Talk to me about not having an U/S

[laughymama]

I'm having my first homebirth sometime near the end of August.

I've found a fantastic CPM and I just really adore her. She does not do U/S and in my state there are no regulations requiring me to have one so this is entirely up to me.

If we do decided to get an U/S done it will only be to find out the gender. We don't feel it's necessary to have any of the scans done so long as this pregnancy is healthy. I am fairly healthy, no medical issues and my first pregnancy was a normal one.

Is this out of the ordinary to not have an U/S done? Have any of you just not had it done with your pregnancies?

Sorry for my ignorance. My state just recently legalized homebirth midwives in 2008 and this entire experience is pretty new to my friends and family. I don't really have anyone else to ask.

[Nicole730]

Hi!

I haven't had my first homebirth yet, but I decided against an U/S because I would only be doing it to find out the sex, and that just seemed silly to me. Had my midwife ever suggested one for a medical reason, then I would have had one. Sometimes I think, ugh - if I only knew if this baby was a girl I could start shopping But mostly I am okay with my decision.

I think you just have to decide that if there was something "wrong" would you want to know? Or would you rather just find out at birth? For me, the stress of knowing something was wrong (or at least the U/S people thought there was a problem) would have more of negative effect on my baby than not knowing. For other people, constantly wondering is the stressful part.

Good luck in your decision!

[bclare]

I chose not to even though my CNM's can opt for one. I think they can cause a lot of worry when something looks suspicious and often nothing is wrong. I feel very connect to baby on the inside-- and once yours starts romping around in there you will have all of the connection you need. As for the shopping-- it is probably the smartest choice I could make-- no one is buying me blue things with footballs or things with pink lace. In fact, I have so many hand me down clothes from friends I feel like I can get by with those for 6 months and when baby comes have fun shopping for gender specific clothes at that time with my MIL.

It's a very individual choice, but I love knowing baby without knowing gender. Our nursery is reds and yellows and weavings and cloths from around the world. One note-- if you won't put a girl in ble clothes you better find out!

[erin_brycesmom]

Both ACOG and AUIM advise that ultrasounds should only be performed when there is a medical indication and that ultrasounds for low risk women do not improve outcomes. Given that even the relevant medical establishments do not recommend any ultrasounds for low risk women (including the standard 20 week diagnostic) in the absence of a medical indication, I feel confident not having any. That said, I always have one because I want to know the sex of the baby but I can do that with just a quick peek between the legs at a non-medical U/S center. Actually, since I have Tricare I technically am not allowed to have any ultrasounds even the standard 20 week one since their policy follows ACOG's guidelines. So even if I went with an OB, I would not be covered for any ultrasounds at all with my insurance.

[alegna]

Two homebirthed babies and no u/s for either.

-Angela

[autumnday]

I did not have U/S (or really any other 'routine testing') done for either of my pregnancies. They can cause a lot of undue concern for all babies develop on their own, and any anomaly, that quite likely will straighten itself out before the birth anyway, can risk you out of homebirth. If you feel that the only reason you would do it is to find out the gender and you're not dying to know that anyway, then it may not need to be done.

Here is a link to an article by Dr. Sarah Buckley about the use of ultrasounds in prenatal care if you are interested in views that support not having ultrasounds unless medically necessary.

[laughingfox]

Congrats!

Apparently, it is rather out of the ordinary to not have routine u/s. It really seems to confuse some people. You can tell the same person 25 times that you're not having ultrasounds, but they will still ask "when's the next ultrasound? do you know the gender yet?" every single time you see them.

I'm guessing you're seeing a CPM who can't order ultrasounds? I am doing the same.

I did get an early u/s to determine due dates since I had just gotten off BC and hadn't had a regular cycle yet. I had that done at a Pregnancy Resource Center, which didn't require orders or referrals.

One of the PP's mentioned going to a non-medical u/s center for a gender check, but around here they won't see you unless you've already had a diagnostic ultrasound from an OB, so you may want to look into their policies in advance if that's included in your plans.

[Amatullah0]

Ok, I have a question...

my last pregnancy was ob - transfer to hospital CNM at 33 wks - birth in hospital with CNM, and i had all the typical OB tests(didn't know i could/should refuse them, but now i DO know better, etc...)

next preg, i'm planning a UC, but was planning to see my old CNM at least for the 20 wk US, because, in my mind, it's extremely dangerous to NOT get a US.

on stating that, i am thinking about what "all the reasons" for this might be, and...

i think my only reasoning for the US is to see where the placenta is.

oh, and, aren't there certain conditions that the baby may have(the the US will catch) that mean he will need immediate medical attention once he is born to save his life?

I don't like to know the gender until birth, and I will not abort, so, are those two aforementioned reasons really reasons at all, or is there something i'm not aware of?

i'm still learning, i'm not being snarky

[autumnday]

You are definitely asking the right questions, Amatullah0, and I think you have answered your own question! If you don't want to know the gender and know you wouldn't abort given any unusual findings, then there is no strong reason to have a scan. I encourage you to look at Dr. Sarah Buckley's article as well. If, however, it would be more unrestful for you to not have a scan to see if everything is alright, then you should consider it to alleviate those fears, but do keep in mind the realities and limitations of scanning technology and know it may lead to inconclusive results causing more concern.

Here are a couple of excerpts from it (RPU=routine prenatal ultrasound):

Regarding detection of conditions regarding immediate medical detection:

"And while many women are reassured by a normal scan, RPU actually detects only between 17 and 85 percent of the 1 in 50 babies that have major abnormalities at birth.11 12 A recent study from Brisbane showed that ultrasound at a major women’s hospital missed around 40 percent of abnormalities, with most of these being difficult or impossible to detect.13 Major causes of intellectual disability such as cerebral palsy and Down’s syndrome are unlikely to be picked up on a routine scan, as are heart and kidney abnormalities."

Further into the article, her comments regarding scanning for placement of placenta:

"As well as estimating the EDD and checking for major abnormalities, RPU can also identify a low-lying placenta (placenta praevia), and detect the presence of more than one baby at an early stage of pregnancy. However, 19 out of 20 women who have placenta praevia detected on an early scan will be needlessly worried: the placenta will effectively move up, and not cause problems at the birth. Furthermore detection of placenta praevia by RPU has not been found to be safer than detection in labour.15 No improvement in outcome has been shown for multiple pregnancies either; the vast majority of these will be detected before labour, even without RPU."

[jeminijad]

I have concerns about skipping the scan, as well.

They are largely illogical, because my primary fear is velamentous cord insertion, leading to it tearing off during labor & experiencing a stillbirth.
I have read that this is about 1% of singleton pregnancies, so it isn't a common problem, but I think about it.

[broodymama]

I didn't have an ultrasound with DD2, and was planning on not having one this pregnancy either. After 2 appointments of consistently not being able to find the baby's heartbeat and hearing strong placenta noises very low, my MW asked that I consider having one to make sure that my placenta was clear of the cervix. This was the first time in 3 pregnancies that she has suggested having one, so I agreed.

I had one at the local Naval Hospital (DH is military) and verified my placenta is clear of the cervix. They don't normally check the cord insertion on the placenta end, only on the baby. I asked the tech to check it since I had a velamentous cord insertion with DD2 (discovered after birth, didn't cause any problems) and it is fine too.

[Peace+Hope]

i third reading the sarah buckley article! love that article.

so far, what i read in that piece, and talking to my midwives, every concern i have and asked, would i need a U/S to see X, they have been able to say, not really because Y.

for instance, if there is previa, as my cervix begins to dilate, i will have bleeding and we'll transfer to the hospital. if the baby is an undetected breech, they will be comfortable delivering at home anyway.

it is true that there are some abnormalities that would require immediate medical attention in a newborn. however, as some PPs have noted (and the article covers), they can easily go undetected by U/S. and given how rare they are to begin with, my husband and i feel confident that we can responsibly make the decision not to let those rare instances guide our prenatal and birth plans.

[Belle]

We opted not to do the u/s for the same reasons you mentioned. If our midwives had found any indication for one we would have gotten one, but just to check the gender we didn't feel a need.

My parents seemed to think we had got one and were just keeping the gender to ourselves. They didn't understand why someone would decline an ultrasound when one was available. Even stranger that my mother didn't have an ultrasound when she was pregnant with me in 1976 or with my brother in 1981.

My MIL understood. She had asked her OB about an u/s when she was pregnant with my dh and his twin in 1975. He told her they only used u/s on high-risk pregnancies. (refreshing that her twin pregnancy was not consider high-risk)

For the record, my midwives (CPMs) could have refered me to a naturopath's office who had an u/s machine. We passed.

[Nicole730]

Originally Posted by Amatullah0

Ok, I have a question...

i think my only reasoning for the US is to see where the placenta is.

I'm also seeing a Dr. a few times and she wanted to do an U/S for this reason. But when I still declined, she said that if I had any bleeding in the 3rd trimester, that could be an indication that the placenta was too low. I asked my midwife about it and she said if I did have 3rd trimester bleeding she would recommend a u/s to check the placenta. So, it appears that if the placenta was too low, you would see bleeding.

[MittensKittens]

Originally Posted by Nicole730

I'm also seeing a Dr. a few times and she wanted to do an U/S for this reason. But when I still declined, she said that if I had any bleeding in the 3rd trimester, that could be an indication that the placenta was too low. I asked my midwife about it and she said if I did have 3rd trimester bleeding she would recommend a u/s to check the placenta. So, it appears that if the placenta was too low, you would see bleeding.

Interesting. I have previously had ultrasounds to find out the location of the placenta as well, that is, to rule out previa.

Does anyone know if it is possible to have placenta previa WITHOUT any bleeding before the onset of labor? Or any other symptoms? I don't want US for any other reason than the placenta location, so I'd like to hear more about it.

[laughymama]

Originally Posted by MittensKittens

Interesting. I have previously had ultrasounds to find out the location of the placenta as well, that is, to rule out previa.

Does anyone know if it is possible to have placenta previa WITHOUT any bleeding before the onset of labor? Or any other symptoms? I don't want US for any other reason than the placenta location, so I'd like to hear more about it.

This is another concern that popped into my head late last night. Does anyone know if there are there other ways for my midwife to estimate the location of the placenta? I'll for sure ask her at our next appointment in a couple of weeks but I'm just eager for information.

[birdword]

We opted out of any ultrasounds including the doppler. I just decided that I'm healthy and trust my intuition that I would have a feeling (or the midwife would notice) if anything was abnormal. All went well, though I wouldn't have resisted one if my midwife had been concerned about anything. Side note: Could be totally unrelated but the technician who tested my dd's hearing said it was the best she'd ever seen. Probably coincidental, but made me wonder nonetheless.

[Bmorefarmgirl]

last time i was at the mw's office, she was listening for the baby's heartbeat with the doppler and said, "that's placenta" and then kept moving with the doppler thing. i did not ask her about it, but apparently she could tell where it was.

also, i would guess, even if there was no bleeding in the third trimester, as you dilated, someone would notice that it was not a bag of waters at your cervix but a placenta and would transfer you to the hospital. even if you declined all vaginal exams, i would think at some point someone would notice that something was wrong, whether by fetal heart tones or lack of progress or at some point, bleeding during labor?

[jeminijad]

Originally Posted by Bmorefarmgirl

also, i would guess, even if there was no bleeding in the third trimester, as you dilated, someone would notice that it was not a bag of waters at your cervix but a placenta and would transfer you to the hospital. even if you declined all vaginal exams, i would think at some point someone would notice that something was wrong, whether by fetal heart tones or lack of progress or at some point, bleeding during labor?

I think a placenta previa would show itself as soon as dilation started, in a lot of bleeding as blood vessels shear away from the cervix. Maybe a pro can correct me if I'm wrong, but you aren't likely to have a good outcome.

[sattygirl99]

I think you can tell rough placental placement from the doppler... I owned a doppler with DD (rented with DS) and I could tell the differences between maternal, fetal and placental sounds.

IIRC, low lying placenta isn't all that common. The 20 wk ultrasound is grossly inaccurate for placenta issues because in 90% of cases, the placenta moves in plenty of time. My placenta with DS was low lying and moved 10 weeks later. It caused a lot of worry and concern for nothing.

We weren't going to have any ultrasounds but I ended up with 1 out of concerns (my own) of an ectopic. I'm not planning any more.