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Using (Extremely) Out-dated Studies

This post, Ultrasound Proven Unsafe, came out today on the Birth a Miracle Services website. A couple of days ago, I "outed" another website's incorrect information and caused a ruckus in the birth world. While I'm not necessarily looking to do the same thing again, I am not going to stop demonstrating the sometimes dangerous curiosities that find their way to my attention. People have begun sending me links to obviously erroneous "informational" sites and, seriously folks, these really do need to be pointed out.

If natural birth and non-nurse midwifery is ever going to be seen as professional, we have got to stop perpetuating ignorant and incorrect information. 

The above-mentioned post's title alone is so far-fetched wrong as to nearly be laughable. Proven? Seriously?

The article the post is based on is from Midwifery Today, its article entitled, "Ultrasound: Weighing the Propoganda Against the Facts," written in 1999. Nineteen ninety-nine. TWELVE YEARS AGO. 12 years ago is a lifetime in science and medicine. As if that weren't bad enough, the studies that article quotes are from 1979 to 1998. 1979?! Are you kidding me? That was TWENTY YEARS before the article came out! (Sorry, I can't help screaming. It's so absurd, I can hardly control myself.)

The Midwifery Today article is so old as to use the antiquated term "growth retarded babies." When was the last time you heard that ghastly and oh-so-incorrect phrase? It's certainly been many years.

I've seen this exact MT article quoted a dozen or more times over the years, but think it's time people stop using it as if it's some great new ultrasound discovery.

Now, if Birth a Miracle Services was going to write about the MT article and show how even reputable magazines might use out-dated studies to prove their points, that sifting through the mass of misinformation can take time, but that it's worth it to give one's clients the best of the studies out there... if they were going to say these things, highlighting the original article might be acceptable.

But in its current incarnation, I think the blog post, (mis)informational piece, does a great disservice not only for pregnant women looking for information, but also to fellow childbirth educators, doulas and non-nurse midwives. I hope someone feels compelled to correct it.

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Reader Comments (23)

Keep at it Barb- keep raising the standards, and thank you for being so on top of it - and also for taking the heat.

June 13, 2011 | Unregistered CommenterKristina

Here is another one from another blogger: https://www.birthinternational.com/articles/birth-intervention/82-ultrasound-more-harm-than-good

June 13, 2011 | Unregistered CommenterJudy

Yes, I've seen that one referred to a lot... it's from Marsden Wagner... from 1994! I think Wagner wouldn't even be referring to it anymore.

I wonder when in the Net Experience discernment kicks in.

June 13, 2011 | Registered CommenterNavelgazing Midwife

Can you point me to an article that has a summary incl more current references?

Would be greatly appreciated :)

June 13, 2011 | Unregistered Commenterliz

Keep at it! It's disheartening to me to see so much erroneous information floating around in the natural birth world. It's one reason I don't really associate myself with the movement. I advocate for VBACs and that is pretty much it, though I myself loved my hospital "natural" birth.

June 13, 2011 | Unregistered CommenterMargaret

Thank you very much for raising these issues! As a VBAC mom hoping to do a homebirth next time, I appreciate a seasoned midwife pointing out what's wrong with some of the information circulating around birthy sites. It all gets confusing.

June 13, 2011 | Unregistered CommenterRachel

I enjoy reading your blog though I rarely comment, and I am sorry to feel the need to comment at this time when I am inclined to contradict you. I can't agree with your dismissal of a summary of evidence purely on the grounds of its age; I am a (post-doc) scientist, though not a medic.
Many important studies with very good experimental results have been lost track of in scientific communities due to the digital data horizon.
If you wanted to point out studies in the text of the article that have been superceded by more recent experimentation, that would be a reason to discount what is written; but not purely on account of the age of the paper.
I would be interested to see the followup studies that have been used as grounds to overturn Beech's line of reasoning. As far as I have been able to determine from those few birth professionals I have come into contact with the routine use of ultrasound has much to do with convenience; the urgency of birth situations is assumed to outweigh any issues about consequences of the use of ultrasound. (My apologies to those birth professionals if I have misunderstood your reasoning.) This, if I have understood it correctly, is an example from what I perceive as a fault-line running across the practice of medicine and health care in the global North - the difficulty that human brains have in keeping in hand long term consequences of particular interventions - in many kinds of medicince, not just midwifery and obstetrics. I will be interested to hear further thoughts on this from you.

June 14, 2011 | Unregistered CommenterA M Yaxley

A: I really appreciate your speaking up in defense of older studies... had someone else do the same elsewhere. I totally understand what you are saying, but I *promise*, the bloggers in question (not just the one highlighted here) have NOT scanned the literature and decided that specific quoted article was the best of the best out there and therefore was THE ONE to be used in their posts. The quoted articles are the same ones churned out over and over, especially this MT one, without *any* commentary about subsequent studies or the studies quoted being the most accurate, proven over time. And I have a REAL hard time believing that ALL the studies quoted in these articles are THE best of all studies on the subject.

So, while I agree there can be older studies that can be fantastic and hold up over the decades, I am not speaking of that when I wrote this post. I'm talking about bloggers parroting without researching.

June 14, 2011 | Registered CommenterNavelgazing Midwife

I would also be interested in seeing more studies about the safety of ultrasound that are more recent; are there recent studies? Part of the problem with studying any kind of pregnancy/birth intervention is that it is nearly impossible to have a control group. So what if this group of women had no ultrasounds or less ultrasounds, but there are so many other factors that can vary (birth method, interventions in the birth process, breastfeeding, social status, etc), that how could risk even be determined?

I noticed that in Nicholas Folgensen's Grand Round on delayed cord clamping, he referred to studies that were several decades old.

June 14, 2011 | Unregistered Commentersara

I'm glad that A pointed out that distinction, especially because it might be lost among readers. Namely, in my own work, I'd rather refer to an older, well-designed study than a newer, poorly-designed one on the same (or similar) topic. This is just generally speaking, of course.

Perhaps a more accurate target would be older magazine or non-research articles (like the Midwifery Today article in question). Using *these* as sources in a blog post or elsewhere can be problematic, especially when one doesn't probe the research (if any) used to support the claims in the article.

June 14, 2011 | Unregistered CommenterKristen

Aye, the internet and instant gratification, rehashing of old information to fit the purpose of the article...I like the old adage of not believing everything I read, questioning everything, and yes - looking at the studies and doing my own literature review to make sure it's reputable, peer reviewed, current, still applies, etc etc...research is interesting, but I realize that not everybody has access to the Cochrane database or the ability to use it. Even I have issue sometimes gathering data to apply to a hypothesis or support/refute something. Then there are other factors to consider as well - being Canadian can sometimes skew the information (even though we all have babies, lol, our ways of doing things can be different in birth practice).

If people are having issue with research, I (sadly) suggest that they keep up the search and find other ways of looking at the issue. I know too many people who will stick like glue to the evidence they find on the first look. I find that in our birth community it can be a real head ache. I shouldn't drop the Wakefield study (not starting anything, I promise) but I still know of many mothers here who don't believe his study should have been refuted and refuse to look further into the issue.

June 16, 2011 | Unregistered CommenterRhonda

Barb, my last hope is to mislead anyone about birth, but it really bothers me that the average woman believes ultrasound is as safe as brushing their teeth! Can you point me in the direction of recent studies concerning ultrasound and pregnancy? Because I have had difficulty finding "new" research. The truth is though, that if a study was deemed accurate in the past, it is NO LESS accurate today. Perhaps we have learned more since, but if study upon study upon study showed a, yes, proven negative effect on unborn children, you can't seriously discount it just because it's old?! I respect your opinion, but unless you have more recent studies to back up your accusations against Midwifery Today's sources, I would ask that you refrain from attacking it. Best wishes.

Birth a Miracle Services

June 17, 2011 | Unregistered CommenterNaomi

I actually don't feel it's my responsibility to find the most recent studies out there. I believe it's the authors of the posts and articles that are given that burden. This post wasn't arguing against specific research, but speaking out against lazy journal writing and parroting the other lazy writers out there. Believe me, if I *was* countering the actual research, I would have exhausted resources to find other studies -AND MENTIONED THAT FACT- in my post. If I couldn't find *anything* (hardly realistic) that has been said or studied since, I would have mentioned that fact.

In fact, just poking around for 30 minutes yesterday, I found not only FIVE newer studies that countered the MT article, but also a site that supports YOUR viewpoint of the dangers of ultrasound... recent cited studies and all. But, *that* site hasn't even been mentioned either! That's a huge clue at the lack of legwork on writing posts about this topic.

So, no... not going to list studies. That's YOUR responsibility.

And to add a note on your comment on your blog wondering if I would even allow this comment to see the light of day, c'mon! I thought you knew me better than that, Naomi. Controversy doesn't scare me. I have no reason at all NOT to publish your thoughts. And I'm glad you feel comfortable coming and talking to me!

Onward Ho!

June 18, 2011 | Registered CommenterNavelgazing Midwife

I hope you aren't calling the original article by Midwifery Today "lazy journalling", because they are highly respectable organization. I understand your concern with people who quote from studies, simply to prove a point they want to make, but the point of making studies in the first place is so people don't have to come up with their own research to know the probable safety of a thing, correct? If we cannot trust multiple studies that show the same outcome, what is the point in the studies in the first place? It seems the readers commenting above were also confused by your attack method, not citing any research to back up your opinion that the MT article is not trustworthy. Yes, loggers need to be smart about what they write, but to say that is MY job, and yours is to complain about my methods without showing a better way is not much help to me or your readers. I hope that if a blogger earns your disregard in the future you will be a bit more sensitive than questioning their character in such an outspoken way.

June 25, 2011 | Unregistered CommenterNaomi

Oh, Naomi... really, must this continue?

Your "attack" is my "critique." I was critiquing your journalism style... or, lack thereof.

Midwifery Today is a nice magazine, but "highly respected" is in the eye of the beholder. It publishes plenty of articles that have zero science behind them, but they are definitely geared towards the natural, homebirth community, so it's a great fit.

Re: the original article, I think it was fine in it's day. It's that you were using it *as is* all these years later that became the issue.

Lastly, Naomi, if I need to show you a "better way" to research, then it's probably best if you don't write any pieces that include research until you learn how to do it. There are great sites online that can give you the guidance you're looking for.

June 25, 2011 | Registered CommenterNavelgazing Midwife

When I am looking up information on studies, I prefer for things to be recent. I just had a mother tell me she was having a homebirth based upon a study from 1976. It's baffling how women can look at an old study and claim it today.

July 8, 2011 | Unregistered CommenterBambi C

In three minutes (admittedly with access to online journal databases) I found that the World Health Organisation did a meta-analysis of studies into ultrasound safety in 2009. 41 different studies were reviewed and it was found that "Ultrasonography in pregnancy was not associated with adverse maternal or perinatal outcome, impaired physical or neurological development, increased risk for malignancy in childhood, subnormal intellectual performance or mental diseases. According to the available clinical trials, there was a weak association between exposure to ultrasonography and non-right handedness in boys (odds ratio 1.26; 95% CI, 1.03-1.54). Conclusion: According to the available evidence, exposure to diagnostic ultrasonography during pregnancy appears to be safe."

July 8, 2011 | Unregistered CommenterMJ

Thanks for the support, MJ & Bambi... and MJ... thank YOU for checking!

July 9, 2011 | Registered CommenterNavelgazing Midwife

"So, no... not going to list studies. That's YOUR responsibility."

This is a real disservice. I for one would very much like to read all the available studies, pro AND con. My wife is pregnant and this matters to me a great deal. Special thanks to MJ for the WHO quote, that is helpful. I do not have access to trade journals or the like, and THAT in itself seems inherently wrong. In fact, I would very much like any and all professional scientific studies on the matter and would pay CASH for them emailed to me as a PDF.

I really want all the pros and cons, laid out in plain English. Anybody with a true concern for human health should support this.

And I have to say that I'm totally open minded to either point of view at this point. I've read some studies, and they scared me a little, but I'm also scared that NOT getting an ultrasound has potential dangers, and I would like to hear those elucidated as well. Anybody who would like to contribute in any way is greatly appreciated, there's a lot of misinformation out there and it's hard for a regular Joe not in the medical field to wade through it all.

Thanks in advance!

July 11, 2011 | Unregistered CommenterrhY

Well, I didn't write that comment for you, Rhy... I wrote that for the other birth folks who are too lazy to look things up on their own. The blog tends to be for birthy folks, not for parents looking for research, so I'm sorry if you were feeling *I* was being the lazy one. I can certainly understand your frustration with my comment.

It isn't fair the studies are kept behind lock & key. I actually have access to studies if you find something that looks appealling that you want to read. Email me at Nave Lgaz ING mid WIF e AT gmai L dot com and I'll help where I can.

My blanket comment: The judicious use of technology is great; it's the indiscriminate use that's abhorrant. You already sound like you're on that path.

July 11, 2011 | Registered CommenterNavelgazing Midwife

Are there any potential dangers of NOT getting an ultrasound that have been proven by scientific study? And thank you very much for your well phrased response. I guess now the only question is whether an ultrasound is judicious or indiscriminate. The information I read seemed to imply that first trimester ultrasound was the most dangerous. Do you have any thoughts on that?

July 12, 2011 | Unregistered CommenterrhY

Indiscriminate use could include:

- renting a doppler and listening to the baby's heartbeat every once in awhile... often... every day... several times a day. (And I know anti-u/s women who've done this!!!)
- having an u/s at every prenatal appointment
- having u/s for non-medical reasons, including "vanity" u/s that are done in mini-malls

Discriminate use would be doing them for clinical/medical reasons:

- an early u/s for dating
- a 20-week u/s for structural visualization
- post-dates checks for amniotic fluid volume and Biophysical Profile

These are the recommendations I made to my daughter, if that helps at all.

And, of course, all of this is subjective. That's probably not the most helpful for you, though. ;)

July 12, 2011 | Registered CommenterNavelgazing Midwife

I agree that research should be recent and am glad that some attempt has been made to update the findings on Ultrasound. The reality these days is that the majority of pregnant women are routinely scanned and WANT it too! I have a deep personal misgiving about US because it does not diagnose or cure anything, only screens, and the quality and accuracy of the screening is only as good as the operator. Time and again I have had terrified women ask me whether the dilated renal pelvis which was found means their child will have kidney disease (usually not, but they spend the rest of the pregnancy worrying) or, worse, whena child is born with a condition which is incompatible with life (as happened to one of my clients a few days ago), the parents angrily demanded to know why the scan had failed to pick up the heart anomaly 3 times. I think those of us who had our babies before routine US were lucky - we didn't know what we didn't know. Finally, babies hate it...this is anecdotal (noone has bothered to study that, I'm guessing) but true. They hate the Doppler and they hate the scan too and yet they are being exposed to the discomfort of the ultrasound waves more frequently than ever before. I think we should be limiting its use, and certainly not using it to discern fetal position - I trust my hands for that!

January 31, 2012 | Unregistered Commentercomadrona

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