Talk to me about not having an U/S - Page 3

[majazama]

Here is something I found from this Article..

http://mothering.com/weighing-risks-...out-ultrasound

Location of the placenta. ...... 19 out of 20 women who have placenta previa detected on RPU will be needlessly worried, as the placenta will effectively move upwards as the pregnancy progresses.12 Furthermore, detection of placenta previa by RPU has not been found to be safer than detection in labor.13......................................

Reasons for Concern
Ultrasound waves are known to affect living tissues in at least two ways. First, the sonar beam heats the highlighted area by about 1°C (2°F). This is presumed to be insignificant, based on whole-body heating in pregnancy, which seems to be safe up to 2.5°C (5°F).21 The second effect is cavitation, where the small pockets of gas that exist within mammalian tissue vibrate and then collapse. In this situation "...temperatures of many thousands of degrees Celsius in the gas create a wide range of chemical products, some of which are potentially toxic."22 The significance of cavitation in human tissue is unknown.

A number of studies have suggested that these effects are of real concern in living tissues. The first study indicating problems analyzed cells grown in the lab. Cell abnormalities caused by exposure to ultrasound were seen to persist for several generations.23 Another study showed that, in newborn rats (who are at a similar stage of brain development as humans at four to five months in utero), ultrasound can damage the myelin that covers nerves,24 indicating that the nervous system may be particularly susceptible to damage from this technology.

[majazama]

Originally Posted by Cheryl33

I have more articles- I apologize if any of these have been posted.

http://mothering.com/weighing-risks-...out-ultrasound

http://www.midwiferytoday.com/articl...oundwagner.asp

http://www.aims.org.uk/Journal/Vol11No4/ultra2.htm

http://www.midwiferytoday.com/articles/ultrasound.asp

I just wanted to say thanks for all these great links!! Everyone should read this before having an ultrasound!

[emnic77]

Originally Posted by Amatullah0

heres a thought, if you only want a u/s to make sure everything is a go for home - i.e. no previa, no life threatening birth defects, then why not get the "20 wk u/s" later, like at 30 or 35 weeks? doesnt that make more sense if previa is a concern? then you dont get worried about something that will probably resolve on its own, no?

I agree with this, a previa at 20 weeks still has plenty of time to move. It would make more sense, if this were a big concern, to have an u/s closer to term.

[MyFillingQuiver]

As someone who came from the mainstream mindset that medicalized pregnancy is a safe pregnancy, I've had my share of u/s. My first 4 children had SEVERAL u/s for various reasons. I never questioned, never researched-nothing. How sad. My last pregnancy I was with an OB and had one early for "dating" and to rule out e/p (I've had tubal surgery), and then the usual 20 week u/s. I can't tell you how refreshing it was to have transferred at 28 weeks to an OB who never once suggested any u/s. I was a VBA2C and I brought up the whole u/s the scar issue, and he said it was pointless. It was so amazing to just let the second half of pg go the way it was going to go...and that wasn't even an u/s free pg!

This time I'm having a homebirth with a midwife, and I had an ultra quick mobile cart type u/s at 7 weeks to ensure it wasn't ectopic. I don't think I'll even bother with that in any future pregnancies. Since I won't do methotrexate, it makes more sense if I experience and e/p to wait for symptoms and be treated then. Anyway, in the absence of a presenting medical issue, I'll have no more. I'm amazed at how much MORE confident I feel WITHOUT planning or already having several u/s than I ever did WITH one!

I don't want to know sex, size, position, nothing outside of palpation and fetoscope. I want my body to do what it will do without undue tests or worry. As a PP said, "What will be will be". Exactly.

[Sijae]

I never had any ultrasounds (or the use of a doppler) during any of my three pregnancies and births.

[erin_brycesmom]

Having an ultrasound at 20 weeks or even later, say after 30 weeks, does NOT insure that life threatening issues such as heart defects or spina bifida will be detected. I know that for a fact and know of a homebirther that had multiple late ultrasounds and none of those issus were detected at any of those ultrasounds. Also keep in mind that ultrasounds can sometimes pick up on issues that aren't really there that may cause undue stress. It's something that women have to decide for themselves but it's not as simple as saying I'll get an ultrasound to check for those things. I'm not aware of any research that shows any increased benefit of having a single ultrasound for homebirths or any evidence that shows increased risk of not having a single ultrasound for homebirths.

[emnic77]

Originally Posted by erin_brycesmom

Having an ultrasound at 20 weeks or even later, say after 30 weeks, does NOT insure that life threatening issues such as heart defects or spina bifida will be detected. I know that for a fact and know of a homebirther that had multiple late ultrasounds and none of those issus were detected at any of those ultrasounds. Also keep in mind that ultrasounds can sometimes pick up on issues that aren't really there that may cause undue stress. It's something that women have to decide for themselves but it's not as simple as saying I'll get an ultrasound to check for those things. I'm not aware of any research that shows any increased benefit of having a single ultrasound for homebirths or any evidence that shows increased risk of not having a single ultrasound for homebirths.

This 100% explains my reasons for not getting any this pregnancy. For my first, with an OB, I had an early (6 week) dating u/s and then one at 41 weeks because I was overdue and needed an NST/BPP to avoid induction. A 20 week anatomy scan was never even brought up.

With DS I had an early dating one, one at 16 weeks for reasons I'm not sure of, because we had to go back at 20 weeks because 16 was too early for them to check any anatomy stuff.

I hear of moms all the time being stressed out and anxious because the tech measured the nose bone off by 1 mm or something...I just see absolutely no reason to worry like that, when as you said, there is no research that shows better outcomes with scans. They are not fool proof, they can and do miss things.

Plus, for each one I had that was later dates, both my kids would put their hands up near their ears and faces and try to "hide" from the u/s...same with the doppler, my midwife used a doppler three times total this pregnancy (she used the fetoscope last time) and each time she put the doppler on me, the baby would wake up and flail around. That kind of icks me out (and dh, who is a scientist who deals with these things on a regular basis).

[Ceinwen]

I do.

My first I chose not to have any testing or early ultrasounds, and our babe ended up having anencephaly. This was devastating to my ex and I.

Ended up having an induction at 22 weeks, as I chose not to carry to term. Also, I would want to know about any heart defects, neural tube defects, possibilities of Downs, etc.

To prepare, mentally, emotionally, financially and otherwise.

[honeybee]

I have never had a routine u/s, even with my first hospital birth.

[BucketsOfMoonbeams]

We had the standard anatomy scan at 24 weeks with our first baby (it was the only u/s I had). It completely missed her large ventricular septal defect (hole in the heart). It was so bad it required surgical repair when she was 5 months old. I was told after she was born that regular U/S doesn't pick up these kinds of defects- just so people who think a clear u/s means the baby is fine knows.

This time we're having a level II u/s, which does pick them up. I need it for peace of mind, but it will still be the only one.

[NuzzleNudge]

This is really an older post but I wanted to bring it up again...

 How many of you who never got Early or ANY ultrasounds KNEW how far along you were either from charting, Ovulation, What Ever...?

 Cuz I have no clue really how far along I am. I could be anywhere from 9 to 13 weeks!

 "Due anytime in July" is rather vague!

Also, i have yet to read some of the articles mentioned, I'm headed there next...but what about detecting Spina Bifida and other Neural Tube Defects, and Heart Defects, Bowel Defects, any and other anatomy defects?

I REALLY DO NOT want to find out the gender. And I am pretty good at navigating what i See on scans, so I don't want to accidently find out. Both My kids tried to hide from the scans, and I can tell they didn't like them. Basically, I want reasurrance that it's okay to not get one....But the anatomy things scare me, especially if there is something we can do to help immediately to save the baby. And seeing as how I could be 9 to 13 weeks...That is somewhat obscure dating in case i 'go early or late'.

ADVICE

[alegna]

I knew my dates.  I don't fully chart, but I know when I ovulate so I knew when I conceived within a couple of days.

The research does not show any improvement in outcomes with u/s vs. not having any.

-Angela

Originally Posted by NuzzleNudge 

This is really an older post but I wanted to bring it up again...

 How many of you who never got Early or ANY ultrasounds KNEW how far along you were either from charting, Ovulation, What Ever...?

 Cuz I have no clue really how far along I am. I could be anywhere from 9 to 13 weeks!

 "Due anytime in July" is rather vague!

Also, i have yet to read some of the articles mentioned, I'm headed there next...but what about detecting Spina Bifida and other Neural Tube Defects, and Heart Defects, Bowel Defects, any and other anatomy defects?

I REALLY DO NOT want to find out the gender. And I am pretty good at navigating what i See on scans, so I don't want to accidently find out. Both My kids tried to hide from the scans, and I can tell they didn't like them. Basically, I want reasurrance that it's okay to not get one....But the anatomy things scare me, especially if there is something we can do to help immediately to save the baby. And seeing as how I could be 9 to 13 weeks...That is somewhat obscure dating in case i 'go early or late'.

ADVICE

[Amatullah0]

Shoot! I just wrote a huge post. now its gone. 

summary was, going late isn't a bad thing unless baby is not well(i.e. movement stops, or possibly, if you have uncontrolled GD)

going early in your case could be anywhere from before early june to mid july. If it were me(and based on my current lack of periods, it just might be, if I can ever get pregnant) I would research what pre-term labor is like, does it feel any different than full term labor? Are there any other ways to check for preterm labor? Although not very reliable, measuring the fundus might be one of them. 

[jenninjapan]

I live in Japan and thought I would give a different idea of u/s use in pregnancy.....

Here a woman is expected to have an ultrasound between 8-11weeks (a transvag) to determine due date.  For the first and second trimesters you are expected to have an ultrasound (4D optional for an extra 10 dollars!)  every four weeks and then in the beginning of your third tri, one every two weeks and in the last weeks of your pregnancy (34 to 35 and up) a scan EVERY week. 

For my first pregnancy I didnt know any better and followed their regimen.  It did nothing but cause anxiety and what I feel was  at that point in my pregnancy an unnecessary c-section.  (breech at 38weeks).  I had different dr.s (I was seeing two OBs in conjunction with my midwife - standard practice) and spent one looooong scan at 36 weeks having her mumble to herself about heart issues and abnormalities (heart is TOTALLY fine) and then justify the c-section to me with cord position (ie your baby will never turn; the cord is wrapped around him). 

This pg I am trying to do as much as I can on my own.  I think I will get a scan at 20 weeks just to stay within the system in case I decide to go to a hospital later on, but I will determine the length of the scan.  I am anxious just thinking about it though......If I had a care provider that didnt insist and fight me on scans, I would refuse them.

[sarahkristy]

I guess I'm the odd one out. I had an early U/S before I told anyone about my pregnancy just to make sure that things looked good and baby's heart was beating, etc. That could be avoided I'm sure if I had just waited until 12 weeks or longer to be able to detect the heartbeat over a doppler.

As for the 20 week ultrasound, I wanted to be sure the placenta wasn't too low as well as make sure other things were developing well. My DS had a kidney issue that we would never have detected without the 20 week ultrasound in my first pregnancy- so not related to birth but because of that, I felt it was important.

Planning my first homebirth has enough unknowns of its own and I felt reassured by the U/S and haven't seen enough evidence to convince me that I should avoid them altogether. I know that I would have worried unneccesarily about a problem appearing at birth that we could have anticipated beforehand.

Maybe irrational thinking, but I chose to opt-in for the 20 week.

[Pirogi]

NuzzleNudge - I always knew when I conceived, so I declined early transvaginal ultrasound for that reason.  I also declined the 20-week scan for various reasons ... I didn't want to know the gender, the chance of ultrasound catching a defect that we could do something about at the time of birth vs the chance of an ultrasound false alarm, ultrasound never tested for safety or efficacy, the wide range of power that different machines have, the lack of training/certification for ultrasound techs, and on and on.  As far as dating, your midwife should be able to estimate based on your fundal heights and when she can hear baby's heartbeat with a fetoscope, etc, over the course of your pregnancy.  Dating by ultrasound becomes increasingly inaccurate as the pregnancy progresses.

jenninjapan - (Not at all to make you feel bad, but just for the sake of others who may read this thread:) WHOA!  That is waaay overuse of ultrasound in pregnancy.  And that statement IS supported by a randomized controlled trial.  Marsden Wagner (neonatologist/perinatal epidemiologist/former WHO maternal and child health director) wrote about this in his book Pursuing the Birth Machine, reproduced in part here:

http://findamidwifetoday.com/articles/ultrasoundwagner.asp?q=msph

 From 2,834 pregnant women, 1,415 received ultrasound imaging at 18, 24, 28, 34 and 38 weeks gestation (intensive group) while the other 1,419 received single ultrasound imaging at 18 weeks (regular group). The only difference between the two groups was significantly higher (one-third more) intrauterine growth retardation in the intensive group. This important and serious finding prompted the authors to state: "It would seem prudent to limit ultrasound examinations of the fetus to those cases in which the information is likely to be of clinical importance."

And that was from only five ultrasounds vs one ultrasound, instead of ... what, 10-15 ultrasounds??  Eeeek.  If you need any ammo for refusing that many ultrasounds, check out the references on that article, and use the RCT.

[Marissamom]

my midwife is able to order ultrasounds, but asked us if we wanted one. I chose to have the 20 week, mostly because I wasn't taking a pre-natal so I wanted to make sure that the spinal cord was enclosed, as well as check for any other development problems (I know it can't check everything, but it does catch some things so I feel safer having a homebirth having had one). If there had been anything that looked like it would need attention shortly after birth, I would be going to the hospital with a NICU. I had a 20 week with DD who was a hospital birth too, because I was planing on having her at a hospital without a full NICU, but the hospital with a NICU was only 5 min farther from my house

[MegBoz]

Originally Posted by NuzzleNudge 

Cuz I have no clue really how far along I am. I could be anywhere from 9 to 13 weeks!

I would think knowing how far you are is pretty important. Now, measuring fundal height could give you an idea, but that doesn't apply until about 20W anyway- and then if you're measuring short, how would you know you're measuring short?! So I would think it would make it harder to diagnose something like IUGR.

Plus, if you don't have a good idea, then how can you make other decisions?? For example, it's not safe to HB a premie (less than 37W gestation) Also, prematurity is a secondary risk factor for GBS, so if I knew I was GBS+ AND had a premie, I'd get IV antibiotics (whereas I wouldn't with only one risk factor - a + swab), and the risk of still birth does go up after 42W so you might want to at least consider NST & AFI if you reach that point (if not consider induction.)

Soooo, yeah, I'd want to know my baby's gestational age for a host of other reasons.

As for the 20W anatomy scan, maybe I'm misunderstanding, but it seems many here have been saying, "US can't catch everything, maybe not even the majority, so it's not worth having." That makes zero sense to me. Just because they may catch only ~60% of things like heart defects, isn't a reason not to do it. That is still a lot of defects that would not have been caught otherwise. Just because not all are caught doesn't seem to me to mean the US is utterly worthless. Not that I have problem with people who opt not to get them, but I don't see the logic in, "They don't catch everything, so don't even bother." Reminds me of that phrase - what is it? - 'throwing out the baby with the bathwater'

Of course, if they don't improve outcomes in low-risk pregnancy, that's a huge reason not to bother. BUT - if that's an American stat, remember that about 91% of American births are in hospitals anyway! I would think it might be slightly worthwhile to TRY to detect some sort of anomaly that would require hospital care so you could reconsider an HB choice.

I'm not sure how high the rate of false positives are, but in case of suspected problems, I'd certainly get at least one 2nd opinion anyway before I'd make any major decisions anyway.

I personally had both the 1st trimester screening (blood test & US at 12W) & 20W scan. Incidentally, "skill level of technician" isn't an issue because the images are analyzed by OBs - NOT technicians, and the OBs tell the technicians if the images they've obtained are adequate or not.

I'm fairly certain my HB MW, a CPM, has no problem with her clients forgoing all US, but she WAS interested in the results when I had my 20W. She remembered the date I had it scheduled and when I emailed her the day after about it, she replied, "Oh, I knew you had that & was going to see how it went." Clearly she didn't think it was worthless.

I don't consider it some sort of "all clear" but I viewed risk as very low & I saw value in the potential benefit. And, OK, I confess, I really wanted to know gender! ;)

[Pirogi]

Originally Posted by MegBoz 

Originally Posted by NuzzleNudge 

Cuz I have no clue really how far along I am. I could be anywhere from 9 to 13 weeks!

I would think knowing how far you are is pretty important. Now, measuring fundal height could give you an idea, but that doesn't apply until about 20W anyway- and then if you're measuring short, how would you know you're measuring short?! So I would think it would make it harder to diagnose something like IUGR.

Plus, if you don't have a good idea, then how can you make other decisions?? For example, it's not safe to HB a premie (less than 37W gestation) Also, prematurity is a secondary risk factor for GBS, so if I knew I was GBS+ AND had a premie, I'd get IV antibiotics (whereas I wouldn't with only one risk factor - a + swab), and the risk of still birth does go up after 42W so you might want to at least consider NST & AFI if you reach that point (if not consider induction.)

Soooo, yeah, I'd want to know my baby's gestational age for a host of other reasons.

As for the 20W anatomy scan, maybe I'm misunderstanding, but it seems many here have been saying, "US can't catch everything, maybe not even the majority, so it's not worth having." That makes zero sense to me. Just because they may catch only ~60% of things like heart defects, isn't a reason not to do it. That is still a lot of defects that would not have been caught otherwise. Just because not all are caught doesn't seem to me to mean the US is utterly worthless. Not that I have problem with people who opt not to get them, but I don't see the logic in, "They don't catch everything, so don't even bother." Reminds me of that phrase - what is it? - 'throwing out the baby with the bathwater'

Of course, if they don't improve outcomes in low-risk pregnancy, that's a huge reason not to bother. BUT - if that's an American stat, remember that about 91% of American births are in hospitals anyway! I would think it might be slightly worthwhile to TRY to detect some sort of anomaly that would require hospital care so you could reconsider an HB choice.

I'm not sure how high the rate of false positives are, but in case of suspected problems, I'd certainly get at least one 2nd opinion anyway before I'd make any major decisions anyway.

I personally had both the 1st trimester screening (blood test & US at 12W) & 20W scan. Incidentally, "skill level of technician" isn't an issue because the images are analyzed by OBs - NOT technicians, and the OBs tell the technicians if the images they've obtained are adequate or not.

I'm fairly certain my HB MW, a CPM, has no problem with her clients forgoing all US, but she WAS interested in the results when I had my 20W. She remembered the date I had it scheduled and when I emailed her the day after about it, she replied, "Oh, I knew you had that & was going to see how it went." Clearly she didn't think it was worthless.

I don't consider it some sort of "all clear" but I viewed risk as very low & I saw value in the potential benefit. And, OK, I confess, I really wanted to know gender! ;)

I respect your opinions.  Just wanted to comment on this, since (I think) I was the only one who commented on the training/certification of ultrasound techs.  My concern isn't that they won't capture a valid image or that they will misinterpret something in the scan.  My concern is from a safety standpoint and the fact that ultrasound machines can vary (greatly! - 5000x) in intensity, and there is no "driver's license" for ultrasound operators.  From the link I posted above,

The safety issue is made more complicated by the problem of exposure conditions. Clearly, any bio-effects that might occur as a result of ultrasound would depend on the dose of ultrasound received by the fetus or woman. But there are no national or international standards for the output characteristics of ultrasound equipment. The result is the shocking situation described in a commentary in the British Journal of Obstetrics and Gynaecology, in which ultrasound machines in use on pregnant women range in output power from extremely high to extremely low, all with equal effect.

If the machines aren't regulated, and the techs aren't regulated, that raises red flags for me, personally, in exposing my fetus to ultrasound energy.
 

[Sijae]

I'm going to disagree and say I really don't think it's all that important to know a specific due date. In fact, it would probably relieve stress to just let it go and not worry so much about it.