US w/o referral

[lightinmyhands]

anyone know how to get a diagnostic u/s w/o a referral? is it even possible?  I'm pretty sure I'm off on my dates, or I'm having twins (lol, i doubt that).... anyhow, everything happened really early...morning sickness came and went earlier than it did for my last two pregnancies, i got heartburn earlier than usual, i started showing much earlier than usual.  and now I'm feeling the top of my uterus nearly at my belly button and supposedly, according to my dating, I'm only just now 14 weeks.  Should I even worry about the possible surprise of a baby a month early? or possibly two? should I just let it go and not worry about an U/S? or should I try to get one-- even if that means making a prenatal appt. that I would have to pay for out of pocket because i'm uninsured?

[Peony]

Planned Parenthood is an option. I went a few weeks back to get an u/s at what I thought was 8 weeks but was wondering about off dates as well because I was already feeling movement. And yep, I was 11 weeks, almost 12. I just said I needed a dating u/s, didn't have maternity insurance, and have HBs. They thought it was awesome. They have sliding scale fees, DH's income bumps up our income quite a bit (high COL area though) so I think they charged me at the upper limits for the visit which was still only $75.00

[xelakann]

There are places like Epic Imaging and other non-hospital associated imaging centers that you could check into.

[tracymom1]

If you know any DEMs or have any connections in the midwifery circle in your neighborhood, I would bet someone could help you find an ultrasound tech or radiologist who 'helps out' the UP community. That's kind of what I did - my old midwife told me about "the guy" and I called him and it was all a little covert, but I got a very quick ultrasound just to check organ development and placenta position. That was perfect for me and it cost $100.

[Mamatoabunch]

I had a good feeling of one or two by 20 weeks w/ all of mine, although I knew at 15 weeks w/ my first pregnancy, which was twins. You can also go to those ultrasound places where you pay, for vanity purposes, if that is the right word. They will tell you if there is two. W/ my second pregnancy, just one baby, my fundus was much higher, almost at belly button at 13 weeks, just one baby.

[Peony]

Most of the 3D/4D places, the ones where people go to get "fun" u/s have certain dates that they follow. I think many of them don't do u/s before 16 something weeks, which isn't far off for you. 

[ElizabethE]

Please also keep in mind that our perception of the accuracy of ultrasound is pretty off. I know docs say it's the best determiner of due date, but I've read a lot of data contradictory to that. Every woman's cycle and also the growth of her fetus are so individual. You could definitely think you were 8 weeks and be 12, or vice versa. Going by cycles or conception dates and also knowing your own body well seem to still be superior to ultrasounds, IMHO.

A lot of the "fun" places, like places that do 4D, require a physician referral. I think it's due to the fear that they may uncover something unsavory as they are not in the business of breaking bad news or diagnosing anything negative to parents. Most of them require that you've already had a previous ultrasound that was meant for such diagnostic purposes.

[purplepaperclip]

Originally Posted by ElizabethE 

Please also keep in mind that our perception of the accuracy of ultrasound is pretty off. I know docs say it's the best determiner of due date, but I've read a lot of data contradictory to that. Every woman's cycle and also the growth of her fetus are so individual. You could definitely think you were 8 weeks and be 12, or vice versa. Going by cycles or conception dates and also knowing your own body well seem to still be superior to ultrasounds, IMHO.

A lot of the "fun" places, like places that do 4D, require a physician referral. I think it's due to the fear that they may uncover something unsavory as they are not in the business of breaking bad news or diagnosing anything negative to parents. Most of them require that you've already had a previous ultrasound that was meant for such diagnostic purposes.

I was under the impression that early u/s were fairly accurate (w/in a week) for dating purposes. I know that later ones are much more likely to be off, but in the beginning of a pregnancy fetal development is pretty standard based from conception. Now, obviously, every woman does not ovulate at the same point in her cycle, but from conception forward, the timing of development doesn't really leave too much room for deviation in early pregnancy.

[Mamatoabunch]

Originally Posted by ElizabethE 

A lot of the "fun" places, like places that do 4D, require a physician referral. I think it's due to the fear that they may uncover something unsavory as they are not in the business of breaking bad news or diagnosing anything negative to parents. Most of them require that you've already had a previous ultrasound that was meant for such diagnostic purposes.

I know several people who have had them here and this has not been their experience. They were only asked who was performing their prenatal care.

[Mamatoabunch]

Originally Posted by purplepaperclip 

I was under the impression that early u/s were fairly accurate (w/in a week) for dating purposes. I know that later ones are much more likely to be off, but in the beginning of a pregnancy fetal development is pretty standard based from conception. Now, obviously, every woman does not ovulate at the same point in her cycle, but from conception forward, the timing of development doesn't really leave too much room for deviation in early pregnancy.

Yes, early, like 6 weeks can be pretty accurate. This OP isn't early anymore at 14 weeks.

[ElizabethE]

It's also the length and regularity of a woman's cycle, too, and not just the point of ovulation. I have semi-irregular cycles, and longer than average as well. This typically makes for longer gestation periods and sometimes in ultrasound, failed guestimates-- since they base everything on averages, anyhow. All guesses and due dates are only supposed to be within a couple of weeks, anyway, right? Even with ultrasound, I believe. So there is a fairly large margin for error when you consider all the variables.

I think counting from conception is smart, when you do the day-count. At least, it seems fairly accurate for me... although I had to do the math and figure out my own "formula". :) According to the docs I would be delivering any day now, but realistically I understand my gestational periods and the sizes of my babies... I don't expect to deliver for at least a couple of weeks. :/

[purplepaperclip]

I agree that at 14 weeks the accuracy of u/s for dating purposes could be sketchy, but it could likely give a good estimate as to whether she is a month or two off on her dates if this is important to her.   I also disagree that a woman's length of cycle and regularity will affect early fetal development when counting forward from conception. That is just simple biology. The length and regularity can make it difficult to pinpoint when conception occurred and thus causing confusion as to actual "x weeks and y days along" logic, but once sperm meets egg, well that's a different story.

OP, how are you doing? How are you are feeling about u/s? Any luck finding someone who can help you if you do decide to go with one? I feel you on the heartburn. Oy! I have it baaaad this time around. 
 

[savithny]

Originally Posted by purplepaperclip 

I agree that at 14 weeks the accuracy of u/s for dating purposes could be sketchy, but it could likely give a good estimate as to whether she is a month or two off on her dates if this is important to her.   I also disagree that a woman's length of cycle and regularity will affect early fetal development when counting forward from conception. That is just simple biology. The length and regularity can make it difficult to pinpoint when conception occurred and thus causing confusion as to actual "x weeks and y days along" logic, but once sperm meets egg, well that's a different story.

OP, how are you doing? How are you are feeling about u/s? Any luck finding someone who can help you if you do decide to go with one? I feel you on the heartburn. Oy! I have it baaaad this time around. 
 

Exactly.  While the systems are forming and the basic structure of the embryo/fetus is being laid down, all fetuses follow a remarkably similar developmental timeline.   They know from studying other organisms that embryos develop on a fairly strict timeline - to within even hours, let alone weeks.   Early ultrasound is looking at those stages, and is quite accurate in dating pregnancies.  It is simply impossible to mistake a 6 week fetus for a 10 week fetus, or even a 7 week for a 9 week -- developmentally, they are light-years apart.

Once the body is formed and its just a matter of growing to a size big enough to be born, then other factors come into play, like genetics, environment, nutrition etc, and after that point babies do vary in size quite a bit, making it harder to determine gestational age (although for the wide variety of eventual sizes of adult humans, healthy 40-week babies are actually remarkably homogeneous in overall length.

[lightinmyhands]

thanks for all of the advice/experience/opinions/input... it's been greatly appreciated.  I don't know that I'm going to get an ultrasound.  I am aware that you ladies are right, after the first trimester, dating gets more difficult.  I wish I could have based it on my cycles, which I usually know pretty well, but I'd only had a few of them since my last birth and since I'm still breastfeeding and they were just starting to come back, they were really irregular with only a day or two of bleeding.... I just don't know when I ovulated to be quite honest.  Based on the moment I think I conceived ... I'll have a baby mid august.  We don't get the opportunity for sex much, only every couple of weeks, so I'm a couple of weeks off at most.  For some reason DH wants to know if I'm wrong on dates or if there's two of them, but he's stopped mentioning it for the time being and so I'm going to let the issue go for now as well.  I'm ok with surprises, such as an early baby, or even a second one when we think we're getting a placenta.  thanks again!

[ElizabethE]

Originally Posted by purplepaperclip 

I agree that at 14 weeks the accuracy of u/s for dating purposes could be sketchy, but it could likely give a good estimate as to whether she is a month or two off on her dates if this is important to her.   I also disagree that a woman's length of cycle and regularity will affect early fetal development when counting forward from conception. That is just simple biology. The length and regularity can make it difficult to pinpoint when conception occurred and thus causing confusion as to actual "x weeks and y days along" logic, but once sperm meets egg, well that's a different story.

OP, how are you doing? How are you are feeling about u/s? Any luck finding someone who can help you if you do decide to go with one? I feel you on the heartburn. Oy! I have it baaaad this time around. 
 

With your first paragraph, yeah, I kind of agree. My point was mostly to indicate that there is a link between people guessing gestation and the length and regularity of a woman's cycle, but I cannot say that this actually affects the gestation period itself. Since the primary topic is ultrasound, I suppose that seemed a bit off topic. I just find it funny I guess at the ways in which we give due dates and find them generally not something to focus too heavily on.

[ElizabethE]

Originally Posted by savithny 

Exactly.  While the systems are forming and the basic structure of the embryo/fetus is being laid down, all fetuses follow a remarkably similar developmental timeline.   They know from studying other organisms that embryos develop on a fairly strict timeline - to within even hours, let alone weeks.   Early ultrasound is looking at those stages, and is quite accurate in dating pregnancies.  It is simply impossible to mistake a 6 week fetus for a 10 week fetus, or even a 7 week for a 9 week -- developmentally, they are light-years apart.

Once the body is formed and its just a matter of growing to a size big enough to be born, then other factors come into play, like genetics, environment, nutrition etc, and after that point babies do vary in size quite a bit, making it harder to determine gestational age (although for the wide variety of eventual sizes of adult humans, healthy 40-week babies are actually remarkably homogeneous in overall length.

Remarkably similar, but not the same. Depending on your perspective, one could say that fetuses develop at remarkably unique rates. We can generally safely assume certain things, like at X number of weeks your baby is X size, and has hit XYZ milestones, etc., but like children themselves it is truly very individual. Maybe this is where you would consider factors like health and genetics, etc.  But I do agree that at the earliest stages it is easiest, because the older the fetus gets the more "human like" it becomes, making it harder to date.

And just another kink to add into the gestational length and discussion, I've read that 41 to 42 weeks is a more sincere average for healthy women to deliver babies at, naturally.

[ElizabethE]

Originally Posted by lightinmyhands 

thanks for all of the advice/experience/opinions/input... it's been greatly appreciated.  I don't know that I'm going to get an ultrasound.  I am aware that you ladies are right, after the first trimester, dating gets more difficult.  I wish I could have based it on my cycles, which I usually know pretty well, but I'd only had a few of them since my last birth and since I'm still breastfeeding and they were just starting to come back, they were really irregular with only a day or two of bleeding.... I just don't know when I ovulated to be quite honest.  Based on the moment I think I conceived ... I'll have a baby mid august.  We don't get the opportunity for sex much, only every couple of weeks, so I'm a couple of weeks off at most.  For some reason DH wants to know if I'm wrong on dates or if there's two of them, but he's stopped mentioning it for the time being and so I'm going to let the issue go for now as well.  I'm ok with surprises, such as an early baby, or even a second one when we think we're getting a placenta.  thanks again!

I seriously think you have the right idea, here. Conception to me IS the most reliable indicator used to get a good guess on a due date. They say that your pregnancy will last 266 days from conception. For me personally, based on my experiences with my own children, I think mine is more like 274. Everyone really is, actually, different. I think we all need to remember just how much due dates are estimations. If you have it in the ballpark, you're doing just as good as or better than any doctor could.

And more power to you on no U/S at all. I'm not that strong. I'm kind of a control freak and have to know certain things, but I admire your willingness to roll with the surprises that may come.

[savithny]

Originally Posted by ElizabethE 

Remarkably similar, but not the same. Depending on your perspective, one could say that fetuses develop at remarkably unique rates. We can generally safely assume certain things, like at X number of weeks your baby is X size, and has hit XYZ milestones, etc., but like children themselves it is truly very individual. Maybe this is where you would consider factors like health and genetics, etc.  But I do agree that at the earliest stages it is easiest, because the older the fetus gets the more "human like" it becomes, making it harder to date.

And just another kink to add into the gestational length and discussion, I've read that 41 to 42 weeks is a more sincere average for healthy women to deliver babies at, naturally.

No, average gestation has nothing to do with the accurace of early ultrasound.   Between 7 and 14 weeks, transvaginal ultrasound is accurate to within 3 days plus/minus.  This is far less than the weeks that you have intimated is the case, and can certainly narrow down the month of conception and month of likely birth.   

If you want to argue about whether we *need* to know such things, that's a different argument, and one that is worth having.  But you're arguing aboutt facts (the accuracy of early ultrasound, the timeline of early embryonic development) that have been established repeatedly through early ultrasounds on well-dated pregnancies (IUI and IVF pregnancies, especially).  

So: Make the point that you don't need ultrasound, or that dating ultrasounds may give you and EDD, but that ANY EDD is an *estimate* -- all that can be done while still accepting that early ultrasound is quite accurate in determining how long it has been since sperm met egg.
 

[elus0814]

My understanding is that an ultrasound is something that is ordered by prescription. You couldn't just call up some place and say 'I want an MRI', they would need a doctor to order it. A big problem would be finding someone to 'read' the results too. The ultrasound tech is not a doctor and could not tell you much, although if all you're looking for is the estimated gestation and if there are one or two babies you would almost certainly be able to find it out. 

[ElizabethE]

Originally Posted by savithny 

No, average gestation has nothing to do with the accurace of early ultrasound.   Between 7 and 14 weeks, transvaginal ultrasound is accurate to within 3 days plus/minus.  This is far less than the weeks that you have intimated is the case, and can certainly narrow down the month of conception and month of likely birth.   

If you want to argue about whether we *need* to know such things, that's a different argument, and one that is worth having.  But you're arguing aboutt facts (the accuracy of early ultrasound, the timeline of early embryonic development) that have been established repeatedly through early ultrasounds on well-dated pregnancies (IUI and IVF pregnancies, especially).  

So: Make the point that you don't need ultrasound, or that dating ultrasounds may give you and EDD, but that ANY EDD is an *estimate* -- all that can be done while still accepting that early ultrasound is quite accurate in determining how long it has been since sperm met egg.
 

I've been agreeing this whole time that earlier is better... *shrug*