Technology in Childbirth. Considering the Future

Tecnology in Childbirth: Prenata technology and diagnostic one, labor technology and postnatal technology. The impact of ultrasound on the organism. How informed is our consent?

Considering the Future: A forward-looking exploration of the profound implications of pre/perinatal experiences. In this session, we will delve into the long-term impact of these experiences on individuals and society, contemplating emerging technologies (ectogenesis) and envisioning the transformative landscapes of the future.

Assessing Long-Term Impact: Assessing the enduring repercussions of pre/perinatal experiences on individuals. Exploring how these experiences shape physical and mental health, educational trajectories, and overall well-being. The ethical complexities surrounding emerging technologies such as genetic engineering, cloning, and artificial wombs, and contemplating on the implications of entering a post-homo sapiens era.

Understanding Societal Dynamics: The intricate interplay between collective prenatal experiences and societal dynamics. Investigating how these experiences influence economic structures, healthcare paradigms, and the fabric of community well-being. Reflecting on the transformative potential of nurturing supportive environments for future generations.

Embracing Perpetual Change: Embracing the immutable nature of change as an inherent facet of human existence. Recognizing its indelible impact on societal evolution and the perpetual quest for adaptation and innovation. Exploring how societies navigate emerging challenges and opportunities in the context of pre/perinatal experiences. The main aspects of the Theory of Change.

Community Implementation:

Advocating for Health-Centric Policies: Fostering awareness about the enduring significance of pre/perinatal experiences. Advocacy for policies that prioritizing holistic health and well-being, laying the groundwork for transformative societal change rooted in the principles of collective health and flourishing.

Completion of the module on prenatal sciences: As we conclude this module, let us reflect on the profound insights gained into the future implications of pre/perinatal experiences. By advocating for health-centric policies and embracing perpetual change, we can pave the way for a future where individuals and communities thrive in harmony with the evolving dynamics of our world.

Birth, Life, Death: Parallelisms

Technology in Childbirth en 1

Technology in Childbirth en 2

Η Τεχνολογία στην Γέννηση του Ανθρώπου 1

Η Τεχνολογία στην Γέννηση του Ανθρώπου 2

Diagnostic ultrasound is a sophisticated electronic technology, which utilises pulses of high‐frequency sound to produce an image. Diagnostic ultrasound examination may be employed in a variety of specific circumstances during pregnancy such as after clinical complications, or where there are concerns about fetal growth.

Favaretto, M., Rost, M. “A Picture Paints a Thousand Words”—A Systematic Review of the Ethical Issues of Prenatal Ultrasound. Bioethical Inquiry (2024). https://doi.org/10.1007/s11673-024-10360-0

Abramowicz, J S et al. “Ultraschall in der Geburtshilfe: Kann der Fötus die Ultraschallwelle hören und die Hitze spüren?” [Obstetrical ultrasound: can the fetus hear the wave and feel the heat?]. Ultraschall in der Medizin (Stuttgart, Germany : 1980) vol. 33,3 (2012): 215-7. doi:10.1055/s-0032-1312759

“Fetuses can hear ultrasound and the sound is as loud as a subway train entering a station.” This statement originates in a single report in a non-peer reviewed journal, despite its name [1], of a presentation at a scientific meeting by researchers who reported measuring the sound intensity in the uterus of pregnant women and being able to demonstrate the above. This was later published in a peer-review journal [2] probably not very widely read by clinicians or the general public. From time to time, the popular press or various pregnancy-related websites repeat the assertion or a worried pregnant patient inquires about the truthfulness of this statement. A second, oft-quoted concern is that ultrasound leads to heating of the amniotic fluid. These two assertions may be very concerning to expectant parents and merit scientific scrutiny. In this editorial, we shall examine the known facts about the physical properties of ultrasound as they relate to these two issues.

Diagnostic ultrasound employs a pulsed sound wave with positive and negative pressures and the Mayo team, quoted in the New Scientist, predicted that the pulsing would translate into a “tapping” effect [1]. According to their report, they placed a tiny hydrophone inside a woman’s uterus while she was undergoing an ultrasound examination. They stated that they picked up a hum at around the frequency of the pulsing generated when the ultrasound is switched on and off. The sound was similar to the highest notes on a piano. They also indicated that when the ultrasound probe was pointed right at the hydrophone, it registered a level of 100 decibels, as loud as a subway train coming into a station. Sound levels in decibels are defined for audible frequencies with the reference level being the threshold for hearing at a given frequency. Although the operating frequencies used in sonography are inaudible, it is possible for the pulsing rate (pulse repetition frequency, PRF) to be heard, thus falling in the audible range. A previous report had hinted at similar phenomena [3].

Ultrasound is a pressure wave with a frequency beyond (ultra) that detectable in the human auditory system. The human ear can discern sound at roughly 20 – 20 000 cycles (hertz) per second. The frequencies of diagnostic ultrasound are roughly 1 – 10 megahertz (MHz) or 1 000 000 to 10 000 000 cycles per second. It is a form of energy and, as such, may have effects in tissues it traverses. Any consequences occurring in living tissues secondary to an external influence are called biological effects or bioeffects. This term does not imply damage or harm. The two major mechanisms for bioeffects are thermal and non-thermal. Thermal effects are secondary to ultrasound energy being converted into heat in the tissue (indirect effect of ultrasound) and non-thermal effects are secondary to the alternating positive and negative pressures generated by the wave (direct effect).

The definition of moderately loud sound is 60 – 70 dB (2 × 10^–3–2 × 10^–2 Pa), defined as high urban ambient sound, normal conversation at 1 m, or living room music [4]. In comparison, quiet conversation is 40 dB, a railway diesel engine passing at 45 mph at 100 feet is 80 – 85 dB and a rock band is 110 dB [4]. There have been a few publications describing harm to fetuses exposed to elevated levels of ambient noise, particularly industrial noise [5] [6] [7], specifically in the aircraft and textile industries, but while there have been reports of impaired hearing in infants who were exposed to ultrasound in the womb, several rigorous studies have disproved that notion [8] [9] [10] [11]. Furthermore, a study of fetuses exposed in utero to vibroacoustic stimulation [12] and a recent study of fetuses exposed to noise generated during an MR exam of the pregnant women [13] showed no ill effect on the auditory system.

There have been some reports of being able to hear a “hum” during transcranial ultrasound. This may be the pulse-repetition frequency (PRF), but, if so, it would be described as a higher pitch, and probably not a “hum”. To our knowledge, this phenomenon has not been investigated. Although the report mentioned above suggested that diagnostic ultrasound is detectable at measurable levels in the uterus, there is no independently confirmed, peer-reviewed, published evidence that the fetus actually hears the PRF, responds to it or is harmed by it.

“The fetus cannot regulate its own body temperature, so amniotic fluid can reach very high temperatures over long periods” [14]. Does this statement reflect a real risk? What does it mean if this statement is scientifically true? The fear is, of course, that this will raise the temperature of the fetus. Thermally induced teratogenesis has been demonstrated in many animal studies, as well as several controlled human studies [15] [16]. A temperature increase of 1.5 °C above the normal value has been suggested as a universal threshold [17]. It is important to note that diagnostic ultrasound was not the source of the temperature elevation in any of these studies. Some believe that there are temperature thresholds for hyperthermia-induced birth defects (hence the ALARA [as low as reasonably achievable] principle), but there is some evidence that any positive temperature differential for any period of time has some effect, in other words there may be no thermal threshold for hyperthermia-induced birth defects [18]. In experimental animals the most common defects are microcephaly with associated functional and behavioral problems [17], microphthalmia and cataracts. There are reports on the effects of hyperthermia and measurements of in vivo temperature induced by pulsed ultrasound but not in humans [19] [20] [21]. Temperature increases of 1 °C are easily reached in routine scanning [22]. Elevation of up to 1.5 °C can be obtained in the first trimester and up to 4 °C in the second and third trimesters, particularly with the use of pulsed Doppler [23]. When the ultrasound wave travels through tissue, its intensity diminishes with distance (attenuation). In completely homogeneous materials, the signal amplitude is reduced only by beam divergence and absorption (conversion of sound to heat). However, biologic tissues are non-homogeneous and further weakening occurs due to scattering. The issue of temperature increase in the amniotic fluid is based on the fact that the energy of the ultrasound waves is partially converted to heat in the tissue traversed by the waves. Tissues with a high absorption coefficient (such as bone) will produce a high conversion rate while the conversion will be lower in tissues with low absorption. Fluids have very low absorption characteristics and, therefore, the risk of temperature elevation in the amniotic fluid is minimal. The only available study on the topic did not demonstrate any increase in temperature in the amniotic fluid when performing diagnostic ultrasound, both in grayscale anatomic imaging (sonography) and Doppler ultrasound [24].

Conclusion

While ultrasound is a sound wave which can produce mechanical effects and temperature elevation in tissues that it traverses, the risk to human fetuses when using diagnostic ultrasound appears to be minimal if certain rules are followed, such as performing a scan when medically indicated, and observing the ALARA principle (using the lowest output power consistent with acquiring the necessary diagnostic information and keeping the exposure time as low as possible for accurate diagnosis).

Sezin Topçu & Patrick Brown (2019) The impact of technology on pregnancy and childbirth: creating and managing obstetrical risk in different cultural and socio-economic contexts, Health, Risk & Society, 21:3-4, 89-99, DOI: 10.1080/13698575.2019.1649922The impact of technology on pregnancy and childbirth creating and managing obstetrical risk in different cultural and socio-economic contexts

Michio Kaku – The Future of Humanity_ Terraforming Mars, Interstellar Travel, Immortality, and Our Destiny Beyond Earth
Michio Kaku – The Future of Humanity_ Terraforming Mars, Interstellar Travel, Immortality, and Our Destiny Beyond-Doubleday (2018)

“To be completely free, an organism must be fully expressive and creative in the context of its immediate reality. When its expression is inhibited, suppressed, rendered secret or obstructed,then we have an ill individual”. _George Vithoulkas, the Science of Homeopathy, p.228