There is no harm in being protective of your unborn child. There is no harm in speaking up for yourself when you have strong feelings about any subject. For heaven sakes we are in a healing profession- we should take care of one another too. We should make a pact- all MiM and MiM followers to steadfastly protect and promote the (physical and mental) well being of our gravid counterparts.
There is potential harm in overstating the risk of x-ray in pregnancy. At least from my perspective. Sorry for additional post Fizzy, I have too much to say for comment section. I really think you are on to something here, and I appreciate this discussion.
First to get this out of the way, there is a major difference between therapeutic (or diagnostic) radiation exposure vs. occupational radiation exposure. All physicians would consider using x-rays to examine or treat a pregnant woman. As long as the benefit outweighs the risk. Do you need dental xrays while pregnant- probably not. You have a serious condition during pregnancy, attempts will be made to use alternative imaging or minimize fetal exposure. The risk to the fetus is based on amount of exposure (may vary based on type of exam) and week of pregnancy. It would be a mistake to x-ray a pregnant woman without considering the fetus (therefore the questions and signs in radiology). Just because there are signs and attempts made to avoid exposure in no way means that it is absolutely contraindicated.
Here as Mothers in Medicine we are discussing occupational exposure. A classic intersection of personal responsibility and professional obligation with undercurrents of gender discrimination. We would all take a bullet (literally) for our children, our own safety/sanity is only a secondary concern. What are we willing to expose our children to- now that is a hot topic.
Fifty percent of Internal Medicine residents are women, yet only 14% of all cardiology fellows and a mere 7% of practicing cardiologists are women. We may be few, but as women in cardiology we are a serious bunch- and are concerned about why more women do not consider careers in cardiology. It is likely women are deciding not to pursue cardiology early- as med students or interns. Concern over lifestyle and radiation exposure during mothering years is likely a key issue.
Tackling the subject head on, two important papers are published in cardiology journals. The first published in JACC in 1998 (http://www.ncbi.nlm.nih.gov/pubmed/9525565) is a consensus statement for radiation safety in the cath lab. This year another consensus statement (http://www.ncbi.nlm.nih.gov/pubmed/21061249 ) was published by a group of women interventional cardiologists (now these are women who I seriously admire). I recommend that you read both if this issue affects you directly.
Here are important points I would like to make:
1. Fizzy's initial post upset me a great deal, it felt like a personal attack (unreasonable I know). I think this points to how intimate and heart wrenching pregnancy related issues can be.
2. Fundamental radiation science: exposure is proportional to energy emitted, inverse to distance from source, and subtracted by protective equipment. When pregnant I wore two layers of lead (my usual apron) in my first trimester then special pregnancy apron (even though it weighed 12 lbs-or maybe a TON) the rest of the time. I never let the fellows control the fluoro pedal and when able always took an extra step away from the camera. On occasion I took it as an excuse to stay far far away from the table, on a stool in the corner where I could rest my feet too, a bonus.
3. When I was a fellow one of my female attendings was pregnant. It really helped me to see her in this role. She gave me the best advice. Meet with the University Radiation Officer- this really helped to balance my fears with what is known about the risk.
4. The female fellows in my current program are not allowed to work in the cath lab during pregnancy. This takes the decision making away from them. I am not 100% behind this, only because it is really hard for them to find coverage for maternity leave already.
5. X ray is not the only source of radiation exposure. I learned from the Radiation Officer that my greatest risk would be during my nuclear cardiology rotation. Patients dosed with isotope emit radiation, and despite high standards areas of radiation can be present in the department. Always wear your badge when reading nucs, do not leave your lunch in the reading room and for heaven sakes do not do injections for stress tests or PETs.
6. The total amount of radiation allowed in pregnancy is 0.5 mSv per month and 5 mSv for entire pregnancy. This is 10% of the amount of radiation defined as negligible by ACOG guidelines (Obstet Gynecol 2004;104:647–651 ). Studies from diagnostic radiology in pregnancy show exposure below 50 mSv is not associated with fetal loss or anomaly. Other population studies suggest that exposure to 100% of the allowed radiation during pregnancy will increase the risk of having a child with congenital anomaly from 4.0% to 4.01%. The chance your child will develop cancer will increase from 0.07% to 0.11%.
7. It is difficult for me to compartmentalize my role as mother and cardiologist. It all runs together in an overwhelming way. Eight weeks pregnant, while taking progesterone for a fetus at risk I was inches away from the camera while doing CPR on a woman while my partner inserted a temporary pacemaker. I had lead on, but had not yet declared my pregnancy and did not yet have a fetal badge. That woman celebrated Mother's Day with her children last weekend. During my 2nd trimester I was exposed to acute viral myocarditis, amazingly 3 times where two of the three patients were killed. Suspected viruses can cause fetal hydrops. The surviving patient was a miracle and my ability to cure him was instrumental. My team knew I had ID consultation and special tests by Employee Health. They did not know I took a "time out" in the call room where I sobbed uncontrollably for 20 minutes.
I carried two pregnancies and worked in the cath lab both times. I checked my fetal badge religiously every month. Under my lead, over 18 months of pregnancy my fetal badge (s) summed total radiation exposure of <0.01 mSv, below the measurable limit, ZERO.
It is probable that women avoid their true calling into cardiology due to concern over the occupational hazard. It is possible those who do pursue cardiology still face additional obstacles based on current maternity policies (I think this is true of most of medicine). My experiences thus far have been challenging, and I hope we can make things better for the next generation.
Okay so you may now jump in to discuss. So let me have it, I imagine being crucified and accused of child endangerment. For the sake of full disclosure in addition to exposing both of my boys to radiation I also ate lunch meat, non-pasteurized cheese and even drank a glass of wine (or two) during my 3rd trimester. And if anyone corrects my writing/ grammar I will kick your ass.