January 18, 2006
Volume 8, Issue 2
Midwifery Today E-News
“Prenatal Ultrasound”
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Ultrasound? Unsound
This book is a review and evaluation of ultrasound research.


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Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

In This Week’s Issue:


Quote of the Week

"Midwifery is the possibility of healing the earth and allowing the woman to transform into a mother the earth has been waiting for."

Jeannine Parvati Baker

All the midwifery world mourns the December passing of Jeannine Parvati Baker—midwife, healer, mother, teacher, spiritual sister. As her legacy, she leaves the physical world a gentler, wiser, more empowered place in which to conceive, be pregnant, birth, and nurture children.


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The Art of Midwifery

In my practice, I recommend every woman to take 20 mg of vitamin B6 every morning for six months before the pregnancy begins (vitamin B6 is removed from wheat and rice when it is processed). I have yet to see a woman who took vitamin B6 for six months before the pregnancy started suffer from nausea and/or vomiting of pregnancy. But as I have a small practice, anyone who wants to report otherwise should write to me at judyslome@hotmail.com.

Pregnancy should be a joy rather than a crisis. There is an unsupported myth that women should be glad they are nauseous and vomiting in pregnancy because it causes them to avoid toxic foods and results in a lower miscarriage rate. This unproven theory has the danger of trying to convince women that pregnancy should be a time of suffering and crisis. Nonsense. Hormones cause the sensation of nausea and vomiting in some women. Some miscarriages do happen because the fetus dies and developing placental tissue stops producing progesterone; the woman is not or no longer nauseous and eventually the fetus miscarries. Or the placenta does not produce enough progesterone hormone to maintain the pregnancy, and the fetus miscarries. So, miscarriage will happen more often in women who have both seriously low levels of progesterone because not enough progesterone is produced for one reason or another. And this lack of progesterone is more likely to be the reason these women are not nauseous and miscarry.

There is no need to accept that nausea and vomiting has to accompany pregnancy.

Judy Slome Cohain


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

Research to Remember

Brigham and Women's Hospital reviewed data collected for nearly thirty years on outcomes for breastfeeding mothers in respect to rheumatoid arthritis (RA). After adjusting for known risk factors, the reviewers found that breastfeeding decreases the risk and irregular menstrual periods increase the risk. When compared with women who did not breastfeed, it was found that women who breastfed for one to two years (total time) decreased the risk of developing RA by 20%, and women who breastfeed for two years or longer (total time) decreased the risk by 50%. Breastfeeding for a total of one year did not affect the risk of developing RA. The study also found that women who had very irregular menstrual cycles between the ages of 20 and 25 were slightly more likely to develop rheumatoid arthritis. Women's age at first delivery and use of oral contraceptives did not influence the risk.

Arthritis and Rheumatism, Vol. 50: 3458–67; November 2004


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Prenatal Ultrasound

It is ironic that women who have had previous miscarriages often have additional ultrasound examinations in order to "reassure" them that their baby is developing properly. Few are told of the risks of miscarriage or premature labour or birth.

Obstetricians in Michigan studied fifty-seven women who were at risk of giving birth prematurely. Half were given a weekly ultrasound examination; the rest had pelvic examinations. Preterm labour was more than doubled in the ultrasound group—52%—compared with 25% in the controls.(1) Although the numbers were small, the difference was unlikely to have emerged by chance.

A large randomized controlled trial from Helsinki randomly divided more than 9,000 women into a group who were scanned at 16 to 20 weeks compared with those who were not. It revealed 20 miscarriages after 16 to 20 weeks in the screened group and none in the controls.(2)

A later study in London randomized 2475 women to routine Doppler ultrasound examination of the umbilical and uterine arteries at 19 to 22 weeks and 32 weeks compared with women who received standard care without Doppler ultrasound. There were 16 perinatal deaths of normally formed infants in the Doppler group compared with 4 in the standard care group.

It is not only pregnant patients who are at risk, however. Physiotherapists use ultrasound to treat a number of conditions. A study done in Helsinki found that if the physiotherapist was pregnant, handling ultrasound equipment for at least 20 hours a week significantly increased the risk of spontaneous abortion.(3)

The Saari-Kemppainen study also revealed the lack of value in early diagnosis of placenta praevia. Of the 4000 women who were scanned at 16 to 20 weeks, 250 were diagnosed as having placenta praevia. When it came to delivery, there were only four. Interestingly, in the unscanned group there were also four women found at delivery to have this condition. All the women were given caesarean sections and there was no difference in outcomes between the babies. Indeed, there are no studies that demonstrate that early detection of placenta praevia improves the outcome for either the mother or the baby. The researchers did not investigate the possible effects on the 246 women who presumably spent their pregnancies worrying about having to undergo a caesarean section and the possibility of a sudden haemorrhage.

There has been inadequate research into the potential long-term effects. Measuring the outcome of any intervention in pregnancy is very complicated because there are so many things to look at. Intelligence, personality, growth, sight, hearing, susceptibility to infection, allergies and subsequent fertility are but a few issues that, if affected, could have serious long-term implications, quite apart from the numbers of babies who have a false positive or false negative diagnosis. Because a baby grows rapidly, exposing it to ultrasound at eight weeks can have different effects than exposure at, for example, 10, 18, or 24 weeks. This is one of the reasons the effects of potential exposure are so difficult to study. Women are now exposed to so many different types of ultrasound: Doppler scans, real-time imaging, triple scans, external fetal heart-rate monitors, hand-held fetal monitors. Unlike drugs, whereby every new drug must be tested, the rapid development of each new variation of ultrasound machine has not been accompanied by similar careful evaluation by controlled, large-scale trials.

Despite decades of ultrasonic investigation, no one can demonstrate whether ultrasound exposure has an adverse effect at a particular gestation, whether the effects are cumulative or whether it is related to the output of a particular machine or the length of the examination. How many exposures are too many? What is the mechanism by which growth is affected? … It should not be forgotten that numerous studies on rats, mice and monkeys over the years have found reduced fetal weight in babies that had ultrasound in the womb compared with controls. Nor should it be forgotten that in the monkey studies the ultrasound babies sat or lay around the bottom of the cage, whereas the little control monkeys were up to the usual monkey tricks. Long-term follow up of the monkeys has not been reported. Do they reproduce as successfully as the controls? And, as Jean Robinson has noted, "Monkeys do not learn to read, write, multiply, sing opera, or play the violin." Human children do, and perhaps we should consider seriously whether the huge increases in children with dyslexia and learning difficulties are a direct result of ultrasound exposure in the womb. Furthermore, when a woman is scanned her baby's ovaries are also scanned. So if the woman had seven scans during her pregnancy, when her pregnant daughter eventually presents years later at the antenatal clinic, her developing baby will already have had seven scans. Do women really know what they consent to when they rush to hospital to have their first ultrasound scan, then trustingly agree to further scans?

— Beverley Lawrence Beech
excerpted from "Ultrasound: Weighing the Propaganda Against the Facts,"
Midwifery Today Issue 51

  1. Am J Obstet Gynecol, 1990, June: 1603–10.
  2. Lancet, 336: 387–91.
  3. Journal of Epidemiology and Community Health, 44: 196–201.

Routine ultrasound scanning in pregnancy became the symbol of modern prenatal care. It is also its most expensive component. A series of studies compared the effects on birth outcomes of routine ultrasound screening versus the selective use of the scans. One of these randomized trials, published in New England Journal of Medicine, involved 15,151 pregnant women. The last sentence of the article is unequivocal: "Whatever the explanation proposed for its lack of effect, the findings of this study clearly indicate that ultrasound screening does not improve perinatal outcome in current US practice."(1) Around the same time, an article in British Medical Journal assembled data from four other comparable randomized trials (meta-analysis). The authors concluded: "Routine ultrasound scanning does not improve the outcome of pregnancy in terms of an increased number of live births or of reduced perinatal morbidity. Routine ultrasound scanning may be effective and useful as a screening for malformation. Its use for this purpose, however, should be made explicit and take into account the risk of false positive diagnosis in addition to ethical issues."(2)

It is possible that, in the future, a new generation of studies (in the framework of primal health research) will cast doubts on the absolute safety of repeated exposure to ultrasound during fetal life. One of the effects of the selective use is to reduce dramatically the number of scans, particularly in the vulnerable phase of early pregnancy.

Even in a high-risk population of pregnant women, ultrasound scans are not as useful as commonly believed. Evidence from randomized controlled trials suggests that sonographic identification of fetal growth retardation does not improve outcome despite increased medical surveillance.(3) In diabetic pregnancies it has been demonstrated that ultrasound measurements are not more accurate than clinical examination to identify high birth weight babies.(4) This led to the memorable title of an editorial of British Journal of Obstetrics and Gynecology: "Guess the weight of the baby."

— Michel Odent
Primal Health, http://www.birthpsychology.com/primalhealth/primal10.html

  1. N Engl J Med, 1993, 329: 821–27.
  2. BMJ, 1993, 307: 13–17.
  3. Br J Obstet Gynaecol, 1992, 99: 469–74; Br J Obstet Gynaecol 1987; 94: 105–09)
  4. Br J Obstet Gynaecol, 1996, 103: 747–54.

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Web Site Update

Read this article excerpt from the most recent issue (Number 76) of Midwifery Today newly posted to our Web site. The author explains how conclusions from a study of early versus late epidurals are flawed and what the study really shows.

This article about the Oaxacan Midwifery Training Center is now online. You'll learn about the indigenous world in the real Mexico. Let your Spanish-speaking friends know! If you're studying Spanish, read it alongside the English version which appears in Issue 75 of Midwifery Today magazine:

  • Luna Llena—by Maria Cristina Galante Di Pace and Araceli Gil Archundia

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Forum Talk

I have been noticing unusual fetal movements. The baby seems to be having "fetal seizures." It feels like the whole body shakes for about 3 seconds; they are jerky abrupt fetal movements (like fireworks inside). This happens several times a day. It is not your normal kick or punch or hiccups. Has anyone else experienced this before or heard of this? My concern is that it could be a neurological disorder in the baby.

Anon.


Share your thoughts and experience about this topic.
**Please do not send your responses to E-NEWS!**


Question of the Week

Q: What do you do to encourage women to trust birth?


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


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Question of the Week Responses

Q: A friend has had two cesarean sections, the last one 19 months ago. She is now considering getting pregnant again and wants to have a VBAC next time. She is concerned about uterine rupture. She wants to know if there are any great remedies for healing uterine scar tissue from her previous c-sections.

— Anon.

A: I'm a physical therapist specializing in scar tissue treatment. In my practice I have treated scar tissue successfully many times. I use techniques such as craniosacral therapy, viceral manipulation, and various forms of myofacial release. I have advanced training in visceral manipulation and urogenital manipulation that includes training specifically for work internally, through the vagina and rectum as indicated. Using these techniques and others, I am able to release the scar tissue from the underlying structures and encourage the tissue to function normally.

— Tanya Tarail

A: TIME. Time is the best healer. Women who have VBACs more than two years after the cesarean have a much lower rate of rupture than women who get pregnant right away. All the research looks at before two years and after two years, so we don't know whether three years is even better. But as the saying goes, "Time heals all wounds."

— Judy Slome Cohain

A: The most amazing plant medicine indicated is arnica Montana, especially where there is trauma to the body, such as c-section surgery.

— Rachel Snell

Q: I recently had a c-section for twins because twin A was a footling breech. Unfortunately, I had to be put under general anesthesia because my platelet levels were too low to safely have an epidural. Is there any sort of homeopathic or herbal remedy that I might try to build up my platelets? My platelets generally are around 70 and have been that way for years, with 50 being the point where treatment is needed, but 100 is the cutoff to get an epidural. When I have another child, I would like to have a VBAC, but if it doesn't work, I don't want to have to be knocked out again.

— J.B.

A: A few of my women with low platelets have successfully raised their platelet counts by drinking pomegranate juice every day.

— Janet Brooks

A: Evidence shows that curcumin, an extract of turmeric, has anti-inflammatory and antioxidant properties. It has widespread use in traditional food and medicine and can help with low platelets (thrombocytopenia). There is more information and links to research on Dr. Andrew Weil's Web site www.drweil.com, as well as the New Chapter website (they make Turmericforce, one of my favorite Curcumin supplements): www.newchapter.info. I would also recommend a full spectrum multivitamin and folic acid.

— Eden G. Fromberg, Holistic OB/GYN, New York City

A: It is important to distinguish between a true case of thrombocytopenia and a reading of low platelets caused by the preservative in the blood collection tubes. I say this because I have seen more than one case where the woman's platelet count was (artificially) low when blood was collected in a lavender top (EDTA) tube, as is customary for a CBC, and the platelet count was then performed by an automatic cell counter. Collection of blood in a light blue top (sodium citrate) tube, and/or seeing a hematologist who manually evaluates the blood will weed out this "artificial" thrombocytopenia.

— Hilary Schlinger, CNM, CPM


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Feedback

In response to the question of recommending or discouraging squatting during pregnancy [Issue 7:25]:

A childbirth educator telling women not to squat in the third trimester! I think your best bet is to meet with this miseducated person one-to-one and bring some educational materials (be prepared first) so you can confront her with the truth. Women must get the best guidance possible.

Of course opening the pelvis and doing lunges, squats, strengthening the thighs, buttocks, and relaxing the lower back with squatting is a great way for any woman to prepare for labor, and build leg strength. This is intuitive female knowledge, but I'm sure there's got to be some literature to support it as well.

Marla Shauer, CNM
Washington, D.C.

While pregnant with babies 4 and 5, I avoided squatting because I had hemorrhoids and a vulvar varicosity. The babies were each anterior, and their births were our fastest and easiest (and squat-free, I might add). I have learned that you can have a fairly comfortable pregnancy and wonderful birth without squatting. It is best to take squatting on a case-by-case basis rather than recommend it for all women.

Kathleen


Editor's Note: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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