To ultrasound or not to ultrasound...that is the question...

[Caityzmom]

So I am having a homebirth with this (my second) pregnancy.  I'm looking for opinions/recommendations about getting an ultrasound. I'm 20 weeks along, and frankly, the only thing I want to know is the sex.  We wouldn't terminate if anything was wrong, so it's kind of moot.  And I'm having a heck of a time figuring out where to go to get an ultrasound.  But then again, I'm a planner and if I find out the sex, then I can accumulate items for a baby of the opposite sex since I saved everything from the last.  I live in Moberly, MO but can travel to Columbia, MO for things easily.  So what do you think?  To ultrasound or not to ultrasound?  And if you have a recommendation, I'd love to have it!  Especially homebirth friendly offices/techs!!

~Caityzmom

[PiggyPiggyOinkOink]

I would get the scan. Even though you wouldn't terminate, IF the baby has a problem, you really need to know ahead of time. What if the baby has a giant Omphacele? They'd need to be taken right to a NICU and operated on ASAP. A baby with a giant O born vaginally can have dire results. I'm not meaning to sound alarmist, but it's true. It's only one scan, and it can give you a peace of mind, IMO.

[ocelotmom]

Originally Posted by PiggyPiggyOinkOink 

I would get the scan. Even though you wouldn't terminate, IF the baby has a problem, you really need to know ahead of time. What if the baby has a giant Omphacele? They'd need to be taken right to a NICU and operated on ASAP. A baby with a giant O born vaginally can have dire results. I'm not meaning to sound alarmist, but it's true. It's only one scan, and it can give you a peace of mind, IMO.

I had an ultrasound (and quad screen) because, if the baby had a problem like a heart defect, spina bifida, or an omphacele, I'd rather know about it and deliver in an appropriate manner and location.

I'm not huge on testing and intervention, but the idea that the only reason to get it done is so that you can decide whether to terminate is a bit of a pet peeve of mine.

[greenmama66]

I had one with several of my pregnancies. Last pregnancy I felt something was wrong with my uterus and went for a scan at 16.5 weeks. They found a fibroid was growing and my placenta had grown over it and that's why I was getting these pains. I'm glad I had the scan but I'm not one that goes for for than one or 2 scans a pregnancy. I just had a nuchal scan done and am happy I had it (I am way older) so it gave me some peace of mind.  I also had the NT scan with my 4th baby. My first pregnancy I had one scan at 7 months to confirm twins. The next pregnancy no scan. It's really up to you and your comfort level. I'd rather know about an issue beforehand but that's me. Some people are dead set against scans and that's fine too. Got to do what works for you. The genetics place I went to this time for my NT scan is very homebirth friendly- all the HB midwives in the area send their clients to him. That was important to me too. 

[echodonn]

I also had on e pregnancy with multiple scans to find out sex of baby.  And two with no scans.  I do think it's important to do with your first birth to make shure things are tip top.  But I chose not to because I had very simular p[regnencies to my 1st pregnancy, so I opted to be surprised!

[MegBoz]

Originally Posted by ocelotmom 

I'm not huge on testing and intervention, but the idea that the only reason to get it done is so that you can decide whether to terminate is a bit of a pet peeve of mine.

Agreed. I also think it's a bit wacky to say, "Well, scans don't catch everything, so don't bother." Uh, yeah, true, but they DO catch some stuff, so while a good scan isn't a guarantee everything is hunky-dory, they are also not worthless. (Besides, there are no such thing as guarantees of positive outcomes in birth anyway, in any circumstances.)

What about cost? Sounds like you're cool either way, so maybe factor that in. After insurance, I owed $60 for my 20W scan. Worth it for me, but maybe not if I would have owed the full original $270 that was billed to insurance.

[carrierwright]

Every mom just has to weigh the pros and cons in her individual situation. It's worth considering that if everything appears fine, you're having no warning signs, your midwife or OB has no concerns, then all medical organizations advise on not having routine u/s w/o a medical indication. That's b/c there is some risk of cell abnormality caused by u/s waves. So, if all is well, an u/s does carry a slight risk and that is enough to make many women choose to avoid the scan. If you have other concerns, or that isn't something that gives you pause, then you may have your answer.

[PiggyPiggyOinkOink]

You, yourself, will often never have any inkling of gestating a baby that is missing a foot or has a hole in their heart, or their intestines hanging out of their stomach. IMO, the "risk" of "cell abnormality" due to a scan is just not a concern when you could literally save your baby's life in a 5 minute scan.

[MarineWife]

I'm opposed to unnecessary scans. I wouldn't get a scan just to find out the gender of the baby. I do think that an anatomy scan at 18-22w is important, especially if you are planning a homebirth. While it can't catch every possible problem, it can catch some issues that may require a hospital birth.

[CBEmomma]

I'd get it. I personally always get the 20 week u/s to check for position of placenta and to make sure there are no problems with baby.

[IdentityCrisisMama]

I think that if you want one because you want to know the sex - go for it!  I'm not convinced that there is any significant harm in one scan.  That was my plan for this pregnancy as well until it was thwarted by DH who doesn't want to know the sex.  I would have just gone to one of those kitschy photo places and gotten a 2-D.  

I will be the voice of dissent on the "better safe than sorry" opinion on the value of prenatal ultrasounds for diagnosing abnormalities.  From my research (and I did read a few of the big studies), the only real impact STATISTICALLY in ultrasound as far as reducing infant morbidity and mortality is with the choice to terminate.  The risks associated with false positives seem quite real and significant (parental worry, further testing, and possibly induction and other birth interventions).  I urge you to not take my word for it (but also don't take the word of those assuring you that ultrasound has largely beneficial outcomes).  Read some of the studies - RADIUS and Helsinki were good ones.  The WHO is also a good source, imo.  

[NuzzleNudge]

Originally Posted by IdentityCrisisMama   I urge you to not take my word for it (but also don't take the word of those assuring you that ultrasound has largely beneficial outcomes).  Read some of the studies - RADIUS and Helsinki were good ones.  The WHO is also a good source, imo.  

Can you maybe post some links? Pretty Please?

[asprague]

I was thinking the same thing as the original poster of this thread. I actually don't want to know the gender of this baby, but I would be worried if there were some sort of defect that will require immediate medical attention. I don't live too far from a hospital, but I would rather know than be worrying about it while in labor. The cost is a little bit of a worry to me, but you are right, it would be worth it to know in the end.

Remember, you can always tell the u/s tech you don't want to know the gender for those of you who would be thwarted by this. You could close your eyes and wear earplugs in case of a possible slip. I have also known people who got the gender written on a slip of paper and put in an envelope, to open when ready (birthday, holiday or by one partner who wants to know).

[tonttu]

Yep , I would definitely get at least the 20-week- scan , just in case there is something wrong , and it doesn´t have to be with the baby , it could be placenta previa for example and the only way you´ll find that out for sure is with an US .

Plus , if there is nothing wrong , at least you have that peace of mind when you plan your homebirth

[prothyraia]

Originally Posted by IdentityCrisisMama I will be the voice of dissent on the "better safe than sorry" opinion on the value of prenatal ultrasounds for diagnosing abnormalities.  From my research (and I did read a few of the big studies), the only real impact STATISTICALLY in ultrasound as far as reducing infant morbidity and mortality is with the choice to terminate.  

This.   There's no evidence that routine ultrasounds do more good than harm.  If you want one, then get one, and if you know someone who avoided tragedy by having one, that's great (and is certainly something that would affect my own decision making).  But there's nothing out there that supports the idea that we would all be better off getting them.

[IdentityCrisisMama]

The RADIUS study: http://www.nejm.org/doi/full/10.1056/NEJM199309163291201.  The Helsinki ultrasound study is very hard to find -- you'll probably have to go to a UNI for that.  You will find the trial as a resource in lots of articles, however. 

As far as placenta previa -- isn't that something that can be discovered (or at least suspected) with a doppler or fetal scope?  I.e. suspected previa can be a medically indicated reason for ultrasound.  

Also, ask your homebirth MW if she feels a routine 20 week scan will provide valuable info.  Neither of mine have suggested a non-indicated ultrasound.  Does anyone know if is an "official" line on this from any of the midwifery associations?   Most of the articles I've read from from Midwifery sources seem to be pretty anti-routine ultrasound but I wasn't really looking for specific info on ultrasound use for homebirth.  It would be interesting to know, ha?  

Edited by IdentityCrisisMama - 12/31/10 at 12:02pm

[MarineWife]

Originally Posted by IdentityCrisisMama 

From my research (and I did read a few of the big studies), the only real impact STATISTICALLY in ultrasound as far as reducing infant morbidity and mortality is with the choice to terminate.

Does this include homebirths or just hospital births with OBs or CNMs?

My CPM recommended an anatomy scan with my 2nd child because I had had a previous c-section and she wanted to make sure the placenta was not attached to my incision site. I agree that routine ultrasounds do not provide much, if any, real benefit. However, an 18-22w anatomy or Level II scan is more detailed than a routine ultrasound. My insurance won't cover a routine u/s at any time unless it is "medically necessary".

[IdentityCrisisMama]

You know, Marinewife, that's a really good question.  I imagine that the study does include HB but I am unaware of any study that specifically looks at ultrasound and infant morbidity/mortality specifically for HB.  I DO know that many, many midwifery articles quote these studies to caution women from receiving routine ultrasound.  

I am also unsure what the language "routine ultrasound" means specifically.  I assumed it meant non-medically indicated, however if it means something significantly different from that (and it doesn't include a non-medically indicated 20 anatomy scan) the meaning of the outcomes of those studies is very, very different.  

I'll see if I can find the definition for "routine ultrasound" or at least some clues as to what that means.  Anyone know?  

Here's the definition from the Radius Study:

"The women randomly assigned to the ultrasound-screening group underwent one sonographic examination at 15 to 22 weeks of gestation and another at 31 to 35 weeks. The women in the control group underwent ultrasonography only for medical indications, as identified by their physicians."  

Here is a note about the care received by most women: "Most patients were at low risk for adverse outcomes, received care from board-certified physicians, and were cared for with the resources typically available to pregnant women in the United States. Whatever the explanation proposed for its lack of effect, the findings of this study clearly indicate that ultrasound screening does not improve perinatal outcome in current U.S. practice."  

It is true that the issue of being born at home comes into play here.  I imagine there must be at least a few articles that address this issue of ultrasound benefit possibly being higher for those choosing homebirth.   Has anyone seen an article like that?  Is anyone's MW advising for routine ultrasound?   Any MW care to share their feelings on this?  

Edited by IdentityCrisisMama - 12/31/10 at 2:01pm

[MarineWife]

I just recently learned that there was a difference between the routine 18-22w u/s and a Level II u/s. I had always assumed they were the same thing because they were performed at the same time. I've been referred to a MFM doc for both a NT scan and a Level II u/s this time because I am AMA.

I will almost certainly get the Level II u/s because I'm planning a homebirth and I do have the issue of the c-section incision site and the slightly increased chances of their being a health problem with the baby because of my age. I'm not sure about the NT scan at this point. I keep flipping back and forth. While my OB said that my chances of having a baby with Down's Syndrome have gone to 1 in 81, he did make the point that there's still a much larger chance that the baby does not have DS. If I weren't planning a homebirth, I probably wouldn't be as concerned. OTOH, if I were planning a hospital birth, I would probably be getting a lot more pressure to have these as well as all the other tests, which I will not have.

Ya know what? I just realized that a better question might be if the studies include situations where mothers were planning a homebirth but switched to a hospital birth after the results of an ultrasound. That's what I meant but I don't think I was clear about that.

[IdentityCrisisMama]

Yea, I agree that it's a good question and one that I think maybe should have been brought up in the anit-ultrasound articles I've read that are HB focused and used these studies as references.  Sigh.  

Here is a quote from a Midwifery Today article that at least partially addresses the issue of prompt care in the event of a congenital abnormality:

"Pregnant women often automatically assume that antenatal detection of serious problems in the baby means that lives will be saved or illness reduced. Knowing about the problem in advance did not benefit these babies; more of them died. They got delivered sooner, when they were smaller, a choice that could have long-term effects. All twelve babies with abdominal wall defects survived. But for the six detected on the scan, their length of hospital stay was longer and they spent longer on ventilators, though the numbers are too small to be significant. They were operated on sooner (four hours rather than thirteen hours) but the outcomes were the same."  

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

It's an interesting question in terms of specifically HB, though.  I really would be curious to know what the trend is on advice from HB midwives and supporting organizations.  I always assumed the line was "no ultrasound unless medically indicated" or desired by the parents but that's a total assumption.  

Ya know what? I just realized that a better question might be if the studies include situations where mothers were planning a homebirth but switched to a hospital birth after the results of an ultrasound. That's what I meant but I don't think I was clear about that.