Transvaginal ultrasounds likely required by Wyoming’s new abortion regulations

A bill sitting on the governor’s desk would place more regulations on abortions in Wyoming, including a required ultrasound at least 48 hours before terminating a pregnancy. 

Pushback on similar legislation led to an outcry in Utah in part because of what it may mean: required transvaginal ultrasounds. 

House Bill 148 – Regulation of surgical abortions initially required clinics that semi-regularly perform procedural abortions to have hospital admitting privileges and become licensed ambulatory surgical centers. Later, an amendment changed that bill to additionally require ultrasounds and a waiting period. 

Back in 2020, a bill in Utah to require ultrasounds nearly passed, too — until a group of female Republican and Democrat lawmakers walked out of the Senate chambers in protest, making national news.

“It wasn’t planned, but a spontaneous decision to put an exclamation mark on our concerns about the invasive nature of that bill,” then-Utah Sen. Deidre Henderson was quoted as saying in the Salt Lake Tribune. “I am very pro-life, and always vote for pro-life bills. But I’m concerned that we are overstepping with government mandates of medically unnecessary procedures.”

The bill didn’t initially exempt the requirement of transvaginal ultrasounds, which involves inserting the top of a long, thin “transducer” — coated in a sheath and gel — into the vagina.

“The transducer will be gently turned and angled to bring the areas for study into focus,” according to Johns Hopkins Medicine. “You may feel mild pressure as the transducer is moved.”

It’s done for early pregnancies and is a main way to confirm ectopic pregnancies — a stated goal of the ultrasound amendment to Wyoming’s HB 148. Researchers have noted that there’s no evidence for universal ultrasound requirements pre-abortion.

After the walkout, the Utah bill failed to progress and died. Another attempt in 2022 failed, too. 

Henderson, now the lieutenant governor of Utah, declined an interview for this story because she didn’t feel comfortable talking about another state’s legislation. 

However, Sen. Chris Rothfuss (D-Laramie) brought up this same issue on the Senate floor several times last week, to no avail. 

“Are we the state of Wyoming mandating by law a transvaginal ultrasound?” he said. “It seems like that’s a little beyond what the state of Wyoming should be requiring of a woman through legislation under any circumstance if it’s against their will.”

Following up with WyoFile, he said it would likely affect poorer and rural residents the most because insurance tends to only pay for procedures that are medically indicated. 

“Whether there is a medical necessity or not, a woman [of early gestational age] would be forced to undergo a transvaginal ultrasound and, invasive as it is, whether they like it or not, just to receive appropriate proper medical care,” he said. “I honestly think the intent of it is to make it as unpleasant and inaccessible an experience as possible.”

Most ultrasounds women undergo before they reach 10-12 weeks’ gestation are transvaginal, according to Amber Holloway, a midwife and women’s health nurse practitioner at Laramie Physicians Women & Wellness Clinic. 

There are reasons to do them even later though, she said, like having a higher body mass index “or if there were other things that you’re wanting to look more closely at. So if a patient had a history of something going on with her ovaries, there’s something going on with her cervix, those structures can be a little bit more difficult to see.”

Typically, that’s the case for confirming an ectopic pregnancy, too, she said. Still, the decision over what kind of ultrasound to use is made on a case-by-case basis, she said. 

“I have a lot of students that work with me, and I always tell them: Medicine is rarely black and white,” she said. “It’s typically just varying shades of gray. And so it’s always hard when you’re making black and white laws about other people’s bodies that ultimately don’t affect you.”

When it comes to a clinic regularly providing abortions, there are also protocols for when to provide ultrasounds for someone’s safety, according to Jackson OB-GYN Dr. Giovannina Anthony.

That includes “patients who have a risk factor for an ectopic pregnancy” or irregular symptoms, she said.

Anthony used to work at a clinic providing abortions in Jackson and is currently a plaintiff in the case challenging Wyoming’s two bans, which have been tied up in the courts. 

Mandating transvaginal ultrasounds — something that can be traumatizing and anxiety-inducing, especially for young women and abuse victims — has no medical backing, Anthony added.

“The objective is to make it impossible to do telehealth abortion,” Anthony said about the bill. “Their objective is not to keep women safe.”

Back on the bill

Beyond ultrasounds, opponents of HB 148 have said its main aim isn’t safety but banning abortions. Proponents stand firm in their assertions it would improve safety, even if medical professionals say otherwise. 

After being the bill’s one opposing vote in the Senate Judiciary Committee, physician assistant Sen. Fred Baldwin (R-Kemmerer) said even he didn’t have hospital admitting privileges.

“I see people with appendicitis, I see people with all kinds of bizarre illnesses, but I don’t have admitting privileges for a number of reasons,” he said. “Sometimes that’s a political thing. They don’t like the hospital, the hospital doesn’t like them … making everybody have admitting privileges, I don’t think that’s realistic.”

Meanwhile, on the Senate floor, Sen. Dave Kinskey (R-Sheridan) made his disdain for abortion clinics clear in voting for the legislation. 

“I’m pro-life, ardently so,” he said. “Years ago, pre-Dobbs, there’s a state to the south of us … that passed a bill just like this, and it quite frankly limited access to abortions.”

He was talking about Texas’ House Bill 2. One estimate found that the legislation forced 23 of the state’s 42 clinics to close in the first few years.

The U.S. Supreme Court struck down the law in 2016 via Whole Woman’s Health v. Hellerstedt. In her consenting opinion, the late Justice Ruth Bader Ginsburg wrote that “it is beyond rational belief” that the law would protect women.

“When a State severely limits access to safe and legal procedures, women in desperate circumstances may resort to unlicensed rogue practitioners, faute de mieux, at great risk to their health and safety,” she wrote. 

But that was before Roe v. Wade was overturned.

“Now since Dobbs, we have the room to bring common sense regulation back to the table and that will, quite frankly, I hope, drive some of these abortion clinics out of business,” Kinskey said. “That’s my hope.” 

Alternately, Sen. Cale Case (R-Lander) argued this bill would cost Wyoming more OB-GYNs fearing repercussions of just trying to do their job. 

“It’s bills like this that kill people,” he said, smacking his hand against his desk. “It’s not just about the unborn. It’s about women and children and our children.”

Ultimately, ​​Senate President Ogden Driskill (R-Devils Tower) backed the bill, but made a bleak prediction for its future.

“This bill gets signed, goes into law and it goes in front of the courts,” he said.

He added that he wasn’t sure that this is the best long-term strategy, because “it might just get you just the opposite of what you’re asking for. Courts do strange things.”

Gov. Mark Gordon has 15 days to decide what to do with HB 148. 

Update: This story has been updated based on new information that now indicates the governor has more time to consider the legislation.

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