of the laws:

"these laws will prevent ...practitioners from practicing evidence based medicine) which will halt efforts to expand medical abortion into low resource settings."
http://drjengunter.wordpress.com/2012/02…

Along with attempting to shame and discomfit women, of course.

"There is no medical evidence to support ultrasound laws. They are a waste of taxpayer dollars and do nothing to accomplish the goal of reducing abortion. They also create a dangerous precedent of allowing hypocritical politicians to set unacceptably low standards of medical care based on political goals, religion, and misogyny."

It is entirely fair to point out that it is really, fundamentally, the fat old white men making the terrible laws who are the bad guys here.

don't show the fetus on the screen

I imagine not, since, at that point, it's not yet a fetus.

Oh the author of those quotes not in support of the forced transvaginal laws in #13 is an actual physician -- not a medical student.

Dr. Jen Gunter, an OB/GYN and a pain medicine physician who authored the book,The Preemie
Primer, a guide for parents of premature babies.

Who graduated from The University of Manitoba School of Medicine in 1990 at the age of 23, followed by OB/GYN training at the University of Western Ontario, fellowship in
infectious diseases at the University of Kansas, board certified in OB/GYN in both Canada and the United States.

She is also board certified in pain medicine by the American Board of Pain Medicine and by the American Board of Physical Medicine and Rehabilitation.

@3 pretty much explains everything.

@13
Not sure where you believe the Medical Student is ill informed. Your post is a bit jumbly to follow.
The Med Student is in line with and corroborates everything my wife has told me when we've discussed this subject. My wife is an OB/GYN. I can completely understand the Med Students reluctance to being identified. It is a very hostile world to OB/GYNs these days. She (the student) should be commended for her post.

@13 Thanks, that's what I was after.

Dear Med student,

You may understand the medical procedure, but you do not understand politics and the law.

If a doctor strongly recommends a procedure to a patient, and the patient agrees, that is consent.

If a politician forces a doctor to perform a procedure in a naked attempt to intimidate a patient, that is not consent. That is coercion, even if the patient goes along with it. Having a doctor shove an implement into your vagina without consent is rape.

Coercion \= consent.

I'm sorry if that makes you uncomfortable, but that is rape. It is rape by the state, and you would be a pawn in that game.

Thanks so much for the post. It is so difficult to find reasoned, informed, objective, unemotional commentary on abortion. Everything's a crusade for both sides. So annoying.

I had a mental image of a woman strapped to a bed, screaming in agony as the maniacal doctor shoved the equivalent of a large dildo up the woman's vagina, emphasizing, "It's the law! I have to do this!" Good to know that it is actually routine and good practice.

I don't think the medical student was as concerned about legal nuance as she was about how this will affect doctor/patient communication.
One of the more clever things the Right does is take non-issue items and turn them into political brush fires. They've taken a standard medical procedure and turned it into a way to both shame women and create drama between doctors and their patients.
They're evil but never say they aren't sometimes canny.

Why would a female OB/Gyn physician-in-training not want to put her name to a thoughtful, rational, scientific based statement like this? That is what i find most unsettling.

What is she afraid of?

There are many activities that are a party with consent and sexual assaults with out it (see Savage for examples). This is one of those activities.

Hope you finish at the top of your class at the Vulcan Medical Academy and find a position on your home planet.

Thanks Cienna

@23
George Tiller

There are a lot of dangerous nuts and fanatics out there willing to kill for their political/religious anti-abortion fanaticism.

@18-I'm not sure if she should be commended. I definitely don't think she should be disparaged, but what does she really add to the discussion? Her statements could unfortunately be used to support arguments I've heard from proponents of these bills that say that if we are willing to have abortion instruments inside us people should be able to mandate whatever other instruments they want being put inside us too. Cause, you know, we need the transvaginal ultrasound anyway, so what's the big deal? That was clearly not the intention of her email, but I think it is a mistake on her part to assume that any of these bills have anything to do with abortion providers obtaining information they need to do their job (referring to her quote, "I don't know an abortion provider who would even consider performing an abortion without these two pieces of information."). It's about shaming and taking away choice and agency from both patient AND physician.
I definitely sympathize with this:"Now we have the uncomfortable task of convincing patients that when we do a transvaginal ultrasound we are doing it because we feel as providers it is in their best interest, and not because the state has mandated it or that what we are doing amounts to rape." I sympathize because we are ALL faced with the uncomfortable task of maintaining our right to safe and legal reproductive health care on our own terms. But it's important to remember that it's the anti-choice advocates and legislatures that have made it more difficult for this woman to do her job --not those of us who are calling these bills out for what they are:mandated breaches of choice and consent that turns a often-necessary medical procedure into a physical violation of a woman's body.
It's important to point out that many physicians have NOT been silent. And it's also important to find ways to support medical professionals like this one who are struggling to find a way to navigate through their profession in the insane times, even if we disagree with their choice of words.

Her statements could unfortunately be used to support arguments I've heard from proponents of these bills that say that if we are willing to have abortion instruments inside us people should be able to mandate whatever other instruments they want being put inside us too. Cause, you know, we need the transvaginal ultrasound anyway, so what's the big deal? That was clearly not the intention of her email, but I think it is a mistake on her part to assume that any of these bills have anything to do with abortion providers obtaining information they need to do their job (referring to her quote, "I don't know an abortion provider who would even consider performing an abortion without these two pieces of information."). It's about shaming and taking away choice and agency from both patient AND physician.
I definitely sympathize with this:"Now we have the uncomfortable task of convincing patients that when we do a transvaginal ultrasound we are doing it because we feel as providers it is in their best interest, and not because the state has mandated it or that what we are doing amounts to rape." I sympathize because we are ALL faced with the uncomfortable task of maintaining our right to safe and legal reproductive health care on our own terms. But it's important to remember that it's the anti-choice advocates and legislatures that have made it more difficult for this woman to do her job --not those of us who are calling these bills out for what they are:mandated breaches of choice and consent that turns a often-necessary medical procedure into a physical violation of a woman's body.
It's important to point out that many physicians have NOT been silent. And it's also important to find ways to support medical professionals like this one who are struggling to find a way to navigate through their profession in the insane times, even if we disagree with their choice of words.

I may not be a doctor, but I am a lawyer, so here's some law.

VA Code 18.2-67.2, "object sexual penetration" (because here in the Commonwealth, we for some reason differentiate between "rape" (man-woman penis-in-vagina sexual intercourse), "forcible sodomy" (anything else involving two body parts) and "object sexual penetration") is defined as:

A. An accused shall be guilty of inanimate or animate object sexual penetration if he or she penetrates the labia majora or anus of a complaining witness, whether or not his or her spouse, other than for a bona fide medical purpose, or causes such complaining witness to so penetrate his or her own body with an object or causes a complaining witness, whether or not his or her spouse, to engage in such acts with any other person or to penetrate, or to be penetrated by, an animal, and

1. The complaining witness is less than 13 years of age, or

2. The act is accomplished against the will of the complaining witness, by force, threat or intimidation of or against the complaining witness or another person, or through the use of the complaining witness's mental incapacity or physical helplessness.

An ultrasound is not always medically indicated, and is not required under Virginia law for medical reasons; rather, the ultrasound is required for social policy reasons. See, for instance, the National Abortion Federation's (the professional association of abortion providers) Clinical Policy Guidelines, which indicate that ultrasounds are not necessary for early abortions.

So, under Virginia's ultrasound law, a woman is:
* penetrated by an object;
* for a purpose other than a bona fide medical purpose; and
* by force of law, and therefore against the will of the woman.

That's all the elements of rape by object sexual penetration in the state of Virginia. Even if an ultrasound is medically indicated for some patients, it is not indicated for all patients, which means that some women will be raped by the Commonwealth of Virginia as a result of this new law.

I wonder how many people have focused their attentions to the other associated parts of the legislation, like those that enable the woman's parents, in-laws, and sexual partner or rapist to also sue the clinic to force it to be shut down. I'm sure there's just as bad or worse ones in the other states' versions.

@31: You apparently don't understand what either the original poster says OR what the actual MD says if you think that they're compatible with your babblings.

I think the issue was that they want women to WATCH the ultrasound and FORCE them to listen to the heartbeat as the doctor describes the "fetus" to the woman. These are all things that are unnecessary and are only there to put some guilt trip on a person already in a difficult situation.

yo peeps. i think an embryo becomes a fetus at around 8 weeks. lotsa abortions happen after 8 weeks, and even at 8 weeks or after transvaginal rather than abdominal ultrasounds may be necessary. so quit it with the "embryo" in quotes silliness. the embryo may need to be visualized with a transvaginal. for reals.

and i think the author of this post has a good point. she is merely pointing out one of the lame-ass complications of all this assault on women's rights. the complication is that women may now unfortunately associate what was once a routine, medically necessary procedure with rape. that sucks. and it is reality. don't get all pissy on her for pointing it out.
blame the shittiness of it on the jerks who make these laws. it's their fault.
however, i don't see why doctors still can't speak up a little more about it all. they don't have to use the rape word. they can still protest without putting it in those terms.

@35: dawg, why don't you actually read what people ACTUALLY have to say before you reply, nahmean?

This med student has said nothing that I didn't say in the original discussion a few weeks back...and I've actually assisted in thousands of abortions.

The problem with this law isn't the ultrasound necessarily, but the attempt to legislate medical procedures instead of leaving them up to the discretion of medical professionals. That is the thing everybody should be getting all pissed off about.

Who control's a woman's body? The woman or the state legislature?

This is the debate. Rape is exactly the right term for some state ordering medical procedures regardless of her wishes.

Does this mean that before we had trans-vag ultrasound technology, that 2-10% of women having abortions had complications? That seems high. What am I missing?

It's not the ultrasound itself that's the issue. Indeed, those of us who've had early abortions know that the trans-vag ultrasound is necessary to locate the pregnancy.

The issue is forcing doctors/technicians to give a detailed description of the fetus and forcing the woman to look at the fuzzy image of her innards.

However, performing any procedure on a patient without her consent is assault, and forcing a health care provider to perform unnecessary procedures is deeply unethical.

Seems to me that the only way for abortion services to get the funding and respect they deserve is for them to become a religious practice and 'faith-based initiative', and then government intrusion would be considered an infringement on religious liberty, which is apparently the only liberty and freedom that gets recognized anymore in your ferkakte country.

I think we are missing the point here. The laws can require additional ultrasounds in order to comply with the specific precedure of the law when there is no medical necessity. It also requires specific descriptions to be given, regardless of whether the patient has already been over the same information with another doctor. Medical procedures required by law whose basis does not lie in the recommendations of medical personnel for medical reasons is invasive and flat out unethical in an evil way.

This isn't the first time I've heard allies of reproductive rights hesitate in claiming that these laws are tantamount to rape, but to this I say, "fuck it." The GOP has earned every ounce of scorn they receive. And whether or not a court would agree with @29 that the term 'rape' is legally appropriate, I maintain my position regardless.

We sat through eight years of "truthiness" used to justify an illegal war with casualties in the thousands, over a trillion dollars in debt, and the debasement of some of our most precious institutions. The right wing can stand a small (miniscule, really) taste of their own medicine.

I think there are problems with inflammatory language in political rhetoric from all viewpoints, so I do appreciate posts like this, and I will be sharing it around. Thanks for writing it, Anonymous Medical Person!

Every abortion is proceeded by sex. That does not mean that ones that were caused by rape were not caused by rape just because in all cases a penis entered a vagina.

A women and her doctor evaluating medical options, like a couple people evaluating fucking options, is not rape. Its a consensual relationship. The State telling every women going to get an abortion that she needs to be penetrated in some manned she does not want is rape.

It's not the act, its the context.

@46 - exactly. This med student had a great argument, and points out the difficulties doctors will now have. The procedure was used to make sure that the woman wouldn't suffer complications (albeit very rare), now it's being compared to rape. It was a method to ensure the safety of the woman. Now, it's being used to shame.

When it's the doctor and patient deciding to do the medical procedure, it isn't rape and is used for proper medical reasons. When mandated by law, with no input from the doctor or patient, it's rape.

The complication arises in that most doctors feel the procedure is necessary and would do it anyways. Now, they're being forced to substitute the legislature's judgment for their own. This breaks down the trust between the doctor and patient and makes women feel used/violated/raped, since they are, for political points.

It's a mess.

Hey. Real live abortionist here (for 25 years). It is RARE for me to need a transvaginal scan in the decision-making process and I would NEVER order one if the patient was unwilling. So: not routinely needed, and never forced. Your med student is simply all wet (behind the ears), Cienna.

Hey @48 - are there differing (medically acceptable) opinions on doing the transvaginal scan?

I'm really curious. If there's very little medical reason for this, it's even more appalling. Doctors' silence is excusable in the med student's scenario, but if it's not a common practice... what's up docs? You should be up in arms as well.

Any way you slice this, family care decisions should only be between a woman and her doctor. Period.

When a friend of mine when in for an ultrasound to look for uterine fibroids (Seattle), she commented on how they did not push the probe in, but instead held it outside and told her to guide it in with her hand. This suggests to me that the use of a probe ultrasound does in fact exist in a nebulous zone of "potential object of rape" and that operators are well aware of this.

@51: I wonder if the anonymous student just had a class where the professor decided to make a current events point at telling all their students that it's "not a big deal because..." and took it to heart, assuming that's actually what practicing physicians believe.

It sounds like the sort of thing college students hear in school and repeat as authoritative fact.

@53 - you could be right. It seems that a bunch of people think this is SOP. The procedure itself may be considered necesarry by a large portion of doctors (or highly recommended).

My question is really irrelevant to the main issue - I'm mostly curious.

Even if all doctors agreed that the trans-vaginal exam should be done, it still doesn't excuse the attempt to substitute the legislature's judgment for the medical professional's.

Hi Karla! As always, love your avatar.

Sometimes in big clinics where they are seeing a LOT of very early pregnancies, (the ones where you can use RU486) the vag probe scan will be part of the protocol. But the vag probe scan has NO use beyond 7 weeks or so, because the abdominal scan is more than adequate. (And beyond 9-10---like most of mine--weeks you really need no scan at all, because you can feel that the uterus is enlarged.) And even in those clinics, unless you have a really obese patient, the vag probe is not needed after about 6.5 weeks. So it's just a load of hooey.

I should add that in medical school clinics, what is standard to be ordered (blood work, imaging) is based largely on the fact that the doctors-in-training have not yet developed their clinical skills. So, everything is routinized and a lot of extra stuff gets done---as a way of preventing mistakes. If a university clinic routinely orders transvag scans, that says NOTHING about how the rest of us function. If we get a stupid law like this here, I think I will simply lie rather than comply.

If I don't speak out against these laws as a doctor it's because I've been the focus of enough hate already, and I am not keen to offer myself up as a target for even more of these whack-jobs.

@56: "If I don't speak out against these laws as a doctor it's because I've been the focus of enough hate already, and I am not keen to offer myself up as a target for even more of these whack-jobs."

I could imagine. Hate mail and threats (at best) await anyone who speaks out against a topic that's important to anti-choice terrorists.

An ob/gyn in training is not a med student but most of the times a resident. That is, she already finished med school and she's learning her specialty at a hospital. And it is HARD and you get a lot of experience FAST.
On medical terms:
an embryo is not a fetus at eight weeks as it was said but at twelve, when the head is made of bone and not just tissue. That's when the procedure actually has to change.
TV ultrasound beats abdominal by a week. That is, TV ultrasound "sees" thing a week before (the sac then the embryo, then the heart beat).
You can safely avoid transvaginal ultrasound by doing abdominal after eight weeks. At that time you can be VERY sure it's not ectopic (most ectopic pregnancies will show the first complications between eight and nine weeks, and the patient will not consult for an abortion but for abdominal pain) and besides, an embryo larger than five milimeters HAS to have a heartbeat or else the pregnancy is miscarried naturally over time.
So you could offer women a tv ultrasound if they want the procedure done before eight weeks or if they prefer an abdominal ultrasound, do the procedure a week later.
I am an ob/gyn myself. Been resident, done all that. I live in Argentina, where abortions are ILLEGAL and we are painfully trying to change that. Seen my share of infected maimed women in back alley abortions, When I was in the last year of med school, the second most important newspaper in my country published a letter I wrote defending abortion and the next thing I knew my email adress was charmingly invaded with bigots sending me dead foetuses pictures. No wonder she doesn t want her name published.

Thanks attitude devant!

That helps explain things - my background is computer science so I really don't know these things and thankfully never had to consider abortion- my pregnancy was wanted and easy - the terrible twos now are another deal!

It makes sense that things are more routinized for new doctors, liability being what it is.

Just glad I live in Canada where we haven't had this religious infringement of people's liberties. At least not much - yet.

Interesting, we now have a doctor who says that it is not implausible to compare it to rape and who advocates that physicians (surprise, surprise!) protect patients first and foremost: http://whatever.scalzi.com/2012/03/20/gu…

The medical profession is full of inconsistencies. For example, a DOCTOR told me that an embryo becomes a fetus at 8 weeks, yet another doctor here says that it is 12 weeks. For example again, I've had a bunch of transvaginal ultrasounds. Three times the technician had me insert the probe. The fourth time, the technician did it herself with little warning that she was about to do so.
Given that the others all had me do it, it squicked me out a little.
Shoot, maybe she raped me!

Nowhere in there does she mention consent. All the idjits fighting for the bill just assume that because a woman has had a penis inside of her or since she's having it aborted anyway that she simply won't mind.

I'm glad I don't go to OB in Seattle, I'd hate to end up under this person's care, if they ever make it out of training.

Thank you to the OB in training. I have had an abortion and the transvaginal ultrasound was a "pre-op" procedure. The physician explained why I was getting one - to confirm the age and position of the fetus, and did nothing to make me feel like I was being violated in any way. The screen was not in my view, and she was efficient and kind. Also, prior to the ultrasound, all information about the length of the pregnancy was self reported. If I had been wrong on the dates, the ultrasound would have shown that I needed a different type of abortion. As I see it, the transvaginal ultrasound is just like any other pre-op requirement, and the invasive argument holds no water for me, as women getting this procedure are about a half an hour away from having their cervix forcefully dilated in order to have a vacuum inserted. At the end of it, I don't believe any woman will be thinking about the ultrasound as invasive. Now, I do not agree with the legislature around the issue, especially since the politicians seem less interested in the health benefits of the procedure and more interested in causing emotional harm to women who have abortions. But, thank you to the writer of this article for saying what I have been thinking since the procedure came under attack. Again, I don't agree with the politics.