Prenatal Ultrasound

Ask questions about your care. Whenever a test or procedure is recommended (such as ultrasound, blood test, amnio, etc.) you have a right, even a responsibility, to ask questions. "What is this test?" "Why is it necessary?" "What will we learn?" "How will we use this information?" "Are there alternatives?" "What are the possible side effects of the test?" "What are the consequences of doing nothing?"

Keep in mind that there are potential side effects to any test, including ultrasound and blood tests. If you would not be willing to take the recommended action for a positive test, is there a good reason to take the test? There may be, or there may not. It is important to understand the concepts of informed choice and informed consent. You and your family are ultimately the ones who have to live with the consequences of choices about your care. Almost every test in the book has good reasons for either doing the test or avoiding the test, depending on your personal situation, priorities and choices. Every test carries risks, and there are some risks also in not knowing. The question ultimately boils down to "Which risks are you willing to take?"

From Ten Ways to Take Care of Yourself in Pregnancy by Jennifer Rosenberg. This article from the Midwifery Today site originally appeared in Having a Baby Today, Autumn 2001, No. 3.

Today ultrasound scans may be repeated on a daily basis. As long as there is sufficient liquid in the uterus, the baby is almost guaranteed to be out of danger. These days, most women are offered a great number of ultrasound scans throughout their pregnancy; most of them are useless, compared with what an experienced practitioner can expect from a clinical examination after listening to the mother-to-be. It seems, on the other hand, that many doctors are paradoxically reluctant to repeat scans when the baby might be overdue. This is precisely the time when scans provide precious data that have huge practical implications. Individualized selective strategies might also lead to reestablishing the use of biochemical tests after the so-called due date; a sudden drop in the urinary estriol levels (and other hormones, such as human placental lactogen) is a sign of placental insufficiency. Routine strategies have largely displaced these non-invasive tests.

From The Tree and the Fruit - by Michel Odent. This article first appeared in Midwifery Today Issue 72, Winter 2004.

It is likely that a routine ultrasound scan will be suggested fairly early in your pregnancy. This presents a perfect opportunity to ask a few questions: "What is the chance the scan will make things worse? Is such a scan safe?" If the answer is a flat "Yes, ultrasound scanning during pregnancy is safe," alarm bells should start going off in your head, because you are not getting the full information. You must then ask, "Show me the data on the safety of prenatal ultrasound," in order to check on what you may be told about the data on the safety of prenatal ultrasound. As a scientist I can assure you that the only correct answer to your question is, "We don't know because there is not sufficient scientific data to prove the safety of prenatal ultrasound." Some research has shown the possibility that ultrasound can cause slowed growth of the fetus while still in the uterus. Other research has shown the possibility that some children who have been scanned while still in the uterus may later have mild neurological deficits. We need more study of both these possibilities. But from a scientific viewpoint, it is impossible to say today that ultrasound scanning during pregnancy is perfectly safe.

The next question to ask when ultrasound scanning is proposed to you is, "What is the chance that a scan will make things better?" When you are told that one reason for the scan is to look for defects in the fetus, ask: "What is the chance a defect will be correctly identified (true positive screening test) and what is the chance a defect will be incorrectly identified (false positive screening test)?" If your provider cannot, or will not, answer this question, watch out!

Your next question when ultrasound is suggested should be, "Is there a better chance my baby will survive the pregnancy and birth if an ultrasound scan is done, and what are the data?" The correct answer is that a large study in the United States of more than 15,000 regnant women showed no improvement in the mortality rate of the babies if ultrasound is routinely used during pregnancy.

From Technology in Birth: First Do No Harm - by Marsden Wagner, an article on the Midwifery Today web site.