Cesarean Birth and Prevention

Blog post featured image: Photo by Jonathan Borba on Unsplash

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Hi. I wanted to come on and talk about cesarean and why I'm so passionate about preventing it. 

But what I want to mention first is that the rates in this country, in the United States, are going up and our outcomes are getting worse. Okay. The national average is 30%.

That's just unacceptable.

Some hospitals around where I live, the rate is 40 to 50%. Unbelievable. Why? There are so many reasons why, but I just want to share something with you.  

My rate is 5%. My rate of cesarean birth is 5%. I'm not bragging. This has nothing really to do with me. I, 

What's different. Why is that?

Why do you think the rates in my practice are 5%, and the rates in the national average of hospitals are 30% and climbing?

The families that come to my practice don't have different bodies. The people don't have different bodies. 

You know what's different. They're getting midwifery care.

They're getting midwifery care. They are low risk and healthy. And maybe someone even labeled them as high risk, but they're not really high risk. They're just healthy. They might have an issue or two, but you know what they're doing? They're taking responsibility. That's also what they're doing.

They're preparing as I recommend them to prepare, and they're taking responsibility for the birth, they're not just saying to me, do whatever, right. 

They are taking it upon themselves. 

Why do they need to prepare? I'll tell you why they need to prepare, because I know that women's bodies know exactly how to give birth. A healthy body knows how to give birth. Right? 

Why in the West do we need to prepare? Because we're in the West. We're in the Western culture.

I feel so strongly about this because I do hospital shifts. I do hospital shifts and I love to do hospitals shifts in hospitals that serve the immigrant populations.

I love that. And I can actually do prenatal care and help a mama in labor as much as possible with my heart and with my Spanish. Now I am not fluent, okay, but I love working with this community, the immigrant population that's coming up, because I'll tell you why. Not just, I love them, but the less Westernized they are, they don't need to take childbirth classes, they just come and birth just like that. 

And you know why? Because the newer they are to this country, the less westernized they are, they came from countries where they were surrounded by people having birth. And in a community. And the women in their community, the elders, the wiser ones would talk to them about it and they would see it. 

I mean, I just spoke with a grand-momma, an abuela, who had 11 babies in her casa - back in her country. 11 babies in her Casa. That's what everybody did.

She didn't need a childbirth course. She was surrounded by everybody doing that. So, she got that education, and she got that by osmosis, that “We know how to do this. This is what we know how to do". And you know what, it's hard, but we can do hard things. Like we don't need to numb ourselves from pain. They deal with pain. They just deal with it. The more westernized they are, the more we are in our brains, the more we are in fear. Not “we”. No, because I've healed myself, I've tried to de-Westernize myself when it comes to helping moms give birth.

And I feel strongly about this, because, we can't help the way of our culture. Okay. We get fear messages. Oh my gosh we get fear messages all over the media. You know, someone sees you're pregnant they're going to tell you a story. And we are addicted to Googling everything. We're just too much in our brains. It's just, it's just the way it is. We have to research this, we have to research that, and we have to numb. We're not comfortable with discomfort.

And that's why I love my yoga training. That taught me, that deep in yoga, to combine that with being a midwife is just an amazing combination. Yoga doesn't come from the West. It comes from the East. To be comfortable with uncomfortable. To be comfortable with discomfort. To be comfortable and relax into intensity. 

And I needed that to help me understand and how to help other people do that. But there are cultures around the world, here are countries around the world that never did any yoga. They just live in a community, and are surrounded by the elders and other women in the community. They just do it. You know, we do hard things. And we just give birth.

So, that’s why I think a huge part of the success of a lot in my practice, and a lot of my colleagues, is that we're really are, to the families that have a baby in the home, in our practice are Westernized. They might want to have a home birth, but it's their first time, they know nothing about birth. They haven't been around it. 

They tell me they don't know anybody that's had a home birth that I can connect them with. Well, I know tons of people that have had a home birth.

So, that's why I love connecting moms and their partners, so that they don't feel so isolated. But a lot of times the families that come to me, their parents gave birth in hospitals with all kinds of interventions and they just, they feel very isolated and unprepared. And, and just looking at videos and pictures, scrolling down, on Instagram is not the way to prepare. I'm sorry. It's not. And that's why I really think a lot of the success comes from myself and my colleagues really being insistent that the family who comes in to have a home birth is going to prepare like a boss, right? 

Get de-Westernized, get primal and get sensual, and learn how to relax into intensity and learn about birth because no one ever taught you. Right. And learn the techniques that you need to do to master your calm. And, and to just let your body do it. And, and I think that's a huge part of our success. 

I track my stats, and unfortunately the 7% of times that I have to go into the hospital, it's not because of an emergency. Emergencies are rare. We deal with them, or I can count them on my hand.

I'm the EMT. The midwife is the EMT at the birth. We prevent and we deal with any problems that come up. And if we need to go to the hospital, we need to go to the hospital.

But that's 7% of the time. That means 93% are having births at home.

But who is my 7% that needs to go to the hospital?
It tends to be, and I track my statistics. I've been tracking them for years. It's people with long, stuck labors, first time birthers, first time vaginal birthers, who did not prepare.

They just didn't want to take a course, they were preparing on Instagram or they, or they just weren't preparing at all before Instagram.

You can't prepare on Instagram. You have to take a class today. Yes. In the West. You have to take a class, unless your mom and your grandparents have given birth at home, and you're surrounded by, natural birth. Because natural birth in the West is very different. It's a very different experience if you've never done it before and you can't prepare on social media. Okay? 

Then, you have to think about who are you going to, who are you going to - let's say you want a natural birth. Well, if the hospital or the provider that you're going to is, let's say you're healthy and you want a natural birth, if the hospital and the provider that you're going to doesn't do natural birth. They're not into it. They weren't trained in it. They're into interventive birth, it's going to be very hard for you to have a natural birth, right? And one intervention leads to another intervention, leads to the other intervention, and unfortunately ends up in too much intervention and complications and cesarean births. 

I am so grateful for cesarean births for when it's necessary and that's why I post on it. And yes, we could have gentle cesareans for those mamas. Five percent - they're still human beings, and that's still a birth, and those mamas are rockstars because they need to have a compassionate, human, respectful family centered, gentle cesarean, and we can have as much as possible that home-sweet-home birth in the hospital or in the operating room, but we still have to prevent. 

So, you have to think about – even if you want a vaginal birth - let's say you want an epidural - if you want a vaginal birth, you have to know. Ask “What's the rate of cesareans in your hospital?”. Is it 30%? Is it 40%? Is it 50%? Then it's very unlikely - unless you prepare. Then have to prepare even more, right, to fight that system. Because, I don’t know, I talk about this all the time and I'm so passionate about it because I think that's how we make the change. 

How we be the change, how we make the change, is for you all to prepare yourselves and take back your birth and know what setting and what provider you're going to. 

And if you are blessed, if you're healthy, or you have a little issue or two, that doesn't risk you out of midwifery care. Find a midwife. 

That's the model of care in a lot of countries where the midwives who are trained. You know, I have seven years of training, it's not just a weekend course. I had to get my bachelor's, and I got my master's, and where I live, I need a master's degree. I have seven years of training and education, and it's specifically focused on supporting the low risk healthy.

Yes, we screen, we prevent, and we look. That's what prenatal care is all about, that relationship, and making sure that it is still safe and appropriate for that mama to have a home birth, or a birth with a midwife in the hospital. 

But midwifery, our specialty, is supporting normal. Keeping it normal. Lay low on intervention. No intervention. No interventions necessary when it's working well. 

What's an obstetrician? What's an OB/GYN. Do you know the difference? There’s a huge difference, and we need them, thank god, but an obstetrician and a gynecologist, OB/GYN, goes to medical school and does residency and extra training for high-risk pregnancies and surgery, to use very highly sophisticated technology to diagnose and treat high-risk situations, medically or surgically. But that kind of provider, I have doctors, I love the obstetricians that I work, but they always tell me they know nothing about natural birth. They're bored of it. They don't know what to do. They love the midwives. If someone's healthy, they say “you're going to get better care with a midwife”. 

So, it's very important for you to know the difference between a midwife and an obstetrician, their training and their background, because if you want a surgical birth, then no, you don't go to a midwife – go to a surgeon.

And that's what an obstetrician and gynecologist, OB/GYN is. And we need them. 

And that's why there are certain countries, that's why the United States ranks the lowest among all developed countries in the world, in terms of maternal and newborn outcomes. We're losing more babies and mamas, or having more serious complications with mamas and babies, than all the other developed countries in the world.

The countries that have the best outcomes are countries where, like Sweden, there's a lot of countries where everybody sees a midwife, if they're healthy. The doctor (obstetrician) is there for the high risk. High-risk and when surgery is needed. When medicine and surgery is needed. 

And that's how we serve the whole population of people having babies, and that's how we get excellent outcomes - live, happy, healthy mamas and babies. 

So last week I talked about a bleeding in pregnancy - this week I thought I'd talk about this.

If you found that helpful, comment, share. I'd love to hear what you have to say, but that's all for now. 

Have a wonderful weekend. Bye.

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Plan like a Boss! Create your ideal birth plan and take back your birth!

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• help you speak up for what you want and what you do not want

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Part one and two of a an awesome video I was invited to do with Joni, a mama in my practice who had a homebirth birth after cesarean, that really brings together many things pregnancy, birth, and breathwork, holistic health and healing.

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Get deep in this childbearing bible, a reference guide for the whole journey from planning a pregnancy, expecting, birth, postpartum and newborn care, with effective holistic modalities for common discomforts and issues along the way.

Posterior Position: Practical Steps for Prevention and Remedy

Art by Katie Atkinson @spiritysol

A baby in a posterior position is facing your abdomen, and baby’s back is towards your back. Some babies are born easily in the posterior position with baby facing mama’s face “sunny side up.” This is especially if Mama:

• Has given birth before

• Is carrying a baby of average or smaller size

• Has an adequate sized pelvis

• Is committed, relaxed and prepared

• Is able to be upright, move and change positions at will

• Has the ability to eat and drink freely

• Is supported by providers who are patient, calm and trained to help baby turn

Art by Katie Atkinson @spiritysol

Other babies in posterior position can be more challenging, creating problems like not going into labor, water breaking prematurely before labor starts, slower more difficult labor progress, exhaustion, and labor felt mostly as back pain that can be harder to cope with. All of these factors increase the risk of complications, interventions and cesarean if baby can not be safely born vaginally. 

Epidurals increase the incidence of posterior babies, as well. But sometimes in prolonged labor, when Mama can no longer cope, the compassionate use of an epidural can help her give birth vaginally. 

The modern sedentary lifestyle of slouching in chairs over smart phones and computers, sitting back in sofas and car seats with associated poor posture, stress and tension in our bodies contributes to the rise in babies presenting in the posterior position. Many of us are no longer as active as our ancestors and indigenous cultures around the globe. We are not often leaning forward doing manual work, which helps baby’s heavier back come forward into the anterior position, unless we are doing activities like gardening.  

Art by Katie Atkinson @spiritysol

Ideally and actually most often, the baby will be in an anterior position facing your spine at term, or turns anterior during labor for childbirth. It is important to know when your baby moves into the optimal anterior position, so you can encourage the baby to stay there, which usually means an easier and shorter labor. 

You can learn on your own what position your baby is in. But if you are unsure, ask your practitioner for help figuring it out. Then try to pay attention to your baby’s position, without getting needlessly obsessed about it. This is easier to do when your baby moves or when momentarily lying on your back. It may take a lot of concentration to understand what is what at first, but soon you will get the hang of it.

When your baby is posterior, your tummy may look flatter and feel more squashy, and you may feel arms and legs and kicks all over the front towards the middle of your tummy. The area around your belly button may dip to a concave, saucer-like shape, and you may also experience long and painful practice contractions with a more severe lower backache as your baby tries to turn around to the anterior position to engage down into the pelvis.

When your baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, and you will usually feel kicks under the side of your ribs. Your belly button will normally poke out and feel firm.

Pay attention to your posture and positioning at the time when your baby may be starting to descend into your pelvis, which is during the last 6 weeks of your first pregnancy, and the last 2-3 weeks of your subsequent pregnancies. The goal is to make room for your baby to assume the optimal position for birthing. 

The baby’s back is the heaviest side of its body, and will thus gravitate towards the lowest side of your abdomen. So, if your tummy is lower than your back (such as sitting on a chair leaning forward), the baby’s back will tend to swing anterior towards your tummy.

If your back is lower than your tummy (such as reclining back in an armchair with your feet up), then the baby’s back may swing towards your back into a posterior position. With this in mind, when you are 34 weeks onward, avoid any position where you are spending time leaning backwards with your knees higher than your pelvis.

Ideally, ditch the chairs. If you do need to sit on one, make sure your knees are lower than your pelvis, and your trunk is tilted slightly forward. If you need to work at a desk, consider a standing one at least some of the time, resting an alternating foot on a step stool.

Watch TV, read and lounge while kneeling on the floor, over a beanbag, birth ball, cushions, or sitting backwards on a straight backed dining room or kitchen chair facing and leaning on its back. 

Practice yoga to be in shape for the lunges and varied positions used to help your baby come down and out. Use yoga positions like bound angle (badha konasana) sitting with your back upright with soles of your feet together, or on your hands and knees while curving your back up like a cat followed by dropping your spine down in an arch and/or wiggling your hips from side to side. Get out your yoga mat and support your body with props like blankets, bolsters or blocks  as needed. 

Avoid crossing your legs, as it reduces the space in front of your pelvis and opens up the back. Sit on a wedge cushion in the car so your pelvis is tilted forward, and keep the seat back upright.

Avoid deep squatting until baby is anterior and well down in your pelvis or when needed in labor. Deep squatting opens up your pelvis and encourages the baby to move down, so refrain from it until your baby is in the anterior position. You can squat on a low stool or yoga blocks instead, keeping your spine upright.

Rest and sleep on your side, with two pillows under your bent right knee, which should be jackknifed up towards your chest, and keep your left leg straight out.

Swim with your belly downwards, doing the front crawl and breaststroke. The leg movements with the breaststroke in particular are great for opening your pelvis and encouraging your baby into an optimal anterior position.

If Your Baby Is Posterior

Continue the above mentioned positions, and add the following exercises for 20 to 30 minutes each, 3 times daily while watching something inspirational, romantic or that makes you laugh, or while listening to music:

Maintain a knee-chest position, with your buttocks sticking up in the air to tip the baby  back out of the pelvis so there is more room to turn around to the anterior position.

• Sway your hips back and forth and do the pelvic rock up and down while on your hands and knees.

• Crawl around the floor on your hands and knees, or hands and feet like an elephant.

• Scrub your floors or do some gardening.

• Swim belly down, kicking with straight legs only. Avoid frog leg movements.

• Lie on a slant board (using an ironing board or see-saw), with your head down and your legs up or lay with your pelvis and legs on the top stair landing or sofa and rest on your hands or forearms on a lower stair so you are at a similar incline. Jiggle your pelvis as you do this.

• Try resting and sleeping on your tummy using lots of pillows and cushions for support.

• Sit on a kneeler-rocker, which is a kneeling stool that sits you in an upright position with your knees lower than your chest, and has a rocker underneath for movement that encourages your baby to rotate. There are several types. See what is best for you. 

When baby turns to the anterior position, you can encourage descent further into your pelvis by walking around upright, gently massaging the baby’s buttocks downward, deep squatting and swimming, this time using lots of breaststroke frog leg kicking.

If you have lax abdominal muscles from several babies or lack of toning exercises, use a supportive maternity binder to keep baby in place. Bellefit makes a fine one, as pictured below. You can check them out and purchase here.

If Going Into Labor With a Posterior Baby

Starting in early labor, try the following movements involving altering the level of your hips, which help wiggle the baby down through your pelvis:

• Walk up and down stairs, sideways if you need to.

• Rock and dance from side to side.

• March or tread in place.

• Step on and off a step stool.

• Climb in and out of the birth pool.

• Lay on your side, so the part of your belly where your baby’s back is, can lean forward almost over the sofa or bed, with your upper knee resting on a lower chair.

• Consider having your midwives help to rotate the baby using a variety of external techniques, or if needed, by manually lifting your baby out of your pelvis during a contraction.

During the pushing stage of labor:

• Kneel on all fours, with the other leg up in a lunge. Switch legs periodically. You can do this standing, alternating one leg up on a chair moving towards and away from it. 

• Maintain a supported high squat in a birthing stool or hanging from a dangling squatting rope or your partner, with your bottom at least 18 inches off the floor.

• You can rest on your side with one leg straight out and the other leg bent up towards your chest, supported with pillows.

• Avoid lying back, semi-reclining, sitting or semi-sitting. 

For more information online, visit Spinning Babies, Association of Radical Midwives, or the GentlleBirth archives for Suboptimal Fetal Positions.

Check out my number one international best selling book Natural Birth Secrets and my Love Your Birth course, an online version of how I have helped thousands in my local practice.

Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything! It is now recommended by midwives, physicians, health care professionals around the globe, and doulas take it for their certification training.

As always, if you need more personalized guidance, schedule a consultation with me. 

Postpartum Bleeding: Holistic Prevention Strategies

It is normal to have light bleeding in labor as your cervix dilates and breaks its tiny blood vessels. And as baby emerges from the birth canal there can some local tearing that can cause bleeding. Expect to experience the most bleeding at delivery and postpartum. Most of this bleeding is from where the placenta was located in your uterus. 

At normal vaginal birth and immediate postpartum, it is common to lose up to a half liter of blood. After cesarean birth, one liter of blood loss is the average. After birth, your uterus needs to contract around the major blood vessels that supplied the placenta to close them off and prevent excessive bleeding. 

The first few days, bleeding can be like a heavy period. Then, it tapers to a moderate period, after which it becomes lighter and changes color over several weeks from shades of red, then pink to brown. The body is healing the former placental site, shedding the internal scab there, and extra tissue and blood that was lining your uterus during pregnancy. 

Postpartum hemorrhage usually occurs immediately, or up to the first 24 hours post birth, and remains a major cause of maternal death in the US and around the world. It must be taken seriously. Currently, there is substantial evidence in support of what is termed ‘active management of the third stage of labor,’ to reduce the risk of severe excess postpartum bleeding. It includes the use of:

•  The synthetic hormone oxytocin (referred to as Pitocin in the US) via intravenous or intramuscular injection

• Early cord clamping with waiting 1-3 minutes until baby gets at least most of the cord blood

• Controlled traction on the cord along with counter pressure on the uterus to effect placenta delivery within the first 5-30 minutes after birth

• Uterine massage to make sure it is firmly contracted

• Assessments every 15 minutes for the first two hours. 

The above process, or a similar version, is done routinely in most hospitals, and can certainly be done in out of hospital birth settings. However, the studies that determined these procedures, were based on hospital births in mostly resource poor but also well developed countries. Like all studies, they have their limitations and flaws, some were even considered to be of poor quality according to the esteemed Cochrane Review. Also these interventions are not without side effects and concerns. The American College of Nurse-Midwives support the use of active management of third stage of labor in low resource settings, according to their position statement, although they do admit its benefits are not as clear in the low risk healthy population, and encourage the provider to have a risk benefit discussion with each pregnant family so they can make an informed decision about it. 

Most homebirth and birth center moms and providers are passionate about physiologic birthing, minimal interventions and holistic modalities, do not routinely want an injection of medication, and are more interested in natural alternatives. They trust the incredible wisdom of the normal birthing process, which has worked for thousands of years or we would not have survived as a species. They share a common belief that if it is not broken, don’t fix it, wary of medication and interventions unless absolutely necessary and benefits outweigh risks. They tend to like the alternative, ‘expectant management’ approach, which also entails close observation by the provider, but tends to take longer, allowing for the normal physiologic process to take its course, and for interventions only if needed in select cases. 

After birth, mom and baby are of course carefully assessed, but encouraged to bond skin to skin. There is no rush. Cord clamping is delayed until pulsation has ceased, or after placenta is birthed. Mom and baby are assisted to breastfeed which helps release mama’s own natural oxytocin.

The provider waits and watches for signs that the placenta is naturally separating and then assists mom into an optimal position usually using gravity, and encourages her to use her own bearing down efforts to birth her placenta. The provider may sometimes guide the birthing placenta with gentle traction on the cord, while supporting the uterus, then massages the uterus to make sure it is firm, assesses the bleeding until stable, and assesses and repairs tearing as needed. 

Certainly, if there are certain concerns or risk factors, you may truly benefit from medical prevention and active management.

If there is an actual hemorrhage, make sure your provider is skilled, experienced, and fully equipped to deal with it with at least the commonly used effective medications, IV fluids, suturing material for lacerations needing repair, and hands on care that are usually sufficient to control it successfully. 

However, you can build up a strong blood supply and reduce excess bleeding and its risks with the following suggestions for natural support both in your pregnancy and postpartum.

Prenatal Support

Make sure you get checked and treated for anemia common in pregnancy, that your iron stores (ferritin) are sufficient. 

Eat 3 large servings of wild greens or dark green leafy vegetables every day. They can be made into a salad, lightly sautéed or steamed. Good options are parsley, dandelion, alfalfa, kale, collard greens, comfrey and turnip greens.  For additional support, you can try the following:

NETTLE AND RASPBERRY TEA

Starting in the third trimester, drink 1 cup of this nourishing herbal infusion several times per day. 

1. Combine a handful each of the dried herbs Nettles and Red raspberry leaf with 1 quart boiling water.

2. Steep for at least 4 hours.

3. Strain to a glass mason canning jar.

4. You can add fresh mint leaves, lemon juice, or honey to taste.

View fullsize

GREEN DRINKS

Drink 1 ounce fresh, frozen, or powdered  wheatgrass juice 1-2 times daily to enrich and build your blood.

Or, try 1 scoop daily of powdered greens in your smoothie, 1-3 Tbsp bottled chlorophyll, or tablets or powders of spirulina and chlorella.

Postpartum

You need to rest in bed, on the couch or an outdoor lounge chair as much as possible for the first 2 weeks to recover.  Make sure you arrange for help in the home during this special time. Limiting activity and increasing rest help the area of open uterine blood vessels where the placenta detached to heal. 

Check the top of your uterus regularly for firmness, and massage it if it feels soft, until it hardens. Postpartum bleeding can be minimized when mothers are taught regular postpartum self massage of the uterus so that it stays firm and contracted around the blood vessels that supplied the placenta. 

Start breastfeeding right away, and every 1 ½ - 3 hours thereafter, especially taking advantage of the times when your baby is awake and alert and eager to suck.  Nursing frequently causes the body to secrete its own natural hormone oxytocin to keep the uterus firm and decrease bleeding.

Urinate frequently to keep the bladder empty so the uterus can contract easier.

You can also take homeopathic caulophyllum 30 or 200 C immediately after delivery, then 3-4 pellets arnica 30C under your tongue every 2-3 hours. Or, try herbal shepherd's purse, 1 dropperful of the tincture three times daily for the first 3-5 days after birth. If you need additional herbal support for heavier or persistent bleeding, you can try a dropperful of Angelica tincture a few times daily. 

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for postpartum bleeding prevention or search them individually. My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple, and the products will be shipped directly to your home or work within a few days.

As always, if you need more personal guidance, schedule a consultation with me. 

If bleeding becomes heavier than a heavy period, and you are soaking through two maxi pads an hour for 2 hours, empty your bladder, make sure the top of your uterus is firm and massage it if soft until it becomes hard. If no relief, take 1 tsp shepherd’s purse herbal tincture under your tongue. You can repeat the dose a few times, but if the bleeding becomes heavier, contact your practitioner. 

Do read my Natural Birth Secrets book, to prepare yourself for a healthy, joyful and calm pregnancy and childbirth - NOW OUT IN SECOND EDITION!

For further inspiration, empowerment, and optimal health in pregnancy, birthing and postpartum, please make sure to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

Photo by Megan Hancock Photography

Should I Have an Ultrasound?

If you’re worried about ultrasound safety, good for you! You should be. The use of ultrasound in pregnancy has become almost a given. Most women in the US and Canada experience at least one ultrasound during pregnancy. Some experience several. There are certainly appropriate situations for the use of ultrasound, but a healthy pregnancy isn’t one of them.

If, after weighing the pros and cons of an ultrasound, you decide to have one, that’s entirely within your right. What’s important here is to make an informed decision rather than just exposing you and your baby to high-frequency sound waves as a matter of practice.

Is Ultrasound Necessary?

The answer to this question really differs from person-to-person and even situation-to-situation. When a health care provider recommends ultrasound to a pregnant woman, the FDA recommends that mom speaks with them to understand why the ultrasound is needed, what information will be obtained, how the information will be used, and any potential risks.

Medicine is big business. There is significant financial incentive for obstetricians to recommend ultrasounds to their patients, as they can bill many hundreds of dollars to insurance companies for each use. According to the Center for Disease Control (CDC), over-use of technology is one of the major reasons for the rise in healthcare costs.

More and more modern obstetricians have been trained to use ultrasound in place of hands-on skills to evaluate the health of the pregnancy. They use it to evaluate fetal growth and position in the third trimester, which can often be assessed by hands-on examination. They also use it to date pregnancies, which can typically be done with a little detective work.

Ultrasound is often used to determine whether a baby will be too large to be birthed naturally via the birth canal. However, ultrasound has been shown to be an inaccurate measure of birth weight. Further, our pelvic bones are joined together with ligaments that allow the pelvis to widen enough for birth to safely take place - especially when supported in upright and asymmetrical mobile positioning. This is true in almost every case, even when the mother is especially small or the baby especially large.

There are some situations in which an ultrasound is warranted. For example, bleeding in pregnancy or a serious abnormality that requires immediate or high risk hospital care. Or if mom has very irregular or absent cycles during breastfeeding, providing no real guideline for gestational age. Sometimes, if mom has a lot of anxiety about the health of her pregnancy and baby, a normal ultrasound mid pregnancy can provide some reassurance - while still not a guarantee.

The American Institute of Ultrasound in Medicine advocates for use of ultrasound solely for medical purposes, and never for things like keepsake images. And the American College of Nurse-Midwives’ position is that “Ultrasound should only be used when medically indicated.”

What Do We Know About Ultrasound Safety?

Ultrasound waves have the potential to produce biological effects on the body. They can heat bodily tissue, as well as produce small pockets of gas in bodily fluids or tissues (known as cavitation). The long-term consequences of these effects are still unknown.

Dr Sarah Buckley provides an extensive article in which she weighs ultrasound safety. In it she says,

“If there is bleeding in early pregnancy, for example, ultrasound may predict whether miscarriage is inevitable. Later in pregnancy, ultrasound can be used when a baby is not growing, or when a breech baby or twins are suspected. In these cases, the information gained from ultrasound may be very useful in decision-making for the woman and her carers. However the use of routine prenatal ultrasound (RPU) is more controversial, as this involves scanning all pregnant women in the hope of improving the outcome for some mothers and babies.”

Dr Buckley goes on to say,

“Studies on humans exposed to ultrasound have shown that possible adverse effects include premature ovulation, preterm labour or miscarriage, low birth weight, poorer condition at birth, perinatal death, dyslexia, delayed speech development, and less right-handedness.”

Despite its rampant use, there has not been sufficient testing for ultrasound safety - especially concerning routine use in healthy pregnancy. In fact, there has been very little testing at all since the 1980s even though the FDA allowed exposure limits to increase by 8 fold in 1992.

It’s important to acknowledge here that technology is often assumed safe until proven otherwise. Just a couple generations back, it was general practice to x-ray pregnant mothers. Sounds crazy now that we know more about the dangers of x-rays to the developing fetus, but back then it made perfect sense.

As Dr Kelly Brogan states, “Multiple Cochrane reviews have demonstrated a lack of perinatal mortality benefit for routine ultrasound in a normal pregnancy, and an increased risk of cesarean section with third trimester screening. A review of outcomes literature condemns ultrasound when used for dating, second trimester organ scan, biophysical profile, amniotic fluid assessment, and Doppler velocity in high and low risk pregnancies.”

While our reasons for using ultrasound are typically focused on healthy pregnancies and healthy babies, there has been virtually no proof that more ultrasounds in a population equate with better health. What’s worse is that there are concerns about their possible link to the alarming increase in autism. In addition, false positives of congenital malformations are not unusual. Sadly, this has lead to more invasive testing and abortions misunderstood to be medically necessary when there is nothing actually wrong. At the very least, this puts undue stress on momma, partner and baby.

In my opinion, technology has put distance between mommas and care providers. In situations where a midwife historically would take a literal hands-on approach to mom and baby’s health, technology now allows for a disconnect where mom is sometimes never touched by her birthing support team. My belief is that this impersonal approach can do just as much harm as the technology can.

The over-use of ultrasound also undermines a woman’s trust in her healthy body’s ability to grow and birth her healthy baby, as modern day families are putting more and more trust in technology over themselves.

Alternatives to Ultrasound

We do not fully understand the effect of directing loud sound waves at baby so frequently, but it does alter DNA in the test tube and there is strong evidence to show that any damage done is cumulative. So, if you must have an ultrasound, keep it as brief as possible and limited to as few as possible. If all is well and you know your cycles or date of conception, but you really want one, do it mid pregnancy…and of course, make sure to request a keepsake picture of your baby.

A doppler is an ultrasound device that can detect fetal heartbeat as early as 10-12 weeks, depending on the device, the location of baby, and position of mom’s uterus. It is used for each prenatal visit in many obstetrical care offices and clinics. If you want to minimize ultrasound exposure, ask for the fetoscope.

A fetoscope, which is similar to a stethoscope and works to amplify baby’s heartbeat, can be used in place of ultrasound or doppler after around 20 weeks gestational age to listen to the fetal heartbeat. It can also help assess baby’s position in later pregnancy.

When baby starts to move regularly, especially in the third trimester, I teach fetal movement awareness and kick counts. Basically, babies sleep a lot, especially when you are busy running around; but they tend to get up and become active after you eat and when your’e resting. Become aware of when and how often your baby is most active and take notice of your baby’s typical daily patterns of movement. An active baby, moving as much as usual, is a sign of fetal health and well-being. If you did not feel your baby move as much usual on a given day, eat food that has previously stimulated lots of fetal activity - usually carbohydrates like a peanut butter and jelly whole grain sandwich or cereal and nut milk - plus have two glasses of orange juice and a cup of coffee; recline in 30 - 40 minutes and count at least 10 separate kicks, body shifts, punches in the hour. Most babies will produce more than that in a few minutes, but if you are not feeling 10 separate moves in that hour, call your provider.

For most of history we did not know we were having a boy or a girl until the birth of our baby. There is something special about the surprise. But for those wanting to know the sex of their baby, blood tests are now available and are actually more accurate than ultrasound for this purpose.

Your Choice

Medical interventions like ultrasound often play into our fears and turn us away from our intuition. We have come to have less trust in the process and believe that we need to rely on technology to assure us that our babies are safe. As mommas, we have thousands of years of the birthing wisdom of our elders that we carry in our DNA. Is that less reliable than a relatively new, under-tested technology when all is well?

Midwives typically use touch and hand skills in place of technology like ultrasound. As a wholistic and integrative midwife that specializes in healthy pregnancy, I always give the option for ultrasound, and discuss the pros and cons with each family in my care. Some opt out of all unless there is an issue or complication when the benefits outweigh the potential risks of sonogram. Some do want one to confirm they have a baby in the uterus with a heart beat before it is too early to tell in the office, and a basic scan between 18 -22 weeks. For those birthing at home, some want just this mid-pregnancy ultrasound to check baby’s anatomy and that the placenta is in the right place, so they are reassured there is nothing detected that warrants birth in higher risk hospital setting.

As midwives, we do not fix what is not broken. We instill trust in the pregnancy and birth process, and have confidence in a mom’s ability to do it.

Learn more about how you can date your pregnancy,  as well as have a holistically healthy journey and birth with confidence.