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Does High Tech Create High Risk in Childbirth?

May 4, 2010

The Birth Machine

Two of the machines used in childbirth at a hospital are the ultrasound equipment and the electronic fetal monitor.  Neither machine has been proven safe or shown to improve outcomes for women and babies.  So why is high technology used all the time: convenience.  The machines provide information quickly, though maybe not so accurately.  Many people believe that the overuse of technology in birth is the reason the cesarean rates have skyrocketed.

In “Is Ultrasound Needed?” the author writes about the safety of Ultrasound saying:

Are there risks to ultrasound?

In the last 30 years, no conclusive evidence has shown that the levels of ultrasound used on humans are harmful. However some animal studies with higher levels of ultrasound have indicated changes in cell structure or function and even cell death. These studies seem to indicate that the tissue or body part that was being examined under the high frequency waves was altered in some way.

As a result the NIH has released the following statement, “ultrasound examination in pregnancy should be performed for a specific medical indication.”

Perhaps one of the biggest risks of ultrasound is the chance of identifying something “outside the normal range” with the baby and the inevitable invasive tests, such as amniocentesis that result. More often than not, these “unusual” findings either resolve on their own or turn out to be normal by the time the baby is born. You can imagine that the stress parents experience during this time of waiting and wondering is never beneficial!

As with any other prenatal test, be sure that you have a very good reason for getting an ultrasound and with regard to safety and multiple ultrasounds, less is definitely more!

The use of the EFM (Electronic Fetal Monitoring) has been highly questionable, and many studies have been done to evaluate the efficacy of this equipment.  The authors (Thacker SB, Stroup D, Chang M.) who studied 13 published papers had the following to say:

The only clinically significant benefit from the use of routine continuous EFM was in the reduction of neonatal seizures. In view of the increase in cesarean and operative vaginal delivery, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use continuous EFM or intermittent auscultation during labor.

The EFM is not more than a technology used to replace caregivers, or to let one nurse monitor multiple women in labor at once.  However, the big concern is the tread meal to the surgeon that doctor’s technology can lead to: EFM, drugs, laboring on the back, labor induction, etc.  The birth factory runs on a tight schedule too: 9 to 5 and forget weekends, doctors have to deliver on week days.

The problem here is that technology may seem cool, hip and all that, but bringing  medical practices in line with efficacy studies.  But in medicine, is that a concern at all?  Your comments requested!

References

WITHDRAWN: Continuous electronic heart rate monitoring for fetal assessment during labor.

Obstetric evidence based guidelines

Obstetrics view of equipment (note: no mention of how the machine can fail with double readings and the like)

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