Reasons to get 18 week US

[mizznicole]

I'm thinking of scrapping the 18 wk US simply because it costs $250 and I don't care about gender.

Can you give me some reasons why I would really need it? I'm VBAC w/ midwife.

[MaerynPearl]

well my midwife requires it... but I am doing a homebirth Im not sure it would be required if I were in hospital.

We want to make sure there are no obvious issues that need to be addressed as of the birth that would risk me out of a homebirth (serious heart problems or spina bifida for example, neither of which I have any family history of but they can also just randomly show up in a healthy pregnancy so we want to rule it out) to make sure all organs are developed as they should and functioning as they should... and to completely rule out placenta previa (if its nowhere near the cervix we wont bother checking again. if it is, we will probably check again later on to confirm that it has moved up.)

[MacKinnon]

We are not finding out sex but we did the 20 week to rule out an potential issues that might want us to have a hospital birth. Of course, not everything can/will be caught, but since we are planning to birth out of the hospital, I feel better having that reassurance that things look good! I also had partial placenta previa with DS, that did resolve itself by 32 weeks, but I wanted that reassurance as well!

[lunarlady]

I had my 20 week u/s not because I wanted to check for gender, but just to be sure there are no serious developmental abnormalities, like heart defects or spinia bifidia, that would lead me to birth at the hospital in the area with a NICU rather than the homebirth I had planned, or the transfer to the nearest hospital (no NICU) that would likely occur if I had issues during my homebirth. I also have a family history of twins and triplets, so I like to rule that out for sure, and I find comfort in knowing where the placenta is sitting. That being said, I think if you are planning a hospital birth already, at a facility with a NICU, then you most likely could skip the u/s and be fine no matter what happens.

[prone_to_wander]

I skipped the 12 week ultrasound but I did go to my 20 week. My friend who was an OB/GYN suggested that the 20 week ultrasound was the one to go to as it can pick up the most abnormalities.

[AustinMom]

We are an HBAC too, and just got our second trimester u/s. We did to make sure the palcenta was not previa (which is slightly more common after a previous CS) and to rule out anything that would make it too risky to HB, like heart defects, etc, or other things that I would more so want a medical team, NICU, etc there.

A U/S is good at identifying these abnormalities if it is done by the correct person. OBs tend to not find as much as often compared to sonographers, or perinatal specialists, so we went through one of them.

Our MW said if it was her, she wouldn't get one, but if it set my mind at peace to go for it. We paid just a copay for the visit, but if it was more than that (which we thought at one point) we wouldn't have done it.

Most things can be found out (as long as your CP is trained and skilled) by fundal height, fetal heart tones, and other stuff.

And no major organization (ACOG, NIH, WHO, etc) all say that u/s should not be done routinely, and only when medically indicated, like bleeding, funny heart tones, funny measurements, history of defects, etc.

[klocke]

Well I found out at my 20 week u/s that baby #4 was really babies #4 & #5. So that changed my birth plan completely since my midwife is not personally comfortable with breech deliveries I had to find a new provider. Also we found out that both babies have excessive amounts of fluid, something that we have had to monitor a little more than you usually would during pregnancy. An I agree that there are a lot of physical or developmental problems that can be discovered at a 20 week u/s that could drastically impact where you birth.


And I wasn't measuring ahead at all at 20 weeks and midwife never heard a second heart beat so a total surprise.

[katelove]

We chose to have the 18-20 week USS as we live in a regional area with a NICU but no neonatal surgery capacity. We wanted to know if there was anything that would require urgent surgery as we would have chosen to birth in a city with surgical facilities in that case.

Before deciding to have it I did the research on the things which can be picked up and the rates at which they're detected. For us, the stats were good enough to make it worthwhile.

We also found out the sex but that was just a bonus and not the reason for having the scan

[HeatherB]

We don't find out gender, but we do the mid-term u/s for many of the reasons stated above. I also have a minor spina bifida (occulta), which doesn't cause me any major problems but might mean my children are at higher risk.

My MW doesn't recommend u/s before 18 weeks, but doesn't discourage it after that point in the family desires it. We have a tradition of getting a video of the u/s and, of course, pictures, which I think help everyone bond.

And, of course, if there were major issues we'd want to know ahead of time, either to be able to address them in utero (if applicable) or prepare to handle them at the time of birth. Honestly, there would not be many things that would make me change my PLACE of birth, but there are a few.

[mizznicole]

Yes, the question I still have is what the birth center does if the baby has serious complications after birth. We're close to hospitals so I'm not that worried about a transfer.

[CorasMama]

Originally Posted by mizznicole

Yes, the question I still have is what the birth center does if the baby has serious complications after birth. We're close to hospitals so I'm not that worried about a transfer.

there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.

[Autumn Breeze]

[karen1968]

Originally Posted by klocke

And I wasn't measuring ahead at all at 20 weeks and midwife never heard a second heart beat so a total surprise.

I'm a surprise twin. Of course, this was 40+ years ago and way before routine u/s - they didn't find out until I was born!

Originally Posted by CorasMama

there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.

I know a lot of people think of the 18/20 week scan as "the gender scan", but it's really "the anatomy scan". We are planning one to rule out placenta previa or any fetal conditions that would warrant a hospital birth. I have never had a section, but IIRC, placenta accreta is a potential problem with post-surgical pregnancies and something you might want to rule out.

FWIW, I'm pretty sure my CPMs can attend a homebirth for twins, Downs, cleft pallette, and a few other conditions, so there are very few and rare things that would cause us to transfer.

That said, it's still a very personal decision. If you are comfortable with skipping it, then you should. For me personally, the peace of mind is worth $250.

[birthangeldoula]

I would get one to rule out heart defects and other abnormalities. We were stunned when we found out with our first child that he had a life-threatening heart defect. Especially when there was no sort of family history and anything to indicate that we would be at risk for that.

[CherryBomb]

Like someone mentioned, fetal abnormalities aren't always as simple as transferring to the hospital. There are some that rule out vaginal birth, for instance, or would require immediate attention that would not be possible if you had to transfer. Also, as a vbac mom myself, I like to know for sure nothing wonky is going on with my placenta.

Finding out the sex is just a nice bonus

[mizznicole]

Originally Posted by CorasMama

there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.

Then I'm surprised that it isn't a requirement to have one at the birth center. Seems like it would place a huge liability on them. What conditions, for example, would warrant hospital birth?

I'm paying for the whole birth out of pocket, which is why limiting costs within reason is a huge factor for me. Thanks for the replies so far.

[HeatherB]

The things I think of are ones where organs are developing outside of the body cavity. That would almost certainly rule out a vaginal birth and would require prompt attention.

I have heard wonderful stories of babies with heart issues who were likely *saved* by being in the calm, responsive environment at home, so heart issues are not my worry. But any major, serious, crazy defect is one to think about.

[CorasMama]

Originally Posted by mizznicole

Then I'm surprised that it isn't a requirement to have one at the birth center. Seems like it would place a huge liability on them. What conditions, for example, would warrant hospital birth?

there are quite a number of said conditions. For only one example, see my signature. A vaginal birth could seriously decrease her chances of making it. There are other conditions for which a vaginal birth would stress the baby too much. While that might be caught by intermittent monitoring at a birth center, and you could initiate a transfer, what if you labor really really fast (like I do), and also a planned c-section is much, much easier to do and recover from than an unplanned one. There are also heart conditions that really do require immediate (not 5 minutes away, but immediate) help, the kind a birth center can't give.

Also, being five minutes from a hospital isn't the same thing as being five minutes from realizing the baby needs assistance to the baby getting assistance.

One more thing. There is a HUGE benefit to being prepared for health issues in your baby. There are many conditions that pre-planning is extraordinarily helpful. We already know, as much as we can, what to prepare our family for. We have been able to warn DH's employer, prepare and pack for a c-section recovery and NICU stay, meet with surgeons (including the man who pioneered the procedure that took the survival rate for giant omphaloceles from 50% to 90%), make informed decisions about where and to whom to go for care, make arrangements for care for my older daughter, get some counseling, speak to other parents with Giant O babies, know what kinds of baby gear we will and won't need, prepare for c-section and recovery, and that's just all I can list off the top of my head. Yes, I'm spending this pregnancy worrying, but that's better than having to process this all totally fresh while dealing with a medically fragile baby, or worse, not having prepared, and not having a good outcome. And if she didn't have any problems, there would be the relief of knowing fairly confidently that we were, in all likelihood, going to have a normal, natural, great birth at the birth center.

I'm all about having a natural pregnancy and birth. Really, I am. But since we have available the ability to minimize the risks of any kind of birth, natural or otherwise, it isn't unwise to avail ourselves of non-invasive stuff like ultrasounds. And if you choose not to, and that's your choice, you just can't say, well, I'm trusting (birth/pregnancy/my body) so everything will be fine. If you feel comfortable with risk, then take the risk. It isn't that big a risk, statistically. But what you can't do is say that because it's a small statistical risk, it'll still be fine if you come out on the other side of the statistics. If you want to take the risk, just own that.

[kavamamakava]

Originally Posted by mizznicole

I'm thinking of scrapping the 18 wk US simply because it costs $250 and I don't care about gender.

Can you give me some reasons why I would really need it? I'm VBAC w/ midwife.

I know you're asking for reasons you might NEED it, but I think it's more of a question of whether you WANT it. I think you could ask your midwife about some of the scenarios in this thread and how she would respond to them and if there is some other way of detecting them without an U/S. An U/S is just a tool that can be used or not. I only had one with my 1st at 30 weeks and he was all squished in there and I could hardly see him and definitely didn't get to see if he was a boy or girl. Ha! So i didn't make the effort to have one with the next two although I did make an appointment for a Biophysical Profile because I was 42 weeks. I was set on missing that appointment and had her the night before.

[Sagesgirl]

It's not something you have to have. Yes there are some conditions that would make birthing in a hospital the better choice and others that would rule out a VBAC, but in all honesty those are quite rare. I only had the anatomy scan with my first child, not the second or third, and I do not plan it with this child either.

My first two daughters were footling breeches, and while some folks will birth them vaginally, there was no way I was letting the people at the Navy hospital where I birthed them experiment on me. Having an ultrasound that showed my first daughter to be breech (she was, at the time, transverse) didn't prevent me from undergoing an unsuccessful induction--even though I dutifully reported to everybody that the baby was breech, no one believed me. Likewise, not having an ultrasound with my second daughter didn't impact the birth at all, because that time they did believe that she was breech presentation. Same story with my third daughter, my VBA2C baby. No ultrasound, baby head down (which is obvious, frankly--you can tell whether it's a head or a foot down there), everything came out fine.

For a healthy woman and a heretofore healthy pregnancy, the chances of some giant problem that would prevent your planned birth and shoot you into ZOMG SURGI-BIRTH territory are pretty darned slim.

(On a side note, having been on this site nearly nine years, I don't think I will ever adjust to ultrasounds going from "have them only if you absolutely have to, as their safety isn't adequately proven" to "have 'em as often as you can, because something might be horribly wrong!")