Standard of care: ultrasound at end of pregnancy because of "fluffiness"?

[mrsfatty]

I thought I had heard it all...

Now the NP at my OBGYN says I need an ultrasound because I'm "fluffy" (her words were, "because you're fluffy, and I'm putting that tactfully.": )...I don't think that is a good, nor a medical, reason to have an ultrasound.

She was competely irked I had asked, "why do I need this ultrasound? what would it change?"

She said that the current tools (measuring fundal height in cm, measuring weight, etc.) in the traditional standard of care weren't reliable or effective for me because i was too "fluffy." I was measuring right on with my OBGYN, then I saw the NP twice in a row...at 32 weeks I was measuring 34 cm, and at 34 weeks I was measuring 37 weeks. I'm not concerned.

I've gained 18 pounds this pregnancy so far.
My fundal height continues to increase in cms.
I am healthy (no PIH or any health problems).
My bps have been fine (no increases--stayed in the same range throughout entire pregnancy so far).
No protein or sugar in my urine.
Baby is moving great and has a great range of heartrate.

She continued on (because I said I didn't think that was a good reason to get an ultrasound--I would have one if there truly was a medical concern--being FAT is NOT one of them): your baby could be growing incorrectly (she said not enough growth, too much growth, or not symetrically: ), amniotic fluid could be "off" (too much or too little), and don't forget the placenta is an aging organ (I'm not concerned, baby is growing and moving and my bp has been fine)...and went on and on with, what I consider, scaremongering that had NO relation to MY pregnancy (I'm not having the symptoms or warning signs for any of those problems, nor did she say I had any of the warning signs for those problems--she just blurted out every "scary" thing to get me to agree to an ultrasound).

I've since cancelled the U/S appointment I was "forced" to make. I've cancelled all future appointments with this NP (I love my OBGYN--just can't put myself through that NP ever again).

So, is it new that the standard of care includes an u/s at the end of the pregnancy for all women (or just women who are fat, or what)?
Does being fat REALLY necessitate a late ultrasound?

[CMcC]

Oh, I'm so sorry that dr did that to you. Around here, they do tend to do late U/S on about all pregnant women. It's one of the ways they try to justify inducing early or schedualing a cesarean for whatever reason. But I totally agree with you. If you and the baby haven't had any kind of symptoms or complication, that U/S is totally unnecessary!

WTG for standing up for yourself and your baby!!!

[bryonyvaughn]

So I don't have such huge blocks of quotes...
MrsFatty said OB/GYN's office NP said all her signs are great *but* she's fat (gee, what an observant NP!) and there might be multiple undiagnosed bad things going on with the baby whose symptoms might cancel each other out (e.g. big baby w/ low fluids), hence the need for an U/S.

Originally Posted by mrsfatty

...I've since cancelled the U/S appointment I was "forced" to make. I've cancelled all future appointments with this NP (I love my OBGYN--just can't put myself through that NP ever again)...

Your NP is a fatphobic idiot. Fat bellies do not compromise placental function. Skinny chicks can have small babies with lots of fluids and big babies with very little fluids. Fat has nothing to do with it.

My personal gripe about most high-tech (and too many low-tech) birth practices is the "professionals" don't have a decent set of hands to palpate and interpret anything and so have to rely on U/S for everything. Their over-reliance on technology is just evidence of their pathetically lacking skill set. <rant over>

I think canceling all future appointments with said NP is evidence of your self respect and ability to draw and enforce healthy boundaries in your life. Good for you!

Originally Posted by mrsfatty

...So, is it new that the standard of care includes an u/s at the end of the pregnancy for all women (or just women who are fat, or what)?
Does being fat REALLY necessitate a late ultrasound?

I'll answer the easiest question first. Fat is not a medical indication for an U/S.

Standard of care, standard operating protocols, and medically indicated procedures can be radically different things. When I was seeking shadow care with my second UC, a midwifery practice wouldn't schedule me a "getting to know you" appointment because, when they asked about U/S, I said I'd only get medically indicated U/Ss. How's that for a discrepancy between SOP and medical indication?

According to the March of Dimes' list of medical reasons for an U/S, the only reason for U/S to monitor health in late pregnancy is if it's a high risk pregnancy. Examples given are diabetes, high blood pressure, evidence of IUGR... all things you don't have. Depending on your relationship with your OB, you might want to print out the list and give it to him/her when you explain being bullied into testing for non-medically indicated reasons is why you'll no longer see the NP during this pregnancy.

I wish you peace.

~BV

[pamamidwife]

darn, that's pretty sad. late fundal height measurements are NOT accurate and not something that I'd base my assessment of how a baby is doing on. I've heard of providers wanting an u/s for position of baby, but come on, if a provider is skilled enough they can figure it out!

I've had clients that were 300 lbs and I still can figure it out.

Tell her to toss that tape measure aside....I hope you can complain to your OB/GYN and he/she will be receptive to this fatphobia.

[Jane]

Sometimes I can't feel the position of the baby, but that has happened only with skinny moms so far. Concerns about growth, fluid levels, or amount of movement would be reasons to consider an u/s. But those are not problems associated with abdominal fat.

[turtlewomyn]

Good for you.
I consented to a "post dates" (i.e. 40w3d by their due date based on an early U/S, 39 weeks by my LMP) U/S to determine if "there is enough fluid in there" based on my CNM's recommendation. I too, was measuring big, I am only a little bit "fluffy", only slightly overweight, I had gained 30 pounds in the pregnancy (and "fluffy"? how condescending!). At the U/S my baby was measured to be 9lb10oz and I had an AFI of 25 (normal is considered 12-24). So, I was coerced into an unnecessary c-section for fetal macrosomia. I have recently forgiven myself for not knowing enough to turn down the ultrasound.

Thank goodness you turned down this unnecessary u/s. Good for you.

Stay away from that NP!