Help me convince my doc (and maybe myself) that I don't need a routine u/s

[Pam_and_Abigail]

I've pretty much decided not to have a routine u/s, which is set for Aug 25. At my last appt, I brought up the idea of not having one with my doc, and she highly recommended it, saying it was safe, and useful in detecting placenta previa (I asked for an example of something an u/s would make a difference for). Since then, I have been feeling like it's just not needed, and I want to learn more about the possible dangers. Also, I read that the placenta moves around, so even if previa was diagnosed at 20 weeks, by the time I give birth, it may not be a problem. Add to that that I have since discovered that a well-trained practitioner can diagnose the condition with outside palpitations, I just don't see the point in an u/s.
Can anyone point me to an article that I can take to my doc showing possible negative effects of u/s?
TIA

[Cyneburh]

Check http://www.midwiferytoday.com/search/default.asp?query=ultrasound

For me, the downsides medically of an ultrasound were small but I thought about my reaction to potential results...

U/S reports all well, it is: So why'd I need it then?
U/S reports all well, it isn't: I know that I'd be furious at the birth. Instead of focusing on my new child, I'd be focusing on my rage at whoever read the u/s wrong and told me that everything was OK.
U/S reports a problem, it's true: This is where the articles come in... I was suprised to find out that many of the babies who are diagnosed in the womb are born via c-section at 38 weeks (to have the surgical team all ready to go) but that the ones whose problems go undiagonosed are born vaginally at 39-42 weeks. Surgery is delayed by an average of 4 hours but the baby handles the surgery better because they have had longer to cook in the womb. Meanwhile, I've spent the later half of my pregnancy stressing out about the problem that my baby will be born with!
U/S reports a problem, it's wrong: So I just spent half my pregnancy stressing out for no reason??? Who do I need to go rant at because of this mistake...

I've found that without an U/S, I'm much calmer because I know that chances are very high that there is no problem with my child and I know that if there is a problem, there are very, very few cases where having had the u/s would have made a difference. Most cases, there is another problem that shows up that leads to the u/s being specifically reccomended and then the more serious problem is found. (Such as vaginal bleeding in the case of placenta previa). And I'm prepared for the potential of a defect that requires surgery without stressing about it.

[Kundalini-Mama]

Well in terms of placenta previa, are you and hubby having sex? Are you bleeding heavily after sex?

I had a low-lying placenta at 19w, evidenced by heavy bleeding after sex, and my MW wanted me to have an u/s b/c this is my 2nd child and the whole rhogam issue. Had an u/s and it was low-lying. So I got some rhogam.

I could be wrong, as I am not a medical professional, but I would think that if you are having sex and not bleeding afterwards, your placenta should be fine.

Instinctually, where do you think your placenta is?

I'm sure this u/s is to cover your dr.'s a**. Listen to your body, listen to your baby, and decide what you want to do :hug

Amy

[Marysmama]

If you do not want the ultrasound then don't have one. The American College of Obstetrics and Gynecology does not recommend routine ultrasounds for low-risk pregnancies. Plain and simple.

You shouldn't need a reason or have to convince your doctor of that. With my first pg, I had an early ultraound due to bleeding around 6 weeks. Anyhow, 17 weeks rolls around and she wants to do another ultrasound. I told her no thanks. She told me it would be for to check the anatomy etc. I still said no thanks. She finally was ok with it. I think docs get into a comfort zone and then someone comes along and throws them out of it.

I'm a little surprised one is already scheduled for you. Did you do that? Just call up and cancel it. Simple as that.

Just remember, these are not recommended by the ACOG at all. And if your doctor persists, seriously think about changing docs. I mean, if this is how she treats your opinion on something like a routine ultrasound, just think of how things might go down the road when things like induction might come up.

Good Luck, and don't sweat it.

[Pam_and_Abigail]

The u/s was scheduled after my last appt. I think I probably agreed to it, after she talked to me about placenta previa (I had only heard of it, so I planned on researching it later, and found out the above). I probably will cancel it, but I want to still discuss this with my doc. Incidentally, I am hoping to be switching my care to a mw soon, but I have heard that you still need a backup doc, esp. since here in Nova Scotia, midwives can't order any necessary tests or prescriptions.
As far as my placenta, at 10 weeks we searhced for the hb with a doppler and only found the placenta beat, and it was right in the front. I think it's still there, because I have alwyas been able to see and feel a very strong pulse (at my own heart rate) coming from the middles of my abdomen. No bleeding after sex. I'll check out the links, thanks!

[BlueMoonTime]

I don't have much information on the subject, but I do know that I'm rather paranoid about them for one very good reason: My parents worked in a hospital for many years (not as dr's or anything, but being around them certainly can give you a lot of information) and my mother told me that you shouldn't have any unneccessary us because the frequency of the monitor can hurt the baby's hearing.
Although... I had to have three us's with Andrew and his hearing is just fine.

[fourlittlebirds]

I'd ask your doctor to provide studies that have proven that ultrasound is safe.

Here's an article about ultrasound by a doctor, that may be helpful:

http://www.lotusbirth.com/doc/FEB2003Lotusbirth-108.htm

[TurboClaudia]

Re: placenta previa: From my reading, often times placenta previa will have visible symptoms such as bleeding that lead to further testing and the discovery of the previa. However, there apparently are some times when there are no or very minute symptoms of a previa. I was somewhat concerned with where my placenta was attached since I chose not to get an ultrasound for my low-risk pregnancy and planned homebirth, but our midwives told me they suspected my placenta was posterior (since I felt baby movements very easily) and higher up (since I also felt tickles on my cervix from baby). The kicks and pushes from the baby will tell you more about where the placenta is NOT.

Re: your physician's comments that it can diagnose a few things that can't be found out in other ways: This list is VERY short, and my thought process was if I were to find out something was potentially wrong with the baby during the pregnancy, it would worry me and concern me and cause me to not revel in the pregnancy and the mystery of the baby. On the other hand, if we found out at birth or soon thereafter that something was wrong with the baby, we felt that we would feel competent to make appropriate care decisions at THAT time. If I had indeed had a placenta previa come labor time, it would have been very obvious from early labor bleeding and we would have gone to the hospital immediately. The only other thing that would have justified a surgical birth in the hospital for me would be a prolapsed cord, which is usually a positional occurrence (baby not engaged when bag of waters breaks and mama is not upright at the time, allowing the cord to slip down).

And ACOG guidelines don't recommend routine ultrasound for low-risk pregnancies, it's true. Sounds like your physician is trying to play the scare-the-patient-into-compliance-so-my-doctor-a**-is-covered game... *sigh*

warmly,
claudia

[Pam_and_Abigail]

I wonder what the Canadian equivalent (if there is one) is of the ACOG? Maybe she follows them? I may have forgot to mention that I'm in Canada. Not that that changes the risks, but it might change where my doc is coming from. I've always thought she was pretty good, I've only been seeing her since this year, but got the recommendation from a LLL friend and a fellow MDC mom. I also just now got an email from the mw I'm considering about setting up an initial meeting sometime soon. I guess I'm thinking if I can tell her I'm switching care providers for the pg, she won't have me cornered into doing it. Of course I want to stay on good terms with her. I think she'll back off if I insist this is my choice.

[Brisen]

There is a Canadian equivalent -- I believe it's the CCOG. I don't know what their recommendation is, though. I'm in Ontario, so things may be different here, and for sure the mw situation is different, but I have had no pressure to have an u/s this time around. (Had them with #1 and #2.) Granted, when I originally declined it, I said I was open to having one if a need was indicated. The impression I get generally is that fewer u/s are done in Canada (or maybe just Ontario) than in the states, but that might have more to do with gov't funded health care than the CCOG's opinion of the safety of u/s.

What it comes down to for me is that I haven't found convincing information that the safety of u/s has been well researched, but I have read articles discussing its risks. It just makes me think of how often the medical community thinks that a certain procedure or drug is safe and wonderful, and then 5, 10, 20 years down the road they found out no, it's just that they couldn't tell right away that it was dangerous. Also, I'm low risk for everything, so that helps. And I like to think of it this way (my mw pointed it out about breech births): if everyone relies on technology, then no one has to practise other skills. Like learning to use a fetoscope well, for instance.

[Houdini]

Just wanted to offer my personal experience. I had two u/s with my second pregnancy. My son was born with no problems. With pregnancy number three I had a routine u/s at 24 weeks. The u/s showed several areas of concern. The biggest being low amniotic fluid (turned out to be ok) and they couldn't visualize my daughter's stomach. I was sent for another u/s at a specialists office. My daughter was diagnosed with jejunal atresia (part of her intestine was blocked and causing the intestine to expand b/c nothing could pass through). I had several u/s after this one to measure the amount of distention (expansion). The intestine could not get distended past a certain amount or we would risk rupture. She was delivered at 35 weeks and taken immediately to a Children's Hospital for surgery (about 2 hrs old). The prediagnosis via the u/s saved her life. She would not have survived to 40 weeks. The delivery was done at 35 weeks b/c the intestine would have ruptured within a day or two. The prediagnosis also gave us the opportunity to find the surgeon we wanted and be familair with the surgery she would require. We also got to choose the hospital and I got to tour the NICU (she was there for a month) and see the different things they would be using with her (ventilator - help her lungs rest after surgery, not b/c of early birth and the various wires she would have). This was invaluable for me b/c I was unable to be with her for three days and I felt more able to deal with it b/c I had chosen the hospital and surgeon and was aware with what would be happening to her. I also had multiple u/s with pregnancy number four to rule out the same problems my daughter had. My son was born with an incomplete unilateral cleft lip (not diagnosed by u/s - too minor). Pregnancy number five. Multiple u/s with him as well to rule out jejunal atresia and to check about cleft lip/palate. My son was born diagnosed with unilateral cleft lip and possible cleft palate with the u/s. This gave us time to research and prepare our older kids for what the new baby may look like. Nicholas was born with complete unilateral cleft lip and complete cleft palate. When our kids saw him the first time they didn't even ask about his cleft b/c they were already prepared for what he would look like. I already had the surgeon in place (b/c of my other cleft baby), but this time I had a lactation consultant on hand as well to see if he could nurse. Sorry this is so long. I was grateful for the forewarning to prepare for everything we had to deal with. I am the type of person who doesn't like surprises of this magnitude. If I had not known prior to the births, I would not have had a choice in my daughter's surgeon or where what hospital she went too. I just wanted to share my stories with you. Congrats on your new baby and enjoy. BTW none of my kids have a hearing issue even with all the u/s.

[Pam_and_Abigail]

I just wanted to pipe back in with another question. Dh's sister is a nurse in the neonatal intensive care unit in a hospital out west. She was concerned about us not having an u/s because of these three things:
diaphragmatic hernia,
gastroschisis,
and heart abnormalities.

Now, in all the things I have read about ultrasounds, these have never been mentioned, but we told her we'd look into it, and she said she'd send us some information. I'm guessing they're pretty rare, and in her job she sees more than her share of problems.
Anyway, I just wanted to see if anyone here knows anything about these things, and what the chances are of my baby having them. I feel more able to trust information I get from MDC than just searching on my own or hearing from other sources. Tomorrow I go to my doc, and I am pretty sure I'll be telling her we aren't doing it. I haven't actually cancelled yet, and the u/s is scheduled for next wednesday. Going to print off some articles for tomorrow.

Thanks!

[gottaknit]

I had a routine U/S, and while it was neat to take home pictures of the baby, I didn't see much point to it other than that. They tried to guess the due date by the size of the fetus, which is irrelevant because I know when I conceived and due dates are a bit arbitrary anyway.

I don't think I would have an u/s again, unless there's something specific that needs to be checked out.

However, the story about jejunal atresia is a bit frightening. I imagine this is a fairly rare occurance though...?

[Houdini]

I really am not sure the statistics for jejunal atresia. I never really looked into. I do know that it was a normal pregnancy will no indications of a problem. The u/s was the only way to see this happening. It may very well be rare for this to occur, but why risk your baby. It can happen even in normal low/no risk pregnancies and the u/s could save your baby.

[Mizelenius]

Thanks for this, ladies! I only had one u/s with DD, and that was fine . . .today the nurse said she wants to schedule ultrasoundS (and I'm only FOUR weeks at this point) even though I have no problems, knock on wood. I was tempted to go along with them, but really, why? I'll have the later one, but not multiple ones unless something big happens.

[Pam_and_Abigail]

Dh was ok with no u/s till now, and here's his point:
no u/s might be ok with a hospital birth, but with a homebrth, if something is wrong and we don't find out till then, we're not right there. I don't know what to do now. I was all prepared to tell the doc we weren't going to, but, now he wants to...

[Pam_and_Abigail]

My doc was fine with my decision ("It's up to you"), but she was still concerned that previa can exist with no other symptoms such as bleeding, and she sontradicted my claims about ACOG not recommending u/s, she said they do, as far as she knows., but she seemed willing to concede she could be wrong on this point(I really do like this doc). Her concern was if I had previa, didn't bleed, and didn't find out till labour at home, baby and I would be in danger. She also said outside palpitations can only tell that the placenta is in front. I still think it is in front, but despit that can feel movemetn, and started feeling it at 15 1/2 weeks. There's just a really strong, visible pulse coming from my abdomen. I also read in one of the links above about a study in Finland where they looked at 4000 women, 250 of which had previa, but by labour time only 4 had it, and there was another who had it, but hadn't been prev. diagnosed. I just don't know what to think. I wish I could be more in tune with my body.
DH is still not convinced about skipping the u/s, he said last night that maybe the fact that we're having a hb makes us high risk???
Here's his argument, can you help me counter it?
Babies with complications (previa, congenital defects, etc) are shown to have no better outcome when their condition has been prediagnosed by u/s versus finding out about it during labour. He says this is because those babies are in the hospital, so as soon as they do find out, they are attending to immediately, whereas in a hb, we'd have to get to the hospital first. I don't know what to say to him, but that I don't see hb makes us high-risk. I am sure there are lots of hb'ers who didn't have the u/s, and all was fine.

Anyway, thanks all of you for your advice, and thanks for helping us work through this decision.

[Asheville Mama]

I have read quite a lot of information on ultrasound and I feel strongly that routine u/s is unecessary and risky. The placenta previa is often misdiagnosed (4 actual out of 250 diagnosed! Sarri-Kemppainen et al., 1990)along with many other conditions. I've read numberous articles about deformaties that were misdiagnosed with the recommendation of termination only for the baby to be born normal. The main issues as far as risks are increased miscarriages (Saari-Kemppainen et al., 1990), double the PTL (Lorenz et al., 1990), hearing loss, delayed speech, dyslexia (Stark et al., 1984). A great overview article is at
http://www.midwiferytoday.com/articles/ultrasound.asp

The most convincing thing I've seen is a video clip that actually shows the changes at the cellular level after u/s. It's scary to think that we are altering our children's cellular information without knowing the outcomes. :eek

I had a homebirth with no u/s and had a perfect outcome, and I'm planning the same for the baby I'm expecting 1/1/05.
Good luck with talking with your dh and with your birth!

[puddinnpeanut]

Well I just cancelled my ultrasound yesterday and the reaction from the girl on the phone was rather comical!:LOL I said I'd like to cancel my ultrasound for tomorrow and she said okay and when would you like to reschedule and I said I would not be rescheduling. She then said are you pregnant? and I said oh yes 10 weeks and I just heard the heartbeat! She could not imagine ANY pregnant woman would refuse an ultrasound!
That being said I have to say I really have enjoyed my past ultrasounds, just because I loved being able to "see" my baby for the first time! I thought it was amazing! However this time due to our expensive new insurance plan and the fact that I don't want to subject my developing baby to unnecessary cellular damage when they are still forming we will be forgoing this early ultrsound and hopefully only have one at around 20 weeks just to assure everyone!
I actually had six ultrasounds for dd, due to preterm labor/birth and then two ultasounds for ds, hopefully only one this time around! Good luck to you in all your pregnancy decisions, so many things to consider!:raz