Friday, August 18, 2006

Use Your B.R.A.I.N.

I received a comment on an earlier post asking if it's okay if this lady gets an ultrasound at six weeks of pregnancy.

That's a hard question. I want to encourage her to make her own decision. I dislike telling people outright what to do, unless I know without a doubt it is the best course of action. Do I think a routine ultrasound at six weeks is a good idea? Nope, I don't. The baby is still in a very fragile formative time. However, if someone had symptoms of an ectopic pregnancy, an ultrasound would be beneficial to rule that out and possibly save the mother's tube from rupturing. Nowadays, women are having a minimum of three ultrasounds with every early ultrasound to determine "viability"; a mid pregnancy ultrasound to "make sure everything is formed okay" and a late ultrasound to see "if the baby is getting too big."

In her article (excerpted from her book) Ultrasound? Unsound Beverely Lawrence Beech talks about the innacuracy of ultrasound for two of these stated purposes and also mentions a few of the potential risks of ultrasound. She does not go into how often ultrasound is wildly innacurate at estimating the baby's weight in the third trimester. I have heard story after story of women who had a c-section for a baby that was going to be "huge" that turned out to be 8 lb or less on the operating table. I, myself, was told with my first baby that he was going to be 10.5 pounds. This was based on an ultrasound in labor. He was 8 lb 14 oz. And I pushed him out in 15 minutes, showing up the doctor who had made a bet with the nurse that I couldn't do it.

So, with all that in mind, here is a tool to help make informed medical decisions. Remember the acronym B.R.A.I.N.

B: Benefits What are the benefits of the test/procedure? Is this being done routinely (this is what we do for all pregnant women), or to answer a medical question or diagnose a problem? Is the test accurate for the purpose we are using it for? Are the results repeatable? What are the benefits worth to me? What are you going to do with the information? If it won't change a thing for you or there is nothing that can be done about it anyway, why have it done?

R: Risk What are the risks to this test or procedure? Is there a bigger danger to me or to the baby? What have the studies shown on both sides and which side is more believable to me?

A: Alternatives What alternatives are available? Sometimes there are natural remedies available or less invasive ways of diagnosing things (like twins! Although with twins for a homebirth, I would want an ultrasound to determine if they were in the same sac or not)

I: Intuition What does your gut say? Do you think there is something wrong? If so, insist on help getting the answers you need. Listen to that little voice that keeps asking over and over about a particular issue. I believe moms know things.

N: Nothing "What would the cavewoman do?" What if you do nothing and just wait? If there is no emergency, you can take time to do some research, to lay out possible risks and potential benefits and decide which column weighs more heavily for you.

It is hard in today's culture to make medical decisions. Especially in obstetrics! Spending 10 minutes reading an obstetrics forum would show any woman that 90% of doctors absolutely disdain women who ask questions and go against their advice. There are some great ones out there! But when speaking among their own, a strong misogynistic streak appears. Doctors will often use fear, intimidations, withholding of information and sometimes outright lies to get patients to do what they want.

Would I like to have an ultrasound to make sure that the baby is in there, safe and sound? I would. I understand the pull to peek into that secret place where our babies are made and to look with awe on their perfectly forming little bodies. I understand the fears of miscarriage and wanting to make sure everything is okay. But I also understand that there is no risk-free intervention and at this point, the benefits don't outweigh the risks for me. But only you have to live with your decisions. I don't. Peace of mind is certainly a thing to put in the benefit column when you're weighing pros and cons.

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