|February 17, 2010|
Volume 12, Issue 4
|Midwifery Today E-News|
“Prenatal Ultrasound Risks”
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When you attend our conference in Philadelphia, April 2010, you can choose from a variety of full-day classes, including a two-day class on Traditional Midwifery Skills. There are also single-day classes such as Beginning Midwifery, Herb Workshop, Spanish Language for Birth, Breech Workshop, and First and Second Stage Difficulties.
Learn about birth from these great teachers when you attend our conference in Strasbourg, France, September 29 – October 3, 2010. Planned classes include Prolonged Pregnancy, Prolonged Labor, Managing Hemorrhage, Posterior Position, and Preventing and Managing Birth Complications at Home.
Plan now to attend the “Birthing in Love: Everyone's Right” conference this June in Moscow, Russia. You'll be able to choose from classes such as Russian Method of Waterbirth, Traditional Birth Practices from Russia, Midwifery Education Possibilities for Russia, The First Hour after Birth, and Prolonged Labor. There will also be a full-day Hands-on Skills Workshop, as well as full-day classes on Shoulder Dystocia, Breech Birth in Water and Improving Your Practice with Research, Insights and Realities.
In This Week’s Issue:
Quote of the Week
“Although we now have sufficient scientific data to be able to say that routine prenatal ultrasound scanning has no effectiveness and may very well carry risks, it would be naive to think that routine use will not continue.”
— Marsden Wagner, MD
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One Month Later: An Update from the Bumi Sehat Team in Haiti
One month after an earthquake devastated Haiti, the Bumi Sehat team is working hard to make the Bumi Sehat Mother and Child Clinic in St. Helen Parish, Jacmel, Haiti, a sustainable medical institution. The following is a recent update from the Bumi Sehat Haiti medical team, which consists of midwives Robin Lim and Kelly Dunn, and emergency medic Alexander Chudis:
"Bumi Sehat has rented a large wooden house, built in 1887. Though not the prettiest, it has survived many earthquakes without damage. This Bumi house will serve as a staff headquarters, and educational facility for trainings, capacity building, environmental education, women's groups, handicraft and art center, etc. … Even though The Bumi Sehat clinic is not operational yet, the medical team has done patient care at St. Michel Hospital, St. Helen's camp, The Emmanuel Medical Center in Caye Jacmel and Park Pinchinant, the tent city where an estimated 4,000 people are camped."
During their first 13 days in Haiti, the Bumi Sehat medical team has assisted:
Please read updates on relief work regarding the devastating earthquake in Haiti, January 2010, on this page: Earthquake in Haiti 2010 Updates
US Women Twice as Likely to Receive Ultrasound Compared to 10 Years Ago
Pregnant women in the US are much more likely to undergo repeated prenatal ultrasound exams now than they were 10 years ago, according to research recently published in the journal Medical Care.
In a study conducted by Northwestern University's Department of Preventive Medicine, researchers looked at the average number of prenatal ultrasounds per pregnancy and percent of prenatal visits that included an ultrasound exam as recorded by hospitals on the National Hospital Ambulatory Medical Care Survey forms filled out between 1995 and 2000 and again in 2005 and 2006.
Results showed that, for low- and high-risk pregnant women, the average number of ultrasounds per pregnancy increased from 1.3 to 2.1 and from 2.2 to 4.2, respectively.
"In an adjusted analysis, the odds of a woman receiving an ultrasound in 2005–2006 were twice those of a visit in 1995–1997," researchers noted, adding that women deemed "high-risk" were almost twice as likely as those in the "low-risk" group to receive an ultrasound during a prenatal visit.
— Siddique, Juned, et al., 2009. Med Care 47 (11) 1129–35.
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Problems with Sound and Heat in Prenatal Ultrasound
One challenge that ultrasound operators face is keeping the transducer positioned over the part of the fetus the operator is trying to visualize. When fetuses move away from the stream of high-frequency sound waves, they may be feeling vibrations, heat or both. As the FDA warned in 2004, "ultrasound is a form of energy, and even at low levels, laboratory studies have shown it can produce physical effect in tissue, such as jarring vibrations and a rise in temperature."(9) This is consistent with research conducted in 2001 in which an ultrasound transducer aimed directly at a miniature hydrophone placed in a woman's uterus recorded sound "as loud as a subway train coming into the station."(10)
A rise in temperature of fetal tissue—especially since the expectant mother cannot even feel it—might not seem alarming, but temperature increases can cause significant damage to a developing fetus's central nervous system, according to research.(11) Across mammalian species, elevated maternal or fetal body temperatures have been shown to result in birth defects in offspring.(12) An extensive review of literature on maternal hyperthermia in a range of mammals found that "central nervous system (CNS) defects appear to be the most common consequence of hyperthermia in all species, and cell death or delay in proliferation of neuroblasts [embryonic cells that develop into nerve cells] is believed to be one major explanation for these effects."(13)
Why should neurodevelopmental defects in rats or other mammals be of concern to expecting women? Because, as Cornell University researchers proved in 2001, brain development proceeds in the same manner "across many mammalian species, including human infants."(14) The team found "95 neural developmental milestones" that helped them pinpoint the sequence of brain growth events in different species.(15) Therefore, if repeated experiments show that elevated heat caused by ultrasound damages fetal brains in rats and other mammals, one can logically assume that it can harm human brains, too.
In fact, the FDA and professional medical associations know that prenatal ultrasound can be dangerous to humans, which is why they have consistently warned against the nonmedical or "keepsake" ultrasound portrait studios that have cropped up in malls throughout the country.(16)
The risks to the baby are potentially higher in commercial enterprises due to the higher acoustic output required for high-definition images, a potentially long session—as technicians hunt for suitable images—and the employment of ultrasound operators who may have no medical background or appropriate training. These variables, along with factors such as cavitation (a bubbling effect caused by ultrasound that can damage cells) and on-screen safety indicators that may be inaccurate by a factor ranging from 2–6,(17) make the impact of ultrasound uncertain even in expert hands. Quite simply, if ultrasound can injure babies, it can cause the same damage whether done for routine, diagnostic or "entertainment" purposes.
— Caroline Rodgers
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Question of the Week
Q: My son, my first child, was born early at 35 weeks and no one was ever able to tell me why. My labor was very fast once my water broke (2 hrs). He had to visit the NICU at the hospital for over a week due to respiratory and feeding issues. I want a homebirth this time around so badly. What natural methods can I do to increase my chances that I'll go to at least 37 weeks this time around? Thank you.
— Jill Klink
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Question of the Week Responses
Q: I have a question about fibroids in pregnancy.
I am currently 5-1/2 months pregnant with my first baby. At 16 weeks, an ultrasound showed that I have three large fibroids in my uterus, ranging in size from 4–6 cm. The 6 cm fibroid is located directly in the center of my placenta (which is at the top of my uterus), and the placenta is attached to this fibroid. Additionally, both edges of my placenta seemed to have separated some. Also, the two other fibroids (4 cm and 5 cm) are located on either side of my cervix; so unless they shrink or move, I am told that I will have to deliver by c-section. My midwife screened me out for a homebirth. There is also concern about me hemorrhaging at birth because of the fibroids, and of the placenta not delivering properly because it is attached to the placenta.
Is there anything I can do to facilitate a more natural birth—hopefully not a c-section—and to avoid hemorrhaging and placental delivery problems? I am drinking 2–3 cups of raspberry leaf/nettle tea a day, and I am working hard to build up my iron levels with green leafy vegetables and yellow dock tincture.
— Jackie Ladomato
A: I had one client who used Organic Excellence, a natural progesterone cream, topically for several fibroids visible by early ultrasound. She applied 1/4 tsp of the cream over the fibroids twice a day until 36 weeks. They were no longer visible when she had her 36 week ultrasound. She delivered her baby at home.
— Constance Miles, LM, CPM
A: Cesarean should not be considered in your case because you will lose too much blood. But you should not have a homebirth. Write to me at firstname.lastname@example.org. I would like to converse with you and stay in touch. I wonder if macrobiotic-style diet would shrink the fibroids?
— Judy Slome Cohain
A: In Midwifery Today, Issue 25, Judy Edmunds, CPM, wrote an article entitled, "Birth Insights: Facing Fibroids." This is the personalized management plan she prescribed for her client, whose fibroids were high enough in the uterus to allow for a homebirth:
"Kathy's personalized management plan included restricting estrogenic foods (fats, dairy, meats); eliminating xanthines (tea, coffee, chocolate and cola), which can stimulate fibroid growth; emphasizing vegetables and vegetable juices (especially carrot juice, which inhibits tumor growth), whole grains, vegetarian protein sources, fresh fruits, high-iron food and seafood. We added top quality prenatal supplements, including at least 400 I.U. vitamin E and 500 mg. bioflavinoids; homeopathic remedies including Silicea, which stimulates the organism to reabsorb fibrous tissues and Pulsatilla for heartburn; and rest and positioning for pressure symptoms."
— Midwifery Today staff
Midwifery Today Issue 25 can be ordered.
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Think about It
According to a research study published in the February 2010 issue of the journal Obstetrics and Gynecology, the average birth weight for a baby born in the US has steadily decreased over the past 15 years.
Using data from the US National Center for Health Statistics, which included 36,827,828 singleton neonates born at 37–41 weeks gestation between 1990 and 2005, researchers concluded that there were decreases in birth weights across the board: a 1.4 percent decrease in birth weight for the overall population and a 2.2 percent decrease in the homogenous, low-risk subgroup.
Researchers reported that the decreases "were steeper after 1999 and persisted in regression analyses adjusted for maternal and neonate characteristics, gestational length, cesarean delivery, and induction of labor."
— Donahue, Sara M.A., MPH, et al., 2010. "Trends in Birth Weight and Gestational Length Among Singleton Term Births in the United States: 1990–2005" Obstet Gynecol. 115(issue 2, part 1):357–64.
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