Benefits of routine 20wk ultrasound - Mothering Forums

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#1 of 66 Old 01-25-2007, 05:15 PM - Thread Starter
 
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What are the benefits of the routine 20-week ultrasound, if everything else is looking good?

I'm concerned about the risks of US (risks of bio-effects, plus the chance of false positives that lead to unnecessary anxiety). I'm also inclined to have as little medical intervention as possible, and I'm sure that getting an US (at the hospital) will be a negative experience for me. I would certainly get an US if something wasn't going right (i.e. if it was "medically indicated"), but I'm leaning toward skipping the routine US.

That said...I want to make sure I'm weighing the benefits against the risks. So, what are some compelling reasons to have the routine 20-wk US? What info helped you make your decision?
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#2 of 66 Old 01-25-2007, 05:25 PM
 
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I never found any. We don't do u/s without reason.

-Angela
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#3 of 66 Old 01-25-2007, 05:47 PM
 
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So, I'm generally very low intervention as is my MW and am concerned with the effects of unnecessary prenatal testing too. She "was glad" that we chose to the the 20 wk US, though didn't say anything until after we had it, as it can be a strong diagnostic tool.

I've also recently had a friend who found out at the 20 wk US that her baby had a serious heart defect and possible Down's, which was confirmed with further testing. She'd had no problems withher pregnancy up until then. Ultimately, she and her dh made the decision to terminate the pregnancy as the heart defect was not treatable and the baby was still born.

I'm not trying to say that this is the normal circumstanceby any means, just that important information can be gleaned, sadly probably only bad information that leads to difficult decisions.

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#4 of 66 Old 01-25-2007, 06:39 PM
 
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I was reviewing a few sources last week, actually, and the studies say that there are no benefits in terms of fetal or maternal outcome for routine ultrasound use. Now, that leaves open the issues of emotional response to a diagnosis, et cetera, but in terms of the science of it, there are no proven benefits.

The studies in question did include that if someone was in a "no ultrasound" group and showed a reason for an u/s, she did have one. So it's not blind "I refuse U/S no matter what" but rather only when truly indicated. Which I personally don't think it often is.

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and Brigid Eleanor (11/20/08)
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#5 of 66 Old 01-25-2007, 07:11 PM
 
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There is certainly nothing wrong in not getting an ultrasound, and possibly many things right. The biggest reason I can think of to get one would be if I were planning a homebirth, or esp. an unassisted birth, and was worried about possible physical issues...like knowing there is a problem that will require surgery might influence someone to have a hospital or birth center birth instead of a homebirth.

But it so much depends on your personal philosophy and situation. DH and I are both 38, and it took us nearly a year to get pregnant. Having the 20-week u/s assured us that the pregnancy was viable. If there had been indication that the baby would not survive birth, or only survive a day or so, we might have terminated in order to increase our chances of having another viable pregnancy. (I say MIGHT because I honestly don't know what I would have done. But I know I wanted the option). At a younger age, that wouldn't have been a concern for me.

We also looked at u/s as a less invasive option to the amnio that seems to be so routine at my age.

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#6 of 66 Old 01-25-2007, 07:12 PM
 
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good point. A big "benefit" of the 20 wk u/s is if you would choose to terminate.

We would not choose to terminate, so we don't do it.

-Angela
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#7 of 66 Old 01-25-2007, 07:30 PM
 
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The 20 week u/s is a perfect time for the Dr/MW to get an update on the growth of the baby. They look at all the skeletal system and the internal organs, including the brain, the heart and the digestive system. They also look at the placement of the placenta, which can be important if you have placenta previa, or some other condition. It certainly isn't required by most people, but for those who have a child with an issue, it is probably useful. My 2nd son had issues after he was born and required a blood transfusion. It was possible that this baby might have started to have issues in utero and this would have affected her liver. It was reassuring to see that her organs are all in perfect proportion to eachother. She'll likely be born with the same condition, but at least the damage begins only after they're born and is completely reversible.

I wanted to know the sex of my baby this time around, so I definitely wanted to u/s. It was also really interesting to see the little baby inside of me and all the little organs. I thought it was exceptionally cool. But I really don't know if it's that big a deal if you don't get the u/s - maybe you could ask your Dr/MW for the benefits and risks?

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#8 of 66 Old 01-25-2007, 08:01 PM
 
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I think there are cases where the baby would have a condition and we wouldn't terminate, but it would be very useful to know ahead.

I have a couple friends who have had babies with some surprises--one with Down's Syndrome and one with a cleft palette. They both spent the beginning of their babies lives dealing with the shock, a bit depressed, and, in the case of the one with cleft palette, needing to do research about how to make nursing work.

I would rather know ahead so I could be mentally and emotionally prepared to welcome the baby for who s/he is, be as present as possible, and have any information necessary to give him or her the most healthy start possible.

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#9 of 66 Old 01-25-2007, 08:20 PM
 
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We thought very hard about doing it, and finally decided to in order to rule out twins.

Getting the ultrasound also qualified us to keep midwifery care through the rest of the pregnancy. Your health insurance and your midwife's malpractice insurance policies might differ.

But they kept the scan short and to the point at my request.
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#10 of 66 Old 01-25-2007, 08:25 PM
 
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Getting the ultrasound also qualified us to keep midwifery care through the rest of the pregnancy. Your health insurance and your midwife's malpractice insurance policies might differ.
I don't understand- did your insurance require it or your midwife's? Never heard of such a thing.

But no homebirth midwives carry malpractice insurance here anyway- something I'm quite glad of.

-Angela
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#11 of 66 Old 01-25-2007, 08:49 PM
 
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I may be in the minority here but I would say the biggest reason I absolutely wanted my 20 week ultrasound and will get them in future pregnancies is peace of mind. I can't belief how much relief I experienced when I was told and could see that baby was perfectly fine, had a healthy spine and heart and that my placenta location was fine. Not to mention being able to see the little guy kept me smiling for weeks.
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#12 of 66 Old 01-25-2007, 09:17 PM
 
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Peace of mind was my reasoning as well. This pregnancy happened right after a misscarriage, so I have been worried from the beginning. I also wanted to know the baby's gender ahead of time. It helps being able to call him by his name.

Those aren't really medical reasons by any means, but I am happy with my desicion.

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#13 of 66 Old 01-25-2007, 11:46 PM
 
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I may be in the minority here but I would say the biggest reason I absolutely wanted my 20 week ultrasound and will get them in future pregnancies is peace of mind.
Oh no - I'm with you there, too! I wanted to know that my baby was OK. I think that a lot of us would rather have a quick check on the baby to make sure that everything is perfect

Shannon, mum to ds1 (8/03), ds2 (6/05), dd (5/07), and ds3 (7/09)
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#14 of 66 Old 01-26-2007, 12:24 AM
 
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In certain cases, we would terminate, so that's reason enough for us. I also really, really want to know the gender.
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#15 of 66 Old 01-26-2007, 12:40 AM
 
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I agree that ultra sound is unnecessary in most cases and I too wonder about possible negative effects.

But I think that if you need some peace of mind it could really be a great tool. By twenty weeks all the pieces and parts of the baby are there so my worries of negative effects would be less.

I think peace of mind would out way my worries.

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#16 of 66 Old 01-26-2007, 09:44 AM
 
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We knew we wouldn't terminate and so refused all of the routine testing suggested for women of my 'advanced maternal age.' However we did a 21 wk u/s at the suggestion of our midwife to rule out conditions that might require immediate medical attention at birth.

We agonized over the decision. It's not so much that I think one u/s would have damaging effects, but more that I question the increasingly medicalized approach to managing pregnancy and birth in general. We postponed from the suggested 18 wks to 21 trying to insure that we wouldn't need a repeat scan.

So I'm not sure the results qualify as benefits, but here's what happened. We're having twins. I was measuring just a tiny bit over normal and it was still too early to hear the two heartbeats well with the fetoscope so none of us expected this. Both placentas are optimally placed and both boy and girl (yin and yang we call them now) are perfect in every way. So yes, we're thrilled and relieved to know the babes are healthy and no doubt it's convenient to know ahead of time that there will be two.

We also risked-out of the possibility of a homebirth with our midwife. She assured us this would've happened sooner or later when my twin girth and the two heartbeats became apparent. So I guess the positive side is that we have more time to find a new provider (renegade midwife or the Farm are looking much better than the recommended docs so far). Our midwife will act as doula if we choose a hospital birth, but isn't comfortable attending a homebirth of twins under any circumstances.

It seems the only way we would've avoided this situation would've been to plan to UC from the beginning. My DH is amazing and we actually discussed UCing pretty seriously, but this is our first. Well, first and second all at once and we'd really like an experienced extra set of hands, heart and mind with us for the arrival.

Would we choose an u/s next time around? Honestly we're not sure.
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#17 of 66 Old 01-26-2007, 10:33 AM
 
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I was reviewing a few sources last week, actually, and the studies say that there are no benefits in terms of fetal or maternal outcome for routine ultrasound use. Now, that leaves open the issues of emotional response to a diagnosis, et cetera, but in terms of the science of it, there are no proven benefits.
Do you have links? I'd really like to see these studies. Did they conclude that even in the event of fairly serious anomalies, there was no benefit to knowing ahead of time? Of course, I think this issue is complicated by the fact that most babies are born in a hospital, so even if there isn't a special care team right on hand, there ARE more resources more immediately available than at home.
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#18 of 66 Old 01-26-2007, 01:03 PM
 
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So far I'm choosing not to do a 20 week u/s. Though I do do dopplar, for my own piece of mind I really needed to hear that healthy heartbeat. I wouldn't terminate, and I don't have any risk factors that indicate an increased need to check for something- no family history either. That said, my midwife has a back up OB who I will have an appt with around 34 weeks, and we will do a quick u/s then just to check for placenta placement, since I am planning a homebirth. It won't be the full baby 100 point check, but I'm sure he'll take a look at baby too.

Though to be honest I've found it to be a harder decision than I thought. I had said before I got preg I would skip it, but it is tempting.

Laura, Mama to Mya 7/02, Ian 6/07 and Anna 8/09
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#19 of 66 Old 01-26-2007, 01:53 PM
 
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Do you have links? I'd really like to see these studies. Did they conclude that even in the event of fairly serious anomalies, there was no benefit to knowing ahead of time? Of course, I think this issue is complicated by the fact that most babies are born in a hospital, so even if there isn't a special care team right on hand, there ARE more resources more immediately available than at home.
The studies only evaluate the number of live births and other outcomes that are easily measured in populations with and without ultrasound. They do not take into consideration peace of mind or the benefit of finding out about an abnormality like cleft palate in advance so you can plan for succesful breastfeeding. Those are the reasons I will have an ultrasound.

The other thing that the RADIUS study brings out is that a screening ultrasound is only as good as the sonographer and equipment. I would encourage you, if you choose to have an ultrasound, choose a registered sonographer and facility. You will greatly increase the sensitivity of the test and reduce the number of false positives.

Disclaimer: I am a registered sonographer. I also honor all of the women here for questioning and reasearching and choosing what is right for you and your family.
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#20 of 66 Old 01-26-2007, 04:35 PM
 
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I am a diabetic, so because I usually measure a few weeks bigger and stuff, I usually have at least 5 ultrasounds. I love having them- for me, that's the best part about going to the doctor! I love to see my baby on the screen-being able to watch him/her move. Its awesome!! I wouldn't terminate a pregnancy for any reason but if something was wrong- i would like to be prepared for it. of course, when you hear that everything look perfect- it makes it all worth it. Knowing that your precious little one is safe and sound.
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#21 of 66 Old 01-26-2007, 04:44 PM
 
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Although the general use of ultrasound for medical diagnosis is considered safe, ultrasound energy has the potential to produce biological effects. Ultrasound bioeffects may result from scanning for a prolonged period, inappropriate use of color or pulsed Doppler ultrasound without a medical indication, or excessive thermal or mechanical index settings. The AIUM encourages patients to make sure that practitioners using ultrasound have received specific training in fetal imaging to ensure the best possible results.
http://www.aium.org/publications/sta...p?statement=31
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#22 of 66 Old 01-26-2007, 04:49 PM
 
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peace of mind. Out of 9 months of pregnancy the only time I was relaxed were the three weeks after the u/s, when I was told he was perfect and my body felt okay.

Otherwise this has been a very rough ride. I would have the 20 week and skip all the others. I want to know about cleft palate and all the other stuff. I need the reassurance.
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#23 of 66 Old 01-26-2007, 05:05 PM
 
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the reason i decided to do it is that ultrasound sees all four chambers of the heart......and IF sees a problem with the heart, you can make sure a heart doc is on hand at your delivery, which can make the difference between life and death. heart issues are a very common birth defect and a treatable one.

this is the only reason i did it but to me it was a big one.

(the peace of mind and photos were nice bonuses)

the procedure was about 15 minutes long and they sent me on my way with a clean bill of health!

deb

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#24 of 66 Old 01-26-2007, 05:21 PM
 
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I don't mean this in a mean/snarky way, but I totally don't understand feeling that everything is "ok" after having an US. I'm not trying to criticize, I just totally don't relate. I just can't imagine relying on something like that for my peace of mind. Maybe it's just an individual personality thing?

I don't mean this all in a downer, pessimistic way but don't know how else to word it. There are so many problems that can't be detected inutero, that not finding any defects during routine screening wouldn't make me feel convinced that everything was "normal."
I'm at 24 weeks and still haven't heard a heartbeat, but that really hasn't affected my feelings about the baby's health. Becuase I could have heard one with a doppler at 12 weeks or whatever and then still had the baby die 3 days later.
That doesn't mean I go around feeling dread, quite the contrary. Maybe I just process things differently.
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#25 of 66 Old 01-26-2007, 05:30 PM
 
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It helped reasure me when I had foolishly agreed to go through with all the fun routine testing such as the AFP test and it came up positive for Trisomy 18.I kept going back to the images of my baby moving and waving his beautiful hands and other perfect parts and helped me make the decision not to agree to an amnio or anything other than another U/S.I had the pictures to comfort myself(DH was deployed) and look at so that I didn't falter under the Dr's pressures.
I had one done this time because I didn't know I was pregnant for several months and was going to be driving cross country and then flying to HI and needed to know just how far along I might be.I thought I was 12 weeks and the U/S guess was 20 weeks.

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#26 of 66 Old 01-26-2007, 05:38 PM
 
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Alice, yes, I wish I could process it like you. Maybe with my second I will be able to relax. Who knows. I will be doing things completely different if I get pregnant again, less anal. Less conventional medicine.

They are the ones that turned me into a worry freak and I am the loser for letting them affect me. But a surprise pregnancy with the pressure to provide a healthy first grandchild was more than I could bear. My fantasy is to have a representative attend all doctor appts with me, someone unemotionally attached, someone like a lawyer
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#27 of 66 Old 01-26-2007, 05:46 PM
 
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They are the ones that turned me into a worry freak and I am the loser for letting them affect me.
Good for you for admiting that THEY are the ones who have made you worry (though I don't think you're a loser )

This is exactly why I WON'T have testing like u/s without reason.

Statistically it is much more likely that they will show something that they think I should worry about, that's not really an issue.

-Angela
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#28 of 66 Old 01-26-2007, 06:04 PM
 
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The "peace of mind" reason can go both ways. A lady in my church did not have an US with her first child and had an uneventful birth and a healthy daughter. She did have an US with her second and was told that he had water on his brain and that he was too big and she would need a c-section. Needless to say she had a very bad rest of her pregnancy (she didn't believe in terminating and imagine if she had! She said the thought just chills her bones...) and when her son was born via c-section he turned out to be a whole pound smaller than his older sister had been and there was absolutely nothing wrong with his brain.

That particular mama could have avoided a lot of unnecessary stress and an unecessary c-section had she NOT had a routine US with her son.

Then again, my mom found out that her third baby had a diaphragmatic hernia from a routine US and, though he didn't survive, she was able to have surgery on him in utero and was spared having a full-term still born child. It was still traumatic and didn't change the outcome, but it could have potentially.

So really... "peace of mind" doesn't just argue for having the US. I'm more at peace trusting my body and not seeing something potentially abnormal on a screen that may be nothing at all. Spending the rest of my pregnancy worrying about something that may have been a sonographer's error is not something I want to deal with. I wouldn't terminate a pregnancy regardless of what the US showed and I would fight to have a home birth regardless of what the US showed (due to serious needle and hospital phobias which I could imagine would interfere with the birthing process a bit...). It's just not worth it to me, personally.

I will only be having an US if my midwife recommends one, and she knows that I would do it if she thought it necessary. No routine US for me though.

But that's just me I respect the right for all women to make an informed choice about this and all other issues relating to pregnancy/birth since the comfort level of the mother is so extremely important :

love and peace.

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#29 of 66 Old 01-26-2007, 06:04 PM - Thread Starter
 
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Thanks everyone for your insights. I asked my MW the same question, and she gave me three reasons to have the US:
1) to locate the placenta
2) to determine if there are any defects that can be treated in utero or for which the baby would need specialized care immediately after birth
3) peace of mind (assuming everything looks good, that is).

I'm still not sure what I'll decide, but you have all given me good food for thought.

Javamama - how do I find out if someone is a registered sonographer? Also, is it appropriate to ask whether the Dr./technician uses the ALARA principle (as low as reasonably acheivable) when setting the machine's frequency, and whether the Dr./tech understands how to read the thermal and mechanical indices? I've read that many docs and techs don't understand these indices (which tell them if the frequency is too high and will cause heating and cavitation effects), or don't know how to adjust the frequency to a safe level. That's what worries me the most.
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#30 of 66 Old 01-26-2007, 06:07 PM
 
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We cross-posted, please read what I wrote about peace of mind because IMO that reason really can go either way.

love and peace.

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