Declining Ultrasound

JMJ

Please keep in mind that I am in no way a medical professional. I am simply a mom who is passionate about doing my own research, and want to share what I learn. Nothing on this blog is to be taken as medical advice. Umkay?

 

 

I’ll let you in on a little secret…

 

I didn’t have any ultrasound use with my second pregnancy until 40 weeks. And even then, it was only because she was breech.  No dating scans. No 20 week anatomy scan. No doppler use. Nothing.

 

 

Why would I decline ultrasound technology?

 

Do I think the internet is evil?  To I believe in zippers? Is it because I’m a crazy hippie momma?  (well, maybe a little, but there is more to it.)

 

First, I want to say I am not adamantly opposed to ultrasound use.  I am concerned, however, with the routine use of ultrasound on all pregnancies whether or not an abnormality is suspected.

 

The thing is, ultrasound was never tested for safety before it’s widespread adoption (like x-rays on our grandmothers’ pregnancies – oops).  And since then it has just been assumed safe, without adequate studies.  Basically, every pregnant woman and unborn child are unknowing guinea pigs.

 

“The routine use of ultrasound in pregnancy is the biggest uncontrolled experiment in history.” -Beverly Lawrence Beech, author of Ultrasound? Unsound

 

 

There are several concerns with ultrasound.

 

  • Ultrasound heats tissue. It heats bone more than soft tissue, and soft tissue more than liquid.  The amount of heat produced depends on several factors, including whether the ultrasound is pulsed or a continuous stream, the length of time it is applied, whether it is moved frequently or held in one place for a long time, and the strength of the ultrasound waves the machine produces, or the dosage.
  • There is currently no standard dosage for ultrasound, and the strength varies by manufacturer and unit.
  • And the doppler, used to check baby’s heartbeat at every visit, is a continuous stream of ultrasound, instead of pulses like the scans.  So not only is a doppler of more concern, but it is used much more frequently. (A fetoscope can detect baby’s heartbeat after about 20 weeks, but very few doctors still have one, much less know how to use it, and not all midwives still use them.  It is worth asking about if you are interviewing providers.)

 

But don’t scans make pregnancy safer?

 

As far as I know, is has not been proven that widespread ultrasound use improves outcomes.  In fact, several studies suggest there is actually no benefit to routine ultrasound on all healthy pregnancies as opposed to just where abnormalities are suspected.

 

“Routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions, and no overall differences were detected for substantive short term clinical outcomes such as perinatal mortality.[…]

 

Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby.”Cochrane Database

 

“Screening ultrasonography resulted in no clinically significant benefit.”Department of Family and Community Medicine, University of Missouri, Columbia 65212.

 

 

What is ultrasound generally used to detect?

 

Intrauterine Growth Retardation (IUGR)

IUGR can be determined more accurately my measuring the uterus than by ultrasound. And ironically, an Australian study makes a possible connection between IUGR and pregnancies that receive more ultrasound. Also, there is no way to treat IUGR, so testing for it seems a little pointless.

 

 

Placenta Previa.

 

This is a very serious condition where the placenta covers all or part of the cervix.  If placenta previa is present at the time of birth, it is potentially fatal for both mother and baby.

 Here’s the kicker though… almost all cases of placenta previa resolve themselves before the birth.  In other words, some placentas naturally start out very low, and as the uterus grows, they move higher.  There is no problem here, except that by monitoring all healthy women with ultrasound, we find these low-lying placentas and have to “diagnose” them.  True, dangerous placenta previa is incredibly rare, and can usually be caught without ultrasound based on abnormal bleeding around full-term.  The Outcomes do not improve by trying to detect placenta previa early (an impossibility) instead of investigating any abnormal bleeding.

 

 

Estimated Due Date (EDD)

 

While an early ultrasound can predict the EDD to within 5 days, an EDD based on the mother’s menstrual cycle can be just as accurate.  And an EDD based on ovulation date (if the mother charts) is even more accurate.

 

 

Anatomical Abnormalities

 

Ultrasound scans can detect abnormalities.  The problem with this is that it is often wrong. And several times abnormalities “spontaneously resolve” which makes me doubt the accuracy of those initial diagnosis.

 

“Routine ultrasound scanning does not improve the outcome of pregnancy in terms of an increased number of live births or of reduced perinatal morbidity. Routine ultrasound scanning may be effective and useful as a screening for malformation. Its use for this purpose, however, should be made explicit and take into account the risk of false positive diagnosis in addition to ethical issues.”H C Bucher, J G Schmidt

 

In other words, the main purpose of ultrasound is to detect possible deformities so the pregnancy could be ended.

 

Fetal Palpation
Fetal Palpation

 

 

Things such as uterine tilt, fluid levels and length of cervix…

 

A skilled care provider’s hands can determine these, often with greater accuracy.

 

 

Will my prenatal care provider let me decline ultrasound?

 

While your care provider cannot force you to submit to any procedures (at least not yet), some providers can, and do, drop you as a patient.  Even the midwife-run birth center where I delivered my first (before I questioned ultrasound) has recently “fired” another mom for declining doppler use.  This is why it is ideal for a mother to be informed and know where she stands on different issues before interviewing potential care providers, to make sure they will be supportive.  We ultimately need to take responsibility for our own health care choices.

 

 

When would I personally consider ultrasound prudent?

 

Like any other procedure, it needs to be evaluated on a case-by-case basis.  The point is that ultrasound is a procedure.And should be treated as one.

 

In high risk pregnancies ultrasound may be advisable.

 

If a problem is suspected based on other indicators such as bleeding, unusually low fundal height, cease of fetal movement etc then an ultrasound is a fantastic tool and I would not hesitate to use it.

 

In an induced or otherwise complicated labor continual fetal monitoring might be chosen.

 

Personally,  when my daughter was footling breech at 40 weeks we decided on an ECV, and ultrasound is used as part of the procedure.

 

Also, although a fetoscope can be used to monitor baby’s heartbeat, the mother must me still and quiet on her back.  So during an uncomplicated labor occasional doppler might be preferred. Especially if it is a water birth.

 

 

What about bonding?

 

There is this widespread idea that getting a “sneak peek” of your unborn baby helps you bond.  I’ll admit, it is fun.  It’s fun to see that little bean jumping around, maybe sucking his thumb, yawning or fighting the hiccups.  It’s fun announcing the gender and picking out a name ahead of time.  It’s fun shopping for tiny pink or blue outfits and imagining what your boy or girl will be like. It’s fun registering for pacifiers with mustaches or kissy lips.

 

But are you really bonding with the baby?  Or are you bonding with the idea of your baby?

 

Like a teenager who is more in love with the idea of being in love, than with her actual boyfriend. 

 

There can be  something very tranquil about just allowing you unborn baby to be the baby, without expectations or preset ideas.  Just knowing and respecting that you two will meet when he or she is ready.

 

 

Make up your own mind.

 

My stance throughout this last pregnancy was that I would decline ultrasound use unless it was medically indicated.  But I am not trying to persuade you to adopt my opinion.  Ultimately you need to weigh the benefits and risks yourself and make your own informed decisions. And be flexible if things change.

 

Anyways, I hope I gave you something to think about.  If you want to learn more here are 2 great articles that helped me make up my mind. Chris Kesser’s article is especially awesome with tons of additional resources and studies.

Chris Kesser

Midwifery Today

 

 

 

How about you?  What are YOUR thoughts on routine ultrasound while pregnant?

 

 

 

Inc Corde Maria,

Jessica Ghigliotti

Immaculate Heart of Mary

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