Electronic Fetal Monitoring -- Is it really saving babies?

 As Tim McGraw's biggest fan, I subscribe to a number of Country news emails and Facebook groups.  I skip over most of it, but sometimes I'll see something that catches my eye that is not even related to Tim.  As you can imagine, it usually has to do with someone having a baby.

A couple of weeks ago it came across my News Feed that Jewel was showing off her new baby.  She lives in this area of Texas, about an hour from me, and because we have about a 50% c-section rate, I was very curious how things turned out for her.  (I had heard that she had desired a "natural birth.") 

The story goes that she was doing Hypnobirthing -- no details available.  Could have been self-study or CDs, maybe a class.  So I assume that desiring a "natural birth" really did mean an unmedicated birth, not just a vaginal birth.

The article went on to describe how violent the Braxton-Hicks contractions were and put the baby at risk.  Yadda, yadda, yadda... she had an emergency c-section that miraculously saved her baby.


The singer, who studies hypnobirthing, was eager to have a natural birth, but things didn’t work out as planned. When Jewel started having early Braxton Hicks contractions, Kase’s heart rate dropped. She admits, “I feel lucky to be pregnant in the modern age where they could actually tell he wasn’t well during those contractions.”  

In the end, Jewel says her scheduled birth plan wasn’t what was important to the young family. “We felt thankful that we had good doctors and a good hospital nearby, and that everything was OK,” she says. “I’m so lucky that we have a healthy baby boy. That’s all I cared about.”

I can't help but think this poor reporter got his terms mixed up about the contractions, and there's little information to go on from there.

Regardless, how many women have had c-sections that truly believe they were necessary -- that their baby would have died without the surgery?  Countless.  The year the Electronic Fetal Monitor was introduced, we went from a 5% c-section rate to 23%.  Studies have shown time and again that a baby who is truly in distress will be picked up with intermittent monitoring.  (Side note:  "intermittent" means different things to different care providers.  It may mean during and between a couple of contractions per hour, or 20 minutes per hour.  Find out what intermittent means at your place of birth.)

One of the problems with the continuous monitoring is the lack of communication between the birth team and the parents.  Mom is monitored from down the hall, and when a nurse does walk in, she tends to look at the monitor and not the laboring woman.  Another problem is obvious:  mom can't move around and help her baby out.  The baby is left to figure it out on his/her own. 

Problem number 3:  Any time a mom receives drugs of any kind, she'll be put on a monitor to be sure the baby is handling it OK.  This can mean hours and hours of a baby being exposed to ultrasound.  That's what Electronic Fetal Monitoring is -- ultrasound.  I've written posts on the risks of ultrasound in the past.  Click here and here and here.  You need to decide how comfortable you are with this intervention.

Problem number 4:  The biggest problem of all is simply that they have to do something with the results of the readout.  Take a baby that has a cord around the neck, for example.  This baby will have decels of the heart rate on the printout.  They aren't sure why the baby's heart rate is dropping, but better safe than sorry, right?  Lawsuit alarms start going off and a c-section is performed.  The baby is fine (Jewel's baby looked great!), but there is this perception -- or defense mechanism -- that thank goodness the c-section was performed and saved the baby. 

Was the baby ever in trouble?

We'll never know.  But now, because it's so hard to find a VBAC-friendly doctor, we've put this mom on a c-section path for all her children -- unless of course she becomes informed of her VBAC options.  As an OB, this is exactly where I want her.  Easier for me and twice as much money.  Few women will question the c-section because it makes her look like a bad mom.  She trusts her doctor.   It's easier to believe that the surgery saved the baby.

Another side note:  The cord around the baby's neck occurs in about one in three births.  When a c-section is performed where the cord is around the neck, the OB often makes a big deal about it, making the parents feel like this was very dangerous.  It's not.  The OB or midwife, after the head is out, will simply lift it over the baby's head.  It could be wrapped around the neck several times!  The most I've seen from one of my student's was 4 times!  Had she stayed with her original hospital and OB -- who required continuous monitoring -- she assuredly would have had a c-section.  Instead, she had a fabulous water birth with CNMs at a different hospital.

So, I feel bad for Jewel.  Maybe her baby really was in distress, but I suspect that the doctor didn't want such a public birth taking a chance at going sour.  Given the high c-section rate in our area, perhaps he was less comfortable with (unmedicated) vaginal birth than cesarean birth.  He knew he could perform a mean c-section and spin it like he saved the baby.  Again, just me speculating.  I do believe that she was likely another victim of our broken maternity system and doesn't even realize it.  While I always advocate for women being informed of their choices in childbirth, sometimes ignorance is probably quite blissful.

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More Evidence About the Possible Dangers of Ultrasound

Year after year, the evidence keeps mounting, and yet, I am hearing about women having more and more ultrasounds during their pregnancy. This week, I came across an article in "Midwifery Today" about problems with sound and heat in prenatal ultrasounds. I'll jump through all the jargon and technicalities and just lay it on the line.

If you've ever had an ultrasound -- and who hasn't? -- the technician likely had to keep moving the transducer to keep up the baby. Did it ever cross your mind that perhaps your baby is trying to get away from the sound of the ultrasound? In 2001, research found, when placing a miniature hydrophone in a woman's uterus, the sound from an ultrasound to be "as loud as a subway train coming into the station." Recent research has found the same. High levels of heat are also associated with ultrasound.

A rise in temperature can cause damage to the baby's central nervous system. Repeated exposure shows that elevated heat caused by ultrasound damages fetal brains in other mammals, with the assumption that it can harm human brains as well. I just have to go back to the dramatic rise in autism in the last decade. Personally, I do not believe this is a coincidence. I believe that it is related to ultrasound.

The FDA and a number of medical associations have repeatedly advised against nonmedical or "keepsake" ultrasound portrait studios in local malls across the United States. There are a number of problems with these: The risks are possibly higher at these type of establishments because of the higher acoustic output required for high-definition images. Also, these sessions tend to be longer because the technicians are searching for suitable images. The technicians may or may not have a medical background or even appropriate training.

There is no way to tell if your baby will be affected adversely by ultrasound. Really, consider the reason for the ultrasound. What will you do with the results? Will it make a difference, regardless of what it tells you? Ultimately, is ultrasound worth the risks?

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More Evidence About the Dangers of Ultrasound

I found a link about some other studies on ultrasound. There are a couple of posts under this link. They are short and easy to understand. The evidence is compelling. Check it out.

Next time your doctor says, "I don't know why 'Bradley' is so concerned about ultrasound," and tries to tell you how safe it is and that Bradley Instructors are the only people out there who care, they couldn't be further from the truth.

Evidence is mounting. Check it out.

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Autism Links to Ultrasound and Other Obstetrical Procedures

I teach in my Bradley class about the risks of ultrasound. This is so controversial to begin with. No one wants to believe that there could be complications or problems with using this device that American parents are so in love with!

Simply put, ultrasound changes the way cells grow. Ultrasound has been linked to a number of things, but the one I want to focus on here is autism.

One in every 150 kids has a form of autism in the United States. This rate has grown tremendously over the last decade. Now let's talk about ultrasound for a moment. When I had my first baby, in 1996, nearly 13 years ago, I remember desperately hoping that my insurance would cover it. Back then, they didn't do them unless there was a "medical reason." (I don't remember my "medical reason".) Gradually, the reasons started including things such as accuracy of the estimated due date. Now, everyone's insurance covers ultrasound, usually not just one, but several. I even had a student last year who had a doctor who routinely did ultrasounds every week starting at 36 weeks. Parents are excited about this, not knowing the risks they are taking with their baby's well-being. Rates of increased ultrasound usage correlate with the rate of autism diagnosis. They have both risen dramatically, simultaneously.

I had read about the possible link between ultrasound and autism about 5 or 6 years ago. It made so much sense to me. There has always been warnings linked to ultrasound, but I rarely talk with a pregnant woman who has been made aware of any warnings before having an ultrasound.

For example, a study in 1993 found that babies exposed to ultrasound were twice as likely to develop delayed speech. According to the FDA, "While ultrasound has been around for many years, expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known."

Researchers reported, in 2005, "Obstetric ultrasound should only be done for medical reasons, and exposure should be kept as low as reasonably achievable (ALARA) because of the potential for tissue heating. Temperature increases in utero have been shown to cause damage to the developing central nervous system of the fetus." In 2006, a study warned that exposure to ultrasound can affect fetal brain development.

Because there are no obvious deformities or problems at birth, we assume that all is well and "normal." It is likely several months or even years later, as the parents are going through testing, no one asks -- yet -- "How many ultrasounds did you have in your pregnancy?" I think that day will come though. As a side note -- what did you learn from all those ultrasounds? Probably that everything was just fine. Even if you were checking for something periodically, what would the difference have been in just waiting until the baby was born? Rarely can anything be done in utero. So why have all these ultrasounds to begin with?

Ultrasound, just like ANY drug in labor or pregnancy, has NOT been proven to be safe. Think about that for a minute. Take Tylenol for example. Women are told that it is "safe" to take it, but that is not necessarily true. It just hasn't been proven to be unsafe. Ibuprofen, on the other hand, has been proven to be unsafe. We know ultrasound changes cellular growth, we just aren't sure exactly what this means long-term. Links are starting to be made now, finally, after 30 years of use -- and damage.

Other research shows that populations exposed to ultrasound have a quadrupled perinatal death rate, increased rates of brain damage, nerve cell demlyienation, dyslexia, speech delays, epilepsy, and learning difficulties.

One more interesting note about ultrasound and the development of the baby. Ultrasounds, along with many obstetrical testing practices, has a high false-positive rate, meaning that parents are told something is, or may be, wrong with the baby. This causes the production of stress hormones in the mother which can have long-term effects on the baby's neurological development and behavior.

It is important to know that ultrasound is not just the scan where you see the pictures of the baby. Ultrasound includes the doptone used to hear the baby's heartbeat at your appointments with your doctor or midwife. (You can hear the baby's heartbeat with a stethoscope after about 20 weeks. This takes more skill, and if your provider is younger, they probably have no idea how to find the heartbeat of the baby without the doptone. If this at all concerns you, you should request to hear the heartbeat by stethoscope.) Another form, and perhaps the worst of them all, the Electronic Fetal Monitor, or EFM. This is often strapped to the mom for hours in labor, especially if she has drugs in her system. Once again, I have just given you another reason to not have drugs in labor. You'll still be monitored, but only a fraction of the time will be required, or needed.

I have to end this post with a simple, trust your body. Trust your baby. You will be seeing him or her in a short time. The risk of ultrasound simply is not worth it. If your doctor or midwife is pushing you to have more than one ultrasound (I understand wanting one to check things out), examine the reasons and the possible results. Can anything really be done during the pregnancy? Usually not.

For those of you who are curious, I pulled this information from a magazine called "Pathways to Family Wellness". Other obstetrical procedures linked to autism include: mercury in pregnancy, including the Rhogam shot, flu shot, dental fillings, and fish. Other procedures linked to autism: induction, epidurals, restricted laboring positions, forceps and vacuum extraction, C-sections, and umbilical cord clamping. Of all these things, ultrasound was at the top of the list.

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