Soli Deo Gloria MFM, LLC Doppler Statement
The Practice of Medicine and Medical Indications for Doppler Ultrasound
Pregnancy Help Medical Clinics have expressed a great deal of interest in providing Doppler ultrasound to their abortion-minded and abortion-vulnerable patients. In addition to seeing the powerful image of her unborn baby, via the sonogram, an abortion-minded patient will also be able to hear the baby's heartbeat when Doppler is utilized. This service is very appealing because, as various clinics report, many abortion-minded patients are empowered to choose life after hearing the fetal heart tones of their unborn offspring. Thus, it is seems logical that Pregnancy Help Medical Clinics should be encouraged to use the Doppler alongside ultrasound in order to maximize the life-affirming impact of medical services. However, Soli Deo Gloria MFM, LLC believes that the use of the Doppler for the sole purpose of enabling a woman to hear her baby's heartbeat is not justified by a medical indicator and should not be undertaken in the normal clinic setting where a limited ultrasound is provided.
The use of the Doppler is indicated when there is justifiable medical concern over the condition of the baby's heart. Doppler sonography is used to evaluate most of the major fetal circulatory systems including the umbilical artery, the umbilical vein, the aorta, the heart and the middle cerebral artery. Its purpose, or medical indication, is to answer concerns about potential heart defects in the unborn baby. To take the necessary measurements Doppler is not utilized until the 2nd or 3rd trimester of pregnancy. This is when the baby's heart is sufficiently mature to enable the proper medical information to be derived.
The medical indicator for the limited ultrasound exam performed in Pregnancy Help Medical Clinics is to render a diagnosis of the condition of the pregnancy, i.e. the existence of a viable intrauterine pregnancy and fetal cardiac activity. The medical reason for the limited ultrasound is not to diagnose the health or physical condition of the baby. Because of this, the use of the Doppler in this context is not medically appropriate.
Doppler Ultrasound and the Alara Principle
Ultrasound utilizes high frequency sound waves that, through modern technology, provide sonographic imaging when exposed to the baby in utero. In its over thirty years of clinical use no harmful effects have been identified on children who were exposed to the level of sound wave energy from an ultrasound exam. However, the use of obstetrical ultrasound is guided by the ALARA principle — As Low As Reasonably Achievable. ALARA defines the standard of practice in the medical community in regards to the amount of exposure to sound wave energy that an unborn baby receives through an ultrasound exam.
ALARA is a principle of prudent scanning. It is true that there are no studies that indicate harm to the mother or baby from exposure to ultrasound energy. However, "it seems reasonable to assume that there is some risk (however small) in the use of diagnostic ultrasound because ultrasound is a form of energy and has at least the potential to produce a biological effect that could constitute risk. Even if this risk is so minimal that it is difficult to identify, prudent practice dictates that routine measures be implemented to minimize the risk while obtaining the necessary information to achieve the diagnostic benefit. This is the ALARA principle." Diagnostic Ultrasound: Principles and Instruments, Sixth Edition, Kremkau, pg. 335, (2002)
Because of ALARA, Soli Deo Gloria MFM, LLC recommends that ultrasound Doppler not be utilized in the context of limited obstetrical ultrasound. Ultrasound Doppler exposes the baby in utero to a higher level of energy than the exposure a normal ultrasound exam provides. Such a practice, unless medically indicated, violates ALARA since the result sought, i.e. a diagnosis of a viable intrauterine pregnancy, can be achieved with a lower energy exposure through the ultrasound scan. The medical purpose for Doppler is to obtain measurements regarding the heart condition and heart blood flow of the baby. This goes beyond the purpose and medical indication for the limited ultrasound exam, which is to confirm the presence of a viable intrauterine pregnancy. Thus, the use of the Doppler is not normally medically indicated in the context of limited ultrasound scanning.
Doppler seeks to obtain information about the condition of the baby's heart and utilizes increased levels of energy from the normal amount utilized in a limited ultrasound exam. Hence, Doppler exposes the baby's heart to increased levels of energy. In order to justify this under the ALARA principle there must be a medical indicator to perform the Doppler examination. If there is not then ALARA and the standard of practice of medicine is violated.
It is essential that Pregnancy Help Medical Clinics (PHMCs) operate under the highest standards of excellence and conform all their medical practices to the standard of care utilized in the medical community. The credibility of PHMCs will be determined by how they are perceived in the medical community at large. If PHMCs detour from standard medical practices regarding the use of ultrasound and Doppler the old charges of being "bogus clinics" will undoubtedly be raised by those who oppose the work of PHMCs. Such charges can only be refuted if PHMCs are operating in conformity to the recognized standards of medical care in the medical profession. The use of Doppler is attractive in that it provides powerful incentives to women considering abortion to choose life. However, in the setting of a PHMC where limited ultrasound is utilized to diagnose the existence of an intrauterine pregnancy and fetal cardiac activity Doppler is not a proper medical service to provide.
In light of this, is it proper to prolong an ultrasound scan to allow other parties such as boyfriends, parents, etc. to view the fetus via the sonogram screen? In doing so the baby is exposed to additional sound wave energy that may be unnecessary since the data has already been obtained to render a proper diagnosis of pregnancy. Does such a practice violate ALARA in the same manner as use of the Doppler without a medical indication? If so, should it be discouraged under the ALARA principle?
For the legal reasons set forth herein Soli Deo Gloria MFM, LLC believes that the practice of allowing family members and boyfriends to observe an ultrasound image after the initial exam is completed, does not violate ALARA. Such a practice is based upon sound medical judgment and medical indications. This opinion is based upon the direct language of the Supreme Court in Roe v. Wade and its companion decision Doe v. Bolton.
The holding in these decisions opened the door for abortion on demand through all nine months of a mother's pregnancy. This is because in Roe the high court held that abortion could not be prohibited even in the third trimester of pregnancy if a mother's "health" is jeopardized by her not being able to obtain an abortion.
In Doe the Court defined the term "health" in the abortion context. It stated:
"The medical judgment (i.e. health of the mother) may be exercised in the light of all factors — physical, emotional, psychological, familial, and the woman's age — relevant to the well being of the patient. All these factors may relate to health." Doe v. Bolton, 410 U.S. 179, at pg. 192 (1973)
In other words, the Supreme Court in these cases stated that "familial" or family related factors are to be included in a medical determination of whether the "health" of the mother justifies an abortion. It clearly follows that allowing family members such as parents, siblings and boyfriends to view the sonogram image of the baby would therefore be medically indicated and justified since such "familial" factors are relevant to the mother's "health" and play a role in her decision to undergo an abortion. Thus, additional exposure to the baby to ultrasound energy in this manner is medically indicated and does not violate ALARA.
The proper use of limited obstetrical ultrasound in the pregnancy help medical clinic setting cannot be compromised. Soli Deo Gloria MFM, LLC strongly believes that adherence to medical standards, such as ALARA, is required to enable pregnancy help medical centers to avoid legal pitfalls and operate professionally, providing the best medical information to empower a woman to make an informed choice regarding her pregnancy.
