A Square Peg in a Round Hole

Square Peg Round Holeby Tammy Stearns, MS, RDMS, RVT, RT(R), FSDMS, LAS
Heartbeat International, Ultrasound Consultant

Pregnancy Help Medical Clinics (PHMCs) fulfill a very unique role. A role that meets the women that we serve on the front lines of chaos in the very throes of crisis. By the uniqueness of the role and the components needed to fulfill it, oftentimes it seems as if our medical side is a square peg trying to be fit in a round hole.

It doesn’t always seem like a fit.

We seem to either embrace a side that is considered too liberal or we find ourselves trying to fulfill our roles with at least one, if not two hands, tied behind our backs. This can leave us not fulfilling the part God has given us to play to the best of the abilities He has given us. Perhaps, instead of trying to fit into this world, we might embrace His equipping.

The key purpose of performing Limited Diagnostic Obstetrical Ultrasounds in PHMC is to introduce mom to her baby for the very first time. This is such a privilege, an honor. During this limited scan, we can also provide her with some vital information to help her make the critical decision she is trying to make. We can provide the approximate age of the baby, verify a beating heart, and the location of the pregnancy. A limited scan is not designed to take the place of a higher level medical ultrasound performed in hospitals, but rather a bridge to her obstetrician.

A hospital setting provides full and complete scans. And this is not an entertainment facility. PHMCs are rather a place that offers hope, encouragement, and options.

Medical clinics and hospitals, depending on where they are located, may be regulated by state and/or insurance regulations. Most of these are directly tied to reimbursement ensuring that the person performing the scan is qualified by the qualifications defined by the governing body. Even the federal laws that have been pursued to regulate ultrasound have been tied to reimbursement. Our services are free and are outside of these requirements.

Currently, some ultrasounds are performed in medical clinics and hospitals by sonographers that have cross-trained over into other areas of sonography. Some have sought additional credentials, some have not. The requirement depends on the standards set by the organization. All medical facilities have varying degrees of requirements for their personnel that perform exams. These requirements are thorough and medically complete, providing diagnostic information. Interesting to note, even the states that require licensure of sonography require that the sonographer be credentialed in sonography but do not require that the sonographer be credentialed in the area of sonography in which they are currently scanning. The requirement is the sonographer must hold one sonography credential.

Therefore, a sonographer credentialed in vascular technology can be licensed in sonography and can scan obstetrical exams. Some hospitals and clinics also permit sonographers who have completed their training, be it on the job, from a nonaccredited program or an accredited program, to scan within their facilities. Again, the requirements are completely dependent on the facility and the Medical Director.

While there is the thought of standards of care, one must look to the peer comparison of the standard being sought. PHMCs are a unique entity. PHMCs are quite different and distinct from hospitals and medical clinics that provide thorough and complete exams for diagnostic purposes as part of the patient care plan. Within these settings, there is a much different standard of care.

Who is qualified to perform ultrasounds within a Pregnancy Help Clinic is decided by each specific Medical Director.

Heartbeat International supports the idea that those who perform ultrasounds must be qualified to perform the unique exams that are offered in PHMCs. Compliance of qualifications may be demonstrated by being credentialed in sonography by one of the nationally recognized credentialing organizations of sonography to include, but not limited to, ARDMS, ARRT or CCI, demonstrates clinic competence specific to the exam and, perhaps most important of all, the LOVE Approach method of scanning. Licensed nurses and other medical professionals may also meet the qualifications by completing recommendations specific to their profession. (AWHONN has set a national recommendation for registered nurses to perform limited ultrasounds.)

The obstacles and spiritual warfare can be fierce for those imaging on the front lines of the prolife movement. Let us not unnecessarily limit ourselves where there currently is favor concerning the legal requirements defining who may perform ultrasounds by seeking to hold the Centers at higher standards than hospitals and medical clinics. Let us remember that God equips Who He calls. Always.