I had a very interesting conversation with the ultrasound tech during yesterday's scan to rule out DVT. She asked, probably to make small talk, if I had already had my pregnancy ultrasound. I said, "I'm not having an ultrasound unless there's a specific indication." We moved on to other topics, such as whether or not I work. (I'm never entirely sure how to answer this; I usually end up saying "I just finished my PhD.") I told her that I was in American Studies and that I focused on childbirth and maternity care.
After the exam was done, she turned to me and asked why I wasn't having an ultrasound. I briefly explained that, based on the medical evidence, I had decided not to have a routine ultrasound. I mentioned several RCTs comparing routine versus medically indicated prenatal ultrasounds; they concluded that routine ultrasounds for low-risk pregnancies brought no significant improvements in neonatal outcomes. (For example, one meta-analysis of several RCTs concluded that "There is no evidence from RCTs of routine ultrasonography that it has any effect on the outcome of live births from low-risk pregnancies. Until there is further information from RCTs about possible subtle effects of ultrasonic scanning, exposure of fetuses to ultrasound scans should be minimised by performing them only where the clinical benefits are established. More research is needed to follow-up children of mothers taking part in RCTs.")
She replied, "Well, you can look at RCTs all you want, but they don't really matter when you've seen what I've seen." She mentioned lots of rare and potentially fatal conditions that ultrasound scans can detect in women with totally healthy pregnancies. One of them was anencephaly--which is 100% fatal, so I am not sure how that would be reason to have an ultrasound. She said, "In this day and age I cannot imagine anyone not choosing to have an ultrasound." She also told me, "I cannot understand how someone as educated as you are would choose not to have an ultrasound."
She kept repeating these things to me; I could tell she was having a really hard time wrapping her mind around the fact that some women would choose not to use this technology. Her comment dismissing the research evidence about routine ultrasounds was particularly fascinating. In her case, no amount of evidence-based medicine would change her views; she had simply had too many first-hand anecdotal experiences to be able to accept the conclusions of the medical research.
I think that personal experience plays a tremendously influential role in those who work with pregnant and birthing women. It's partly our human tendency to remember the (numerically small) scary, unusual, and exceptional situations rather than the more common "normal" pregnancies and births. For example, you can cite literature about the safety of VBAC all you want, but some OBs will still insist that they are too dangerous and too risky, perhaps because they have witnessed first-hand the rare case of uterine rupture. It's fine to have personal opinions and even certain preferences based your first-hand experiences. However, it is highly problematic when a care giver allows their personal biases to overwhelm or even erase the medical evidence or to dictate what a pregnant woman can or cannot do. I would hope that every health care provider would be able to separate their personal experience and emotional preferences from both the medical evidence and the woman's autonomy in decision-making.
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After the exam was done, she turned to me and asked why I wasn't having an ultrasound. I briefly explained that, based on the medical evidence, I had decided not to have a routine ultrasound. I mentioned several RCTs comparing routine versus medically indicated prenatal ultrasounds; they concluded that routine ultrasounds for low-risk pregnancies brought no significant improvements in neonatal outcomes. (For example, one meta-analysis of several RCTs concluded that "There is no evidence from RCTs of routine ultrasonography that it has any effect on the outcome of live births from low-risk pregnancies. Until there is further information from RCTs about possible subtle effects of ultrasonic scanning, exposure of fetuses to ultrasound scans should be minimised by performing them only where the clinical benefits are established. More research is needed to follow-up children of mothers taking part in RCTs.")
She replied, "Well, you can look at RCTs all you want, but they don't really matter when you've seen what I've seen." She mentioned lots of rare and potentially fatal conditions that ultrasound scans can detect in women with totally healthy pregnancies. One of them was anencephaly--which is 100% fatal, so I am not sure how that would be reason to have an ultrasound. She said, "In this day and age I cannot imagine anyone not choosing to have an ultrasound." She also told me, "I cannot understand how someone as educated as you are would choose not to have an ultrasound."
She kept repeating these things to me; I could tell she was having a really hard time wrapping her mind around the fact that some women would choose not to use this technology. Her comment dismissing the research evidence about routine ultrasounds was particularly fascinating. In her case, no amount of evidence-based medicine would change her views; she had simply had too many first-hand anecdotal experiences to be able to accept the conclusions of the medical research.
I think that personal experience plays a tremendously influential role in those who work with pregnant and birthing women. It's partly our human tendency to remember the (numerically small) scary, unusual, and exceptional situations rather than the more common "normal" pregnancies and births. For example, you can cite literature about the safety of VBAC all you want, but some OBs will still insist that they are too dangerous and too risky, perhaps because they have witnessed first-hand the rare case of uterine rupture. It's fine to have personal opinions and even certain preferences based your first-hand experiences. However, it is highly problematic when a care giver allows their personal biases to overwhelm or even erase the medical evidence or to dictate what a pregnant woman can or cannot do. I would hope that every health care provider would be able to separate their personal experience and emotional preferences from both the medical evidence and the woman's autonomy in decision-making.
