Midwife: First-Trimester Ultrasounds Are Not Part of Routine Prenatal Care

In the wake of the Virginia forced transvaginal ultrasound debate in Virginia, bill supporters have tried to justify their bill by stating that ultrasounds are the “gold medal standard” of pre-abortion care.  But are they? 

As one midwife explains in an article on The Clinical Advisor, unless a patient presents with an issue that would have a medical practitioner suspect an ectopic pregnancy, often they aren’t used at all.

Robyn Carlisle, MSN, CNM, WHNP, full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J., writes:

I recently saw a patient in the office for amenorrhea, severe left-sided pelvic pain, and a positive home pregnancy test. I ordered blood work and a stat ultrasound to rule out ectopic pregnancy. When I mentioned the ultrasound, the patient balked and confided that she was uncertain whether she wanted to continue the pregnancy.

My patient felt that an ultrasound would just complicate an already painful decision to terminate the pregnancy. I explained to her that while I understood her apprehension, given her clinical presentation, we needed to ensure this was not a tubal pregnancy and move forward with the ultrasound.

Under normal circumstances in New Jersey, this patient would not have needed an ultrasound to confirm her pregnancy, especially if she was considering an abortion. Unfortunately, not all women have this choice.

First trimester ultrasounds are not part of routine prenatal care.  Many insurance companies will not cover first trimester ultrasound without a medical indication, such as vaginal bleeding or severe pelvic pain. So why are politicians now requiring this expensive procedure for a woman who plans to terminate her pregnancy? 

Despite what some prolife advocates may think, the decision to terminate a pregnancy is never an easy one. Prochoice does not mean pro-abortion. Prochoice means supporting a woman’s legal choices regarding pregnancy and her body. Requiring unnecessary ultrasounds add to the pain women experience when making an already difficult decision, but will most likely not change the decision once it has been made. 

Pregnant women who show signs or symptoms of ectopic pregnancies receive ultrasounds. Not every other woman does.  Why are legislators insisting that it be different for women wanting to end a pregnancy?

When legislators mandate more “care” for a woman who wants to terminate than is usually given to a woman with a wanted pregnancy, and expensive, medically unnecessary care, how can that be anything but government sanctioned coercion?

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  • therealistmom

    … was when I was pregnant with my third, and I volunteered for it. The hospital had a lot of students rotating there and they needed experience with doing a trans-vaginal u/s. I’m not particularly ‘modest’ and figured I would be a good candidate for practice, and it was an awkward, uncomfortable experience. I can’t imagine what it would be like for someone who has already undergone trauma. And gee, all we could see was a small black ‘space’ where the gestational sec was. It provided absolutely no useful information. The push to force women to have a u/s prior to an abortion is nothing but punishment, pure and simple.

  • divine-oubliette

    I was under the impresion that all abortions require ultrasounds, not only to screen for ectopic pregnancies (1 out 100 pregnancies will be etopic) but to give the women an option of the procedure to be used (under 9 weeks she may be able to have a medical abortion) and to inform the practicioner of the gestational age of the pregnancy to decide on the proper method to be used for a surgical procedure (as the procedure differs with a 10 week pregnnacy and a 20 week pregnancy).

    Where I am in Texas it is routine to give an ultrasound before an aboriton for these reasons. Granted they are jelly on the belly ultrasouns not transvaginal ones but they are routinely given for the above reasons.

  • jodi-jacobson

    There is a difference in medical care between what is required or indicated, what is suggested, and what some, many, or all physicians might or might not do depending on their professional judgment.


    Ultrasounds are not required.  For example, the American College of Obstetricians and Gynecologists bulletin on abortion says:

    An induced abortion is a procedure that is done to end a pregnancy. Most induced abortions are done in the first 12 weeks of pregnancy.

    Before the procedure, a test is done to confirm the pregnancy. The health care provider will ask questions about your health and perform a physical exam. Blood tests will be done. An ultrasound exam may be done to confirm the date of the pregnancy. In most cases, a counselor is available to answer any questions.

    Ultrasounds are at the discretion of the doctor and pertain to how different practices, clinics or individuals choose to practice.  In some places, performing an ultrasound has become the adopted practice, not because it is unequivocally indicated, but my guess is because abortion procedures have been made so contentious ultrasounds are over-used for purposes of reducing liability and other concerns. In this way I believe that politics has already affected the practice of medicine with regard to ultrasounds.

    In Virginia, for example, as pointed out in this American Independent story “ultrasounds are used in the case of abortion at the doctor’s judgment or if a patient requests it.”

    So no, though they may be common practice, they are not either medically mandated, nor necessarily indicated for all abortions.



  • halli620

    For women who have no way of knowing when their last menstruation or ovulation was, such as if their periods are very irregular or they’re on a hormonal birth control that stops their periods but was compromised by other medications or misuse, you’re right that the gestation age may need to be determined, such as by ultrasound. However, many, if not most, women know the precise dates of their last menstruation, which significantly narrows down the gestation age. If they can provide this, and they are not close to the recommended time guidelines, there should be no need for an ultrasound to determine the gestation age. I know you meant the 10 and 20 week comparison as an extreme example, but it’s so extreme that it doesn’t even make sense to use an example, as if most women won’t know if they’re 2 months or 4 months late for their period. The rare cases where this is a complete unknown and an ultrasound may be necessary to determine gestation age should have no bearing on the many cases where, say, the woman is 1 or 2 weeks late, had a period within the last 6 weeks, and knows that the opportunity for possible conception occurred 3-4 weeks ago.

  • crowepps

    Before ultrasounds doctors still figured out gestational age, by measuring the size of the uterus.  My kids are 40 and 30, I’ve been pregnant four times, and and there weren’t any ultrasounds done with any of my pregnancies because they just weren’t that common yet.