What could an ultrasound tell you that would stop you from planning a home birth?

[havsulen]

I am planning for our second home birth, and I am not sure whether I want an ultrasound or not.

I am generally sceptical to ultrasound, and I have opted out of doppler - we are waiting until we can hear the heartbeat by fetoscope.
The only ultrasound I am considering, is the anatomical scan - a short one - I am offered one at 19 weeks. I was thinking that they could check the baby - who we would welcome and love no matter what!!! - to see if there is something the baby might need help with either during pregnancy or right after birth.

A home birth midwife that I know told me that several of her clients had chosen not to have ultrasounds, and that did not worry her. She mentioned that if there was a problem with the placenta covering the opening, the woman would normally find out during pregnancy anyway - due to bleeding, and that she could find out while examining.

But - are there other things that they might be able to find out during an ultrasound that you would want to know before planning a home birth? Could a finding stop you from giving birth at home?

I feel that to be able to comfortable refuse the ultrasound I need to know what it is exactly that I might not know?

[StephandOwen]

Anything happening with the baby that would/could require immediate care (heart defect, etc) would stop me from having a home birth.

[Buddhamom]

Spina Bifida would require very careful handling of the spinal cord at birth.

[SubliminalDarkness]

Placenta previa comes to mind.

[la mamita]

two things i want to look for in a u/s: placenta previa or a major birth defect that would require immediate care.

[Evergreen]

I didn't have an ultrasound last time but plan on it this time. My midwife was able to determine the placenta's location just fine with the fetascope so that might ease some of your minds.

Heart defects, spina bifida, omphlocele all come to mind.

[WifeofAnt]

Well a fetoscope can usually tell you where the placenta is but it can't tell you where the edges are. If placenta sounds are only heard near the very top then there's most likely not an issue but if they are heard on the side then I think its worth it to at least get a quick 5 minute scan to be sure of how high the edges are. Not everyone who has a previa has the classic bleeding signs prior to labor.

Then there's also birth defects and multiples. I know people home-birth twins all the time but twin pregnancy is not without the risks of circulation and growth issues between the babies and I'd want that checked on.

[Earthy Mama]

Originally Posted by SubliminalDarkness

Placenta previa comes to mind.

Yep. Turned my homebirth in to a scheduled c-section.

[nia82]

We are planning on a birthing center birth and did a 22 week anatomy scan (that was just the week I returned from a vacation, otherwise done at 20 weeks). things that impair a home or birthing center delivery:

- Placenta Previa (however this might move, a 20 week previa might go away entirely by 40 weeks)
- heart defects
- spina bifida
- cysts or tumors
- other organ malformations that require immediate pediatric assessment

[lillymonster]

Originally Posted by havsulen

She mentioned that if there was a problem with the placenta covering the opening, the woman would normally find out during pregnancy anyway - due to bleeding, and that she could find out while examining.

Placenta previa and you can have it without bleeding. My mother didn't know until she birthed the placenta first and had to have an emergency c-section with my brother. It was pretty scary for her and him, so I prefer to take that very seriously

Also any birth defects, lung issues, heart issues, brain issues.

[GoBecGo]

I've had 2 HB's. I had 2 u/s with DD1, one at 11weeks to date and one at 39+4 to check fluid levels. With DD2 i had one at 15 weeks to date (pointlessly too late, but equally completely accurate). I didn't have the anatomy/anomaly scan because with #1 it wasn't offered and with #2 i read through the leaflet and realised the chance of there being an anomaly and diagnosing it was lower than that of them being one and them not seeing it (for example, only 25% of heart anomalies are seen on u/s, so even if the technician thinks all looks fine, it is very far from a guarantee of safety). Since it wasn't giving me peace of mind i skipped it.

I personally would probably not bother with a scan for praevia. It's incredibly rare, and for it to be undx because there were NO symptoms prior to labour would be even rarer (i know it happens and has happened, but so have a lot of things which i know are rare and don't try to control for in everyday life).

I don't mind having the short one when i'm booked, since it is part of the routine care at the hospital (whom i book with for theoretical back-up care) but if i had to pay for them i'd skip them.

[babymango]

As other mentionned, placenta previa and significant malformation that would require immediate interventions (my friend had a baby with hypoplastic left heart who required immediate care. He would have been ok being born at home and transfered to the hospital within hours once they noticed he was not pinking up, BUT giving him oxygen would have been the wrong thing to do for him, although without knowing the cause of the color issue, anyone would have given him some oxygen)
Another significant problem, althought more difficult to pick up on US, in a vasa previa. you can see signs of it, then you have to really look. But that's the type of thing that won't give you any problem until labor, when the vessel ruptures and there potentially is massive fetal blood loss.

[Mamatoabunch]

I have had 8 HB's, the last 7 UC's and have not had U/S's at all w/ the last 7.

[WifeofAnt]

Originally Posted by babymango

Another significant problem, althought more difficult to pick up on US, in a vasa previa. you can see signs of it, then you have to really look. But that's the type of thing that won't give you any problem until labor, when the vessel ruptures and there potentially is massive fetal blood loss.

If I remember correctly a ruptured vasa previa has a fetal mortality rate of nearly 100%. Its very rare but overwhelmingly fatal.

[GoBecGo]

But do they even LOOK for vasa previa during routine scans? They don't even use the colour doppler in my Health board except with suspected twin-to-twin/other indicated problems. AFAIK vasa previa is a post-mortem diagnosis, not a prenatal one.

[Ola_]

Obviously placenta previa and I was also thinking of spina bifida or any issues with the baby's organs being exposed outside of their body. Those would need not only immediate care after birth but I would think the actual birth process could cause damage as well, potentially.

[AFWife]

Previa is my first thought.

Anything that would require an emergency care team on standby would stop a homebirth for me...

[Jenne]

Yes! Of course there are things that would prevent me from having a planned homebirth that could show up on ultrasound. To me, homebirth is for low risk birth. That risk is for both Mom and baby. So, if I or the baby could reasonably expect to need hospital care immediately after or during birth I would want to be at the hospital. It might not effect the choices I made regarding drugs and interventions though. Also, there are things which can be corrected in utero that I would want to do if possible that could show up on ultrasound. My local hospital does those.

But, I recognize that not having an ultrasound is a choice too.

For me, the decision to have the anatomy scan came down to how much risk I felt it was to have one vs not. But this is how I do most types of decision making. What are the risks and benefits of this intervention? In the end I decided that knowing about a cleft palata, exposed organs, single vessel cord, previa, or other anomalies out weighed the risk I felt ultrasound to be.
Other mamas make different choices and that is okay too. It is about what you are comfortable with.


I wish you all the best!
Jenne

[mylilmonkeys]

I've never felt a need to have an ultrasound with the five homebirths we've planned. At the end of the last pregnancy, circumstances warranted an amnio which requires an ultrasound. This pregnancy we suspected twins, which alone would not make me question a home birth, but coupled with the facts that my primary midwife has zero twin experience (but has a partner who does), and that I am due in mid March in an area which has long, hard winters, and am 45 min in good weather from a hospital with the necessary facilities, and have birthed my last three in 3-4 hours from first contraction, well... I decided I needed the peace of mind of an US. Yes, it's twins, and no, I have no idea where I'm going to birth. But now I can explore my options.

So, I guess, the short answer is that twins were the possibility that made me go ahead with an US and reconsider home birth.

[HeatherB]

One thing to note is that most of the issues you'd be looking for will show up better LATER. The whole 20 week thing is in case you want to terminate. If you don't or won't, it's probably better to delay an anatomy scan until everything is better developed.

The things I would be looking for include spina bifida (I have spina bifida occulta - a minor version - so it's a real although still unlikely concern for my babies) which can sometimes be corrected in utero; a complete previa or other major placental problem such as accreta; or one of the very rare instances where organs are not growing in the body (i.e., omphalocele). I would actually not be looking for heart defects in general, as I know of many of those that end up better off in a home birth with a gentle and peaceful entrance and subsequent care as necessary. Clearly, if there was something shown we'd consider all the options, though.

Basically, for me, it's issues that would prevent a vaginal birth. If a vaginal birth is still an option, I'll do it at home and then deal with any issues that might need additional care.