Monday, October 22, 2018

Planned Parenthood doesn't require sonographer certification; pregnancy centers do

Not long ago, there was a strong push by abortion rights groups to “expose” crisis pregnancy centers, or pregnancy centers that do not provide or refer for abortions, as “fake clinics.” These advocates goal was to educate women about a service NOT offered at places that offered a multitude of other services for FREE. Whatever the faults of pregnancy centers, I have never heard of a pregnancy center EVER charging a client for ANY services received no matter what choice that woman ends up making after she leaves that center. With “comprehensive” clinics that provide or refer for abortions, it is the complete opposite. Sure, many clinics have sliding scale fees, relief scholarships, or fundraisers to help defray the cost of SOME women’s abortions, but not every woman seeking abortion services receives free or reduced cost services (most don’t).

I have volunteered, or attempted to volunteer for, various pregnancy centers throughout Ohio for over five years. I have run the gamut of experiences visiting, touring, and learning about facilities offering help for women facing unplanned pregnancies. As someone who actually knows what it’s like being involved with these entities, let me educate you on what they are and what they offer.

Pregnancy centers run by private, often faith-based organizations are of two types: medical models or aid-based models. Aid models provide options counseling, basic testing (urine over the counter pregnancy testing), adoption agency referrals, government social services resource lists, and in house resources in the form of parenting classes or tangible goods needed for caring for a baby, usually up to one year in age (this is not an exhaustive list of all services offered by aid based clinics). Medical models provide many or all of the options of aid models, but also usually provide a free basic viability/dating ultrasound, free referral to an OB/GYN doctor, free consultation with a nurse, and sometimes medical model clinics offer free STD testing.

Medical model pregnancy clinics employ counselors, nurses, doctors, and sonographers to provide the medical care clients receive, free of charge. Sometimes these medical professionals are volunteering their services for free, sometimes they take a reduced rate of pay from the center, and sometimes these professionals get special training to be able to perform multiple job functions to save pregnancy centers money. Often medical model pregnancy centers will get nurses to take classes from REGISTERED DIAGNOSTIC MEDICAL SONOGRAPHERS or other credentialed medical professionals so that they can learn to perform limited OB viability/dating scans. These nurses are supervised by a person who holds a registry in ultrasound and are trained to perform limited protocol scans on pregnant women.

The important thing to know about medical model pregnancy centers is that they have medical professionals doing these services. Either a doctor, nurse with ultrasound training, or a REGISTERED DIAGNOSTIC MEDICAL SONOGRAPHER is, and should be performing all medical services.

In America, there are laws pertaining to who can practice medicine, how they are trained, how they are licensed or certified, and how they maintain that license or certification. The legitimacy of doctors and nurses is more secure and trusted because of these measures put in place to protect the public. What is less widely known is that the person doing ultrasound scans is not regulated with the same vigor. Without the extra push of legislation, there is no requirement for who provides ultrasound scans to be licensed or certified in any way.

In the United States there are two bodies that provide credentialing for people who have received specialized training in performing ultrasounds: the American Registry of Radiologic Technologists (ARRT), and the American Registry of Diagnostic Medical Sonographers (ARDMS). Before anyone can sit for the tests that each of these organizations offers, their educational background is scrutinized and confirmed. Their academic and hands on clinical hours scanning real patients under supervision are verified, and there are minimum clock hours for both requirements. Once confirmed, someone who has studied ultrasound can take an academic knowledge test and become registered.

According to the Society of Diagnostic Medical Sonographers, a professional trade organization for those in the field of sonography, there are only four states that require a sonographer to be licensed at this time; they are New Hampshire, New Mexico, North Dakota, and Oregon. What these state licensure requirements are trying to do is standardize the level of education needed to perform ultrasounds that are diagnostic. All four states accept the requirements set forth by national accrediting agencies for sonographers as an adequate minimum qualification for the state license, meaning if you are registered through ARDMS OR ARRT, then you will be able to get a state license. For all other states, this means that anyone with any training could be doing your ultrasound, with the only repercussion being retroactive lawsuits filed by patients hurt after a medical procedure.

The general public does not know about this lack of requirements for people running ultrasound machines. The people who work in radiology giving CT scans, MRI scans, doing X-rays or doing nuclear medicine studies all have to be trained, educated, and registered, just like nurses and doctors. Sonographers too must be registered to work in hospitals and outpatient clinics, and the majority of medical facilities recognize and hold professional medical support staff to this standard for the safety of all patients. The fact that there are no laws mandating this level of training isn’t much of a problem in the medical professional community, until you run in to an organization that puts profit before patients best interests and safety.

The campaign by abortions rights activists to “expose” fake clinics was amplified by many mainstream media news sources. Many of the pieces I have read covering this push to expose facilities were very clearly biased and agenda driven. As someone who sits on the fringes of the pro-life movement, I have a unique position and ability to provide commentary on some unique factors related to a clinic's legitimacy and/or bottom line. Allow me to educate you; this is a REAL job listing for a “real” clinic that provides “comprehensive” reproductive options (right-click and select "open image in new tab" to enlarge). Currently there are no laws requiring licensure of sonographers in Ohio.

Notice the first two essential duties and responsibilities listed: perform ultrasound imaging procedure of clients for the purposes of pregnancy dating, identification of the presence or absence of cardiac activity, and fetal number. The ability to recognize when findings require evaluation by an APN or a physician. Since in this entire application there is no explicit requirement that the person doing this job be registered through the ARDMS or ARRT, there are several concerns about these job requirements. Unless you are trained in anatomy and physiology, ultrasound, and the unique conditions that can sometimes occur surrounding pregnancy, how can you properly date a pregnancy? Anyone can place measurement calipers on to a fetal pole to estimate how far along the pregnancy is, but can they do that accurately? It can sometimes be hard to do. Bowel gas can make the ultrasound image less clear. If a woman is very overweight, the ultrasound beam cannot penetrate the tissue very well to see in to the uterus, and that can make the image unclear. Knowing ways to work around these limitations is WHY having standards of training is so important. Also there is a condition called heterotopic pregnancy that can happen. It is rare, but again without training, you wouldn’t know to look for this condition. In a heterotopic pregnancy, there is a fetus in the uterus and a fetus in an ectopic location (somewhere outside of the uterus, like on an ovary). Unless you are trained, you might not know where to look to visualize the ovary, or you might THINK you visualized an ovary, but in actuality did not. So how would you know to look for this condition or notify the nurse or physician about a suspected ectopic if you’ve not been trained? And just because a nurse or doctor comes in to look at the screen doesn’t mean they’ve been trained to interpret ultrasound scans unless they have received additional training for interpreting those images. Usually a radiologist specializes in reading all types of medical imaging studies and knows the subtle things to look for that can indicate a more serious problem. The room for error in not using a registered sonographer is much greater, and you’ll notice in this entire job listing that there is no requirement to be registered to work at this abortion facility.

Pregnancy centers use trained nurses or sonographers when doing limited OB scans. The goal of pregnancy centers is to support women and help them feel like they can keep their pregnancies. Pregnancy centers get no money for any decision a woman makes. Planned Parenthood uses anyone with a Bachelors degree in the medical field or a minimum of 4 years of related work experience will be considered in lieu of degree. The goal of Planned Parenthood is to support women and help them feel like they don’t need to keep their pregnancies. Planned Parenthood get money from women who decide to get abortions.

When you look at the two clinics objectively, it is clear that one of them is motivated by profit and when given the choice will choose the less credentialed person in favor of making more profit. Of course, the registered sonographer will want more money, the process of school and getting registered is not cheap. If there’s no law saying you need to be registered, then they won’t explicitly ask for the highest level of training, and this put patients at risk. Registered sonographers have a minimum of training and are tested to know about the intricacies of doing ultrasound. Anyone else scanning you as a patient is a risk, but how would you know to ask?

[Today's guest post by Sarah Anne is part of our paid blogging program.]

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