Ultrasound: Should prenatal ultrasound be routine?

Should ultrasound be performed routinely if there is no concern for the baby's health? I have heard that there has been very little testing done on the effects of ultrasound.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Ultrasound employs sound wave transmissions at certain frequencies. To date, no adverse effects on the human embryo or fetus have been identified from exposure to energies comparable to those used for clinical sonographic examinations. Ultrasound has been used in obstetrics in various forms for 25 years. It has been rigorously tested and the research is ongoing.

At very high intensities, there is a potential for human tissue damage from heat and the formation of cavities in tissue. "Real-time imaging" (the kind of procedure used for obstetrical applications) uses low-intensity waves. The FDA limits ultrasound energy exposure to 94 milliwatts/cm2 during fetal imaging. This is a non-ionizing form of radiation exposure and, unlike many procedures and interventions, there is NO contraindication for its use during pregnancy.

Having said all this, reassuring as it sounds, there is no need for routine ultrasound in pregnancy. Too often, we learn to rely on the "toys" and lose our ability to listen to the client. I have seen dates moved, clients told they were having a boy when they actually had a girl, clients told they were having one baby and had two or vice versa, clients told to prepare for a fetal anomaly where none existed, etc.

The financial burden on clients and insurance plans is not to be overlooked. If a clinic purchases a piece of new technology, they must use it to pay for it. Then there are the necessary updates to the equipment and the purchases of newer, better models. Care providers begin to rely on the technology instead of their own hearts and hands.

If an ultrasound is indicated -- for example, with bleeding, size and dates discrepancy or no dates, to visualize for a testing procedure such as amnio or version, or many other valid indications -- I would agree that it is an indispensable tool. But for routine "screening" or so that the parents can have a picture, there is no validation for its use.

If an ultrasound is recommended, do not feel guilty asking for the indications. And if you feel there is no indication, politely refuse.

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