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Thursday, March 15, 2012

Ob-gyn doc: Republican posturing over ultrasound "doesn't make any sense"

Posted by on Thu, Mar 15, 2012 at 6:02 PM

There's been a lot of buzz over remarks Gov. Tom Corbett made recently about mandatory-ultrasound legislation. What does our state's leading small-government champion think about legislation creating burdensome government regulations on medical procedures? Well, we're talking about making women jump through hoops before getting an abortion. So not surprisingly, Corbett told reporters that he supported House Bill 1077 "as long as [the ultrasound] is not intrusive."

For some, the bill would seem intrusive by definition: It requires that the ultrasound be projected on a screen that would be shoved in front of the woman's face. But Corbett didn't see it that way. If a woman didn't want to see the images, he said, "You just have to close your eyes."

Corbett did have one caveat, however: He only favored an ultrasound requirement "as long as it's exterior, not interior."

It's the "close your eyes" line that has set up a howl of protest, one so loud that it almost conceals the sound of Democratic hands rubbing together with glee.

But according to one of the state's leading obstetricians, Corbett's preference for "exterior" ultrasounds is at odds with how the law is currently written. And while the law can be amended to meet his concerns, previous changes have only made it worse ... and the whole exercise demonstrates how little thought Republicans have given to medical science.

Currently, HB 1077 doesn't specify which kind of ultrasound must be used -- a fact which some antichoicers seem to regard as a boon to women. ("HB 1077 does not specify a particular type of ultrasound. The legislation simply requires that a woman be given the opportunity to see an ultrasound image of her preborn baby.") But during much of the first trimester -- when the vast majority of abortions are carried out -- an ultrasound would almost have to be conducted internally in order to satisfy the requirements of the bill.

"In general, up to about six weeks, you usually need a vaginal probe to do a good ultrasound," says Sherry Blumenthal, who chairs the Pennsylvania section of the American Congress of Obstetricians and Gynecologists. In particular, the bill requires that the ultrasound be carried out "including fetal heartbeat when present and detectable, in a manner which will enable accurate determination of the gestational age and development of the unborn child." As Blumenthal puts it, "You could probably see something beating at five weeks with a vaginal probe, but not with an abdominal probe."

So unless these requirements of HB1077 are rewritten, she says, Corbett's position on it "doesn't make any sense." Not that she's surprised: "The issue with the vaginal probe," she says, "is the issue with the whole bill: It's all about politics."

Which isn't to say the bill couldn't be changed to meet Corbett's requirements. One way to do that would be to exempt women from the ultrasound requirement in the early weeks of pregnancy. Interestingly, in fact, an earlier version of the bill did just that. Under a section labeled "exemptions," the bill waived an ultrasound requirement in cases where "in the physician's reasonable medical opinion, the probable gestational age of the unborn child is less than eight weeks."

"Restoring that language would pretty much obviate the need for a vaginal probe," Blumenthal says. But that language has been deleted from the current version of the bill. Prior to Corbett's remarks, in other words, the bill was changing in the opposite direction.

When outrage over the transvaginal requirement blew up in Virginia, meanwhile, the state amended its bill to specify that only transabdominal -- "external" ultrasounds, in Gov. Corbett's parlance -- would be required. The Virginia bill foresees the possibility that an external ultrasound may show little more than a peanut-like gestational sac. In such cases, the bill chivalrously declares that the woman "shall be verbally offered other ultrasound imaging ... which she may refuse."

The political advantages of Corbett's position are obvious: A Quinnipiac University poll out today shows that voters oppose mandatory transvaginal ultrasounds by a 64-to-23 percent margin. Mandating ultrasounds of any kind is unpopular, but opposition drops to 48-42 when the transvaginal procedure is dropped from the question.

Still, Blumenthal says there's a larger issue here, which is that the state is requiring ultrasounds at all -- and doing everything short of prying women's eyelids back to make sure they are seen -- though the images produce no medical benefit. "You have to ask yourself, what does the ultrasound add to a woman's ability to give informed consent? This bill isn't based on providing any information that is medically necessary; it does nothing for the health of the woman." That's why her organization, and the Pennsylvania Medical Society, oppose the bill as an attempt to legislate what should be a doctor's prerogative.

Blumenthal notes that many abortion providers do ultrasounds as a matter of course -- a fact that has prompted some antichoice advocates to ask what the big deal is. "Abortion providers say that they already do ultrasound before an abortion, including transvaginal ultrasound, to determine gestational age," argues the Pennsylvania Pro-Life Federation. "Are they raping women?"

Blumenthal brushes that argument aside. "First of all," she says, abortion providers "don't turn the screen toward the woman," forcing her to avert her eyes. What's more, the bill spells out considerable paperwork and recordkeeping requirements that Blumenthal says "are adding another level of expense, and the question is, what does that achieve? The converse of their statement is, 'Yes, we are already doing it, so why pass this law?' The people who do abortions know when it is appropriate to do the ultrasound."

And she adds that the GOP's shenanigans -- including Corbett's dictating what kind of mandated ultrasound is acceptable -- prove that politicians don't.

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