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1 CONCLUSIONS AND My Baby's Ultrasound Exposure Record RECOMMENDATIONS I would urge all pregnant women to think deeply before they choose to have a routine ultrasound. It is not compulsory, despite This is necessary to obtain the following information be considered for each mother and baby according to their specific situation. (mother's name) If you choose to have a scan, be clear about the information that you do and do not this information that carries less risk to Signature (doctor or midwife). Date of last calibration tical. And remember that it's your baby, your body and your choice. © The following procedure requires the use of ultrasound .. . . . . what some doctors have said, and the risks, To my knowledge, there is no current alternative method available to obtain benefits and implications of scanning need to want to be told. Have your scan done by an operator with a high level of skill and experi- The ultrasonographer is asked to specify: ence (usually this means someone who per- forms at least 750 scans per year) and say Manufacturer and model of ultrasound equipment .......... cece eeeee terete that you want the shortest scan possible. Ask them to fill out the form or give you the cececeeecececeeceeecceseeeeeeseeeeeeeseees information, as above, and to sign it. oo. If an abnormality is found, ask for coun- Type or combination of types of ultrasound Used ....... ce eeeeeeeeeeseeteeeeeeees selling and a second opinion as soon as prac- Intensity of exposure (w/cm sq Or MW/CM Sq) ..... sees este eeeeteeeeeeeeteeeneeeees seseeseeneseeteneaneseneaneneees Time completed... Time commenced References « American College of Obstetricians and Gynecologists (ACOG). Routine Ultrasound in Low-Risk Pregnancy. In: ACOG Practice Patterns — Evidence-Based Guidelines for Clinical Issues in Obstetrics and Gynecology, no. 5, August 1997. « Association for Improvements in the Maternity Services (AIMS), UK. Ultrasound Unsound? AJMS Duration of exposure Name of hospital or clinic Carried out by Qualifications 0 Journal, vol. 5, no. 1, spring 1993. The updated version . is available at http://www. birthinternational.com.au. Signature coceconpaqnnccenconrdneccencoendacece9900027200000000000 Date... eeceeceeseseeeeeeseteeeeeeenees + American Institute of Ultrasound Medicine Bioeffects Report 1988. Journal of Ultrasound Medicine, September 1988, 7:51-S38. women whose babies have died at birth; in fact, there are sugges- + Beech BL. Ultrasound - Unsound? Talk at Mercy Hospital, Melbourne, April tions that the opposite may be true in some cases (Watkins, 1989). 1993. And when termination has been chosen, women are unlikely to « Brand IR, Kaminopetros P, Cave M et al. Specificity of antenatal ultrasound in share their story with others and can experience considerable guilt the Yorkshire region: a prospective study of 2261 ultrasound-detected anomalies. , ain f; , . . . “o Br. J. Obstet. Gynaecol. 1994, vol. 101, no. 5, pp. 392-397. and pain from the knowledge that they themselves chose the loss * Brookes A. Women's experience of routine prenatal ultrasound. Healthsharing (MIDIRS, 1996). Women, the newsletter of Healthsharing Women's Health Resource Service, vol. 5, When minor abnormalities are found—which may or may not nos 3 & 4, December 1994—March 1995. be present at birth, as discussed above—women can feel that * Campbell JD et al. Case-control study of prenatal ultrasonography in children some of the pleasure has been taken away from their pregnancy. with delayed speech. Can. Med. Ass. J. 1993, vol. 149, no. 10, pp. 1435-1440. Women's experiences with ultrasound and other tests used for © Chan FY. Limitations of Ultrasound. Paper presented at Perinatal Society of renatal diagnosis (e.g., amniocentesis) are thoughtfully presented Australia and New Zealand Ist Annual Congress, Fremantle, 1997. PI gNOsis (€.8., . _ 8 . y pres * Davies J et al. Randomised controlled trial of Doppler ultrasound screening of by Barbara Katz Rothman in her book, The Tentative Pregnancy. placental perfusion in pregnancy. Lancet 1992;340:1299-1303. The author documents the heartache that women can go through + de Crespigny L, Dredge R. Which Tests For My Unborn Baby? Oxford when a difficult diagnosis is made; this pain can take years for _ University Press, Melbourne, 1996, revised edition. some women to resolve. She suggests that the large numbers of + Ellisman MH, Palmer DE, Andre MP. Diagnostic levels of ultrasound may dis- screening tests currently being offered to check for abnormalities upt myelination. Experimental Neurology 1987, vol. 98, no. 1, pp. 78-92. may make every woman feel that her pregnancy is "tentative" + Ewigman BG, Crane JP, Frigoletto FD et al. Effect of prenatal ultrasound screen- ae vale taneene? The ing on perinatal outcome. RADIUS study group. New England J. Med. 1993, vol. until she receives reassuring results. 329, no. 12, pp. 821-7. To my mind, ultrasound also represents yet another way in * Geerts JGM, Brand E, Theron B. Routine obstetric ultrasound in South Africa: which the deep internal knowledge that a mother has of her body cost and effect on perinatal outcome — a prospective randomised controlled trial. and her baby is made secondary to technological information that Br. J. Obstet. Gynaecol. 1996, vol. 103, pp. 501-507. comes from an "expert" using a machine. Thus the "cult of the « Kieler H, Axelsson O, Nilsson S, Waldenstrom U. Comparison of ultrasonic mea- expert” is imprinted from the earliest weeks of life surement of biparietal diameter and last menstrual period as a predictor of day of : . delivery i ith regular 28-d: les. Acta-Obstet.-Gynecol.-Scand. 1993. Furthermore, by treating the baby as a separate being, ultra- ol 75. n0-5.pp 3479. AEE EAY CYS ACT OOSTEL ONMECSCAN ; sound artificially splits mother from baby well before this is a * Kieler H, Axelsson O, Haguland B et al. Routine ultrasound screening in physiological or psychic reality. This further empha: ture's favouring of individualism over mutuality and s £ a Ss our cul- pregnancy and the children's subsequent handedness. Early Human Dev. 1998, vol. the scene 50, no. 2, pp. 233-245. © ore a (mother's name) women whose babies have died at birth; in fact, there are sugges- tions that the opposite may be true in some cases (Watkins, 1989). And when termination has been chosen, women are unlikely to share their story with others and can experience considerable guilt and pain from the knowledge that they themselves chose the loss (MIDIRS, 1996). When minor abnormalities are found—which may or may not be present at birth, as discussed above—women can feel that some of the pleasure has been taken away from their pregnancy. Women's experiences with ultrasound and other tests used for prenatal diagnosis (e.g., amniocentesis) are thoughtfully presented by Barbara Katz Rothman in her book, The Tentative Pregnancy. The author documents the heartache that women can go through when a difficult diagnosis is made; this pain can take years for some women to resolve. She suggests that the large numbers of screening tests currently being offered to check for abnormalities may make every woman feel that her pregnancy is "tentative" until she receives reassuring results. To my mind, ultrasound also represents yet another way in which the deep internal knowledge that a mother has of her body and her baby is made secondary to technological information that comes from an "expert" using a machine. Thus the "cult of the expert" is imprinted from the earliest weeks of life. Furthermore, by treating the baby as a separate being, ultra- sound artificially splits mother from baby well before this is a physiological or psychic reality. This further emphasises our cul- ture's favouring of individualism over mutuality and sets the scene for possible—but, to my mind, artificial—conflicts of interest between mother and baby in pregnancy, birth and parenting. 20 ¢ NEXUS Continued on page 82 www.nexusmagazine.com OCTOBER — NOVEMBER 2002