ultrasounds

[desertpenguin]

this pregnancy i had decided that i wasn't going to have an ultrasound unless i had any reasons (such as unexplained bleeding, measuring very large for dates, etc) that would call for one. i have researched some the possible risks of u/s and i don't think that they are routinely necessary. however, at my last midwife's appt the midwife i saw this time said basically that she would feel safer attending my birth if i had had an u/s to make sure there is no placenta previa. i told her i would do some more research and if we decided it was better to do an u/s that we would wait until at least 32 weeks to have it done.

i have already done a little bit of research and what i have come up with is that the prevalence of placenta previa is 0.5% or 1 in 200 women, and the risks of having asymptomatic placenta previa is only 2% of that 0.5%. i have also read that when the woman goes into labor and has placenta previa it can usually be distinguished by gushes/spurts of dark red blood. the midwife voiced her concern to me that if a woman was in labor and having a little more bleeding than is normal with typical "show" and the woman hadn't had an u/s ruling out placenta previa that this would mean an automatic hospital transfer. if an u/s had already ruled out placenta previa then she would take a watch and wait approach. my concern is that asymptomatic placenta previa doesn't seem common enough to warrant me having an u/s, but now i feel almost like i'm kinda being scared into thinking i should get one "to be on the safe side."

thoughts anyone?

[desertpenguin]

p.s. i don't have any risk factors from my understanding that would indicate an increased risk for placenta previa other than i have already had a child. no previous c-sections or uterine scarring from abortion or anything else, i'm 21, don't think i'm pregnant with multiples and so on...

[sadiejane08]

My opinion is biased by my current experience of vasa previa, which is an often fatal complication during vaginal delivery that can only be antenatally detected by u/s (preferably color Doppler). VP involves fetal blood vessels that lie in front of the cervix and can rupture during labor. It can be a consequence of a low-lying placenta or placenta previa that resolves, and there are certain other risk factors that make it more likely: IVF, previous abortion / uterine scarring, and so forth (none of which it sounds like you have).

Knowing what I know now, I'd always have an u/s between 20 and 30 weeks to rule out VP, so I would recommend it to you too . It's a rare complication, but so easy to 'treat' and so likely fatal to an otherwise healthy baby if undetected it seems worth it to me to rule it out.

The problem with VP is that by the time you see more blood than is normal, the baby is in dire straits or perhaps already expired. It can go so quickly, literally in minutes.

[JavaFinch]

I have marginal placenta previa and haven't had any spotting at all - I will be 35 weeks on Monday. I think one ultrasound at about 30 weeks or something just to quickly check placenta is not going to harm your baby at all. I'd be more worried about frequent ultrasounds in the first trimester.

[wannabe]

How does the risk of asymptomatic praevia compare with the risk of ultrasound? Both the rates and the outcomes?

Personally, with a small risk of something that could kill compared to a risk so low it's unquantified of an outcome so minor it's also unquantified I choose the miniscule risk of minuscule harm.

[Shanana]

My mw is comfortable attending my birth without me having an u/s, and I'm comfortable with it too.

I don't feel that I'm able to answer your questions about asymptomatic placenta previa, though. Perhaps you should post over in the birth professionals forum, and see what they have to say there. I imagine you would get some good feedback.

[desertpenguin]

thanks for the replies so far. Shanana, i will take your advice and post in the Birth Professionals forum.

[txdancer]

I think in this istuation what you need to look at are all the possibilites. What I mean by this is what will happen if you choose to or not to have the ultrasound.

1. You have the ultrasound, you're mw is happy but you aren't. Can you live with this?

2. You don't have an ultrasound. Does your mw decide not to work your birth? Does she work your birth, but transfer you very quickly for even the smallest bad sign? Are there other options for mw's? Could you do uc?

[SublimeBirthGirl]

I know that I would not have an u/s, nor would I use a midwife who recommended routine u/s. You're the only one who can decide what's right for you. In my UC pregnancy, I saw a HB midwife for a couple of prenatals, before I decided to UC. I'd decided NO u/s, including the doppler. I was somewhere around 12 weeks when I had my 1st prenatal. I waivered a bit on the doppler-I was like, well, it would be nice to hear the baby and she reinforced my initial preference, telling me, basically, I should do what I was comfortable with. I like that attitude-she's told you why she likes them, now you decide. If your midwife is bringing fear to your birth, I'd say that's not a good thing.

[kerikadi]

I wouldn't do it personally for all the reasons you have researched.

I did have a U/S during my last pregnancy but only after heavy bleeding (no previa).

Three homebirths under my belt and my MW never suggested U/S without medical cause.

[desertpenguin]

Originally Posted by txdancer

I think in this istuation what you need to look at are all the possibilites. What I mean by this is what will happen if you choose to or not to have the ultrasound.

1. You have the ultrasound, you're mw is happy but you aren't. Can you live with this?

2. You don't have an ultrasound. Does your mw decide not to work your birth? Does she work your birth, but transfer you very quickly for even the smallest bad sign? Are there other options for mw's? Could you do uc?

those are definitely all factors to keep in mind. i have decided i will not commit myself nor rule out the possibility of having an u/s between 32 and 35 weeks. i'm going to a midwifery practice (so i'm seeing 3 midwives, instead of just 1, which does complicate things a bit) but they wouldn't refuse to attend my birth unless i had specific risks that popped up that they feel are outside the scope of their practice and would be safest at the hospital. i'm mostly concerned about the quick fly-by-the-seat-of-your-pants transfer, which is why i have decided to not rule out having an u/s..but i want to go with my intuition on this one. right now i don't have any true worries about anything going wrong and i honestly think that this labor will go too quickly for much chance of anything going wrong. with my son i was dilated to 5 cm within 2 hours of nearly painless contractions and it was only after i went to the hospital that my labor slowed down drastically. i think if i had stayed at home he would've been born in 4-5 hours instead of the 12 hours it took at the hospital.

there is another midwifery practice i know of but i have met the midwives previously and didn't feel comfortable with them. i think if it came down to it i could do u/c but i would rather it not be a last minute thing because the midwife wants me to transfer when i see no immediate need to...but i haven't ruled out having an "oops, the baby is here" either, depending on how fast my labor progresses.

[desertpenguin]

Originally Posted by SublimeBirthGirl

I know that I would not have an u/s, nor would I use a midwife who recommended routine u/s. You're the only one who can decide what's right for you. In my UC pregnancy, I saw a HB midwife for a couple of prenatals, before I decided to UC. I'd decided NO u/s, including the doppler. I was somewhere around 12 weeks when I had my 1st prenatal. I waivered a bit on the doppler-I was like, well, it would be nice to hear the baby and she reinforced my initial preference, telling me, basically, I should do what I was comfortable with. I like that attitude-she's told you why she likes them, now you decide. If your midwife is bringing fear to your birth, I'd say that's not a good thing.

after doing more research i have decided i will tell them i no longer wish to use the doppler because i found out that it's far more powerful than imaging ultrasound. freaky, and no wonder the baby runs away from it all the time! i am going to request that they use a fetoscope from now on.

[Shanana]

Originally Posted by desertpenguin

after doing more research i have decided i will tell them i no longer wish to use the doppler because i found out that it's far more powerful than imaging ultrasound. freaky, and no wonder the baby runs away from it all the time! i am going to request that they use a fetoscope from now on.

That's why we are using the fetoscope this time.

I wanted to mention that my mw said sometimes you can find the location of the placenta by listening for the mother's heartbeat. I think it's only if you have an anterior placenta, though, but it might not hurt to try. If yours happens to be anterior, and they can find it by listening for your hb, then they should be able to determine if it's low-lying or not. HTH!

[alegna]

Originally Posted by SublimeBirthGirl

I know that I would not have an u/s, nor would I use a midwife who recommended routine u/s. You're the only one who can decide what's right for you. In my UC pregnancy, I saw a HB midwife for a couple of prenatals, before I decided to UC. I'd decided NO u/s, including the doppler. I was somewhere around 12 weeks when I had my 1st prenatal. I waivered a bit on the doppler-I was like, well, it would be nice to hear the baby and she reinforced my initial preference, telling me, basically, I should do what I was comfortable with. I like that attitude-she's told you why she likes them, now you decide. If your midwife is bringing fear to your birth, I'd say that's not a good thing.

:

We don't use doppler without reason and we don't use u/s without reason. I would not be comfortable with a midwife who was UNcomfortable with that.

-Angela