Just because I happened to have turned 35 in January... - Mothering Forums

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#1 of 23 Old 08-22-2013, 12:22 PM - Thread Starter
 
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Had a level II ultrasound today, which I guess is standard for "AMA" even though the baby is due 3 days after my 36th birthday. Whatever. The midwife warned me that they would talk about additional monitoring possibilities because I am so ancient, but I was surprised to have the doctor tell me afterwards that they suggested MONTHLY ultrasounds plus a no-stress test just because I happen to be 35.

 

Both this and my previous pregnancy have been ridiculously healthy and uneventful. Baby has never once measured off dates or shown a single thing wrong, first trimester screening came back with a 1/9000 odds of chromosomal problems, everything at the anatomy scan today looked textbook great...

 

I guess this is just a rant to say the idea of monthly ultrasounds in such a healthy pregnancy seems so ridiculous, arbitrary, and wasteful. GRRRRRRRRRR. What a waste of money, resources, and time. I told the doctor I really didn't feel any sense of necessity, because there have been no indicators that this is anything but a healthy pregnancy, and he was fine with that, but it was just the principle of it even being offered. If problems had shown up or I had a history of pregnancy complications, that would be different...

 

What pregnancy micromanaging have others experienced or had suggested to them, just because they happen to be over 35?

 

BTW, it's a girl :)


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#2 of 23 Old 08-22-2013, 01:46 PM
 
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Not I, at the tender age of 33. However a coworker of my DH's wife had a similar issue. They had gotten the 12 week nuchal scan done, the actual ultrasound showed nothing, but because she herself was over 35,the scan was considered positive (1 in 200, I think).  The doctor recommended an amniocentesis (which has a 0.5% to 2%  (I stand corrected) chance of resulting in a miscarriage) to be certain. So they had a very nerve wrecking couple of weeks while they waited for the results. The end result? Baby was totally fine and completely normal. It was all for no reason.

 

This happened 3 years ago.


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#3 of 23 Old 08-22-2013, 01:56 PM
 
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#4 of 23 Old 08-22-2013, 02:21 PM
 
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There is no way I would do all that and I'm considered "high risk" PLUS I am 39 next month. OMG how am I alive much less pregnant???? LOL one foot in the grave.

Any amount of risk of miscarriage from any tests is too much. There is no way I would be doing an amnio. Right now, I am denying a lot of interventions that my OB wants me to do, even though none of it has been proven to change the outcome of a pregnancy. The system is a mess. It's up to us to be educated and protect our babies from a system that cares more about money than our welfare.

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#5 of 23 Old 08-22-2013, 02:38 PM
 
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Both of my pregnancies were age 35 or later. I had level II ultrasounds with both, but I didn't have monthly ultrasounds with either, nor did I have any other special things due to my age. Not even for my second pregnancy, which was high risk. No one even suggested I have an amnio.
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#6 of 23 Old 08-22-2013, 02:47 PM
 
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Yeah, isn't an amnio sort of "old school"? I wasn't offered one either.

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#7 of 23 Old 08-22-2013, 03:08 PM
 
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My second babe was born 2 weeks before my 37th birthday. There was no mention of my age or any additional testing by anyone.

I had no first trimester ultrasound and the standard 20 week anatomy scan. I did end up having a couple more scan at the end of the third trimester but that was due to growth and fluid level concerns, nothing to do with my age.0

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#8 of 23 Old 08-22-2013, 03:43 PM - Thread Starter
 
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Yeah, no one offered me an amnio. I think that's being edged out by the much-less-invasive cell free fetal dna (aka MaterniT21). But I was so surprised that he was suggesting monthly ultrasounds, as if that is standard practice, which I guess it is. I didn't feel like he was pushing it, and like I said, he was fine when I said "I don't think that's necessary," but I can see someone who's had a more anxious pregnancy, or maybe a 1st timer feeling like she should do that. I just hate the whole aggressively-managing-a-normal-pregnancy thing, and was taken aback by how much that seems intensified just because I happen to be over 35. 

 

When I was in labor with my daughter, they performed an ultrasound when admitting me to the hospital "to make sure she's head down," even though the baby had consistently been head down and I was already 5 cm dilated. If I hadn't been in active labor on no sleep, I would have declined--this time I will. They charged my insurance $300 for a 5 second ultrasound to determine what they could have determined by palpation. Soooo dumb.


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#9 of 23 Old 08-22-2013, 06:58 PM
 
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Don't you hate it?  I just turned 37 last week and just had my quad screen.  The general vibe has changed since my other kids were born in my late twenties and early thirties.  Anyway, I had the test, I was getting nervous over the results and then thought 'screw it.'  I'm not going to stress out about a screen that has a high false positive rate.  I'm not even going to call back as I've been doing this whole week to see if results are in.  I don't care.  I won't let the hyper-test crazy white coat establishment bully through what might be my last pregnancy and questionable tests.  I'm going to enjoy it, my baby is part of me and that's that.  I'm not having an amnio nor will I ever have an amnio, but will be having the level 2 in two weeks.  I hope and pray everything will be fine.  Nobody has mentioned any additional u/ss so I'll see if that happens.  I wonder why they recommended that to you? Age or is there a specific concern or risk?  I've never heard of that.  They get very crazy about screening for birth defects though, and, while understandable, I think they take it too far too often.  MOST of the time, the baby ends up being just fine and the mother goes through unnecessary stress and so does the baby as well.  Sending you wishes for an uneventful rest of your pregnancy!

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#10 of 23 Old 08-23-2013, 06:03 AM - Thread Starter
 
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Thanks, Starflower! He only offered it because I'm "AMA." He said it was standard to bring up with anyone over 35. Granted, I was not at a regular OB office, but at a hospital-affiliated maternal fetal health center that deals with a lot of high risk cases--they just sent me there for the level II which again, is standard for over 35 (last time, at 32, I just had a regular anatomy scan). My midwife (affiliated with the same hospital) did warn me ahead of time that they would probably talk to me about additional monitoring and testing, and when I said that was silly, she just shrugged and said it's just because I'm over 35 and it's not a big deal to decline any of it.

 

Interestingly, a friend of mine who works with OBs in another state said one of them was just ranting about how there is this pressure to classify women as high risk to increase the "cycle of referrals" which ups the pay for the people involved. I know OBs have a hard time because their malpractice insurance is so high, but that is not the right way to go about it! It was refreshing to know that the doctors don't necessarily like it either.


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#11 of 23 Old 08-23-2013, 07:55 AM
 
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I know that an OB I spoke with said that the age factor is over-stated.  I think it's because she had her children over 35 as well and experienced these things directly.  The referral part would not surprise me.  It is pretty much all about the money and an industry of it's own.  I didn't know there was a difference between level II and an anatomy scan.  I thought they were the same thing.  Either way, chances are that your baby will be just fine :)

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#12 of 23 Old 08-23-2013, 08:50 AM - Thread Starter
 
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I know that an OB I spoke with said that the age factor is over-stated.  I think it's because she had her children over 35 as well and experienced these things directly.  The referral part would not surprise me.  It is pretty much all about the money and an industry of it's own.  I didn't know there was a difference between level II and an anatomy scan.  I thought they were the same thing.  Either way, chances are that your baby will be just fine :)

I think the level II is just a more detailed one? I know with my last pregnancy I had a lot of anxiety and my doctor said I could go for a level II instead of standard if that would help--but it would have cost several hundred more for my insurance and seemed silly. The one my doctor did in the office wasn't quite as detailed as the one I had yesterday, but she checked the basics--how the cord looked, heart chambers, etc. Honestly, the one yesterday looked the same to me, I think she just checked for a few additional factors. It probably took 20 min-half an hour.

 

Thanks for your good wishes. I'm really not worried about the baby. They found a choroid plexus cyst in her brain, but apparently that's nothing to worry about--they go away on their own and don't affect anything.


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#13 of 23 Old 08-23-2013, 11:01 AM
 
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I turned 36 in July and am due with number 6 in February. No one (obgyn or midwife) has said a word to me about advanced maternal age. I haven't been offered any additional testing/screening either. I asked for the Harmony aka cell free fetal dna test. I see the Harmony as non-invasive and really cool science! (I'm a scientist and that is remarkable technology!) Also my insurance covered it. I am a fan of non-invasive tests. I home birth and for me the information is critical to my decision on where to birth.

 

Blanca78, I have heard that the cyst thing is nothing to worry about as well.
 


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#14 of 23 Old 08-23-2013, 11:36 AM
 
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Here they don't offer you amnio unless your blood test indicates some cause for concern.  I wasn't offered with either child (maternal age 35 and 39), nor any additional testing besides the one extra blood test to look for genetic markers. Everything else was completely standard. I understand that I'd be offered more if I was over 40, however.
 

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#15 of 23 Old 08-23-2013, 02:18 PM
 
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I was offered amnio for my first one but refused it. Since then I've had a tubal pregnancy so my doctor wants to do more ultrasounds for my next one, whenever that happens. Considering what I've been through I really don't mind. But I will still refuse amnio.
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#16 of 23 Old 08-23-2013, 02:33 PM
 
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Originally Posted by Blanca78 View Post

Yeah, no one offered me an amnio. I think that's being edged out by the much-less-invasive cell free fetal dna (aka MaterniT21). But I was so surprised that he was suggesting monthly ultrasounds, as if that is standard practice, which I guess it is. I didn't feel like he was pushing it, and like I said, he was fine when I said "I don't think that's necessary," but I can see someone who's had a more anxious pregnancy, or maybe a 1st timer feeling like she should do that. I just hate the whole aggressively-managing-a-normal-pregnancy thing, and was taken aback by how much that seems intensified just because I happen to be over 35. 

 

 

 

Congrats on your girl Blanca! love.gif  I completely understand and agree. I am 37 and had to have some help conceiving my first. Even though I have a had a perfectly healthy pregnancy right from the start I was told that I had to have weekly ultrasounds until 16 weeks then monthly thereafter for the entire pregnancy. When I questioned why all he could come up with was that I was over 35. eyesroll.gif  I declined all but 2 ultrasounds. I was also told that it was mandatory for me to have certain testing- which I found out was a complete lie. My midwife hasn't said anything about my "advanced" age or about risk to the babe. I feel so much more at peace with my midwife and am glad I chose her!! I just don't like all that poking and prodding when its unnecessary.  


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#17 of 23 Old 08-23-2013, 02:40 PM
 
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I am 38 and pregnant. It has been a very healthy pregnancy. I live in a rural area classified as "medically underserved". Despite a history of multiple serious losses and infertility, I was not pushed to have or offered any additional testing. I was not offered an amnio (I would not want one anyway).

 

It might very well depend on where you live. I wonder if it has anything to do with how good your insurance is or how expensive malpractice insurance is in your state/area?

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#18 of 23 Old 08-23-2013, 02:41 PM
 
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I will be 37 when this babe arrives and at my first appt. the midwife just asked if we had done any genetic screening on our first two (genetic issue in my family). When we said no, she asked if we were planning to for this one and we said no. That was it. You can decline any of it, and frankly there is a risk anytime you choose to have a child. They can't screen for everything, so there are no guarantees. That's the way I look at it (particularly because I have a genetic issue in my family - not screenable, btw).
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#19 of 23 Old 08-24-2013, 09:32 AM - Thread Starter
 
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JustJenny--Weekly ultrasounds sounds a little crazy to me! I wonder, though, if they are used to other patients with fertility challenges wanting that level of reassurance/monitoring. I've had four ultrasounds this pregnancy: one at 6 weeks to rule out a recurrence of the molar pregnancy I had a few years ago, one at 8 weeks because I switched practices and they typically do one at 8 weeks for dating, then a nuchal scan at 12 weeks, and the anatomy scan at 18 weeks. 

 

When I switched practices, I told the receptionist I'd already had a 6 week one and I don't think she really prcessed what I was saying. The doctor was like "You already had one? Why are we doing this, then?" but then since everything was already all set up she went ahead and did it. I didn't mind because it was still early and I admit I liked the chance to see the baby.

 

I'm relieved none of this has been framed as stuff I HAVE to do, but even offering the monthly ones seems so silly.


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#20 of 23 Old 08-24-2013, 01:08 PM
 
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This sounds like the medical community covering their butts beyond silly. While I understand that laws and policies are to blame, what you're being told to do is excessive. I had my daughter, naturally, at 39 last year, and we had no ultrasounds after the anatomy u/s. We never had the stress testing, and there is no reason to have one if there isn't a medical concern. Find out if refusing this nonsense (assuming everything continues to be fine) will cause a problem. Some care professionals will threaten to drop you if you don't do all they want, a few of them will follow through. Find out now what the situation is, and weight your options. No prenatal care person who isn't worried about being sued would do all that. Most will want the gestational diabetes testing in the third trimester, but that's all that's really necessary barring any signs of a problem. Other than an amnio or CVS test, testing and u/s's aren't known to have risks, but if you have to pay even a penny, it's not worth it.

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#21 of 23 Old 08-24-2013, 04:15 PM
 
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Yes absolutely there is an aspect of CYA- and I completely agree with OP that that is a weird and unnecessary number of tests and ultrasounds. But it is also incredibly horrible when someone under your care has an unexplained term fetal demise, it's also very memorable. Even though at 35 the increase in risk is not huge, it is there, and my guess is the doc may have had someone on the lower end of "advanced maternal age" who had a fetal demise, and he's a little haunted. But again, I'd object to that level of monitoring, too.
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#22 of 23 Old 08-24-2013, 05:05 PM - Thread Starter
 
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This sounds like the medical community covering their butts beyond silly. While I understand that laws and policies are to blame, what you're being told to do is excessive. I had my daughter, naturally, at 39 last year, and we had no ultrasounds after the anatomy u/s. We never had the stress testing, and there is no reason to have one if there isn't a medical concern. Find out if refusing this nonsense (assuming everything continues to be fine) will cause a problem. Some care professionals will threaten to drop you if you don't do all they want, a few of them will follow through. Find out now what the situation is, and weight your options. No prenatal care person who isn't worried about being sued would do all that. Most will want the gestational diabetes testing in the third trimester, but that's all that's really necessary barring any signs of a problem. Other than an amnio or CVS test, testing and u/s's aren't known to have risks, but if you have to pay even a penny, it's not worth it.

Thanks, Roggedance.To be fair, I think I should emphasize that no one was pressuring me. He simply broached it, I said no, he shrugged and said, "that's fine, you can just discuss it with your midwife when the time comes." (I am working with a hospital-affiliated midwife practice, and I feel certain that they won't pressure me for addtional monitoring or testing, because she was the one who warned me they'd bring it up at the anatomy scan.) But ITA that it's ridiculous. My previous pregnancy was no complications, everything textbook, straightforward vaginal delivery two days before my due date--I have no reason to believe (so far, knock on wood) this will deviate too much. 

 

I did also appreciate that the doctor went out of his way to emphasize that the choroid plexus cyst they found "meant nothing" and the only reason he was mentioning it was because it was noted in the records for the ultrasound. So I feel he wasn't trying to be alarmist, at least.

 

I've never felt threatened or strong-armed by a caregiver, though I know that other people have.


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#23 of 23 Old 08-24-2013, 08:19 PM
 
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I'm glad you weren't pressured Blanca. Sounds like it was just routine stuff to them. In my case I was most certainly pressured and received multiple lectures with scare tactics because I refused. Up until I got pregnant I was happy with their care. I don't feel the same about them now. They most definitely over use ultrasounds and I'm sure its to cover their butts. Like I said before I asked him all the why's - and was not being snarky, it was genuine- if it was medically necessary I would do it in a heartbeat. He just couldn't give me any answers.


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