Published in "Birth and Babies" volume 1. Spring 2012.
The use of ultrasound has become common practice in pregnancy and delivery ~ so common that providers often don’t think to discuss its use. However, a large body of research questions its safety.
In her book Gentle Birth, Gentle Mothering, Sarah Buckley, MD. devotes a whole chapter to the subject, titled: Ultrasound Scans ~ Cause for Concern, where she points out the reality of its use: "[...] it is important to realize that ultrasound technology is very new and relatively untested, in terms of safety" (p. 78). (1)
In his article Ultrasound, More Harm Than Good, Marsden Wagner speaks of the dangers of ultrasonography and the unknown of its effects. (2)
In Journal of Nurse-Midwifery, Doris Haire writes:
“There is a growing concern among consumers and health care providers that the immediate benefits of diagnostic ultrasound used in obstetrics may not outweigh the potential risks. Dr. Melvin E. Stratmeyer, of the Center for Devices and Radiologic Health (CDRH), recently confirmed an earlier statement by the United States Food and Drug Administration (FDA) that expressed the following concerns: Increasing concern has arisen regarding the fetal safety of widely used diagnostic ultrasound in obstetrics. Animal studies have been reported to reveal delayed neuromuscular development, altered emotional behavior, EEG changes, anomalies, and decreased survival. Genetic alterations have also been demonstrated in in vitro systems. Millions of women and their unborn children are being exposed to diagnostic ultrasound before the long-term effects on human development of such exposure are fully understood. [...] Fetuses are often exposed to prolonged sonography because the physician or technician lacks sufficient expertise in evaluating what be or she is seeing.” (3)
EFM (electro fetal monitor[ing])
In hospitals, the protocol usually involves the use of constant (or intermittent) electro fetal monitoring. This implies that women in labor need to sit semi-prone in bed while a tracing can be made of the fetal heart tones in relation to her contraction.
However, the research shows that: “Twenty-five years after electronic fetal monitoring became a part of intrapartum care, ... it is yet to be proved of value in predicting or preventing neurologic morbidity.” (4)
The American College of Obstetricians and Gynecologists (ACOG) has issued a technical bulletin that states: “No well-controlled study has yet proved that routine scanning of all prenatal patients will improve the outcome of pregnancy.” (5)
One may ask why EFM is still part of the care in hospitals if its use is controversial and if the research realities don’t seem to show any improved outcomes, if it’s extremely uncomfortable for mother and babies (the sounds is comparative to a train driving by), let alone possibly dangerous?
In “Understanding Diagnostic Tests”, Anne Frye explains why this practice is still a trend beyond the research realities: “The problems with ultrasound are many. Unborn babies are being exposed routinely to a technology that has not been proven safe. Practitioners are becoming so dependent on the machines that they are losing their hands-on skills. As they become less and less connected with the essential process of birth, they frequently communicate fear to mother and baby about possible negative outcomes. Routine use of scanning, presented as necessary and to see "if your baby is alright" covertly and overtly implies that a scan can absolutely rule out fetal variations and defects. Women and families are led to believe that modern technology can guarantee them a perfect baby. It is imperative that as midwives we counter this worldwide cultural trend by being very clear with clients about the risks, benefits and deficiencies of ultrasound exam procedures and by emphasizing that no one can guarantee anything in life or in birth. Parents must be told in no uncertain terms that scans look for specific defects and that it is unrealistic to expect detection of all fetal anomalies regardless of the methods used and the stage of pregnancy when the exam takes place, even with the most exert ad thorough scanning." (6)
Dopplers
In many practices in the US and in Canada, birth workers use dopplers to check fetal heart tones at every prenatal visit. Many providers don’t mention that the doppler is an ultrasound, thus failing to inform women of an important choice. In Understanding Diagnostic Tests, Anne Frye writes: "In general, fetuses move away from the Doppler beam. Many midwives have concluded that babies don't like them and certainly if Doppler is audible, this could explain fetal aversion as well. [...] However, unlike imaging ultrasound, Doppler devices are always ‘on’, emitting radiation. Continuous wave devices receive and analyze the echoes constantly, and are often used for many hours at a time." (6)
There is a place for intervention, and there is a place for close monitoring. However, automatic monitoring of a normal function such as a normal pregnancy and birth may bring dramatic consequences for babies. Like many technologies, we just DON'T KNOW the long terms effect of ultrasounds on babies ~ we can only speculate. In doubt, I opt to pass, and will go for the old fetoscope. At least, I KNOW I'm not hurting any babies.
The use of ultrasound has become common practice in pregnancy and delivery ~ so common that providers often don’t think to discuss its use. However, a large body of research questions its safety.
In her book Gentle Birth, Gentle Mothering, Sarah Buckley, MD. devotes a whole chapter to the subject, titled: Ultrasound Scans ~ Cause for Concern, where she points out the reality of its use: "[...] it is important to realize that ultrasound technology is very new and relatively untested, in terms of safety" (p. 78). (1)
In his article Ultrasound, More Harm Than Good, Marsden Wagner speaks of the dangers of ultrasonography and the unknown of its effects. (2)
In Journal of Nurse-Midwifery, Doris Haire writes:
“There is a growing concern among consumers and health care providers that the immediate benefits of diagnostic ultrasound used in obstetrics may not outweigh the potential risks. Dr. Melvin E. Stratmeyer, of the Center for Devices and Radiologic Health (CDRH), recently confirmed an earlier statement by the United States Food and Drug Administration (FDA) that expressed the following concerns: Increasing concern has arisen regarding the fetal safety of widely used diagnostic ultrasound in obstetrics. Animal studies have been reported to reveal delayed neuromuscular development, altered emotional behavior, EEG changes, anomalies, and decreased survival. Genetic alterations have also been demonstrated in in vitro systems. Millions of women and their unborn children are being exposed to diagnostic ultrasound before the long-term effects on human development of such exposure are fully understood. [...] Fetuses are often exposed to prolonged sonography because the physician or technician lacks sufficient expertise in evaluating what be or she is seeing.” (3)
EFM (electro fetal monitor[ing])
In hospitals, the protocol usually involves the use of constant (or intermittent) electro fetal monitoring. This implies that women in labor need to sit semi-prone in bed while a tracing can be made of the fetal heart tones in relation to her contraction.
However, the research shows that: “Twenty-five years after electronic fetal monitoring became a part of intrapartum care, ... it is yet to be proved of value in predicting or preventing neurologic morbidity.” (4)
The American College of Obstetricians and Gynecologists (ACOG) has issued a technical bulletin that states: “No well-controlled study has yet proved that routine scanning of all prenatal patients will improve the outcome of pregnancy.” (5)
One may ask why EFM is still part of the care in hospitals if its use is controversial and if the research realities don’t seem to show any improved outcomes, if it’s extremely uncomfortable for mother and babies (the sounds is comparative to a train driving by), let alone possibly dangerous?
In “Understanding Diagnostic Tests”, Anne Frye explains why this practice is still a trend beyond the research realities: “The problems with ultrasound are many. Unborn babies are being exposed routinely to a technology that has not been proven safe. Practitioners are becoming so dependent on the machines that they are losing their hands-on skills. As they become less and less connected with the essential process of birth, they frequently communicate fear to mother and baby about possible negative outcomes. Routine use of scanning, presented as necessary and to see "if your baby is alright" covertly and overtly implies that a scan can absolutely rule out fetal variations and defects. Women and families are led to believe that modern technology can guarantee them a perfect baby. It is imperative that as midwives we counter this worldwide cultural trend by being very clear with clients about the risks, benefits and deficiencies of ultrasound exam procedures and by emphasizing that no one can guarantee anything in life or in birth. Parents must be told in no uncertain terms that scans look for specific defects and that it is unrealistic to expect detection of all fetal anomalies regardless of the methods used and the stage of pregnancy when the exam takes place, even with the most exert ad thorough scanning." (6)
Dopplers
In many practices in the US and in Canada, birth workers use dopplers to check fetal heart tones at every prenatal visit. Many providers don’t mention that the doppler is an ultrasound, thus failing to inform women of an important choice. In Understanding Diagnostic Tests, Anne Frye writes: "In general, fetuses move away from the Doppler beam. Many midwives have concluded that babies don't like them and certainly if Doppler is audible, this could explain fetal aversion as well. [...] However, unlike imaging ultrasound, Doppler devices are always ‘on’, emitting radiation. Continuous wave devices receive and analyze the echoes constantly, and are often used for many hours at a time." (6)
There is a place for intervention, and there is a place for close monitoring. However, automatic monitoring of a normal function such as a normal pregnancy and birth may bring dramatic consequences for babies. Like many technologies, we just DON'T KNOW the long terms effect of ultrasounds on babies ~ we can only speculate. In doubt, I opt to pass, and will go for the old fetoscope. At least, I KNOW I'm not hurting any babies.
(1) Sarah Buckley. (2005). Ultrasounds: cause for concern. Retrieved from: http://www.sarahbuckley.com/ultrasound-scans-cause-for-concern/
(2) Marsden Wagner. (1999). Ultrasound: more harm than good? Retrieved from: http://www.midwiferytoday.com/articles/ultrasoundwagner.asp
(3) Journal of Nurse-Midwifery Vol. 29, No. 4 July/August 1984
(4) Rosen and Dickinson (1993. In Henci Goer. Obstetric Myths Versus Research Realities, p. 131.
(5) Diagnostic ultrasound In obstetrics and gynecology Tech. Bull. No. 63 American College of Obstetricians and Gynecologists. October 1985.
(6) Anne Frye. Understanding Diagnostic Tests, p. 919-921.
©2012 paule bezaire
(6) Anne Frye. Understanding Diagnostic Tests, p. 919-921.
©2012 paule bezaire
