Sonagrams? Safety...

[J-Bean]

Hi there,
I'm new to this discussion but have been reading if off and on this past year. And here I am in a total quandary. I just got pregnant with child #2 (my first is 15 mos. old) and my new health insurance provider (Kaiser) is very protocol/procedure-happy. So, I am very curious to know what some like-minded women think about sonagrams.

I've read that although there is no proven link between sonagrams and XXX (you name the negative affect), most countries except the USA limit their use to 1-2 times during pregnancy and use as needed for cases as they arrive in pregnancies where there are questions to be answered. This of course leads me to wonder why my Dr. wanted to give me an sonagram at 3 weeks pregnant when he hadn't done a pregnancy test even to confirm, 2 months pregnant, and nearly every month afterwards. I am extremely reluctant and the Dr. was extremely offended that I'd think anything could be unsafe with the procedure....But this is Kaiser and I'm new to their protocol world... And I don't see sonagrams as the key to prenatal care.

Can anyone give me some advice, news, knowledge about this? Thanks so much! Oy, sonagrams! My last pregnancy I had one at five months, and that felt sufficient for me since everything looked healthy and normal.

[Sagesgirl]

Well, I don't believe sonograms are risky. But neither do I believe they are necessary. While I don't think there is any risk to the procedure itself, there is a clear risk--the typical intervention leads to intervention risk. KWIM? Constant sonograms can put you on a fast track to the doctor believing the baby's too big/too small/there's too much fluid/too little fluid, etc etc. At the very least, it's likely to be more stress you don't really need. Also, I'd have to think that monthly sonograms are IMO a huge indicator that he's going to be very pushy of other "prenatal testing". It is not a track I would want to set myself upon.

[alegna]

I don't use u/s without medical reason. In fact the main OB/Gyn association even suggests as much. They say not to use u/s without medical reason.

IMO "taking a look" is not a medical reason.

-Angela

[velcromom]

One good thing about Kaiser is that you can change doctors anytime you want for whatever reason you want. Do not worry about offending them, they probably won't even notice. Besides they change patients to other doctors w/o notice all the time anyway, so they are used to patients switching around.

I agree, sonogram for medically indicated reasons only. I'm trying to think of a reason we might accept one. I'm not coming up with anything really compelling right now. All the reasons I can think of are based on pretty remote "what if's" and that's not the way I'm doing things this time. So odds are we won't have one. Protocol, policy, requirements, mandatory this or that, - none of it overrides your power to make evidence-based choices for your baby's health care.

[skyblufig]

Well, here's one article I found. If you Google or Yahoo "prenatal ultrasound" a whole bunch of stuff comes up. Can't post any more right now -- 2 yr old's climbing me.

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

Keep in mind, too, that your HCPs work for you, not the other way around, and you can always defer/not consent to any test they offer. Don't feel like you have to defend your position. "Because we feel it's not in our best interest" should be good enough reason for them. GL!

[J-Bean]

Thanks for the reminders...

I just wanted to post again and say thanks for all of the great advice and reminders. I'm trying to use my instincts here on this second pregnancy and so far, my instincts seem to be in opposition to my new healthcare provider (actually everyone I've spoken to there). I think I'll be looking into a homebirth regardless of the price now. (Two advice nurses literally went off on me yesterday at Kaiser because as they say, sonagrams are a great way to find out if you are pregnant and to keep tabs on it and they had planned on doing another 'first sonagram' at my next appt.!) I've never heard of this and just can't ascribe to it. Thanks for calming my raging-with-frustration hormones.

[Sagesgirl]

Kaiser must have a very liberal sonogram policy! Seems as if they just pay without question if the doctor deems it medically necessary, and of course he will.

[cristeen]

I find this very interesting. I also have Kaiser, and they don't even "let" me see an OB, I see a NP for every visit. Anyway, at my last visit, after the RE had done a U/S to count noses (after fertility drugs, at 6 weeks), the NP had done one to confirm heartbeat (at 8 weeks), and then having the NT at 12 weeks, I indicated I didn't want the 20 wk U/S. I was told then that Kaiser's policy was 2 U/S (the NT was out of network, and the one the RE did falls under the heading of "fertility" and not "prenatal"), one at the beginning to confirm heartbeat and 1 at 20 wks, so the 20 wks would be the only other one I had (unless I go past EDD). She did employ "scare tactics" to get me to consent to the 20 week, but she made it very clear there would be no other ultrasounds.

But, I agree with pp, this is Kaiser. If you're not liking what your doc is telling you, switch docs. You don't need to talk to an advice nurse about it (I've gotten horrible advice from them in the past, so I rarely talk to them if I can avoid it). Call the business office, and just ask them to switch you to a different OB. Every Kaiser facility has plenty of them. And then call the switchboard and reschedule your next appt so you get in with your new doc. Tell him/her upfront that you are declining any further U/S, and that it's not open for discussion. I'm expecting to have to have this convo with my NP next visit about the Doppler. If they schedule you for one (I just got a card in the mail about the 20 wk U/S appt), just call and cancel, don't discuss it with them, just call up and I think they even have an automated "to cancel an appt press X".

I don't even do the pee tests with Kaiser, and no one has given me flak about it yet. I just make sure I go before I check in for my appt, and gee, I don't need to go right now. You want weight and BP, fine. My NP has already brought up the GTT, and I'm only 13 wks, but I intend to decline it. And if she has a problem with that, I'll switch NPs.

You have to be very proactive about your own care with Kaiser, because to them you're just another number. But, being just another number has it's advantages, as well, in that you can change that number any time you feel like it.

[applejuice]

I believe sonograms/ultrasoundscans are dangerous and there is plenty of clinical data and scientific studies of the last forty years in the medical literature to prove that as a fact.

Ultrasound is present not only in the scans that are ordered for most pregnant women but also in the machine that listens to and broadcasts the fetal heartbeats, in the vaginal scan, in the EFM, in the telemetry, and the IFM.

The medical profession will only reveal all the dangers they know about "non-ionizing radiation" when there is another more ominous and dangerous tecnnology waiting to take its place.

[~~Mama2B~~]

I had a UP up until the 7th month when I caved in to pressure andmy own curiousity and began seeing a midwife. I go in for appts every 2 weeks and I get the heart beat checked using a doppler every other time. From what I've read, limiting your exposure is very important and even moreso in the first trimester or two. From my studies occasional, limited use of a doppler or one or two episodes with an u/s device haven't shown any detrimental effects. However, we need to be aware of the facts. I think for my next pregnancy, I will limit the doppler usage even more.

Kristi

[HerthElde]

I believe dopplers are operated at a higher frequency than the visual ultrasound, but I could be wrong.
I didn't have any of either with my second pregnancy - I waited until my m/w could hear the h/b with a wooden scope thingy (can't remember what it's called - fetoscope, maybe?) - that was good enough for me.
What made me decide not to use u/s was the fact that u/s is used therapeutically for the purposes of changing cell structure. Now, that's at much higher frequency than fetal u/s, but as far as I'm concerned, just because we assume fetal u/s does no damage at the cellular level doesn't mean it's safe - what about at the atomic level? Or smaller? How would we know?
So, that may seem odd or overcautious to some, but that was my reasoning. Athough, if I had had bleeding or had been in an accident or something, I would have had a u/s.

[koofie]

I am with Kaiser too and I have been told their policy is usually 1 u/s at ~20 weeks. This DOESN'T include vag. u/s in the office, because after a m/c in April, I was freaked out about the possibility of it happening again, so I actually requested vag u/s - I had one at 5 w and one at 6w. This was more because I was so stressed out that I was worried that I would make everything worse with my stress level. We then had the standard u/s in their radiology dept at 19 w and then another a few weeks later because the baby was scrunched up and they couldn't see much from the lower half. I found out about their policy bc DH REALLY wanted to find out the sex, so he asked when the next one was and they said I wasn't likely to have another (fine with me!).

As for other Kaiser policies, you can decline any of the tests, but with the GTT they basically told me that if I decline they would consider me GD since I had failed the 1hr. That meant checking my blood sugar 4x per day and a nutritional diet for GD, and the usual GD pressure for induction early. So, I went ahead and then failed the GTT, so I am testing my blood sugar 4x per day (which now I think isn't a bad idea since I have found out some "triggers" and I have been able to maintain myself and I have been eating more protein).

Anyway, at Kaiser you will end up with whoever is on call, so it is important to talk to every dr you see, and try to see them all so you can tell them what you want and get a feel for who is on board with you and who you will need to watch very carefully during labor (or tell DH to do it). I am UCing, so I will hopefully avoid this.

Some things about Kaiser annoy me, but some things are actually nice. Many Drs at Kaiser have a lower c/s rate because they don't get paid more for them. Because they don't get paid per procedure, sometimes it is easier to say "no thanks" because they are not losing $ when you choose not to do something. Also, if you do have a problem, if you are persistant you can get really good care with no or little out of pocket expenses. For example, I have had headaches most of my life and have been to see MANY specialists because of them to figure out what was causing them, with no extra expense.

That is my ramble : Hope this helps in some way. Most of the time with Kaiser you just need to speak up, and you can get someone to listen.

[applejuice]

Dopplers = Continuous Wave Ultrasound.

[attachedmamaof3]

If you research how an ultrasound works I believe you can make this decision very easily!! It is not well known (because people don't look it up) but an ultrasound works by bouncing sound off of objects correct?

high level sound=ultrasound=energy. This type of energy LITERALLY = the development of heat which results in better 'picture' of the object. Hmmm...do I want to heat my baby/amniotic fluid up INSIDE of my uterus JUST to check things out? I think not. I've had 3 kids...never an ultrasound.

I've attached a link which states the following:

Dangers of Ultrasound


There have been many concerns about the safety of ultrasound. Because ultrasound is energy, the question becomes "What is this energy doing to my tissues or my baby?" There have been some reports of low birthweight babies being born to mothers who had frequent ultrasound examinations during pregnancy. The two major possibilities with ultrasound are as follows:

development of heat - tissues or water absorb the ultrasound energy which increases their temperature locally
formation of bubbles (cavitation) - when dissolved gases come out of solution due to local heat caused by ultrasound
However, there have been no substantiated ill-effects of ultrasound documented in studies in either humans or animals. This being said, ultrasound should still be used only when necessary (i.e. better to be cautious).

http://health.howstuffworks.com/ultrasound4.htm

http://en.wikepedia.org/wiki/Ultrasound

http://www.fda.gov/fdac/features/2004/104_images.html

[mrskennedy]

Wish I Hadn't...

I agree with applejuice, HerthElde, and attachedmamaof3. I did have a U/S at about 24 weeks and heard the heartbeat with a hand-held doppler every 2 weeks from about 24 to 36 weeks, when I quit with the OB. But I wish I hadn't had the scan or heard the heartbeat in that way. I now know you can hear the heartbeat in other ways, including even just using a toiletpaper roll!, and many studies question the safety of U/S technology. We're planning to have another baby in a few years, and if/when we do, we're doing a total UP--no U/S, no bloodwork, no other tests--and we're looking forward to the lack of stress!

[QueenOfThePride]

Originally Posted by applejuice

I believe sonograms/ultrasoundscans are dangerous and there is plenty of clinical data and scientific studies of the last forty years in the medical literature to prove that as a fact.

How is it dangerous? Like what kind of problems does it cause? A woman I know had twins a few months ago and one of them had to have surgery for a hernia. I just found out she was getting like weekly sonograms.

[applejuice]

There is plenty of evidence that ultrasound technology raises the temperature of the amniotic fluid that can result in birth defects and stillbirths. There is evidence that ultrasound can cause deafness and delays in development later in life. There are studies that are thirty years old that were done in Oxford and other reputiable locations. No one listens.

Time will tell. Of course, science will only allow us to know this when, as I said, another more ominous, and more dangerous technology is available to take its place. Remember that DES was given to millions of unsuspecting expectant mothers for over forty years without any scientific studies or evidence to show that it prevented miscarriages or improved pregnancy outcomes, yet now we have grandchildren of DES grandmothers, a third generation of a medical mistake. When are we going to learn that it is not nice to fool mother nature?

[Crunchie]

I am 23 weeks along and I have had 4 ultrasounds. The first was at 8 weeks because I was bleeding; the second was at 11 weeks as a follow-up to the first, just to make sure everything was still going OK. Both were with a mainstream OB practice, before I switched to a birth center/midwife practice. I don't regret either of those two, because I truly believe the stress of wondering if something was wrong was far more dangerous than the risks of the ultrasound itself (I'm totally type-A, completely neurotic...stress is disasterous for me!!). The third sonogram was a referal by my midwife to do "the 20-week" ultrasound. My midwives do not routinely order ultrasounds, but after the scares in the early part of my pregnancy, I thought it would be comforting. It turned out to be quite the opposite. : I really wished that I'd listened to my gut and skipped it.

This isn't scientific by any means (others have posted a ton of great information/studies, etc., so I dont need to go there!) but, for what it's worth....the first thing I noticed (during the 20 week ultrasound)was that my little guy did not like having his picture taken! I was so sad! It was so obvious he was stressed and upset--you could see it on his face, and in the way he moved, on the screen while I was having the ultrasound done! And he kicked and moved and flip-flopped for a long time afterwards--much harder than usual, and for longer. Then, a few days later, I got a call that I was being referred to a specialist for a Level-II ultrasound because they had seen something on his heart that they wanted to look into further. So of course I agreed to that one, too, because of the possibility that something was wrong. It turned out to be nothing, but the stress...wow. And I got the same reaction from my baby with the last ultrasound--he was obviously agitated.

I wouldn't do it again, unless I had a medical reason to do it. I feel so guilty...Like I said, I don't for the first two, I believe that they were medically necessary. But the last ones...never again!!