Why I Am Declining Ultrasound

Please note: This is my own personal informed choice. It is up to parents to research their options and make their own informed choices weighing the risks and the benefits.

One of the first things I've been asked since announcing my pregnancy is when I am having my first scan. The first scan at 12 weeks is a momentous occasion since this is usually when parents feel brave enough to share with the world their happy news, since the miscarriage rate has significantly decreased and they now have proof that their baby is alive and well in the womb.

I haven't waited until 12 weeks to share my news with all my close friends, family and clients. The taboo around miscarriage is pervasive and I feel responsibility to do my part in shifting that. Mums should be encouraged to share the news as soon as they want to and reach out for support if needed.

However, I've found it difficult to try and explain why our intention is to decline ultrasound for this pregnancy.

I first began to question ultrasound when I read an article shared by a birth worker I really admire and respect. I discovered that ultrasound has NEVER been proven safe. I couldn't believe it. I knew that ultrasound was inaccurate - I have worked with mothers who have had their baby estimated to be of large weight, or have excess of amniotic fluid, or given due dates 2 weeks from when they know they conceived, for the ultrasound to ultimately be proved wrong. All these things are associated with increased intervention for these birthing women. Without the ultrasound, there would be no 'high risk' label, no pressure to induce, no reason to be birthing in a consultant-led unit. I knew ultrasound affected outcomes, and not always positively.

The article gave evidence of studies done on mice using ultrasound, where it actually changed the temperature of the brain and impacted neural migration. We can't prove that the same thing happens to human fetuses, but we don't really have any way of knowing. Babies have been known to squirm away and hide from the ultrasound and doppler as if it were an unpleasant experience, which is enough for many to question its use.

In some older studies (when ultrasound was weaker), the rate of miscarriage doubled when ultrasound was used in the first trimester. Ultrasound technicians were also shown to be at a higher risk of miscarriage. It is unfortunate then that those who have had many miscarriages are often offered an early scan for reassurance. Many conditions are diagnosable via ultrasound, such as placenta praevia, growth defects and growth retardation. The evidence I read showed that early detection of these did not affect outcomes for the babies and was associated with pre-term labour and interventions.

The outcome of many of these studies condemn routine ultrasound in pregnancy.

This was enough for me to decide that it was not for me. Although it was harder for Dom (as I am experiencing the pregnancy and often the two ultrasounds is when the father gets to see and bond with their unborn child) he agrees with me wholeheartedly. We will also be refusing the anomaly scan. If I had any abnormal bleeding or concerns about my baby's movements as my pregnancy progresses, I would then review my decision but as it stands I don't feel it is necessary.

It is also interesting to contemplate the psychological affect ultrasound has on the mother - when you are pregnant you feel the presence of your baby in your womb as part of you. To use the ultrasound to view it as something separate and alien, although admittedly an enjoyable experience... I wonder what affect this has on the pregnant woman's subconscious as she views her unborn child as a separate being to her that must be scanned for anomalies.

I have had online discussions with many people who think my decision is bizarre, and also many others who agree with me. Those who are pro-ultrasound have usually had a friend or relative with a baby with a diagnosable condition that required extra care after birth, whether that be neonatal unit or surgery. This is where risk perception comes in. My risk perception comes from my work with pregnant women and seeing how ultrasound shakes women's confidence and often leads them into unnecessary intervention. It's also affected by my personal beliefs around conception, my own good health and my first healthy pregnancy and birth. My own risk assessment for myself means that as it stands the risks of ultrasound outweigh the benefits. We are all different and perhaps your experience, whatever it has been, means that despite all this for you the benefits of ultrasound outweigh the risks. That is the beauty of informed choice and this is what I will always champion.

Sources:

http://www.midwiferytoday.com/articles/ultrasound.asp
https://www.midwiferytoday.com/articles/ultrasoundwagner.asp
https://www.mamanatural.com/baby-ultrasound/
http://kellybroganmd.com/human-studies-condemn-ultrasound/
https://www.ncbi.nlm.nih.gov/pubmed/24249575
http://sarahbuckley.com/ultrasound-scans-cause-for-concern

Additional info (Added 12th June 2016): Recent evidence links first trimester ultrasound with increased severity of autism symptoms in boys https://www.ncbi.nlm.nih.gov/m/pubmed/27582229/

YES, you need to obtain informed consent!

Informed choice is the big catchphrase in the birth world. All birth workers claim to uphold informed choice and decision making. How lovely that people are finally giving the agency back to women, right?

It would be nice to think that we do have choice, but as it stands we don't. How many of our choices are taken from us before we have even begun? When you attend your antenatal appointments and are designated midwife-led or consultant-led, more often than not that dictates your place of birth. How many second time mums know that statistically the evidence says if they want to avoid intervention they should birth at home and far away from an obstetrical unit?

Even worse if you go overdue, have a prior caesarean section, carry multiples, have premature rupture of membranes, are older, or with a raised BMI. You can expect to have your choices whittled away into something considered acceptable by somebody else. To be told that you HAVE to do things a certain way. Bullying phone calls and letters through the door demanding you relinquish your right to choose.

Then maybe you arrive at the hospital in labour and have your choices completely disregarded. Perhaps you get sidelined into something you didn't want by emotive language, emotional blackmail, even tricks. Consent not clearly obtained to do procedures on you, the need for a solid yes or no hidden by ramblings about obscure risks and guidelines. How many women have been assaulted by a medical professional, be it via a vaginal examination, monitoring device or drug administration as true consent was never properly obtained?

Let me be clear on what consent is.

Consent is not... I'm just going to do this now.

Consent is not... You need to listen to ME now as the medical professional.

Consent is not... You can't do this without this pain relief.

Consent is not... You are at risk and your baby WILL die.

All of these things have either been said in my presence or witnessed by colleagues.

Consent is... Do I have your permission to do this?

Consent is... You have options. These are the percentage risk factors involved. What would YOU like to do?

Consent is... I am suggesting we do this. These are the benefits and the risks. These are the alternatives. Yes or no? What would YOU like to do?

I would really like to know... what is so threatening about a woman exercising her right to choose? Is it so inconceivable that she is capable of making her own decisions? Why do you think just because she is not doing what YOU want then she clearly must be under the influence of somebody else? Yes, record that she is declining whatever if it makes you feel better and protects you professionally, but don't force her to say it to you ten times before you'll actually stop harassing and scaring her.

Until women are seen as people and not just a set of risk factors we will not see any change. I am exhausted by this whole thing. Every day women are bullied, coerced and demeaned into things they do not want by those who claim to be protecting them and their baby. Let us be completely clear - nobody in that birth room cares more about that baby than the mother. She is the one who will live with her birth experience for the rest of her life. So many women telling their stories are angry, and rightly so. They felt that their rights were taken away and they were coerced in their most vulnerable moments. 

Informed choice, informed consent, they're great phrases to bandy around but I'm beginning to believe they are worthless.

Nobody Is Coming To Rescue You, And That's Okay

The first time I realised that nobody was coming was Christmas Eve 2017.

My mother has so many stories about me playing pretend and dress up, wearing princess dresses to nursery and talking to a huge “Grandmother Willow” (from Pocahontas) that I’d constructed with about 20 sheets of A4 paper stuck together. I am a huge romantic and all I’d ever wanted was to be married and have a family. I wouldn’t say I had high expectations from life – I like simplicity, honesty, love. I am a giver. I had always wanted a man to look after me, to build a life together. I am a feminist but I hadn’t relinquished that notion. I wanted it, was still able to trust. This is what I believe made me most vulnerable.

I now believe it to be gone.

On Christmas Eve my parked car slid all the way down a steep hill and crashed into somebody’s wall. It was oddly fortuitous, it had somehow swerved outwards and not hit anybody else’s car. The entire back was smashed, sending glass all over my teaching kit and breaking one brake light. I didn’t have any nappies with me and the prospect of waiting for recovery on Christmas Eve miles from Cardiff was a grim one. The young male police officer advised me that I could drive it to my mother’s house as long as I just made that one trip but we would have to tape the back window up with binbags. The man and woman whose wall I had smashed taped it up while I bobbed and breastfed the baby in the sling. They were all so kind. Then they all disappeared.

As I drove home with my eight week old baby in the backseat in the drizzling rain, coming down the motorway to Cardiff, I realised I had nobody. I didn’t know what I was going to do about my car. I felt totally lost. There was nobody whose voice would be on the other end of the phone telling me it was okay, that they loved me, to get home safe for cwtches. Nobody to help me work out a solution. I burst into tears as I realised that the buck really stopped with me, that nobody was coming to rescue me, it was just me driving my falling apart car back to Cardiff and working out what I was going to do next. Alone, nobody to depend on, to come home to. Solely in charge of mine and the children's destiny. I sobbed - I didn't want it.

I don’t think that longing to be rescued has completely gone away. I remarked to a friend in a conversation recently that although I am on my own with the children indefinitely now, I can’t shake this feeling that somebody is just going to come along and lift me out of it. Some childish fancy that flitted across my mind as I gazed across the city… living on the top floor, like a tower. I haven’t lived on the top floor since before I was a mother. Taking a long time to process that this actually is it, this is my life, the romantic part of the story has already ended. In fact, it was never real to begin with.

You say I’ve been strong, and I thank you for it, but I feel like I’m on automated.

More recently, with my new car, only had it two weeks and it’s having problems. Taking it back to the garage again and again. The man who has been helping me look at it – an ordinary guy, the mechanic. We realise it’s leaking fluid, I would have to come back another day, and I saw myself through his eyes, briefly, as he said something about gaskets and then “Sorry, when you’ve got your kids out of the car and everything…”I see the chatterbox blond child with the steely glint in his eye, over half my size, the fat-cheeked baby in woollens, me in my long skirt, stressed out, strung out, begging - I drive it every day, I can’t be without it, without my car I really can’t cope... He was kind, men in general are always kind to me, he topped up the fluid and told me to just drive it home for now and use public transport until I had time to book it in for a couple of days. Advice I ignored afterwards, I admittedly am headstrong… again I was brought to tears by the futility of it all, I don’t know what more I was expecting than that, why am I forever casting men in the role of rescuers when it comes down to it, it’s always been just me?

Nobody is coming. More often than not it's the women around that support and give aid, more than any man actually ever has really - but that integral other half, that partnership, that safety net, that happy ever after is never going to be.

Nobody is coming to rescue you, and that’s okay.

And I connect this to birth work, in that life is scary and so is birth… women often look to people like midwives and doulas, even consultants, to save them – but all these external people can only ever be support, ultimately it is the woman who has to go through it herself. That belief, that looking outward for a saviour is detrimental and disempowering, in birth as in life—

And birth is life.

So stand on your own and call your power to you.