Routine Ultrasound: Ultra-Suspect

Despite being 15 weeks into my second pregnancy, I have not had an ultrasound scan. Recently we made a trip to hospital (to prevent me from becoming dehydrated during my chronic morning sickness) where hospital staff were dumbfounded by this fact: "You've already given birth? To a healthy child? But you've never had an ultrasound?" It's not surprising that this was the reaction from medical staff, even some of my fit, healthy, low risk, homebirthing friends have ultrasounds.

My decision not to have ultrasounds was made after extensive reading I did during my time as a PhD student (working on a thesis about the hyper-medicalisation of present day maternity care). After learning that ultrasounds:

• have never been proven to be safe (Wagner 1999),
• can have false positives (Buckley 2005; Reist 2005),
• have unknown long term consequences for exposed children,
• have no benefits to the health of pregnant women or their unborn children (Buckley 2005; Wagner 1999), and
• can increase parental stress unnecessarily (Rothman 1988),

I decided I would not have ultrasounds during pregnancy unless there were physical signs that something might be wrong.

My reading also taught me that studies have shown ultrasounds increase the risk of:

• newborns having low birth-weights (Newnham et al 1993)
• retarded foetal growth (Hande & Devi 1995)
• preterm labour or miscarriage (Beech 1999; Buckley 2005)
  
• postnatal mortality (Hande & Devi 1995)
• speech problems (Campbell et al 1993) and
  
• impaired brain function (Devi et al 1995)
  

I was also concerned by accounts of mothers who had experienced ultrasounds and found that it caused them to doubt their body's ability to safely grow their babies and increased their stress during pregnancy.

Once upon a time women confirmed pregnancies by noting the changes in their bodies and trusted their bodies to grow healthy babies. Sociology Professor Barbara Katz Rothman (1988) discovered that the routine use of technologies such as amniocentesis and ultrasound have led to a cultural shift where women experience their pregnancies as tentative until a doctor and his machine tell them otherwise. This obviously has consequences for mother/baby bonding, as Ina May Gaskin shares:

"Having that early look inside is not always reassuring, nor does it always prepare you for what is to come. I remember my cousin who told me that she felt like she grieved through the second half of her pregnancy because she had learned her baby's gender (which was the same as her older child's). She later fell in love with her second child, but she spent several months burdened by information that did her and her baby no good." (Gaskin 2003: 192)

This was one of my primary motivating factors for avoiding ultrasound. We had seen beautiful footage of homebirths where the parents were so overwhelmed with joy immediately after birth that many minutes passed before anybody bothered to find out what the sex of the baby was. There were happy tears and laughter and parents gazing at their newborn in wonder, falling totally in love, a stark contrast to the hospital births we had seen where more often than not before the mother even got to see her baby a stranger had announced the sex. We wanted to meet our baby before the battle to resist gender constructing began. We also weren't comfortable with the idea of a sonographer knowing the sex of our baby before anyone had met her or him.

Knowing all this, how can it be that 99% (Buckley 2005) of Australian women have at least one ultrasound during pregnancy? .Simple, like almost all obstetric interventions, the ultrasound was originally developed for use in rare, high-risk cases, but within 15-20 years of its creation the ultrasound became a routine test recommended to all pregnant women.

It is also important to note that the majority of technicians who perform ultrasound examinations are not aware of the above risks associated with the scans. Dr Buckley (2005) notes that training is voluntary for Australian obstetricians, thus skill levels vary among doctors, which could account for false positives. Buckley also writes that there are no standards to ensure that the lowest doses from a single machine are used and that the intensity of doses have increased in the last twenty years. Similarly in the United States:

"The use of ultrasound is especially unregulated and popular...The Food and Drug Administration (FDA) bowed to pressure from industry and organized medicine to relinquish control over the amount of sonic energy that can be emitted by the new ultrasound devices used in obstetrics. Currently, there are no federal or state regulations requiring periodic calibration of obstetric ultrasound machines, written consent of the pregnant woman, indications for the procedure, the type of equipment used, the amount of exposure, or the identification and qualification of the sonographer." (Gaskin 2003: 191)

My partner and I believe it is highly unethical on the part of the medical system in Australia and the United States to make such widespread use of this technology without providing patients with all the information available and enabling them to make an informed choice. Much like The World Health Organisation states:

"Ultrasound screening during pregnancy is now in widespread use without sufficient evaluation. Research has demonstrated its effectiveness for certain complications of pregnancy, but the published material does not justify the routine use of ultrasound in pregnant women. There is also insufficient information with regard to the safety of ultrasound use during pregnancy, including: clinical effectiveness, psychological effects, ethical considerations, legal implications, and safety.

WHO strongly endorses the principle of informed choice with regard to technology use. The health-care providers have the moral responsibility: fully to inform the public about what is known and not known about ultrasound scanning during pregnancy; and fully to inform each woman prior to an ultrasound examination as to the clinical indication for ultrasound, its hoped-for benefit, its potential risk, and alternative available, if any."

Get Informed!

Dr Sarah J Buckley MD: Ultrasound Scans: cause for concern
(Sarah Buckley MD is a trained GP/family physician, an internationally-acclaimed writer on gentle choices in pregnancy, birth, and parenting.)

Dr Marsden Wagner MD: Ultrasound More Harm Than Good?
(Marsden Wagner, MD is a neonatologist and perinatal epidemiologist. He was responsible for maternal and child health in the European Regional Office of the World Health Organization for fourteen years.)

Beverley Lawrence Beech: Ultrasound: weighing the propaganda against the facts
(Beverley Lawrence Beech, honourary chair of the Association for Improvements in the Maternity Services (AIMS), is a freelance writer and lecturer and lives in the United Kingdom.)

Melinda Tankard Reist: Defiant Birth: women who resist medical eugenics
(Melinda is an author, social commentator and advocate for women and girls.)

See also Doppler Danger on Facebook

Books

Ann Oakley "The Captured Womb"

Barbara Katz Rothman "The Tentative Pregnancy"

Robyn Rowland "Living Laboratories"

Sarah Buckley "Gentle Birth, Gentle Mothering"

Studies
Campbell, James D., Wayne Elford, and Rollin F. Brant, "Case-Control Study of Prenatal Ultrasonography Exposure in Children with Delayed Speech," Canadian Medical Association Journal 149, no. 10 (1993).

Devi, P. U., R Suresh, and M.P Hande, "Effect of Fetal Exposure to Ultrasound on the Behavior of the Adult Mouse," Radiation Research 141 (1995).

Hande, M.P. and P.U. T Devi, "Eratogenic Effects of Repeated Exposures to X-Rays and/or Ultrasound in Mice.," Neurotoxicol Teratol 17, no. 2 (1995).

Newnham, John P, et al., "Effects of Frequent Ultrasound During Pregnancy: A Randomised Controlled Trial," The Lancet 342 (1993).