Politically Mandated Vaginal Procedures

In their noble quest to protect the bumbling, infantile female population from itself, politicians in Michigan pass yet another [mind numbing] law, HB 4446.

HB 4446 mandates physicians commit malpractice by performing a medically unnecessary procedure on a patient who's decided to have either a medical, or surgical elective termination of pregnancy (emphasis mine):

(8) [Before obtaining the patient's signature on the acknowledgment and consent form as required under this subsection, a physician or a qualified person assisting the physician shall perform an ultrasound on the patient, provide the patient with an opportunity to view the active ultrasound image of the fetus, and offer to provide the patient with a physical picture of the ultrasound image of the fetus.]

An obstetrical U/S is a medical imaging study used to evaluate the pregnancy--fetal anatomy (any birth defects?), fetal environment (is there enough fluid around the fetus?), well-being (was fetus successfully converted from a feet-first presentation, to a head-first one?), growth, maternal-fetal blood flow, etc.

Ultrasound is high frequency sound waves, which penetrate the body and bounce off the internal structures, giving an electronically produced picture on a screen.





1st trimester transabdominal U/S
[the sac is between 8 and 10]



vaginal U/S probe



1st trimester transvaginal U/S
[the sac is between 2.0 and 3.0]

There are specific indications for an obstetrical U/S. Some of these indications* are:

Evaluation of gestational age, fetal growth

Vaginal bleeding of undetermined etiology

Determination of fetal presentation

Suspected multiple gestation

Adjunct to amniocentesis, cerclage

Significant uterine size/clinical dates discrepancy

Pelvic mass

Suspected molar, ectopic pregnancy

Suspected fetal death, uterine abnormality

IUD localization

Biophysical evaluation of fetal well-being

Observation of intrapartum events

Suspected polyhydramnios or oligohydramnios [too much or too little fluid]

Suspected abruptio placentae [shearing off of placenta]

Adjunct to external version [manipulation] from breech to vertex [head] presentation

Estimation of fetal weight and/or presentation in preterm prematurely ruptured membranes and/or preterm labor

Abnormal serum alfa-fetoprotein value

Follow-up observation of identified fetal anomaly

Follow-up evaluation of placental location for identified placenta previa [abnormally located placenta]

History of previous congenital anomaly

Serial evaluation of fetal growth in multifetal gestation

Evaluation of fetal condition in late registrants for prenatal care

So, in real life, an ob U/S is a medical test, possibly an invasive one during the first trimester (when most elective terminations are done), performed by following an established protocol, for a specific medical indication, and interpreted according to a set standard.

In other words, ob U/S tests are not done just because modern technology has managed to come up with U/S machines and vaginal probes, and/or female patients have internal organs.

Unfortunately, when it comes to politicians and medicine, reality is irrelevant.

Case (study) in point:

Woman on the Pill becomes pregnant. [The majority of unintended pregnancies occur in women already using birth control.] She has an U/S to establish EGA; it's a first trimester IUP. The woman decides to have a medical abortion.

However, before she can take a couple of pills during a routine, unobtrusive office visit, she has to have another [most likely vaginal] U/S.

This invasive procedure is performed without a (any) medical indication. [With the exception of pregnant women who decide to have an abortion, performing an invasive procedure on a patient without a medical indication is considered malpractice, and, in some instances, assault.]

Moreover, the physician doesn't have to adhere to any medical standard of care when performing the U/S. The only thing the politicians require is that the physician locate an active ultrasound image of the fetus (?active). Contrast this with the components of a medically indicated basic, first trimester U/S--e.g., gestational sac location, crown-rump length, uterus and adnexal evaluation.

Finally, while the woman is forced to undergo an invasive procedure that's not indicated [and the physician is forced to perform it], when all the probes are inserted, and/or urinary bladders are almost bursting, the doctor doesn't have to interpret the U/S image, and the woman doesn't have to look at it.

HB 4446 only requires the physician to provide the patient with an opportunity to view the image. [What, no forcing the woman to look at the U/S image? No set time she is obligated to stare at the image? No mandated government bureaucrat with a stop watch, timing the woman? Outrageous! Next thing you know politicians will allow women to pick their own clothes, and chew solid food.]

Actually, the fact that women can only be offered an opportunity to view the U/S image, as opposed to being forced to view it, works out great for all involved. The physician can ask the woman, before the U/S is performed, if she intends to look at the image. If she doesn't, the physician can just drug the woman, and render her unconscious for the duration of the procedure [without consenting her, of course].

This way the physician can concentrate on what really matters--the U/S equipment and the gestational sac--without having to deal with the woman's thoughts, words, or actions.

At the same time, the woman can take advantage of not having to be awake and alert during politically mandated vaginal procedures.

So, who is going to pay for all these medically unnecessary U/S procedures? Well, the patients forced to undergo the U/S, and/or the physicians forced to perform them, of course:

(9) This subsection does not prohibit notifying the patient that payment for medical services will be required or that collection of payment in full for all medical services provided or planned may be demanded...

...

[(h) Include on the informed consent website developed under subdivision (g) a list of health care providers, facilities, and clinics that offer to perform ultrasounds free of charge.

In addition to undergoing a medically unnecessary U/S, this is what a woman in Michigan is required to do before she can have an abortion:

(5) The requirements of subsection (3)(c) through (e) may be fulfilled by a patient accessing the internet website maintained and operated through the department and receiving a printed, valid confirmation form from the website that the patient has reviewed the information required in subsection (3)(c) through (e) at least 24 hours before an abortion being performed on the patient.

Subsections (3) (c) through (e) require the patient to obtain:

(c) a physical copy of the written summary described in subsection (11)(b) that corresponds to the procedure the patient will undergo...

[Note. Subsection (11) (b):

Subject to subdivision (g)...written standardized summaries, based upon the various medical procedures used to abort pregnancies, that do each of the following:

(i) Describe, individually and on separate documents, those medical procedures used to perform abortions in this state...

(ii) Identify the physical complications that have been associated with each procedure described in subparagraph (i) and with live birth...

(iii) State that as the result of an abortion, some women may experience depression, feelings of guilt, sleep disturbance, loss of interest in work or sex, or anger, and that if these symptoms occur and are intense or persistent, professional help is recommended.

(iv) State that not all of the complications listed in subparagraph (ii) may pertain to that particular patient and refer the patient to her physician for more personalized information.

(v) Identify services available through public agencies to assist the patient during her pregnancy and after the birth of her child, should she choose to give birth and maintain custody of her child.

(vi) Identify services available through public agencies to assist the patient in placing her child in an adoptive or foster home, should she choose to give birth but not maintain custody of her child.

(vii) Identify services available through public agencies to assist the patient and provide counseling should she experience subsequent adverse psychological effects from the abortion.

And subdivision (g):

(g) Develop and maintain an internet website that allows a patient considering an abortion to review the information required in subsection (3)(c) through (e). After the patient reviews the required information, the department shall assure that a confirmation form can be printed by the patient from the internet website that will verify the time and date the information was reviewed. A confirmation form printed under this subdivision becomes invalid 14 days after the date and time printed on the confirmation form.]

(d) a physical copy of a medically accurate depiction, illustration, or photograph and description of a fetus supplied by the department of community health pursuant to subsection (11)(a) at the gestational age nearest the probable gestational age of the patient's fetus.

[Note. Subsection (11) (a):

medically accurate depictions, illustrations, or photographs of the development of a human fetus that indicate by scale the actual size of the fetus at 2-week intervals from the fourth week through the twenty-eighth week of gestation. Each depiction, illustration, or photograph shall be accompanied by a printed description, in nontechnical English, Arabic, and Spanish, of the probable anatomical and physiological characteristics of the fetus at that particular state of gestational development.]

(e) a physical copy of the prenatal care and parenting information pamphlet distributed by the department of community health under section 9161.

Bottom line: I challenge you to find one other medical or surgical procedure, performed on pregnant women who don't plan to terminate the pregnancy, nonpregnant women, or men, with even a fraction of the politically mandated requirements of HB 4446.


Update: I had the wrong date for the post, 5/22; I changed it.

* modified from Williams 21 ed. p 1112

(via feministing)