Doctor Appointment

I finally made an appointment with the doctor that the midwife recommended. It's on Saturday morning. I have been going over in my head what I will say to him. I feel strongly about keeping the interventions to a minimum during this pregnancy and birth. I don't want to go forward with any test or procedure that may disturb or potentially harm my baby (or me!) unless the benefits clearly outweigh the risk. But I don't want to come across as a crazy lady and alienate this doctor either. The culture here is very medicalized and I doubt many people question their doctors' recommendations. So I want to choose my words and timing carefully.

I haven't completely decided what to do about ultrasound. I expect that he will want to give me one on Saturday. If I were in Winnipeg, a midwife would be using a doppler to listen for the baby's heartbeat. That instrument also uses ultrasound waves, but a doppler is continuous, whereas ultrasound is intermittent. Which means that exposure is actually higher from a doppler.

What is the risk, you may ask? Doesn't everyone get at least one ultrasound and plenty of dopplers?

There are a number of possible risks. These include cell damage from the waves and from the temperature increase caused by the scan. Also because they are sound waves it is possible that the baby can actually hear them and that may be very disturbing to the baby.

Unhindered Living cites a number of studies:

Newnham, J.P., Evans, S.F., Michael, C.A., Stanley, F.J., & Landau, L. I. (1993). Effects of Frequent Ultrasound During Pregnancy: A Randomized Controlled Trial. The Lancet, 342(Oct.9), 887-891.

A study of over 1400 women in Perth, Western Australia compared pregnant mothers who had ultrasound only once during gestation with mothers who had five monthly ultrasounds from 18 weeks to 38 weeks. They found significantly higher intrauterine growth restriction in the intensive ultrasound group. These mothers gave birth to lower weight babies.

The researchers concluded that prenatal ultrasound imaging and Doppler flow exams should be restricted to clinically necessary situations. This recommendation comes at a time when ultrasound during prenatal visits has become increasingly popular and serves as a kind of entertainment feature of office check-up visits.


Campbell, J.D., Elford, R.W. & Brant, R.F. (1993). Case-Controlled Study of Prenatal Ultrasound Exposure in Children with Delayed Speech. Canadian Medical Association Journal, 149(10), 1435-1440.

Delayed speech is not a pathological or organic syndrome but developmentally defined symptom complex. Clinicians have noted an increased incidence of delayed speech in pediatric patients.

This is a matched-case control study of 72 children 2 to 8 years old presenting with delayed speech of unknown cause. The children were measured for articulation, language comprehension, language production, meta-linguisticskills, and verbal memory. When checked for ultrasound exposure, the speech-delayed children were about twice as likely to have been exposed to ultrasound than the matched controls.

The authors believe that delayed speech is a sensitive measure reflecting sub-optimal conditions for development. If ultrasound can cause developmental delays, the authors are concerned about the routine use of ultrasound and they warn against it.


Devi, P.U., Suresh, R., & Hande, M.P. (1995). Effect of fetal exposure to ultrasound on the behavior of the adult mouse. Radiat Res (QMP), 141(3), 314-7.

Pregnant Swiss albino mice were exposed to diagnostic ultrasound. There were significant alterations in behavior in all three exposed groups as revealed by the decreased locomotor and exploratory activity and the increase in the number of trials needed for learning. These results indicate that ultrasound exposure during the early fetal period can impair brain function in the adult mouse.


If I have no ultrasounds during this pregnancy, we won't have a chance to hear the baby's heartbeat until at 16-20 weeks, when a fetoscope or normal stethoscope could pick it up. Will my caregiver even own a fetoscope? If no ultrasounds are given, the caregiver will need to be hands on, palpating my abdomen and doing fundal measurements instead of relying on ultrasound technology. Will he be comfortable or willing? How much experience would he even have? The OB/Gyn I saw when I was pregnant with Micah never touched me except to help me on and off the exam table.

The benefits of routine ultrasound are a double-edged sword. Ultrasound is used to screen for abnormalities. An "all's clear" can give families a wonderful sense of relief and well-being. Unfortunately the false-positive rate is very high. Stories proliferate about families who underwent substantial stress due to the diagnosis of an abnormality, and then went on to have perfect babies.

How often does ultrasound detect something where that something can actually be treated and corrected? I can't think of many cases. I know one woman whose baby was diagnosed with a diaphragmatic hernia. (This diagnosis caused A LOT of stress for the family, because the survival rate with this condition is quite low.) The diagnosis allowed for arrangements to be made for the baby to have surgery shortly after birth- and he today he is perfect!!

In my mind, then, this is what it boils down to:

I have had two healthy babies. I am a healthy person. There is no reason to believe that this baby has any sort of abnormality. Chances of us being able to do anything about a potential abnormality before birth are very low. I would rather be able to enjoy this pregnancy to the end than spend much of it stressing out about possible problems. Stress is known to have a negative effect on pregnancy and baby. I believe that the risk from an ultrasound scan itself exceeds the risk from not finding out about some sort of abnormality. Therefore I am inclined to refuse ultrasound (and doppler) scans.

The complicating factor may be if this doctor has little hands-on experience and skill. If he would be unable to diagnose through palpation, for instance, that the baby were transverse (lying across the uterus instead of head down), then the risk of refusing ultrasound may indeed exceed the risk of having it. BUT, that ultrasound wouldn't have to take place until the baby were full term, and therefore somewhat less vulnerable.