A female OB/Gyn physician-in-training thoughtfully responds to physicians’ silence on the alarming, state-by-state trend of mandating up-the-hooha ultrasounds for women seeking abortions (after one physician equated the requirement to rape).
She asked that I keep her identity anonymous (for obvious reasons) but agreed to let me post her email. And it’s pretty insightful:
I just thought I would offer a different perspective on why physicians have been silent on this issue. It is a delicate and now difficult position for abortion providers because we actually perform transvaginal ultrasounds routinely before providing abortion services. In fact, it would not be standard of care to skip this important procedure. The transvaginal ultrasound is necessary to confirm dates of the pregnancy—a six-week fetus requires a different abortion procedure than a 12 week fetus—and to ensure that the pregnancy is intrauterine (ie, not an ectopic (tubal) pregnancy—which is a life threatening emergency). I don’t know an abortion provider who would even consider performing an abortion without these two pieces of information.
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.
Unfortunately, any early pregnancy would not show up on an abdominal ultrasound, so transvaginal is the only option. Transvaginal ultrasounds are already uncomfortable for someone seeking an abortion, but we do what we can to mitigate that. We are as rapid as safely possible, don’t show the fetus on the screen, etc. However, we can’t provide safe abortions without them. Access to safe abortion is the goal, right?
I do disagree with these laws because it infringes on my doctor-patient relationship (or in my case—the medical student-patient relationship), but referring to it as rape has put us in a difficult spot. What we do is already fairly difficult. I guess I don’t really have the right answer, but I thought I would share this perspective.
UPDATE: The OB/Gyn-in-training writes: If you wouldn’t mind posting the following, I feel a bit like defending myself. I never wanted to come across as defending these laws. I don’t. I just wanted more contemplation on the overall issue. Anyway, if you don’t mind posting the following, I will exit the conversation and let the commenters take over!
I am not misinformed. I have watched and performed this procedure many times. The statistic we use is that 95 percent of women could have an abortion safely without a transvaginal ultrasound (98 percent is quoted in one of the articles left in the comments). However, no one who does, say, 100-200 abortions a year, is comfortable missing the 2-5 percent of women for whom there would be complications (2-10 women a year), which can be life-threatening. Women rarely experience complications for an abortion and that is because the woman and her doctor can determine what is necessary for her care. However, like I stated earlier, transvaginal ultrasounds will be used more often than not.
I did not write to say we shouldn’t oppose these laws. We should. The politics behind these proposed laws is appalling. I just wrote to explain that these procedures (transvaginal ultrasounds and abortions) are common and the language we use surrounding these procedures can and will affect the women who may someday need one. Like I said, I don’t have the answer. We have to fight these laws, and calling the transvaginal ultrasound “rape” has certainly been affective. Making people cognizant of the overall picture was my aim.
