Unpacking Ultrasound

Ultrasound is one of the most ubiquitous aspects of modern prenatal care. But is it safe? And is it really useful? Ultrasound exemplifies so much about obstetric culture and birth culture, and its use reveals so much about how we see birth and the values we express in how we do birth as a society.

Over the past 18 years of researching ultrasound, I’ve learned that although ultrasound is billed as an amazing technology that assures us that our infants are safe and healthy, and supposedly prevents many issues, it’s actually far less helpful than we’re led to believe. Ultrasound carries risk—enough risk that I have chosen to never expose my babies to ultrasound technology, including the doppler.

Those risks might come as news to you. The potential dangers of ultrasound are almost never discussed by nurses, obstetricians, gynecologists, or family doctors.

Let’s try a little thought experiment. Say a young woman shows up for her first pre-natal appointment, and the doctor says, “Congratulations, Cindy, you’re pregnant! I bet you can’t wait to see your baby. So just lie down, and I’ll set up the ultrasound machine and we’ll make sure your baby is healthy. How about it?”

Now here’s another scenario: In this case, the doctor says, “Congratulations Cindy, I’m so happy for you. I suggest that you try your best to eat well and spend lots of time in nature, tuning into your body. Do you have support from friends and family? Good nutrition, self-care, and a loving community are the most important things to make sure your pregnancy and birth go well, and that your baby is healthy.”

Then the doctor says, “Now, I also have an ultrasound machine. But! Before you decide if you’d like to receive an ultrasound, I have to inform you that it has never been proven safe. Ultrasound has never been put through double-blind control trials. What we do know, definitively, is that ultrasound damages and modifies cells; it changes the way cells develop. In animal studies, ultrasound has been correlated with neurological problems, low birth weight, and miscarriage. While humans are, obviously, not rats or mice, the mammalian reproductive system is remarkably similar across species, and tissues and cells respond pretty much the same way whether you’re a goat, a rodent, or a human being. Ultimately, having an ultrasound will offer you no statistical improvements in terms of whether or not your baby will be born healthy. Even in regard to potential problems like placenta previa, you having an ultrasound will not statistically lower the chances of adverse outcomes. But, it will give you a fuzzy black-and-white photo of a shape that kind of looks like a floating baby blob, although every time I’ve ever performed an ultrasound it’s pretty clear that babies frantically swim away from the high frequency sound waves the machine emits, which, on its own, certainly might give a mother pause. So, what do you think? Would you like to have an ultrasound?”

The reality is that this latter scenario almost never takes place. Yet everything described therein about ultrasound is true. Despite the lovely concept of informed consent and the right to refusal, can women really make an informed choice about ultrasound when their doctors are not transparent, honest, or accurate with the information they’re sharing about those possible risks? The answer is: We can’t.

I have noticed that the entire medical paradigm is predicated on strong internal biases. The result is that mothers may be making choices in the absence of the full scope of information. And that’s not informed consent.