To ultrasound or not - I've changed my mind.

[othersomethings]

I've been pretty anti-ultrasound since day one, when I first found out I was pregnant with DD.

The research is so sketchy, we just don't know the long term effect, better play it safe than sorry, etc. etc. etc.

Recently however, I've had to rethink my position. Especially in light of being pregnant again.

Basically, I found out that 1 in 100 children is born with a congenital heart defect. When I found out this statistic, I thought about it...I actually know at least 3 children born with it, 2 who needed surgery within days of birth in order to survive. One is my cousin's little two week old son, who is right now recovering beautifully from his first surgery.

I had no idea before my cousin's baby entered my circle of consciousness. The only reason the heart defect was discovered was because at 11 weeks, she started bleeding from a hemorrhage. They were sure she was miscarrying and went to the ER, where an ultrasound confirmed baby was fine. But the u/s tech said he saw something weird and referred them to a specialist, who diagnosed the exact kind of heart defect and what needed to happen for little Joshua to stay healthy and live after birth.

If it had been me? I don't know that I would have gone to the ER if I'd started bleeding. I probably would have waited it out at home, and as time proved the baby was still growing, I would have ignored the bleeding problem. I also wouldn't have gotten an ultrasound at the normal 20 wk mark, since I wouldn't want to find out the gender, and didn't want to expose my baby to unwanted possibly harmful U/S waves.

And I would have given birth with my midwife, at her birth center, and several days later...if it had been my baby...it would have died.

Thinking through those scenarios has REALLY made me rethink.

I'm 9 weeks now. I'm still not cool with ultrasounds, but knowing that it's not a rare condition...it's so common that I know 3 children in my immediate circle of family and friends age 2 and under who have survived it (that's more children than I know with forms of autism!!!!) that the odds are THAT high....

I think I will be getting the 20 wk ultrasound.

If I had been in my cousins shoes, I would never have lived with myself knowing I could have prevented it if I hadn't been so hard headed in what I thought was right for my baby. I still believe I as the mother know best. But my picture of "best" is definitely changing.

If you want to read more, Signs of CHD this blog post helped me think through the statistics.

And if want to see my adorable first cousin (once removed), check out his mommy's blog Real Life Of A Redhead

Thanks for listening mamas!

[AshleytheIslander]

For this reason I would definitely get the 20 week scan. But the, I don't believe that ultrasounds are bad anyway.

[kaPOW!]

interesting. thanks for posting.

[sarahkristin]

I think that getting an anatomy scan (that's the ultrasound that checks all the organs to make sure they are developing properly) is a great idea. One ultrasound that will last a total of 5 or 10 minutes can ease your mind. I got just one ultrasound when I was pregnant with dd, I loved having a picture of her! It gave me a lot of peace of mind that she was developing properly. Also, if you decide to get the ultrasound, you don't have to find out the sex if you don't want to. just make sure you tell the tech or they will spill the beans

[kalamos23]

My sister was born with a CHD, Tetralogy of Fallot, 26 years ago. My mom did have an u/s with her and she had surgery and is totally fine now. Because of this, I will never turn down the anatomy ultrasound.

[IdentityCrisisMama]

I remember reading that postnatal outcomes for infants are not better with the use of routine ultrasounds. I did a lot of reading on this subject when I was pregnant but don't remember everything I read. There are some great studies about it. From what I remember it seemed like maybe the benefit for some may have been balanced by a negative impact on others (pre-term delivery and other results of routine ultrasound).

[sarahkristin]

Routine ultrasounds, meaning multiple ultrasounds? Did you read any studies that talked about moms that just got one ultrasound? I'm only planning on getting one, but if there is negative evidence on it, I will definitely reconsider.

[othersomethings]

I've read that information about outcomes regarding Electronic Fetal Monitoring during labor and birth, but I've never read that in relation to ultrasounds.

If you can find those statistics, i'd be interested in reading them. In light of the scenarios I've outlined above, 1 ultrasound scan during the pregnancy would in fact have a dramatic effect on the health outcome of the baby post-delivery. In many cases CHD babies must be treated within days of birth or they will not live, and the outward signs that could be diagnosed AFTER birth without electronics (echos, cardiograms, etc, all just as risky IMO to expose a newborn to as an unborn) are extremely unreliable.

[IdentityCrisisMama]

There was a big thread/debate on it in my last DDC (August 2010) I think. I'll see if I can find the link. From what I remember it was def. about ultrasound during pregnancy. I'll see what I can find. If I don't get around to it, I posted on the thread back in Feb or March.

From what I remember on that thread, there were also a lot of mothers who had experiences in which they felt ultrasound had saved lives.

I'll see what I can dig up...

[IdentityCrisisMama]

Here's the thread I was talking about. It has a few links to studies.

http://www.mothering.com/discussions...043&highlight=

[ILoveMyBabyBird]

i had 3 with ds which honestly the 1st and last we're definitely unnecessary, this time around i am sticking with 1 required that's it. Of course this time around i will have to pay oop unless it is medically necessary so that does factor in, last time i was on medicaid, and i didn't know any better. I will definitely be staying away from the 3-d ones, those i have no clue about...

[othersomethings]

The NEJM article is the only research I was familiar with. I based my anti-u/s stance largely on that evidence, and still today consider u/s a technology to be used with great care.

Here is why I have re-evaluated.

1. Articles like this one indicate that incidents of congenital heart defects are rising. The reports in earlier decades were 4 or 5 per 1000, but now they are between 10-12 per 1000. The study outlined in the NEJM was done nearly two decades ago, and the statistics have not been updated.

2. The NEJM article only considered no difference between the groups, defining "perinatal outcomes" as "fetal death, neonatal death, neonatal morbidity." This is unacceptable to me...there are too many variables for outcomes that don't end necessarily in death, that play a large role in the health and well being of the child. I really wished they included more statistics on the outcomes of those not ending in death.

3. BOTH the NEJM article, and the mice study, implicate use of ultrasound that I don't consider acceptable. An extended ultrasound, multiple ultrasounds for no reason, etc. are, as implied in the midwifery today article, unsound medicine and science. As I said in my first post, I think I will be having the 20wk ultrasound. I want to make it clear to whoever needs to know at the time, that it will be for diagnostic purposes only, make sure all systems are OK, the end. Don't hang out there for an hour trying to get a better shot of his/her face for me. That's not the point.

4. I've prayed for, cried with, hoped for, and rejoiced with my cousin holding her little baby. And I've asked myself honestly and sincerely what I would do in her shoes. And I know if I had been in her shoes....I would have had a different outcome based on my previous anti-ultrasound position. I would have buried my baby, instead of holding and nursing it through the trials as she has done. That is just the bottom-line, bare-knuckle facts. I would have lost my baby.

And that is, above any of the other reasons, the unacceptable outcome for me.

[nerdymom]

Originally Posted by sarahkristin

Routine ultrasounds, meaning multiple ultrasounds? Did you read any studies that talked about moms that just got one ultrasound? I'm only planning on getting one, but if there is negative evidence on it, I will definitely reconsider.

From what I remember reading with my last one, it doesn't IMPROVE outcomes, but I don't recall it being linked to negative outcomes.

In the end, do what you feel most at peace with. Aren't we being constantly told to "trust our mothering instincts" by holistic practitioners? Your instinct is saying "I need this test to feel at peace". So go with it and say goodbye to guilt.

[IdentityCrisisMama]

Originally Posted by othersomethings

2. The NEJM article only considered no difference between the groups, defining "perinatal outcomes" as "fetal death, neonatal death, neonatal morbidity." This is unacceptable to me...there are too many variables for outcomes that don't end necessarily in death, that play a large role in the health and well being of the child. I really wished they included more statistics on the outcomes of those not ending in death.

I think that they do. I think that "morbidity" in that study means negative outcomes that do not include death. It may be within the study how they define morbidity but it most certainly is negative outcomes that do not include death.

*ETA: Yes, they define morbidity on Table 2 in this study and it includes things like: Stay in special care for more than 5 days, oxygen for more than 48 hours, on up to spinal injury.

For the record, I will probably do a prenatal ultrasound and don't feel that an indicated or even one or two non-indicated ultrasounds are really the issue.

Similar to you, I just think there's cause for pause... rhyme.

I like the WHO and remember reading their stance on ultrasounds (which I think is linked in that thread), which is probably similar to lots of ours here - that they should be used sparingly.

This link is 10 years old as well...http://www.midwiferytoday.com/articl...oundwagner.asp

Like I said earlier, there were a few moms on the other thread who had an experience in which they believe that an ultrasound saved the lives of a child. There is something about the frequency of these that leads me to question that...only because of my research on the safety of homebirth. Especially if we're talking about the lives of 1 in 100 children, it can not be that that many children are saved by ultrasound technology - AND homebirth (which often does not include ultrasound technology) is just as safe as OB/hospital MW care. Can it? Or are that many homebirth mamas getting a diagnostic ultrasound? I also have so much faith in many homebirth midwives as far as their willingness to use technology to save lives that if a ultrasound really saved 1 in 100 lives -- they would all recommend one, yk?

[IdentityCrisisMama]

Originally Posted by othersomethings

1. Articles like this one indicate that incidents of congenital heart defects are rising. The reports in earlier decades were 4 or 5 per 1000, but now they are between 10-12 per 1000.

I just read the study - this is NOT, not what that article is saying.

Here is the conclusion:

"The variations in the reported incidence of CHD are primarily due to variations in the ability to detect trivial lesions, notably small muscular VSDs that usually close in infancy. The incidence of severe CHD that will require expert cardiologic care is quite stable at about 2.5 to 3/1,000 live births. The moderately severe forms of CHD probably account for another 3 per 1,000 live births, although another 13/1,000 live births have BAVs that will also eventually need cardiologic care. The majority of minor forms of CHD do not need specialized cardiologic care, and indeed many of these, such as the tiny VSD or ASD and the small PDA, may either close spontaneously or never cause medical problems."

[Adasmommy]

I don't plan to have an ultrasound or use the doppler, but I totally agree with pp who said that you go with your instincts and gestate in peace. No ultrasound is the peaceful route for me, personally.

This article outlines a lot of the reasons NOT to ultrasound:
http://www.sarahjbuckley.com/article...ound-scans.htm

I have had a healthy baby after having done one ultrasound, and a healthy baby with no ultrasounds, and one baby with a fatal condition for which we had several ultrasounds in the 24 hours prior to birth. I kind of feel that I've experienced it all, and I don't regret any of my choices, nor would I dictate what you should do.

[lizzylou]

I think there is certainly a place for modern technology such as ultrasound even for those of us who espouse natural family living. Personally I too would never reject an anatomy ultrasound for many reasons - both for my own peace of mind and to prepare myself and restructure my life as needed if the baby had a medical condition.

[echospiritwarrior]

DDCC

I have determined for myself having had only homebirths and planning yet another that I find the mid-term ultrasound helpful and reassuring. We don't even check the gender, and so far we've been blessed enough to have a 'perfectly healthy, normal baby' determined via ultrasound and then I am able to relax through the rest of my pregnancy.

That is what works for me and my family. GL finding the decision you and your family are most comfortable with...

[kalamos23]

Originally Posted by IdentityCrisisMama

I just read the study - this is NOT, not what that article is saying.

Here is the conclusion:

"The variations in the reported incidence of CHD are primarily due to variations in the ability to detect trivial lesions, notably small muscular VSDs that usually close in infancy. The incidence of severe CHD that will require expert cardiologic care is quite stable at about 2.5 to 3/1,000 live births. The moderately severe forms of CHD probably account for another 3 per 1,000 live births, although another 13/1,000 live births have BAVs that will also eventually need cardiologic care. The majority of minor forms of CHD do not need specialized cardiologic care, and indeed many of these, such as the tiny VSD or ASD and the small PDA, may either close spontaneously or never cause medical problems."

Do you really want to play the odds though? We have no genetics that would play a part in my sister having her severe CHD. In fact, my family was involved in the big heart defects study (they were trying to see if there was any genetic or environmental link to CHDs) and the outcome of the study was that it is pretty much chance.

Now that is not to say that I am all for u/s and dopplers a million times a pregnancy, but they do have their uses. I am getting an u/s at 6w6d because I have a history of hematomas and there are things I can do and take to help reduce a hematoma if I have one. So far I have lost 2 babies to them, so for me, a 1-3 minute ultrasound to check is vital to the baby's health.

Just don't throw out the baby with the bathwater here, kwim? U/s does have good uses, you just need to weight the risk/benefits. I think the benefits outweigh the risks for a anatomy u/s, especially if God forbid, you have a child that DOES fall into a small minority and has a serious defect that could be corrected. I also think if you are planning a homebirth, it is a very good idea.

One of the studies showed that there was c-sections for 100% of the babies u/s'ed in pregnancy? and they went more preterm? IIRC, that was a VERY small amount of pregnancies followed - it was something like 50? so I don't really trust that study because of its very small group. Does anyone know if there is a bigger study done?

[IdentityCrisisMama]

Originally Posted by kalamos23

Do you really want to play the odds though?

I don't think any of us really play the odds, yk? I think we have our experiences and our values and then we apply our "views" of the odds to those things to make our decisions. I put views of the odds in quotes because the statistics are so varied that they become subjective, imo. And, anyway, I think many of use use the studies and statistics to reinforce what we already feels is the right thing to do - and that's OK.

For you and anyone who knows someone with a life-threatening CHD it is totally understandable that you would want to take extra precautions.

For someone who feels that pregnancy interventions largely do more harm than good, they may come up with a different view. Some homebirthers may feel a diagnostic ultrasound is the only way to responsibly birth at home while there are others that may feel that ultrasound has little place in homebirth.

And on and on...