In the January edition of Obstetrics & Gynecology was an article entitled, “Relationship Between Ultrasound Viewing and Proceeding to Abortion” by Gatter et al that has already received publicity. There is no doubt that this article will be oft-cited for many years, so it merits discussion.
The authors performed a retrospective review of one year’s worth of records at Planned Parenthood clinics in Los Angeles, finding that in that particular practice setting the voluntary viewing of ultrasound (after being asked, “Do you want to see your ultrasound picture on the screen as the clinician performs the examination?” or a similar question) did very little to dissuade women who were seeking an abortion from going through with it. They found that, “Most women presenting for abortion care in our sample had high decision certainty, and ultrasound viewing had no effect on their abortion decision.” Even among those who had “medium or low decision certainty” about having an abortion, 95.2% of those who viewed the ultrasound proceeded to abortion, compared to 98.7% who had not. Overall the difference was even smaller: 98.4% compared to 99.0%.
We can all probably agree on one conclusion— that this particular article certainly does not provide data to support the notion that viewing ultrasounds of pregnancies causes women seeking abortions to change their minds in significant numbers. But it is, unlike what the authors might nudge us toward believing, too early to write off the merits of offering and performing ultrasounds for these patients.
But what critiques can we make? I can think of a few, which I will enter over the coming weeks.
First, the reader must note that the ultrasounds were done in Planned Parenthood clinics in Los Angeles. The article did not attend to any details of what the “viewing” of the ultrasound entailed; the authors did not indicate that there was any attempt to “script” that process. I would propose that in the setting of a clinic dedicated to providing abortions, the discussion surrounding the ultrasound may bear little resemblance to the detailed explanation of fetal anatomy that a happily expectant couple may get from her obstetrician. Features like the brain, spine, heartbeat, limbs, fingers and toes, spontaneous movements as well as reactions to the pressure of the ultrasound are all part of what I discuss with my patients. For the woman seeking abortion, the physician performing it seems unlikely to attend to these details. I propose that not all ultrasound experiences are alike.
The article later raises concerns about mandated ultrasound viewing (arguing against it). It is a contentious notion already; to suggest that the viewing of an ultrasound ought to contain specific content and discussion would make it only more so. But would not true informed consent require it? And for the purposes of research, would not a dismissal of the impact of ultrasound’s effects on a woman’s decision require a more descriptive effort of what happens inside the exam room?
This is a reflection on the method of the intervention; in coming blogs I will add more thoughts about interpretation of results, and the ethical conclusions made by the authors.