fetal echogenic bowel and IUGR monitoring. Would an independent midwife see me as high risk?

[ajanery]

Hi everyone,

I have lots of questions in here :)

I am 24 weeks pregnant with my third child. At my 20 week ultrasound, an echogenic bowel was discovered. Cystic fibrosis was ruled out because we're not carriers. A TORCH panel was done. Also, there are no chromosomal abnormalities. I was scared into having an amnio done. So, while everything has come back normal, the fetal medicine doctor has labeled me "high risk" because of the "possibility" of fetal growth restriction. 

Now I am on schedule to be monitored every 3 weeks with an ultrasound to look out for fetal growth restrictions. According to fundal measurements and u/s, my baby's growth is on target for where he needs to be. I am unconvinced that this is the right approach. 

-Are there other ways to determine fetal growth restriction by methods other than ultrasound?

-Could something like raw milk, cultured dairy, and homemade kombucha contribute to fetal echogenic bowel? Maybe even a tick bite?

I really want to switch my prenatal care over to a birth center/midwife. How do midwives respond to echogenic bowels in a setting that is not managed by an OB?

Thank you!

Edited by ajanery - 3/25/13 at 11:43am

[lulami]

Whether a midwife would risk you out would depend on several factors - are you considering a home birth/birth centre or a midwife attended hospital birth? Hospital midwives might be restricted because of your high risk diagnosis and hospital policies - call and ask. Homebirth/birth centre midwives might have more flexibility depending on your state laws, which can vary widely. Consider interviewing a few homebirth/birth centre midwives to get a feel for what is possible in your state. Mention that you have been labelled high risk by an OB but wait until the interview to discuss the details. Go armed with whatever information you can find about the condition. Most homebirth midwives would measure fundal height and weight gain, and use palpation to monitor baby. You could also consider tandem care with a less frequent ultrasound schedule to monitor growth.  Trust your instincts and back them up with research. Good luck with whatever route you choose!

[ajanery]

I am receiving care by midwives in a hospital setting, but I am looking at midwives who work out of birthing centers in our area. In the hospital setting, there is a lot of deference to the OBs. My "high risk" status does not preclude me from the care of the hospital midwives, but my gut is telling me to move on. Or at least research all other possibilities. 

[mamato3cherubs]

My gut would tell me to move on as well! There is a high false positive rate of diagnosis with this condition. As a homebirth midwife I would monitor growth using fundal height and palpation of baby, if at some point we really became concerned, then maybe a follow up u/s. but they are so notorious for being wrong when it comes to fetal size that it is not a real reliable tool IMO. It terrifies me to think of your baby being exposed to so much ultrasound. I would also want to know how you felt about birthing out of hospital. do you feel like you would be ready to take responsibility for that? and know that if something was not right at birth a transport would be needed? possibly taking longer to receive care than if you birthed at the hospital.

What state are you in?