THE ROLE OF THE NURSE IN THE
PREGNANCY HELP MEDICAL CLINIC:
by Thomas A. Glessner, J.D.
Because the use of ultrasound amounts to the practice of medicine, NIFLA strongly recommends that pregnancy help centers not attempt to use ultrasound unless they are operating as a licensed medical clinic under the laws of their states.
The powerful impact of an ultrasound examination upon a woman contemplating an abortion cannot be overstated. An article in the New England Journal of Medicine, February 17, 1983, describes the influence of such an examination:
One of us pointed to the small, visibly moving fetal form on the screen and asked, "How do you feel about seeing what is inside you?" She answered crisply, "It certainly makes you think twice about abortion!" When asked to say more, she told of the surprise she felt on viewing the fetal form, especially on seeing it move. "I feel that it is human. It belongs to me. I couldn't have an abortion now." The mother was asked about her experience with ultrasound. She said, "It really made a difference to see that it was alive." Asked about her position on the moral choice she had to make, she said, "I am going all the way with the baby. I believe it is human."
Because of the powerful impact the ultrasound images have upon a woman's choice, many pregnancy help centers are now seriously looking into providing ultrasound examinations to their abortion-minded clients. The National Institute of Family and Life Advocates (NIFLA) strongly promotes this trend among pregnancy help centers. However, a center must undertake certain organizational changes before it can properly and legally provide this service to its clients.
The Medical Clinic Model
In 1994, the Food and Drug Administration (FDA) undertook efforts to halt an emergence of businesses which were using ultrasound equipment to produce prenatal keepsake videotapes for the parents of unborn children. The FDA confiscated ultrasound equipment from several businesses which had been set up to undertake ultrasound examinations without the guidance, supervision, and direction of a medical doctor. In doing so, the FDA stated: "Persons who promote, sell, or lease ultrasound equipment for making keepsake fetal videos should know that we view this as an unapproved use of a medical device and that we are prepared to take regulatory action against those who engage in such misuse of medical equipment." In support of the FDA's actions, the American Institute of Ultrasound in Medicine (AIUM) stated: "While ultrasonic fetal scanning is generally deemed to be safe, we feel strongly that its use is only indicated for a prescribed medical purpose. The use of ultrasound for producing videos for entertainment purposes simply cannot be justified."
It should be noted that the FDA's actions were not against pregnancy help centers. However, the language used by the FDA in taking these steps strongly emphasizes that ultrasound should be used only under the supervision and direction of a licensed physician. Indeed, AIUM states in its publications regarding the use of ultrasound: "Ultrasound studies shall be supervised, and interpretations must be rendered by a physician with training and experience in the specific area of ultrasonography. Findings must be recorded, and results communicated in a timely fashion to the physician responsible for care. Although a sonographer may play a critical role in extracting the information essential to deriving a diagnosis, the rendering of a final diagnosis of ultrasound studies represents the practice of medicine, and, therefore, is the responsibility of the supervising physician."
Because the use of ultrasound amounts to the practice of medicine, NIFLA strongly recommends that a pregnancy help center not attempt to use ultrasound unless it is operating as a licensed medical clinic under the laws of its state. NIFLA has produced a manual (The Pregnancy Help Medical Clinic) which can guide your center from the beginning to the end of the process of converting operations into this medical model.
Who Should Perform the Ultrasound Examination? The Role of the Nurse
Once your center has made the conversion to the medical clinic model and can provide ultrasound services, you will need to recruit trained personnel to provide the examinations. For some pregnancy help medical clinics, the recruitment of properly trained ultrasound personnel can be difficult.
Physicians who are properly trained in the use of ultrasound may provide such exams. In addition, a sonographer who is a Registered Diagnostic Medical Sonographer (RDMS) or is in the process of registry certification may also provide ultrasound exams. However, since the sonographer is not a physician, all findings made are subject to and the responsibility of the supervising physician, i.e., the medical director of the clinic. The major problems centers have in recruiting such personnel are the small number of sonographers and physicians willing to volunteer and the limited amount of time they can give.
While the availability of qualified sonographers and physicians is limited, centers have reported substantial success finding properly trained nurses to provide such services. Gynecologic infertility nurses may be trained to provide limited ultrasound examinations to clients at your clinic.
The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) has provided guidelines for limited ultrasound examinations by obstetric and gynecologic nurses. A "limited ultrasound examination" is one in which an exam is given to provide specific limited information regarding the pregnancy. It is not undertaken to provide a complete diagnostic examination of the unborn child. Rather, it is provided to give limited information regarding the pregnancy so that the client will be given adequate information to make a well-informed decision. For the abortion-minded client, such an examination can be undertaken to provide information to confirm the existence of a viable pregnancy and the existence of a fetal heartbeat.
Under the AWHONN guidelines, nurses can be trained and certified in the performance of limited ultrasound examinations. One component of this training consists of 12 hours of instruction specific to the use of ultrasound examinations in obstetric settings. Such instruction should be followed by sufficient supervised clinical hands-on training to obtain competency. The length and amount of hands-on training may vary with the individual nurse and the practice setting. However, the opportunity for continued clinical supervision in the nurse's practice setting must be provided by appropriately qualified supervisors.
Nurses' Institute in Limited Obstetrical Ultrasound
NIFLA is very pleased to be providing training for nurses based upon the AWHONN guidelines. Since 1998, NIFLA has sponsored its Nurses' Institute in Limited Obstetrical Ultrasound, which provides three intensive days of training. Participants spend the last day of the institute scanning women in various stages of pregnancy. The course has been held at the headquarters of Shimadzu Medical Systems in Torrance, California, and has been approved by the State of California for 20.5 continuing education units for nurses. Most states will honor these credits under their continuing education guidelines.
In order to ensure close personal instruction, the course is limited to twenty enrollees at a time. For more information regarding upcoming dates for the course, please contact the NIFLA office at (540) 785-9853.
Thomas Glessner is the President of the National Institute of Family and Life Advocates. For details, contact NIFLA, P. O. Box 42060, Fredericksburg, VA 22404, phone: (540) 372-3930.