In what may become a ten part series, I am about to undertake a comprehensive treatise on the inner workings of the mentality of ob/gyn physicians in relation to their disdain and disapproval of 3D ultrasounds.  This disapproval is not unanimous by far.  In fact, since we have started our business in September, 2008, we have found more and more ob/gyn doctors and midwives approving and even recommending our business to their pregnant patients.  This series of articles is solely dedicated to those ob/gyn doctors who have told their patients to not get a 3D ultrasound because it is not medically necessary or that it is unsafe for a slew of other reasons.

Because I know that many of you may not have time to read the entire series of articles, I will just write my final point here:  Ob/gyn physicians do not approve of  3D and 4D ultrasound services only and precisely because they are not the ones profiting from this service. 

Although a few ob/gyn’s are clearly motivated in their discouragment of the practice for this profit motive (and I will pinpoint these ob/gyn physicians at a later date), many ob/gyn physicians do not have such a clear intention in their minds, and their discouragement of the practice may be more unconsciously influenced by the fact that they are not profiting from the service.  This is much the same way as physicians have been found to increase their recommendation of drugs that happen to be advertised on the pens that they write with which have been given to them by drug reps. 

Other ob/gyn physicians simply follow the advice of these aforementioned ob/gyn physicians, until it has gotten to the point where there has developed a culture of disdain for 3D ultrasound services.  This disdain is not rooted on any solid ground, although there are many reasons that ob/gyn physicians have brought up once this disdain has set in.

To further prove the point, a few ob/gyn physicians have opened up 3D ultrasound practices themselves, proving the point that that 3D ultrasounds are bad unless they own the 3D ultrasound facility themselves.

As part of the series, I will explore each of the reasons that ob/gyn physicians hate 3D ultrasounds and often tell their pregnant patients not to get this service, thus depriving these pregnant women of the opportunity to see and bond with their baby in this unique way.

This series of articles is meant to be a controversial, no holds barred, account.  I will definitely anger and upset some ob/gyn physicians.  And for that, I would like to apologize in advance to the ob/gyn physicians who do silently recommend my services to their patients and who have to work with these angry ob/gyn physicians.

In this article, I will attack head on the notion that 3D ultrasounds are wrong because they are elective and not necessary.  I will show that many ob/gyn physicians do not actually care about what is actually medically necessary or not.  When it comes down to it, many ob/gyn physicians will go along with something that is not medically necessary if it provides them more money or more convenience.  This can be seen in the elective C-section rate, which has been increasing steadily.

The following article discusses elective inductions of labor.  Again, elective inductions of labor are, by definition, not medically necessary.  Yet 20% of pregnancies are induced, and 10% of pregnancies are induced electively, by ob/gyn doctors, according to the following article, taken from MSNBC, and can be also seen here.

WASHINGTON – Hoping to schedule your baby’s birth while your mother’s in town, or before the doctor goes on vacation? Labor is becoming less of a late-night surprise, but some hospitals are starting to tighten the rules for elective deliveries — because some babies are being delivered too early.

More hospitals are expected to crack down as regulators begin new quality measurements next spring that aim to reduce too-early elective inductions and first-time cesareans.

Induced labor is on the rise for lots of reasons, some medical and some not. But recent research shows a troubling link between elective inductions and these so-called “late preemies.” These aren’t the dire too-small babies that the word premature conjures, but near-term babies who nonetheless are at higher risk of breathing disorders and other problems than babies who finish their very last weeks in the womb.

 “It was an ‘aha’ moment for me,” recalls Dr. Bryan Oshiro of his visit to a Utah intensive care nursery several years ago, where neonatologists pointed to babies there simply because they’d been induced too soon.

New guidelines will require that a mother’s cervix be nearly ready for natural labor, and limit the hospital beds available for elective inductions.

More hospitals are expected to start enforcing that criteria this spring, when the Joint Commission that regulates health quality will require hospitals to report all elective deliveries and the gestational age to its public database, providing peer pressure for improvement. Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction.

“That’s not a good outcome for the baby or the mom,” says Joint Commission President Dr. Mark Chassin. “We believe this will be a very important driver of improvement in perinatal care.”

1 in 4 inductions were before 39 weeks
National guidelines from the American College of Obstetricians and Gynecologists have long discouraged elective deliveries before the 39th week of pregnancy. But some hospitals that took a close look were surprised. At Utah’s Intermountain Healthcare, for example, 28 percent of elective deliveries were breaking ACOG’s rule in 2001, Oshiro told a March of Dimes meeting on preventable prematurity this month.

Most were being induced in week 37, such a small difference that local obstetricians argued it wasn’t a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator.

It took several years of policing: Inductions now are allowed only after meeting a checklist of requirements. But today, only about 3 percent of Intermountain’s elective deliveries occur before 39 weeks — and infant hospitalizations have dropped, saving money, too, says Oshiro, now a maternal-fetal medicine specialist at Loma Linda University in California. He’s about to pilot a similar program at hospitals in that area.

“If there’s no need to intervene, please don’t intervene,” is Oshiro’s message.

1 in 5 new moms induced
Labor is induced in more than one in five births, double the rate in 1990, according to the Centers for Disease Control and Prevention. Many cases are for clear health reasons, such as a problem with the fetus or a sick mom or a pregnancy that has dragged well beyond the woman’s due date. 

There’s little data on how many are elective. But a Hospital Corporation of America study of nearly 18,000 births at 27 of its hospitals around the country suggests 10 percent of all births are performed electively before the 39-week mark. (That date is considered the point at which doctors can be sure a pregnancy has reached full-term, typically defined as 40 weeks give or take about a week.)

There are many reasons to perform an elective induction, such as if mom lives two hours from a hospital, notes Dr. John Fisch of the University of Pittsburgh Medical Center’s Magee-Women’s Hospital.

Patient and doctor preference helped drive the rise in inductions, such as women timing grandma’s arrival to take care of the siblings, or minimizing 3 a.m. deliveries. Then there’s defensive medicine, where doctors worried about litigation induce for minor reasons like a slight uptick of the mother’s blood pressure.

So Pittsburgh also had “a little bit of a hard sell” after discovering nearly 12 percent of elective deliveries broke the 39-week rule in 2004, Fisch says. “It was perceived to be a safe and effective way in delivering a baby — and it is, as long as it meets certain criteria.”

After Magee began strict enforcement — requiring that a mother’s cervix be nearly ready for natural labor, and limiting the beds available for elective inductions — too-early inductions dropped to 4 percent by 2007 and are “effectively zero” today, Fisch says. Overall, elective inductions dropped 30 percent.

When ob/gyn physicians as a whole have been found to perform elective inductions in 10% of pregnant women, as a matter of convenience, whether it is for the physician’s convenience or the mother’s, then they have no basis at all to make the argument that 3D ultrasounds should not be performed because it is not medically necessary.

3D ultrasounds are not performed for the mother’s convenience or simply for entertainment.  3D ultrasounds, along with many other services and products that have been used by pregnant women for centuries, have served to fulfill a deep need of pregnant women and the dads to see and bond with their unborn baby.

It has been shown that 3D ultrasounds increase the bonding between mother and unborn child.  This is probably due to the very real emotional connection that occurs when visually seeing your child.  This should not be trivialized just because it is not medically necessary.  There are many things that are not medically necessary and yet still can fulfill a real need in society, such as weddings and baby showers.  The 3D ultrasound can be yet another rite of passage of pregnancy.

If you are pregnant and believe that your 3D ultrasound fulfilled a need, whether it felt like a biological need, emotional need, psychological need, or spiritual need, we would love to hear your perspective.

Next: Is the 3D ultrasound machine a medical device, and can medical devices only be used for medical purposes?  We’ll see what ob/gyn’s say and what they actually do.

Tags: 3D ultrasound, 3d ultrasound ban, 3D ultrasound Chicago, 3d ultrasound controversy, 3d ultrasound safety, ban on 3d ultrasounds, Chicago 3D ultrasound, elective induction of labor, elective procedure, induction of labor, ob/gyn, Pregnancy