A Doctor on Transvaginal Ultrasounds

[swag]

http://whatever.scalzi.com/2012/03/20/guest-post-a-doctor-on-transvaginal-ultrasounds/

Where Is The Physician Outrage?

Right. Here.

I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.

I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.

I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.

. . . more

[Richardo]

1. Kicked and highly recommended...

...great find, swag

My favorite (spoiler alert)

If you are forced to enter an image of the ultrasound itself into the patient chart, ultrasound the bedsheets and enter that picture with a comment of “poor acoustic window”. If you’re really gutsy, enter a comment of “poor acoustic window…plus, I’m not a rapist.”

[Skittles]

2. disconcerting it has to be anonymous

[The Wielding Truth]

3. Women have the right to be informed of the risks of pregnancy and abortion, not humiliation.

[truedelphi]

4. good read.Thank you.

One other thing to point out - ultrasounds are not without risk to the fetus itself. So if a woman were to decide she didn't want to abort, now you have this invasive procedure that carries an additional risk, of miscarriage and an additional risk of birth defects, being "inserted" into the equation.

Link to discussion of ultrasound and fetal risk:

http://www.ehow.com/facts_5161477_risks-ultrasound-pregnancy.html

[Richardo]

7. I was thinking about that too...

...thanks for providing the facts...

[obxhead]

16. The proponents of these laws and all anti abortion fights in general

have proven time and again that they do not care about the fetus or potential child.

All they care about is control. Their right to impose their will (or their religions will) on women.

They also don't support contraception. They don't support any welfare programs for children. They rail against sex education. They fight any kind of health care for children.

They do not care about children or even fetuses for that matter.

They care about their "right" to impose their religious will upon all women.

[JDPriestly]

29. So true, obxhead.

If they really cared about the fetuses, they would be willing to pay taxes to insure that every mother of a small child has enough money and the proper healthcare to take care of that child. And every disabled child would receive the care it needs from government, taxpayer-funded grants.

But the very people who are so fanatically opposed to abortion are unwilling to provide for the mother and child once a real baby is born.

[truedelphi]

33. That is very true. Sadly, they don't comprehend that.

And these "religious" folks give a free pass to the millionaires and billionaires who run the American work places.

So what if conditions at a job cause a woman to miscarry? For some reason, the toxic corporate polluters, who have annually caused thousands of incidents of still born babies, birth defects and spontaneous abortions (that is, miscarriages) are offered a spot at the communion rail. While the woman who has one single abortion is excommunicated.

[Chorophyll]

5. Enthusiastically kicked and rec'd. Thank you. nt

[felix_numinous]

6. Oh thank you

this person speaks like so many physicians I have known and worked with. Now if only the AMA would come out against this nonsense.

[SunSeeker]

15. Good point. Why has the AMA been silent on this?! nt

[chervilant]

19. Well,

perhaps for the same reason they've failed to require that nutrition and exercise courses be included in all pre-med curriculae. E.g.: a push to promote health through prevention equals less money; a push to promote more procedures (a transvaginal ultrasound) equals more money.

[JDPriestly]

30. I don't think it is about the money. Doctors are way over-worked.

I think it is about tradition.

The medical profession is essentially conservative and traditional.

Semmelweis is an interesting example of this. He lived a long time ago, and things have improved since his time, but not to the extent that they should have.

Ignaz Philipp Semmelweis[Note 1] (July 1, 1818 – August 13, 1865) was a Hungarian physician now known as an early pioneer of antiseptic procedures. Described as the "savior of mothers",[1] Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfection in obstetrical clinics.[1] Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweis postulated the theory of washing with chlorinated lime solutions in 1847[1] while working in Vienna General Hospital's First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives' wards. He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever.

Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory. In 1865, Semmelweis was committed to an asylum, where he died, ironically, of septicemia at age 47.

More.

http://en.wikipedia.org/wiki/Ignaz_Semmelweis

Doctors have to be very careful about adopting new, untested ideas that could harm their patients. On the other hand, a certain amount of ego and a desire to defend their honor by defending what they have always done play a part in the conservatism of the professional standards in medicine.

[truedelphi]

34. Thank you for bringing up the heroic Semmelweiss.

He was the canary in the coal mine, attempting to save women from the horrid death of uterine infection. For this, he was ostrazised and he died I believe in an asylum.

[chervilant]

38. Okay,

I see your point. However, when I was pre-med at Rice, the members of my study group--to a one--denigrated me when I suggested that all future doctors would benefit from courses on nutrition and exercise. I insisted that I wanted to help my patients lead healthier lives. More than half of the group derided me, and said they were only in it for the money.

[janet118]

8. Question for a physician, nurse, etc. . . .

If you know . . .

If a woman is required to get a regular ultrasound (not transvaginal) when she is between 2 and 4 months pregnant, how detailed will the fetus appear on the monitor?

[Beaverhausen]

11. I don't think women are required to get them

[janet118]

21. In Virginia, I believe ultrasounds are required if women wish to end pregnancy

A woman must watch a monitor during ultrasound exam (or she can "just close her eyes&quot - The requirement for a transvaginal ultrasound was removed from the bill. However - I thought I heard one legislator claim that a T-V probe could be used if the fetus was not visible via regular ultrasound.

Ergo, the question.

[AngryOldDem]

23. I can answer this.

I'm not a doctor, and I'm not a nurse, but I am a woman who has undergone two of those heinous procedures during two pregnancies.

No, regular ultrasounds will not show all aspects of fetal development much before the end of the first trimester (12 weeks or so). The heartbeat (which is what pro-lifers fixate on) is not typically easily visible before then. So, in order to get a more "up close and personal" look, T-Vs are done.

My first was when I was on the verge of a miscarriage around five weeks or so. Looking back, I think everyone knew where this preganancy was heading, but we didn't want to give up on it, so my OB ordered it as a precaution. The T-V showed that development had stopped and miscarriage was imminent. The second was with my last pregnancy, because I was being monitored closely because I was considered to be high risk. That T-V, also done around the five-week stage, confirmed I was carrying twins, one of whom soon after stopped developing and was subsumed into my body (which is a fairly common occurrence, so I've been told -- a lot of pregnancies, especially with older women, begin with two fetuses and the woman doesn't even know it).

Looking back on both, there were no benefits gained from either procedure. The first pregnancy was a loss -- what I thought I had seen on the screen as a "heartbeat" was actually not, which made it all the more crushing. And the second pregnancy was made even harder with the knowledge that I had already lost one fetus (which I would not even had known about, if not for the T-V). So, I was on eggshells the entire time, which was not good -- either for me or the baby.

Both T-Vs were psychologically traumatizing -- the first, because I had no clue what was going on other than that things were totally out of my control; the second, because of the bad memories and stress from remembering how the first one turned out (I almost passed out afterward). I can't imagine what it would be like to have to undergo this procedure under mandate of law.

So, please, pardon my abject outrage when I see men using T-Vs as a sadistic political tool to punish and keep a woman from exercising her rights under the law to dictate her own health care, and then talking about this procedure as if it's no more invasive than root canal. They have NO clue as to what they are talking about.

[nolabear]

26. Thanks for you reply. I'm sorry for what you went through.j

[AngryOldDem]

27. Thanks.

It's been years, but I still have a very visceral reaction to this. It has, in some respects, scarred me.

That said, my two T-Vs were done for medical reasons -- not exactly elective, but not at the point of a legislative gun, either. I know how I felt when I went through them, and I know how I felt after, and still feel, when I read stories like this. I cannot for the life of me imagine what it is like for a woman who has to go through this because she has no choice if she wants to exercise her right to take care of her own health.

Enough said. The more I type, the more incensed I get.

[JDPriestly]

31. In my opinion, all this energy spent on abortion, whether it should be legal or not,

should be spent on determining why women miscarry. Is it really that the fetus is not healthy? Or is it something else.

The sorrow and loss of miscarriages and stillbirths should be dealt with first before abortion is targeted.

So many women want children and have difficulty having them. All this nonsense about abortion is an insult to a woman or a man who wants a child of her or his own and cannot mother or father one.

And I think that miscarriages are probably more common than abortions. That is my experience. But we women do not normally talk about this.

[AngryOldDem]

35. No, we don't talk about miscarriages

I call it the "silent loss." In the case of my first miscarriage, it was a case of low amounts of the necessary hormones needed to sustain a pregnancy early on. That can be treated with medicine. It took a long time to emotionally heal from it, however, as I got little to no support or sympathy from those around me.

There are so many variables to miscarriage that I think it could be hard to pin down exactly why they happen.

And unfortunately, some legislators are looking to even criminalize **them**:

http://www.huffingtonpost.com/2011/02/23/antiabortion-georgia-lawm_n_827340.html

All of a sudden this country has turned unspeakably sadistic toward women, and I am at a loss to understand why. It's becoming tantamount to both physical and psychological rape -- in the name of the law.

[janet118]

39. Thanks . . . and there is nothing to pardon.

Your outrage at legislation that adds unnecessary cost and is designed only to shame women undergoing abortions is totally justified. My own outrage is a primal scream that I want to let loose at those smug, moralistic misogynists who pass legislation affecting only women and then minimize those effects.

Thanks so much for answering my question.

[elias7]

24. ER physician here

Eight weeks, you'll an oblong bump with arm and legs buds and a little tiny heart beating. By 16 weeks the anatomy is reasonably well developed and very recognize able as a potential human.

Transabdominal US is perfectly adequate for visualization in any normal pregnancy, and as such, Transvag US is usually not needed. It is useful in the first 4-8 weeks Ifthere are concerns re: ectopic pregnancy, threatened abortion (miscarriage), or to assess for uterine/placental abnormalities later in pregnancy that a transabdominal scan is not delineating well.

There is no indication for a transvaginal US in an uncomplicated pregnancy, and it is most certainly not needed to better assess a situation prior to a first trimester abortion.

The law is a travesty and should be considered a violation. I think most physicians would agree. We order tests based on indications and contraindications, not to cater to political whims.

[janet118]

40. Thanks for your answer

I agree with you totally. These procedures are all about harassing and shaming women who decide to have abortions. The tell is that women are required to have the monitor aimed at their faces as the ultrasounds are performed. In Kentucky, a doctor is required to describe the fetal image on the ultrasound aloud so that, even if a woman closes her eyes, she will be forced to suffer audio abuse.

This is not medicine - this is some weird religious ritual.

[got root]

9. Has america turned into a fucking never ending south-park episode for anyone else?

JHC on a trailer hitch, stop it already.

[Alcibiades]

12. Yep

It's been that way for me for some time--I think it was election night in 2000 when things really began to get absurd.

[chervilant]

20. And,

let's not forget the magic trick that turned the tide some time in the wee hours of the morning, after all the talking heads announced that Kerry would be our next prez...

(re: the 2004 debacle, just in case...)

[freshwest]

10. The baggers who screamed about the TSA touching their junk, love putting a cattle prod up a woman.

So they really have no problem with invasive procedures at all. Or losing their privacy or dignity.

And their so-called religion, their dead spirituality, reduces all of humanity to the level of cattle. Good going, GOP.

Thanks, Swag, for bring this doctor's words here. Needs to be heard.

[pacalo]

13. That's a good point!

[freshwest]

14. Thanks. I try, LOL.

[libodem]

18. It's meant to be invasive

Demeaning, humiliating, degrading, and shaming, because they can't find any Syrian Muslim Virginity Verifiers to come here and virtually rape our women.

[SDjack]

22. Jurors for trials of physicians not complying with transvaginal ultrasound law

must vote "not guilty".

[Citizen Seattle]

25. I have a theory that the whole reason these women's issues have been brought up is

to keep the news cycle going and people engaged in time for the election. The Republicans ain't got nothin' so they're back to another version of God/gays/guns and abortion. An old trick.

[irisblue]

28. american registry for diagnostic medical sonography? they do the TV u/s they

american college of radiology? they provide the offical dictations of a study done by a registered technologist done at a approved JACHO hospital, american board of obstretics and gynecology? american medical association? any public statements from those professionals...yet?

[lark]

32. I love you, man

[Brettongarcia]

36. If anyone has post that is relevant to abortion, cross-post to DU "Health/Pro Choice" section too?

Thanks!

I'd just say, 1) copy the address of your relevant post; 2) go to DU "Health," then 3) sub-section "Pro Choice"; then 4) start a post there, repeating the name of your earlier post, 5) with the additional words "DU cross-reference/link"

Then? 6) as "message text," just paste the address/link to your first post.

That way? People in the Pro Choice sectio, don't miss important, relevant articles elsewhere in DU.

[Deep13]

37. sustained! nt