Monday, January 31, 2011

Pregnant Mothers are Carrying their Grandchildren

Pregnant Mothers are Carrying their Grandchildren

Dear Birth Peeps,
Yesterday I went dancing with my friend Sharon, who is a nurse-midwife. She asked me what I was up to, and I mentioned I was researching the safety of prenatal ultrasound and she immediately said she was not comfortable with prenatal ultrasound, “It hasn’t been researched enough.” She told me when parents ask her to order an early ultrasound, she asks them why. When they say they want to know what colors to decorate the nursery and what colors of clothes to buy, she tells them to be safe, “Buy yellow or green!”

Mothers and fathers should consider that in order to determine the baby’s gender, ultrasound waves are pointed directly at, and are heating, the genitals of their developing baby. Many babies are exposed to ultrasound multiple times during pregnancy, some are getting even more exposure from the keepsake (or “4-D”) pictures taken at the mall (which can take up to an hour). No one can be absolutely sure what effects this popular practice is having on the long-term health of the child; or how much, how often, or at what gestation it becomes unsafe.

At what point do we become cautious? Whom do we trust? Many people say ultrasound is safe, but is it too soon to say? How do we know for certain that sending in high frequency waves of heat pointed directly at the heart and genitals of our unborn will not have consequences during their adult lifetime?

These questions call to mind another prenatal intervention that was believed at the time to be safe, and yet was later found to have caused serious genital, brain and behavior problems in the offspring, and even in the third generation!(1) Fading from public memory now is the era when diethylstilbestrol (DES) birth defects were discovered. Have you heard of DES daughters? Well, there are also DES sons and DES grandchildren.

I’d like to present a little review of this obstetric bungle from the US Center for Disease Control:

Diethylstilbestrol (DES) is a synthetic estrogen that was first manufactured in 1938. The prevailing theory at the time was that miscarriages and premature births occurred because women did not produce enough natural estrogen. So, in the name of prevention, between 1938-1971, doctors prescribed DES to an estimated 5 to 10 million pregnant women—and their unborn children--to prevent miscarriages and avoid other pregnancy problems. Hundreds of thousands of DES sons and daughters were also born in Canada, Europe and Australia between the 1940s and 1980s.

In 1953, published research showed that DES did not prevent miscarriages or premature births. However, DES continued to be prescribed until 1971. Does anybody ever practice evidence-based medicine?

In 1971, about thirty years after the practice of prescribing DES began, the Food and Drug Administration (FDA) issued a bulletin advising physicians to stop prescribing DES to pregnant women because a rare vaginal cancer was being found in girls and women who had been exposed to DES before birth.(2)

DES, believed to be safe, even though ineffective, was in fact not safe. Later research classified DES as a carcinogen and teratogen (Maydl, etl. 1983). For years, there was a huge scramble to confirm or disprove the claim that DES caused vaginal cancer in women. Before long, mothers were taking their daughters to be screened (and sometimes treated) by a gynecologist, because this rare form of cancer was found in girls as young as 8 years old!

And what about our sons: DES sons? The scope of health problems linked to DES includes: reproductive tract abnormalities, testicular cancer, behavior effects such as depressive disorders, and sexual differentiation disorders of the brain and body.(3)

DES seemed safe. The babies exposed to DES looked healthy and weighed in just fine at birth. Not all birth defects are visible at birth. Nobody knew for thirty years.

As I write this blog, until long-term effects across generations can be determined or disproven, my intention is to raise awareness and caution among both parents and birth peeps. It is my hope that we can exercise more patience, more "wait and see," more hands-on assessment. For decades, health practitioners made, and can still make, a reasonably accurate assessment of how the uterus is growing, the position of the baby, and some people develop very good skills at estimating fetal weight (I’d like to find a study to see if a skilled practitioner is as accurate or more accurate than ultrasound). Evidence-based research is not showing that multiple ultrasounds improves the baby’s health at birth.

If the baby seems like it is growing slowly, eat better and eat more! Food grows babies and placentas; ultrasounds won’t make the baby and placenta grow.

If a mother has gestational diabetes, give her excellent nutritional counseling so she can eat well and maintain her blood sugars. Weekly ultrasounds won’t prevent, or treat, a baby growing too fast from a diet high in calories, sugar and fat.



After-thought: Some readers who are learning that there may be possible risks with prenatal ultrasound have already had one, or even a few. To date, there is no conclusive evidence that a single exposure during pregnancy will have long-term effects on your baby. Begin where you are. Give the recommendation for ultrasound serious consideration, look for alternative ways to achieve and maintain a healthy pregnancy.

1 Titus_Ernstoff, L., Troisi, R. et. al. (2009, November). Birth defects in the sons and daughters of women who were exposed in utero to diethylstilbestrol (DES).

2 Retrieved from:

3 Kerlin, S. (2005). Prenatal Exposure to Diethylstilbestrol (DES) in Males and Gender-Related Disorders: Results from a 5-year study.
[A very thorough] paper prepared for the International Behavioral Development Symposium 2005

Wednesday, January 26, 2011

Sinistrality and Ultrasound

Dear Cindi and Birth Peeps,
Cindi wrote us about her child being born left-handed when there isn’t an obvious hereditary link and said she'd found a few articles linking left-handedness to prenatal ultrasounds. So I gathered up my notes on this topic to share with you.

Sinistrality or being sinistral means "left-handed," oriented toward the left, or going counter-clockwise.There you have a new "word for the day."

8-15 % percent of the population is left-handed as a result of heredity. One of my sisters is a “lefty,” and my housemate tells me many of his relatives (born before the introduction of prenatal ultrasound) are left-handed—by heredity. However, in recent decades there has been a puzzling rise in left-handedness. When the rate of left-handedness rises above 9 % in offspring born to right-handed parents and above 35% for children of left-handed parents--something other than heredity is impacting the unborn. Doctors have known for a long-time that when left-handedness is not genetically-determined, it can be a sign of brain damage. Prenatal ultrasound has been suggested as the common factor, or “insult,” causing the new rise in left-handedness.(1)

An increase in non-right-handedness (left-handed or ambidextrous) has been associated with ultrasound exposure from early studies (Salvesen, Bakketeig et al. 1992; Salvesen, Vatten et al. 1992; Salvesen, Jacobsen et al. 1993; Salvesen, Vatten et al. 1994).(2,3,4,5). This effect is significant because it implies that ultrasound can change the lateralization of the brain, which represents a significant shift in brain development. At the time of these studies in the early 90’s, ultrasound output was much lower, and examinations much shorter than today. Recent FDA regulation allows for a delivery of 8 times higher intensity!

In another study (Keiler, 2001)(6), left-handedness and prenatal ultrasound was studied in a cohort of men born in Sweden between 1973 and1978 who enlisted for military service. One group comprised of 6,585 men were born in hospitals that used ultrasound routinely (the “exposed” group). The other group, 172, 537 men, were born in hospitals without ultrasound (“unexposed” men).

Among men born between 1973 to 1975, no difference was found in rate of left-handedness between the exposed and unexposed groups.

As the use of prenatal ultrasound increased between 1976 and 1978, left-handedness in the “exposed group” increased 30 percent above the normal hereditary incidence; furthermore, when mothers received more than one ultrasound, there was a greater incidence of left-handedness in their offspring.(7)

On her “The Healthy Home Economist” website, Sarah points out that premature babies are five times more likely to be left-handed, and that the brain of the developing male fetus develops more slowly than the female, and puts boys at greater risk for ultrasound injury.

Something to think about.
I’ll be back with a few more interesting studies I found later this week.


Monday, January 24, 2011

Change #16

Dear Birth Peeps,
I had a busy weekend teaching, and wanting to do a little more research on prenatal ultrasound… so I am a few days behind. But let’s begin.

During his 30-year career, Dr. Christopher Olson observes that the use of ultrasound has “ballooned.” Initially doctors were warned about potential risks to the developing fetus from the heat generated by ultrasound waves, so diagnostic ultrasound was used with caution for specific purposes.

Ultrasound has become the standard of care for diagnosis in medicine and is even used in physical therapy to heat-treat deep muscles. But, Olson observes, “amniotic fluid absorbs more heat energy than solid tissue. And, the developing brain is known to be sensitive to a number of “environmental stressors” such as alcohol, drugs, and hot tubs. He raises the question, “Is it possible that the amount of heat generated by multiple ultrasounds lowers the threshold in a fetus that puts it at increased genetic risk of autism and related neurological disease?”1

Ultrasound has become as popular as apple pie, but some of you may not actually know how it works and how it affects fetal tissues. So allow me to present or review the basics.

Ultrasound is a pressure wave that causes air around it to vibrate. It works like radar, sending sound waves to a “target” and making a “picture” from the sound waves that bounce back. In prenatal ultrasound the “target” is the baby’s yet undeveloped, and developing, body, and/or the developing placenta or amniotic fluid.

Since the expectant mother cannot feel (or hear) the high frequency sound waves or rise in temperature, she is not aware or alarmed by what is happening to her baby. However, when receiving ultrasound waves, babies tend to move away from the stream of high-frequency sound waves. They may be feeling vibrations, heat, or both.

A study was conducted to “hear” what babies hear when they are subjected to ultrasound. Ultrasound waves, aimed directly at a miniature microphone placed in a woman's uterus, recorded sound "as loud as a subway train coming into the station."(Samuel, 2001)2

Ultrasound waves heat the baby’s tissues when “taking a picture” or hearing fetal heart tones. The heat waves from ultrasound or doppler may be beneficial in treating deep muscle spasm in physical therapy, but it may present subtle or long term effects in the developing fetus. Although the research is still “inconclusive” before consenting to diagnostic ultrasound or getting a “keepsake” ultrasound picture at the mall, mothers and fathers need to understand why a temperature increase can cause significant damage to a developing fetus's central nervous system.(Miller, 2002)3

Why Heating the Intrauterine Environment and Baby May Be Harmful
Pregnant women are advised to stay out of hot tubs, hot baths, steam rooms, and saunas. Here’s why: The mother’s core temperature is 98.6. When she is immersed in a hot tub or bath, her body cannot cool off via perspiration, thus raising her core temperature by as much as 2 degrees Fahrenheit.

When a mother’s core temperature is elevated of as little as 2 degrees Fahrenheit, it can result in embryonic death, miscarriage, slowing down of fetal growth and weight gain, and developmental defects. (Edwards, M.J., 2003)4 One study reported that "women who used hot tubs or saunas during early pregnancy face up to triple the risk of bearing babies with spina bifida or brain defects."(Milunsky, A., et al. 1992)5

The unborn baby is in a little hot tub of its own in the mother’s body. So if the mother’s core temperature goes up —- for any reason (maternal fever, hot tubs, diagnostic ultrasound or keepsake ultrasound) -- her baby cannot escape elevated temperatures in the womb. This is important because, across mammalian species, elevated maternal or fetal body temperatures have been shown to result in birth defects in offspring. (Miller, M.W., et al. 2002)6

What’s interesting here is that mothers are warned about hot tubs, but not about ultrasound heat. Even if the research is still "inconclusive," mothers and fathers deserve informed consent, they deserve to be warned about potential risk of ultrasounds —- so they can make an informed decision about whether or not to take this risk for their baby.

Ultrasound heats bone at a different rate than muscle, soft tissue or amniotic fluid.7 As the baby grows in utero and its bones calcify, they absorb and retain more heat from ultrasound. During the third trimester, the baby's calcified skull can heat up 50 times faster than its surrounding tissue (Barnett, 1998), subjecting parts of the enclosed brain to secondary heat that can continue after the ultrasound exam has concluded.8

“The amount of ultrasound-induced [brain] heating increases with gestational age and the development of fetal bone. The rate of heating near bone is rapid; 75% of the maximum heating occurs within 30 seconds.(Barnett, 2001)9

There are more questions than answers at this time. One thing we have to consider is that we are trusting the health and well-being of our next generation to a technology that has not yet been proven safe, even though it has become the standard of care. More patience, caution, and research is needed to investigate:

• Acoustic output (more about this topic in the next blog entry)
• The amount of time the fetus is exposed to ultrasound waves
• If, and in what way, the number of ultrasounds during pregnancy affect the baby
• What, if any, teratogenic/toxic effects result at different stages of fetal development

But this research will not easy to do; “there are roadblocks to this research,” Olson warns, namely “fear-based resistance among clinicians in a litigious society to give up ‘safety’ of the current standard of care.”10 And, with the majority of mothers and babies now exposed to routine prenatal ultrasound, it will be more difficult to find control groups for comparative study.

In the meantime, it is up to us to inform parents, and for parents to ask themselves if the risks outweigh the benefits.

Parents need to know that the frequent use of ultrasound has not been shown to improve baby’s health or birth outcome. Except for diagnosing the gender of the baby, skilled birth attendants can make the other assessments with their hands. But this skill is rapidly being lost as more doctors and midwives refer parents to ultrasound rather than take the time to do a thorough hands-on exam.

We will continue with a review of the literature and other factors to consider in a day where ultrasounding our next generation in utero has become the almost unquestioned standard of care.



1 Olson, C.D. (2009). Does ultrasound increase risk for autism? Journal of American Osteopath Association. 109(2), 71-72. Retrieved from Pub Med:

2 Samuel, Eugenie. 2001. Fetuses can hear ultrasound examinations. New Scientist. Accessed 11 May 2006.

3 Miller, M.W., et al. 2002. Hyperthermic teratogenicity, thermal dose and diagnostic ultrasound during pregnancy: implications of new standards on tissue heating. International Journal of Hyperthermia. 18(5): 361–84.

4 Edwards, M.J., R.D. Saunders and K. Shiota. 2003. Effects of heat on embryos and foetuses. International Journal of Hyperthermia. 19 (3): 295–324.

5 Milunsky, A., et al. 1992. Maternal heat exposure and neural tube defects. JAMA 268(7): 882–85.

6 Miller, M.W., et al. 2002. Hyperthermic teratogenicity, thermal dose and diagnostic ultrasound during pregnancy: implications of new standards on tissue heating. Int J Hyperthermia 18(5): 361–84.

7 "The ultrasound procedure: Physical effects and research." Birth. Accessed 23 Sept 2006.

8 Barnett, S.B. "Can diagnostic ultrasound heat tissue and cause biological effects?" In S.B. Barnett and G. Kossoff, eds. 1998.

9 Barnett, S.B. (2001, July). Intracranial temperature elevation from diagnostic ultrasound. Ultrasound Medical Biology. 27(7); 883-8.

10 Olson, C.D. (2009).

Wednesday, January 19, 2011

Change #16

Good Morning Birth Peeps,
I have been deliberating about how to go about presenting today's Change, which is also my chosen resolution for Changing Birth in our Culture in 2011.

During this year another book will be published. It is well underway. A video will be produced. Lectures, classes, and workshops will be offered... each of those may chip away at some form in this dream of birth in our culture... although I cannot know how.

When I was a young midwife I worked in a public clinic for a short time before my "firing" was inevitable, and I quit to save myself the embarrassment. I recall that one of my "failures" was that I didn't order enough ultrasounds. Instinctively, I did not trust this new technology. For the most part, I did not use a doppler: I used my ears and an old fashioned fetascope to hear the baby's heart beat. I never liked or trusted the idea of using ultrasonic waves as early as possible in the first trimester aimed at the developing heart just to amplify the sound of the tiny baby's heart beat. What are those waves doing to the developing fetus? And how is hearing this, or seeing a distorted image (back then they were more distorted) truly helpful? The early research was "reassuring," but I believed it was only a matter of time before the hidden changes caused by heat rays of ultrasound would manifest.

In recent months I have been researching the effect, and possible effect, that frequent ultrasound is or may be having on our babies and the next generation. I have interviewed caregivers who order ultrasound. And I have examined my conscience deeply as to what needs to happen next, what it is that I am called to do.

And it is to share the ultrasound research with you here, on this blog, in small installments so you can consider this for yourselves and... if you are moved, let parents know about it.

I am finding caregivers don't know about ultrasound risk (because as one caregiver told me, they work long hours and can't always keep up with the latest research in journals), and if they do know about it, they have a dilemma: It takes time to provide true informed consent. Clinics are too busy for caregivers to explain to each of the 20 or 30 patients that day, many of whom will be ordered an ultrasound, the potential risks--and leave the choice to them. Then there is the very real problem of habit mind: all of us tend to continue doing the things we were first trained to do; radical change comes hard. And finally, whenever something, like ultrasound, has become the standard of care, there is collective, not just personal, trust.

So I am going to approach this change methodically and slowly. Beginning tomorrow, and from time to time in 2011, I will present evidence-based research with the intention of raising awareness and caution in the hope that a collective conscience demands protection of the next generation's health.

As you are deciding what your 2011 Change or Gift to Birth in Our Culture will be, may I offer you an image that guides my own process?:
A Love Warrior does not act impulsively, unless the situation is so immediate, swift action IS what needs to happen next. Warriors are Hunters by nature, and Hunters are patient. They suss out the terrain, the predator, and--as all of nature is energy conserving (with the exception of Westernized human beings!)--the huntress acts deliberately, decisively, without ambivalence.


Tuesday, January 11, 2011

New Year for Change

Dear Birth Peeps,
I've been silent a while. Writing madly. I have not forgot about you. Our numbers are growing. Welcome newcomers.

I've been thinking about all of you--and me--in 2011 coming together to Change Birth in Our Culture. I like making New Year Resolutions or Intentions. I am asking myself a question that I will pose to you:

If there were one small change I could help bring about in 2011, and Fear--in any of her many forms--was not a player, and no other obstacles were allowed to stop me, what would I do next? What action would I take? What words would I speak?

I am choosing my 2011 Intention based on this and will share it soon. Would you please let us all hear from you, tell us what you will do in 2011 to Change Birth in Our Culture.

I am,