Saturday, January 2, 2010

Ultrasound

Ultrasound is very worrisome to me. Most people having babies think about ultrasound as the scan or scans a technician does to date the pregnancy, measure the baby, determine the sex, etc. What studies have shown, and this is all over the 'net so you can look this up yourselves, is that ultrasound potentially shakes things around in the fetal brain, to put it technically. But what a lot of people don't realize is that electronic fetal monitoring in hospital during non-stress tests, labour, etc. is ALSO ultrasound. If these studies are being done and we are being warned about repetitive, routine ultrasound scans (on average a woman here receives around 3 ultrasounds per pregnancy, from what I've observed of my clientele...some have less, some have one almost every doctor's visit), I think it's important to inform consumers the monitoring they are receiving throughout labour might have risks too.

When a woman receives an epidural and/or synthetic oxytocin during labour, she is constantly monitored, and this can often leave her baby exposed to ultrasound for many consecutive hours. Considering the epidural rate is incredibly high for first time mothers in hospitals, in the high 90th percentile, this means the vast majority of fetuses are being exposed to ultrasound that we don't have evidence is safe. Even mothers who are birthing naturally are still exposed to occasional 20 minute stints of monitoring.

Becaue of a few things I've seen, I don't reject ultrasound as a tool at all. There have been a couple of sad incidents I've known where had just one scan been done to have a look at the baby, information would have been easily revealed that would have given caregivers knowledge of the babies' treatable conditions before it was too late. I personally had one scan with 3 out of 4 of my pregnancies. While I know ultrasound is not the be all and end all of diagnostic tools, a basic peek makes me feel reassured. To have a listen to my babies prenatally, the midwives and doctor I've seen have used a fetoscope. I was very pleased with the OB I saw during a couple of my pregnancies who respected my wish to not have my baby listened to with a Doppler in order to reduce exposure to ultrasound. Instead of criticizing me for being "overly cautious" or for undermining her by questioning her methods, she thanked me for the opportunity to keep up her auscultation skills.

Having ultrasounds for nuchal translucency tests, dating, etc. is up to the level of comfort of the parents and not something I'd advise for or against because the choices are personal, but when we get into the realm of having ultrasounds repeatedly when not for clear reasons, we should be aware that we do not really know conclusively what kind of effect this will have on our babies. It is always a bit scary to me to know that many people will do their best to avoid things like caffeine, over the counter remedies, etc. to have the healthiest baby possible, but accept many ultrasounds simply because they're offered, expect to take an epidural full of all kinds of crazy narcotics, and have no worries about receiving hormones and hours of electronic fetal monitoring. I know that when parents-to-be ask about these procedures, they are often told things like "there's no risk to ultrasound", "epidural doesn't have that much effect on the baby and will actually give you more energy to push your baby out", and "the synthetic oxytocin is not harmful...after all, it's the same thing your own body makes." Not that I want to fear monger labouring parents, telling them all these things are bad, because inherently they are not...every intervention holds value if it is truly needed. But how are parents supposed to make informed choices if they are not told some of the real potential risks, and in fact, often misled? If a parent to be were to research the risks of these interventions from several sources, they would have more information with which to make choices.

The best advice I can give my clients is to do their homework. Sadly, one cannot just accept some of the answers they're given to their questions and must research further. Unfortunately, consumers of medical care cannot take everything they're told about medical interventions during pregnancy and labour at face value. This is certainly not true in every case...I work with some great doctors and nurses who strive to give patients the best information they can, giving both sides of the coin and respecting parental decisions. But it is true in many. Simply believing all your questions will be answered with everything you will need to make an informed decision is an innocence you can't really afford. YOU are the consumers of medical care. Shop around and do your research.