Saturday, April 26, 2008

Pregnant women are having too many ultrasound scans

The evidence has been around for some time that ultrasound scans have no effect on outcomes of pregnancy and birth for low risk pregnant women. This has been confirmed by Associate Professor Janet Vaughan, an obstetrician from the University of Sydney. Dr Vaughan says that healthy women should have only one scan when they are about 12 weeks pregnant, to confirm dates.

15 comments:

Anonymous said...

surely even thats debateable - not everyone needs or values date confirmation?

Carolyn said...

I agree with anonymous. What is the evidence to support the need for one scan at 12 weeks. In my experience when a woman goes for one scan there is just about always some 'reason' why she has to go back again.

Sarah Stewart said...

Yep, I wouldn't argue with either of you. I was just celebrating the fact that an obstetrician is questioning the need for frequent scans.

But now that scans are such an inherent part of pregnancy mythology, how can we take get women, midwives and doctors to question the necessity of frequent scans?

Dot said...

Frequent scans may not be necessary, but they are very reassuring in the atmosphere of worry that attends pregnancy; and also it's just lovely to see your baby, real and present and bumbling around! The semi-private clinic at the Rotunda had scan machines in the consulting rooms; every time I attended, the doctor did a quick scan to check for the foetal heart beat and position of the baby, rather than using the doppler and feeling my belly with his hands. There was only one routine 'big' scan, the foetal anomaly scan (reassuring name!) at 20 weeks. So mine was a very scanned pregnancy, but it was an aspect of my care I really enjoyed.

Sarah Stewart said...

Thanks for your comment, Dot, and I really appreciate your point of view. My following rant is not an attack on you personally because I fully honour where you are coming from.

The problem I have with that approach to ante natal monitoring is that the health professional is losing his/her hands on skills which are invaluable. Abdominal palpation, for example, is a core assessment skill for midwives and obstetricians. Scans cannot be replied on for routine assessment - they can get it wrong. If that obstetrician/midwife loses that skill, what do they do when the scanner isn't working? How do they teach students when they no longer have that skill? We have seen it with the use of the pinard (the tool we use to listen to baby's heart beat). People rely on sonocaid now, but I know of very upsetting situations that have occurred that would never have happened if a pinard was used.We have seen this happen with breech birth - very few people are skilled to support women birthing breech babies which has had a monumental effect on women's choice in this area.

It breaks my heart at the thought of obstetricians/midwives losing a vital assessment skill like abdominal palpation.

The other concern I have is about the safety of ultrasound. I know we're pretty much think it is safe but the fact is we don't know for sure.

Whilst I fully understand how you felt about knowing the baby was fit and healthy, it is my opinion that obstetricians/midwives should be encouraging women to know about their baby's health by other means such as talking a woman through an abdominal palpation, explaining about baby movements and encouraging her to trust the intuition of her own body.

Anonymous said...

i agree it is compelling seeing your (xray) baby - but i think it also (in fact I found moreso) amazing to feel your baby bumbling around - I always had a sense of my babies nature from the signals they sent....I really like the intimate mother baby connection and the exclusive relationship we have at that time. I value that more than the scan personally and I like the touch aspect of palpation and the connection that evolves between me and my midwife. In pregnancy there are daydreams and hopes and aspirations - mystery too - these are all magical.
As a midwife I find it absolutely hugely valuable to palpate the woman/baby and monitor the progress. It is an important picture.

Anonymous said...

no ultrasound at week 18-20 to verify for congenital malformations? No ultrasound in the third trimester for weight and positioning of the baby?

careless... very careless...

Sarah Stewart said...

But since when did you need a scan to work out baby's size and position in low risk pregnancy? Surely you use your clinical assessment skills for this? This is basic midwifery and obstetric practice.

Anonymous said...

I am not a careless parent- I wouldn't have a scan at 20 wks to see if my baby had a congenital abnormality - as there is little i can do to change what is there. Thats my choice!

Anonymous said...

where is the evidence that says a scan to determine weight and position is without risk? is even accurate? or would improve the outcome?
Anyone providing maternity care is obliged to have good enough clinical skills to determine position by palpation - not to rely on a scan - not having these clinical skills is what i call careless!

Anonymous said...

I'd rather have an ultrasound scan than leave an inexperienced midwife doing an abdominal palpation on me.
the last time she pushed hard on my uterus, and the baby stoped moving for a couple of days after that. she barely killed her with her heavy hands

Sarah Stewart said...

I am very sorry to hear about your difficult experience, anonymous. It is a 'chicken and egg' situation - you cannot become experienced without 'practising'. I hope you were able to give the midwife feedback so she was able to adjust her practice.

Anonymous said...

One experience of a midwife's heavy hands does not represent all midwives. You can also have obstetricians with questionable skill levels and motivations for pratices.

In our country abdominal palpation is part of every midwifery appointment from 24 weeks and is used to assess size and growth at first, and position as the pregnancy nears end.

Scans can get things wrong, but they are useful in picking up anomolies, things such as cleft pallate, spinal abnormailites etc. While this may not change the birth outcome, having this information beforehand does give parents the time to prepare mentally before the birth. Mental preparation/health is important, and the opportunity to provide reassurance to people, or allow them time to prepare for an abnormality so they are not shocked at a birth, is a positive tool.

Most parents also love to see their little darling in its first home, and should not be criticised for that. While there is no evidence that scans are safe, I haven't seen any solid evidence to the contrary yet either.

Susan said...

I disagree, I honestly don't think that monitoring the health of your children can be a bad thing, as it's a non intrusive, non surgical prodedure. Congrationations on the awesome blog though, pregnancy scans aren't all that bad =P

Anonymous said...

Perhaps I can offer a different point of view. I had a scan at 13.5 weeks which showed that my baby had a severe neural tube defect (acrania) and would not survive the pregnancy. It was unbearably difficult to learn the news at 13.5 weeks about my baby. I cannot imagine this could be picked up by manual examination at this early stage, and I wouldn't want to find out any later in the pregnancy.

Otherwise I agree that there are too many ultrasounds. I'm now 10 weeks pregnant again and had my second ultrasound last week for 'measurement'. I think my obstetrician is now more worried about things going well than I am! But I still would advocate to have them at key milestones.