Guest post: TRANSVAGINAL ULTRASOUNDS! Or How We Missed the Real Story in Virginia

If you work in any field related to abortion, you probably remember that our so-called "win" in the battle over Virginia's ultrasound bill was actually somewhat horrifying. But Amy Littlefield's telling of that story is among the best I've seen, so and she's graciously shared it with us here. You can also catch the original at her beautiful new site for the Provider Project.

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TRANSVAGINAL ULTRASOUNDS! Or How We Missed the Real Story in Virginia


To demonstrate why we need stories from abortion care workers in the struggle for reproductive justice, I want to share a little story about an recent legislative attack you may remember...

A couple months ago, some legislators in Virginia decided to pass a law mandating ultrasounds for women seeking abortions. Their thinking seemed to center on a few monkey-brained assumptions:

1. Women seeking abortions may not realize they’re pregnant until they have an ultrasound.

2. After viewing a blurry, black-and-white blob, women will become so overcome with motherly emotions that their financial/logistical/emotional/spiritual reasons for seeking abortion will disappear.

3. Women can’t make decisions for themselves. Legislators should make decisions for them.

4. People who know nothing about medicine are qualified to dictate medical policy.

The legislators might have benefited from speaking to someone in abortion care who had a basic grasp of what happens between providers and patients. If they did, they might have realized:

1. Most women seeking abortion realize they are pregnant.

2. Ultrasounds are routinely provided as part of abortion care.

3. The level of detail required of the ultrasound image would mandate a TRANSVAGINAL ULTRASOUND for many women in early pregnancy.

Then something glorious happened. People who had a basic grasp of medical knowledge noticed that the law would require a specific medical procedure that involved putting.something.potentially.unecessary.into.my.vagina. The rage of the feminist community was unleashed upon Virginia. More than a thousand people protested outside the State Capitol and some were arrested. The word “vagina” was EVERYWHERE.

“Transvaginal,” said the TV anchors.

“Vaginal probe,” agreed the newspapers.

“Holy crap!” said those of us unaccustomed to seeing the word “vagina” in such places.

Many decried the bill as state-sponsored rape. Here, the feminist community may also have benefited from the wisdom of abortion care workers, who might have noted that transvaginal ultrasounds are in fact a routine medical practice that clinics often use to accurately diagnose gestational age.

Some in the world of abortion care worried that patients might come to see all transvaginal ultrasounds as rape. Others hoped patients would understand it was the legislative force -- not the actual probe itself -- that was a violation of will. For the most part, these voices were drowned out by sound bites.

The outcry forced Governor Bob McDonnell and the Republican legislators to back down, instead passing a watered-down version of the bill that required an abdominal ultrasound and the offer of a TRANSVAGINAL one.

But the debate ignored another key provision of the Virginia law -- one that many in abortion care believed would far more dramatically impact the lives of women seeking abortions. The bill required a waiting period between the ultrasound appointment and the abortion -- you know, so women could get a good hard look at that fuzzy, black-and-white picture. Women who lived within 100 miles of the clinic would need to wait 24 hours. Those who lived more than 100 miles away would need to wait two hours.



I spoke to Rosemary Codding, Director of Patient Services at Falls Church Healthcare Center in Virginia. She suggested it was the waiting period that worried her most, not the transvaginal ultrasound requirement. For many patients it meant two days of childcare, two days off from work. Some women would need to wait a week between the ultrasound and the abortion because of their schedules, meaning the clinic’s diagnostic ultrasound -- you know, the one with an actual medical purpose -- would need to be repeated. Insurance companies bill patients every time they walk in the door, so it would mean two co-pays at least -- or even more for women without insurance.

“If you’re 99 miles away, you’re looking at a 200-mile drive,” she told me.

But the workers at this clinic in Virginia hardly had time to worry about this law, she went on. Because Virginia had passed a series of onerous TRAP laws, part of a nationwide effort by anti-choicers aimed at stopping abortion by imposing ridiculous requirements on things like the size of a clinic’s janitor’s closet. I’m serious about that. That’s not a joke. The janitor’s closet is actually part of this law.

“We have a very nice janitor’s closet that is really well-organized,” sighed Codding.

The law requires things like eight-foot-wide hallways and a cavernous size for surgical rooms, she said. Already, thousands of dollars had been spent determining whether the clinic could come into compliance with the law -- or whether they would need to close.

The ultrasound mandate was an outrage, yes, but it was only one of many threats faced by providers in Virginia. And unlike the issue of TRANSVAGINAL ULTRASOUNDS, the TRAP law received little coverage by the mainstream media.

And that is why I believe we need to listen to the stories of abortioneers. As we face unprecedented attacks on women’s access to abortion, we need to be informed about what a TRANSVAGINAL ULTRASOUND actually is and when it is necessary. We need to know the impact laws will have on the ground -- not just in theory, but in practice. When we listen, we may come to understand the situation is far more complicated -- and far more urgent -- than we may have imagined.

Gimme Presents

If I ever have an abortion you can damn well guarantee I’m having my friends throw me an abortion shower. In addition, I will register online for a gift registry where my loved ones can support me through buying me stuff. Ok, so this is one-part mockery of the baby-industrial complex and one-part me recognizing that abortion is just as important in terms of family planning. If you are friends with me you have been hearing me talk about this abortion shower idea for years. I almost want to have an abortion JUST to have a shower and registry.

So, I think an abortion shower is a great idea because it will serve to reduce stigma and silence around abortion and instead create a way for a woman to share the experience and be supported. Additionally, who wouldn’t want to get all sorts of abortion gifts from a registry such as heating pad, Glee DVDs, lots of vegan baked goods, comfy sweatpants, and maxi pads? For friends low on cash they can offer non-monetary presents such as writing you silly (or serious) poetry, performing an interpretive dance at your shower, or offering to run errands if you need a day to stay in bed after your abortion. For people who have more creative friends, they could come up with gifts that represent what the woman has to look forward to in her life, such as an SAT prep book, supplies for a dorm room at college, or presents for the kid(s) she already has.

Then there are all those silly games people play at baby showers. Things involving chocolate stained diapers and guessing games about baby weight/length. I think a fun game for an abortion shower would be something involving maxi pad sculptures and/or pin-the-pad on the female silhouette. Perhaps a guessing game about sonogram measurement of weeks/days since last period? Really the possibilities are endless.

If you think this whole abortion shower and registry sounds ridiculous, well then you now understand how bizarre baby showers (and wedding showers while we’re at it) sound to me. This could be because I’m Jewish and we traditionally do not participate in these pregnancy rituals—it is considered bad luck to have a baby shower before the baby is born. Hmm, but it’s also probably because I think it’s ridiculous to expect my friends and family to outfit MY kid. I understand that many people use baby showers as a way to get all the necessities in the beginning and that makes sense if you are financially strapped and need help. However, the obsession with baby showers has gone way beyond providing for those in need and has morphed into out of control consumption regarding baby things that borders on baby/pregnancy worship.

For those of you who had an abortion, what do you wish someone gave you? Have any of you given presents to friends who had abortions?

Legislators think they are our daddies (and good daddies make things harder on their children)

Happy Fathers' Day! I was going to write you a post about dads, but it'll have to be tomorrow, because I got distracted by an entirely different kind of paternalism. Today I'd like to direct your attention to this post at The Curvature: Anti-Choice Ultrasound Laws Don’t Change Abortion Rates, But Continue Getting Tougher. It's about the wave of state-level legislation that's been passed in the last year or so, much of it having to do with forcing a woman to pay for a medically unnecessary ultrasound, look at it, and/or hear a description of it from the sono tech.

Now, many clinics use ultrasound as a way to determine at what point in the pregnancy the abortion is going to be performed -- there are important technical distinctions between, say, six weeks and sixteen weeks, though ultrasound is not the only way to figure this out -- and I'm all for patients having access to their own medical records if they want it. However!

(a) There is really not that much to see on a sonogram that's made for the purpose of determining gestational age. The screen is pretty dark, the image is fuzzy, and 90% of abortions are performed in the first trimester, a time when all the print-out shows is a roundish grey blur. 

(b) Instructing, as some laws now do, that the technician must turn the screen to face the woman but the woman "may avert her eyes" is pretty ludicrous. So is the idea that a woman averting her eyes must still hear the doctor or tech "describe the fetal development at that stage" (no provision for "averting her ears" in such laws!). If it's in some way relevant to care, a doctor should -- and would -- explain this sort of thing. If it's not relevant to care, well then, it sounds to me like legislators are trying to alter medical practice for political purposes, and as we know that's not OK. Actually it sounds to me like our state reps are practicing medicine without a license -- which happens to be illegal, you know? 

(c) Most of the laws make no provision for victims of sexual trauma who may be re-traumatized by this process. In fact, the Oklahoma bill which was vetoed by the governor even specified that if the abortion is taking place very early in pregnancy, the ultrasound must be done with an intra-vaginal wand, rather than over the abdomen, to "give a clearer image." I was struck to the core when I read this. Like the state was mandating a second rape -- yes, that's what it's called when someone puts something in you that you don't consent to -- if you wanted an abortion. 

(d) Most strikingly: I have never seen a patient change her mind about her abortion because of an ultrasound. My clinic does perform a sonogram before every procedure. By law, clients fill a form indicating whether they want to see the image, listen to the "fetal heart tones if present," both, or neither. We get back forms with all sorts of answers, meaning plenty of clients do choose one or both, but I don't know of anyone who has said, "Oh my god, you know what? I had NO IDEA there was an embryo in there! I thought an abortion was something to do with my bladder! Now that I know, there's no way I can go through with this." 

(e) Which brings us back to the conclusion at The Curvature: it's probably not at all about changing patients' minds, but simply yet another approach in the campaign to guilt, shame, isolate and traumatize women who choose abortion. To punish them for having made this choice that we know she will go through with, because women are not stupid and women are not children, they understand their lives better than a stranger ever could and they already know in their guts what they are capable of at this moment. 

Sometimes that's giving birth and giving her parental rights to another family. 

Sometimes it's leaving high school or going on public assistance in order to afford a wanted, or perhaps unwanted, child. 

And sometimes it's selling her furniture to scrape together 400 or more dollars (have you ever had someone count dollars and nickels on your desk for a medical appointment?), facing a crowd of clueless shame-mongers, listening to maudlin scripts written by state legislators while her pants are down and a high-tech stick is moving around in her vagina, watching a video about a screaming fetus, spending six hours in a crowded waiting room, and having a safe five-minute procedure before going back into the world, back through the clueless crowd, back to her loved ones and not asking them for reassurance that she is still a worthy human being, because they might rebuke her, because they might not understand, because they've heard from ten thousand shame-mongers that anyone in their right mind who's seen an ultrasound would change her mind and leave the abortion clinic. Yes, sometimes women are capable of all that. But god forbid we make it any easier on them.