Reasons to get 18 week US - Mothering Forums
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#1 of 31 Old 04-29-2010, 07:17 PM - Thread Starter
 
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I'm thinking of scrapping the 18 wk US simply because it costs $250 and I don't care about gender.

Can you give me some reasons why I would really need it? I'm VBAC w/ midwife.
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#2 of 31 Old 04-29-2010, 07:27 PM
 
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well my midwife requires it... but I am doing a homebirth Im not sure it would be required if I were in hospital.

We want to make sure there are no obvious issues that need to be addressed as of the birth that would risk me out of a homebirth (serious heart problems or spina bifida for example, neither of which I have any family history of but they can also just randomly show up in a healthy pregnancy so we want to rule it out) to make sure all organs are developed as they should and functioning as they should... and to completely rule out placenta previa (if its nowhere near the cervix we wont bother checking again. if it is, we will probably check again later on to confirm that it has moved up.)

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#3 of 31 Old 04-29-2010, 09:12 PM
 
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We are not finding out sex but we did the 20 week to rule out an potential issues that might want us to have a hospital birth. Of course, not everything can/will be caught, but since we are planning to birth out of the hospital, I feel better having that reassurance that things look good! I also had partial placenta previa with DS, that did resolve itself by 32 weeks, but I wanted that reassurance as well!

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#4 of 31 Old 04-29-2010, 11:13 PM
 
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I had my 20 week u/s not because I wanted to check for gender, but just to be sure there are no serious developmental abnormalities, like heart defects or spinia bifidia, that would lead me to birth at the hospital in the area with a NICU rather than the homebirth I had planned, or the transfer to the nearest hospital (no NICU) that would likely occur if I had issues during my homebirth. I also have a family history of twins and triplets, so I like to rule that out for sure, and I find comfort in knowing where the placenta is sitting. That being said, I think if you are planning a hospital birth already, at a facility with a NICU, then you most likely could skip the u/s and be fine no matter what happens.

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#5 of 31 Old 04-29-2010, 11:18 PM
 
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I skipped the 12 week ultrasound but I did go to my 20 week. My friend who was an OB/GYN suggested that the 20 week ultrasound was the one to go to as it can pick up the most abnormalities.
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#6 of 31 Old 04-29-2010, 11:35 PM
 
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We are an HBAC too, and just got our second trimester u/s. We did to make sure the palcenta was not previa (which is slightly more common after a previous CS) and to rule out anything that would make it too risky to HB, like heart defects, etc, or other things that I would more so want a medical team, NICU, etc there.

A U/S is good at identifying these abnormalities if it is done by the correct person. OBs tend to not find as much as often compared to sonographers, or perinatal specialists, so we went through one of them.

Our MW said if it was her, she wouldn't get one, but if it set my mind at peace to go for it. We paid just a copay for the visit, but if it was more than that (which we thought at one point) we wouldn't have done it.

Most things can be found out (as long as your CP is trained and skilled) by fundal height, fetal heart tones, and other stuff.

And no major organization (ACOG, NIH, WHO, etc) all say that u/s should not be done routinely, and only when medically indicated, like bleeding, funny heart tones, funny measurements, history of defects, etc.
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#7 of 31 Old 04-30-2010, 12:50 AM
 
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Well I found out at my 20 week u/s that baby #4 was really babies #4 & #5. So that changed my birth plan completely since my midwife is not personally comfortable with breech deliveries I had to find a new provider. Also we found out that both babies have excessive amounts of fluid, something that we have had to monitor a little more than you usually would during pregnancy. An I agree that there are a lot of physical or developmental problems that can be discovered at a 20 week u/s that could drastically impact where you birth.


And I wasn't measuring ahead at all at 20 weeks and midwife never heard a second heart beat so a total surprise.

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#8 of 31 Old 04-30-2010, 01:01 AM
 
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We chose to have the 18-20 week USS as we live in a regional area with a NICU but no neonatal surgery capacity. We wanted to know if there was anything that would require urgent surgery as we would have chosen to birth in a city with surgical facilities in that case.

Before deciding to have it I did the research on the things which can be picked up and the rates at which they're detected. For us, the stats were good enough to make it worthwhile.

We also found out the sex but that was just a bonus and not the reason for having the scan

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#9 of 31 Old 04-30-2010, 03:31 AM
 
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We don't find out gender, but we do the mid-term u/s for many of the reasons stated above. I also have a minor spina bifida (occulta), which doesn't cause me any major problems but might mean my children are at higher risk.

My MW doesn't recommend u/s before 18 weeks, but doesn't discourage it after that point in the family desires it. We have a tradition of getting a video of the u/s and, of course, pictures, which I think help everyone bond.

And, of course, if there were major issues we'd want to know ahead of time, either to be able to address them in utero (if applicable) or prepare to handle them at the time of birth. Honestly, there would not be many things that would make me change my PLACE of birth, but there are a few.

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#10 of 31 Old 04-30-2010, 09:58 AM - Thread Starter
 
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Yes, the question I still have is what the birth center does if the baby has serious complications after birth. We're close to hospitals so I'm not that worried about a transfer.
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#11 of 31 Old 04-30-2010, 11:06 AM
 
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Originally Posted by mizznicole View Post
Yes, the question I still have is what the birth center does if the baby has serious complications after birth. We're close to hospitals so I'm not that worried about a transfer.
there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.

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#12 of 31 Old 04-30-2010, 11:12 AM
 
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#13 of 31 Old 04-30-2010, 11:23 AM
 
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Originally Posted by klocke View Post
And I wasn't measuring ahead at all at 20 weeks and midwife never heard a second heart beat so a total surprise.
I'm a surprise twin. Of course, this was 40+ years ago and way before routine u/s - they didn't find out until I was born!

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Originally Posted by CorasMama View Post
there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.
I know a lot of people think of the 18/20 week scan as "the gender scan", but it's really "the anatomy scan". We are planning one to rule out placenta previa or any fetal conditions that would warrant a hospital birth. I have never had a section, but IIRC, placenta accreta is a potential problem with post-surgical pregnancies and something you might want to rule out.

FWIW, I'm pretty sure my CPMs can attend a homebirth for twins, Downs, cleft pallette, and a few other conditions, so there are very few and rare things that would cause us to transfer.

That said, it's still a very personal decision. If you are comfortable with skipping it, then you should. For me personally, the peace of mind is worth $250.

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#14 of 31 Old 04-30-2010, 02:47 PM
 
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I would get one to rule out heart defects and other abnormalities. We were stunned when we found out with our first child that he had a life-threatening heart defect. Especially when there was no sort of family history and anything to indicate that we would be at risk for that.

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#15 of 31 Old 04-30-2010, 03:08 PM
 
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Like someone mentioned, fetal abnormalities aren't always as simple as transferring to the hospital. There are some that rule out vaginal birth, for instance, or would require immediate attention that would not be possible if you had to transfer. Also, as a vbac mom myself, I like to know for sure nothing wonky is going on with my placenta.

Finding out the sex is just a nice bonus
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#16 of 31 Old 05-01-2010, 11:42 PM - Thread Starter
 
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there are some conditions that warrant birthing in a hospital, regardless of how close to a hospital your birthing center is, or even changing the mode of birth. It doesn't hurt to rule them out.
Then I'm surprised that it isn't a requirement to have one at the birth center. Seems like it would place a huge liability on them. What conditions, for example, would warrant hospital birth?

I'm paying for the whole birth out of pocket, which is why limiting costs within reason is a huge factor for me. Thanks for the replies so far.
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#17 of 31 Old 05-02-2010, 01:07 AM
 
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The things I think of are ones where organs are developing outside of the body cavity. That would almost certainly rule out a vaginal birth and would require prompt attention.

I have heard wonderful stories of babies with heart issues who were likely *saved* by being in the calm, responsive environment at home, so heart issues are not my worry. But any major, serious, crazy defect is one to think about.

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#18 of 31 Old 05-02-2010, 04:58 AM
 
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Then I'm surprised that it isn't a requirement to have one at the birth center. Seems like it would place a huge liability on them. What conditions, for example, would warrant hospital birth?
there are quite a number of said conditions. For only one example, see my signature. A vaginal birth could seriously decrease her chances of making it. There are other conditions for which a vaginal birth would stress the baby too much. While that might be caught by intermittent monitoring at a birth center, and you could initiate a transfer, what if you labor really really fast (like I do), and also a planned c-section is much, much easier to do and recover from than an unplanned one. There are also heart conditions that really do require immediate (not 5 minutes away, but immediate) help, the kind a birth center can't give.

Also, being five minutes from a hospital isn't the same thing as being five minutes from realizing the baby needs assistance to the baby getting assistance.

One more thing. There is a HUGE benefit to being prepared for health issues in your baby. There are many conditions that pre-planning is extraordinarily helpful. We already know, as much as we can, what to prepare our family for. We have been able to warn DH's employer, prepare and pack for a c-section recovery and NICU stay, meet with surgeons (including the man who pioneered the procedure that took the survival rate for giant omphaloceles from 50% to 90%), make informed decisions about where and to whom to go for care, make arrangements for care for my older daughter, get some counseling, speak to other parents with Giant O babies, know what kinds of baby gear we will and won't need, prepare for c-section and recovery, and that's just all I can list off the top of my head. Yes, I'm spending this pregnancy worrying, but that's better than having to process this all totally fresh while dealing with a medically fragile baby, or worse, not having prepared, and not having a good outcome. And if she didn't have any problems, there would be the relief of knowing fairly confidently that we were, in all likelihood, going to have a normal, natural, great birth at the birth center.

I'm all about having a natural pregnancy and birth. Really, I am. But since we have available the ability to minimize the risks of any kind of birth, natural or otherwise, it isn't unwise to avail ourselves of non-invasive stuff like ultrasounds. And if you choose not to, and that's your choice, you just can't say, well, I'm trusting (birth/pregnancy/my body) so everything will be fine. If you feel comfortable with risk, then take the risk. It isn't that big a risk, statistically. But what you can't do is say that because it's a small statistical risk, it'll still be fine if you come out on the other side of the statistics. If you want to take the risk, just own that.

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#19 of 31 Old 05-02-2010, 06:16 AM
 
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I'm thinking of scrapping the 18 wk US simply because it costs $250 and I don't care about gender.

Can you give me some reasons why I would really need it? I'm VBAC w/ midwife.
I know you're asking for reasons you might NEED it, but I think it's more of a question of whether you WANT it. I think you could ask your midwife about some of the scenarios in this thread and how she would respond to them and if there is some other way of detecting them without an U/S. An U/S is just a tool that can be used or not. I only had one with my 1st at 30 weeks and he was all squished in there and I could hardly see him and definitely didn't get to see if he was a boy or girl. Ha! So i didn't make the effort to have one with the next two although I did make an appointment for a Biophysical Profile because I was 42 weeks. I was set on missing that appointment and had her the night before.
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#20 of 31 Old 05-02-2010, 11:29 AM
 
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It's not something you have to have. Yes there are some conditions that would make birthing in a hospital the better choice and others that would rule out a VBAC, but in all honesty those are quite rare. I only had the anatomy scan with my first child, not the second or third, and I do not plan it with this child either.

My first two daughters were footling breeches, and while some folks will birth them vaginally, there was no way I was letting the people at the Navy hospital where I birthed them experiment on me. Having an ultrasound that showed my first daughter to be breech (she was, at the time, transverse) didn't prevent me from undergoing an unsuccessful induction--even though I dutifully reported to everybody that the baby was breech, no one believed me. Likewise, not having an ultrasound with my second daughter didn't impact the birth at all, because that time they did believe that she was breech presentation. Same story with my third daughter, my VBA2C baby. No ultrasound, baby head down (which is obvious, frankly--you can tell whether it's a head or a foot down there), everything came out fine.

For a healthy woman and a heretofore healthy pregnancy, the chances of some giant problem that would prevent your planned birth and shoot you into ZOMG SURGI-BIRTH territory are pretty darned slim.

(On a side note, having been on this site nearly nine years, I don't think I will ever adjust to ultrasounds going from "have them only if you absolutely have to, as their safety isn't adequately proven" to "have 'em as often as you can, because something might be horribly wrong!")

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#21 of 31 Old 05-02-2010, 01:52 PM
 
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Then I'm surprised that it isn't a requirement to have one at the birth center. Seems like it would place a huge liability on them.
The chance of finding something that would truly be problematic for a home/birth center birth is much, much smaller than the risk of finding something that looks like it might be wrong and turns out to be just fine. More babies die from unnecessary interventions caused by something being seen on ultrasounds than from undiagnosed conditions from not having ultrasounds. I have not had any ultrasounds with my first nor with this pregnancy and my midwife agrees that there is no evidence to support routine ultrasounds.

If you worry about the birth center's liability, perhaps you should consider what would happen if the ultrasound showed something wrong. They might have to transfer your care to an OB and a hospital birth for something that is not a real danger.

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#22 of 31 Old 05-02-2010, 02:20 PM
 
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#23 of 31 Old 05-02-2010, 03:03 PM
 
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More babies die from unnecessary interventions caused by something being seen on ultrasounds than from undiagnosed conditions from not having ultrasounds.
While I agree that U/S should never be done "routinely" and all the major medical orgs. agree with us, can you show me some statistics on this? I'm curious. I can see how more babies have major health problems due to ECS in something that wasn't a cause for concern/"false positive" on the U/S, but death, I'm not to clear on. Email me if you don't want to post here, I would really like to see more info on this.
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While I agree that U/S should never be done "routinely" and all the major medical orgs. agree with us, can you show me some statistics on this? I'm curious. I can see how more babies have major health problems due to ECS in something that wasn't a cause for concern/"false positive" on the U/S, but death, I'm not to clear on. Email me if you don't want to post here, I would really like to see more info on this.
I don't believe she is saying that the ultrasound directly caused a death. It's the intervention cascade that can begin with seeing something "wrong" on an ultrasound. I have a friend whose baby showed an abnormally large stomach on the ultrasound and she was concerned because she's "mature" and that could indicate Down Syndrome or other issues that would need to be addressed immediately at the time of birth. She went back for another U/S two weeks later and baby looked just fine. Or there are moms who are told their baby is waaaaaaay too big to birth vaginally and therefore they schedule a c-section which is a major surgery and does carry the risk of death.
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#25 of 31 Old 05-02-2010, 05:10 PM
 
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It's not something you have to have.
(On a side note, having been on this site nearly nine years, I don't think I will ever adjust to ultrasounds going from "have them only if you absolutely have to, as their safety isn't adequately proven" to "have 'em as often as you can, because something might be horribly wrong!")
I don't think you should have a ton of ultrasounds, or even "as often as you can," but there are a couple of conditions that warrant immediate care by trained natal specialists, and some that do mean c-section is safer. Yes, those conditions are rare! And yes, some of those conditions, like transverse presentation and placenta previa can be detected by a skilled midwife without an ultrasound. But I honestly do not think that all MW are created equal. I love my MW, but I find seeing and measuring the location of my placenta via u/s to be a fairly safe, non-invasive, and easy procedure that helps prevent major risks.

That being said, a good friend of mine birthed a baby with a heart defect that needed immediate open heart surgery. They actually went from birth, to airlifting the infant to a different hospital, to surgery within about 4 hours. That defect was NOT seen on her 19 week u/s. So u/s is not a sure fire screening for all issues. Like most medical tests, it is excellent at detecting the very rare, major issues, and okay at detecting the more common, subtle yet still serious health issues.

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#26 of 31 Old 05-02-2010, 05:36 PM
 
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Nope, not really. An u/s at 18 weeks won't be able to tell you if you'd rupture or not, which is really the only slightly miniscule higher risk a VBAC has compared to others. Even ACOG doesn't recommend routine u/s, even though just about every OB in the country ignores that recommendation.

I do homebirths and don't feel a need for a "security" u/s. Just my $.02.

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Baby wouldn't move into position to get a good view of her heart at the 20 week u/s so I had to return at 23 weeks and they discovered that I had lost my mucus plug & begun to dilate. I was wheeled from the doc appt to the hospital and had an emergency cerclage that probably saved my pregnancy.

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#28 of 31 Old 05-02-2010, 10:57 PM
 
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I think most pregnancies and babies get along fine without an u/s. That said, if you're a worrier, for whatever reason, I think the u/s is a worthwhile step just for peace of mind.

In my first pregnancy, the mid-term anatomy scan showed tumors on baby B's heart. A few weeks later, they showed up on baby A's heart, too. Because of that, we suspected a certain genetic disorder. We were able to meet with doctors and prepare ourselves (as much as you can) for having children with this disorder. It's not something we expected....dh and I are not carriers. We were able to have a natural hospital birth, but NICU staff and cardiologists were standing by at the birth to make sure everything was okay. I am so thankful for that.

With the second and third pregnancies, we did a mid-term anatomy scan just for peace of mind, and to make sure the babies didn't have the same genetic disorder (long story short, even if dh or I aren't carriers, we have an increased risk of having a child with the disorder). The peace of mind is really, really valuable....for stress levels, for bonding, for anticipation, for everything.

So yeah...for me the 20-wk ultrasounds have been really important. In the first one they found a life-threatening heart defect, and in the second and third pregnancies it was the u/s that let me relax and enjoy the pregnancy more.

Best of luck in your decision!

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#29 of 31 Old 05-03-2010, 11:39 AM
 
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Originally Posted by lunarlady View Post

That being said, a good friend of mine birthed a baby with a heart defect that needed immediate open heart surgery. They actually went from birth, to airlifting the infant to a different hospital, to surgery within about 4 hours. That defect was NOT seen on her 19 week u/s. So u/s is not a sure fire screening for all issues. Like most medical tests, it is excellent at detecting the very rare, major issues, and okay at detecting the more common, subtle yet still serious health issues.
This is my tiff, some women are getting u/s by their OBs who are not trained (and I'm not sure any OB is, because that is not in their schooling, and if it was, it's not something they typically specialize in) to do U/S, so they miss things that ARE there, and identify things that ARE NOT there. So, if you get one, I'd go see a specialist.
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Originally Posted by AustinMom View Post
This is my tiff, some women are getting u/s by their OBs who are not trained (and I'm not sure any OB is, because that is not in their schooling, and if it was, it's not something they typically specialize in) to do U/S, so they miss things that ARE there, and identify things that ARE NOT there. So, if you get one, I'd go see a specialist.
Some OBs are trained to look at what the sonographer (ultrasound tech) and/or radiologist are pointing out. The vast majority of them are perinatologist (aka high-risk OBs or Maternal Fetal Medicine Specialists). I would never have an ultrasound done any other way than by a sonographer, with a radiologist who consults, unless it was like when I had some sharp pains, and needed to make a quick stop at L&D to have them check out the placenta real quick.

And SOME reading of ultrasounds is part of the resident training of OBs. But it's limited, afaik, to things like measuring cervix length via transvag u/s, and checking for placental position or abruption. Not diagnosing serious structural issues.

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