[ursusarctos]

So I still haven't scheduled a prenatal yet, but when I do I will be offered (or they will assume that I will have, rather) an early (vaginal) ultrasound to "set dates" and see the heartbeat. I believe that one is offered again at 12 weeks and again at 18ish weeks and if they detect anything slightly out of the ordinary (such as "small" baby for example) probably again after that.
Btw I'm curious, is this many routine ultrasounds normal in a hospital setting in the states? This would be the public health clinic for my area of the city (in Finland).
I have several issues with getting that many ultrasounds. One is the fact that long term effects of ultrasounds are not known. While it seems that they don't cause a huge amount of damage, I don't like that they are used as a routine diagnostic tool without knowing for sure that they are 100% safe. Also, I have heard sooo many stories that go something like "my baby was looking big/small for dates so they induced me/gave me more ultrasounds and in the end it was smaller/larger than they thought by a large margin" and would like to avoid that whole drama. Also, as far as I have been able to tell (did a perfunctory pubmed search) routine ultrasound of low-risk pregnancies has not been proven to improve outcomes. I also dislike the overemphasis on the sense of sight in diagnosing/caring for pregnancy - what about my internal sensations, physical changes, and intuition and practitioner palpation as opposed to ultrasound as sources of knowledge about how the pregnancy is progressing?
I would like to get one ultrasound maybe around 20 weeks just to see that everything is "in place", rule out twins, check for placenta previa, etc. Right now I am on the fence about the primary ultrasound, though, because I think that will be hardest to refuse and it is true that the date of conception is hazy enough that my edd calculated using my lmp could be a whole week earlier than it should be (which would affect how long the midwife that I will hopefully get can wait before legally having to drop me). I have read that at such an early stage an ultrasound can predict gestational age quite accurately. On the other hand, the fact that it is a vaginal ultrasound rankles me a bit and also freaks me out for the baby's sake since the u. waves are so much closer. It also bothers me that it should matter so much to them that I give birth exactly between 37 and 42 weeks when everyone knows that the date of conception is rarely sure and babies come in their own sweet time. Going to get my exact due date via vaginal ultrasound feels a little bit like catering to that view, with which I do not agree. Though it could ultimately help keep them off my back in the future.
So I guess I'm wondering what you would do in my situation, what your thoughts about ultrasound are, what your ultrasound experiences have been, how you intend to use ultrasound (or not) in your pregnancy... whatever you can think of that has to do with the subject, really!

 

[MamaZoZo]

I know you asked about the states, but in Canada it is only routine to have an 18-20wk ultrasound. The earlier one is only if you are very unsure about dates (extremely irregular period, recent miscarriage.. etc). You can ALWAYS refuse and early u/s.
From what you've written, I think you want to refuse it - so why not. Just say "No thanks, I'd rather wait until the 18-20wk one."

Good luck!

 

[VegMomma]

I'll pipe in!

Multiple ultrasounds are certainly not common here in Canada. People might have a few, but certainly not more than 2 or 3 for a low-risk, pregnancy. (At least this has been what I've heard from asking around... if someone has had a different experience, feel free to correct me!)

With my first, I had one ultrasound around 18 weeks, and that's all. With my second, I had an ultrasound at 18 weeks, and then I had to have another one at 27 weeks due to a pre-labour scare.

I don't meet my midwives until Tuesday, but I am fairly certain that they don't recommend u/s unless a problem is suspected. I don't intend to have an ultrasound this time (much to the chagrin of my family) unless the midwives suspect something.

Anyways. I don't know much about the effects of u/s (no one really does...), but to me it just seems unnecessary. That said, it is totally a personal choice, and is completely up to you and your DP.

I feel like I'm being rambley, and not helpful at all... haha. Okay. Maybe I'll try to help when I'm feeling less foggy....

 

[DJ's_Girl]

With my 1st 2 pregnancies I got 3 ultrasounds. 1 to "confirm"/date, 1 in the middle to check growth and on at around 36 weeks to check position and feta size. My ast 2 pregnancies I only got one- at 18-20 weeks. BUT that is b/c of the cheap Tricare insurance. I, personally, would rather have the 3 ultrasounds (or at least 2) b/c it helps me feel better in terms of the growth and health of the baby. Not to mention I just LOVE getting a sneak peak of my sweet little one!

I am crossing my fingers for an ultrasound at the ob tomorrow!

 

[thelocaldialect]

Here in China I got one at 8 or so weeks, mostly for peace of mind since I'd had a missed miscarriage at 8 weeks previously. The I had the anatomy ultrasound at around 20ish weeks, and then one more towards the end of the pregnancy to check the baby's position and because there was some concern about the cord being around his neck. So three altogether.

Of course humankind went without ultrasounds forever, and none of them are absolutely necessary, but I think the 20 week anatomy ultrasound is pretty useful. If there are any special issues -- twins, placenta in the wrong place, or any issues with the baby's health -- you want to be prepared for those when you give birth.

I know from friends living there that in Japan they do an ultrasound every visit as a routine thing. Of course you can always refuse any of the ultrasounds, but I imagine most people don't. I remember when I gave birth to my first it seemed like the trend in the States was definitely towards more ultrasounds, and earlier. I knew many many people who had ultrasounds at 5 weeks or so, saw no heartbeat and were freaked out by it, only to have another follow up ultrasound a week later and have everything be fine. So ultrasounds too early can also cause a lot of stress.

I think at this point they shouldn't have to do a vaginal ultrasound ... I don't know how far along you'll be at your first appointment, but I had a regular, non-vaginal, ultrasound at 8 weeks with both my son, and my first ultrasound with my miscarriage was I think actually at 6 weeks, again, non-vaginal.

I agree with the others though, if you don't want it, refuse all but the "big" one. Dating is only really an issue if its a question of months, not a couple of days. They'll still be able to date your baby at the big ultrasound, it just might not be down to the exact day accurate. They'll certainly be able to tell the difference between say, a 20 weeker and a 24 weeker though, which is really the only reason, imo, that dating would be important.

 

[speculaa]

I'm torn, myself. I don't want to have any unnecessary testing (what I see as unneccessary, anyway) however I would like a little peace of mind. I think I will go for the 18 week morphology scan where they check everything is in the right place, but I won't have the 8 week dating scan or the later one unless medically indicated.

Here in Oz they routinely do three ultrasounds - dating at 8 or 9 weeks, morphology at 18 weeks, and a checkup at 30 weeks or so.

 

[Jane]

I'm like you, I think, in that I'm not overly concerned about ultrasound, but I don't want to use anything in excess.

I do think that an early ultrasound can be invaluble for dating when there is uncertainty. If you've got great dates - ie, you use a calendar to mark your menstrual history and have pretty regular cycles - I think it can be totally reasonable to refuse the early ultrasound and force your providers to use your dating. Or take 'em up on the ultrasound if you want to see the baby - also a reasonable choice, IMO.

There is usually an option for genetic screening at 10-13 weeks - an ultrasound can look at the nuchal (neck) measurements and detect some chromosomal problems. Also something you can learn more about, see if it meets your needs and accept or refuse. Other genetic screening options include an amniocentisis (a needle sample of the baby's amniotic fluid), CVS (a needle sample of the placenta), a blood test for you only, a combo of ultrasound and bloodtest, a combo of these or nothing at all.
Finally, the ultrasound at 18-22 weeks looks at anatomy. All the organs have formed by this point, and are big enough to see, but the baby isn't big enough to obscure the view. If there's a concern about heart problems in the family or they can't see everything in this ultrasound, they usually bring the woman back at 24-26 weeks - better heart visualization.

The standard in the US is to do a dating ultrasound if indicated, a 20 week anatomy scan, and offer genetic screening if the parents have any known risk factors or are over 35. But the professional organization of ob's says that ultrasound isn't neccesarily indicated for healthy pregnancies. On the other hand, plenty of doctors have an in-house ultrasound and routinely use it at almost every appointment, gathering data and making nervous moms happier. I DO think that anxiety is actually a good reason for ultrasound, but lets try other things in addition to make women more comfortable with their intuition, feelings, notations of baby's mov't, etc.

Personally, my dh and I talked over all our options and made our selections. But it took a discussion of the facts, the options, our risks, what we'd do with bad information, etc. to figure it out.

 

[kcparker]

I feel similar trepidations about ultrasounds. The midwives at the hospital here like:
- 1 early US to date the preg (preferably before 9 weeks because the measurements are the most accurate the earlier you are)
- 1 at 11-13w6d to do a nuchal translucency screen, but they offer it "only if you have thresholds for what is acceptable or not in the baby - i.e. if you would terminate or want to know in advance about a Downs/trisomy baby, get the testing, but if you don't care, it's not necessary.)
- 1 at about 20 weeks to check for anatomical problems, placenta implantation site, etc., but they would be okay with not doing this one also if they didn't see any medical indication that it would be helpful to know what's going on.
- 1 at 41 weeks to do a BPP.

I am thinking about seeing if I can combine the dating and nuchal translucency screen (cuz I am "old" - 35). At 10 weeks, they can hear the heart with a doppler, and at 11 weeks, the dating would still be reasonably accurate and they could do the NT test at the same time. On the other hand, I would LIKE to have an earlier one because prior to my live birth, I had a missed miscarriage before at 8 weeks that didn't get caught until I was 11 1/2 weeks along; it was such a rude shock and sorta ruined any joy I might find in positive pee sticks. I feel like I can't get too excited about this pregnancy because maybe even now, it's not there.

 

[VeezieTG]

its my experience that u/s are pretty routine here. i've had 2 "mainstream" pregnancies and births (ob, tests, hospitals, etc) and 1 pregnancy and birth with only a midwife at a birth center. and now i'm hoping for a home birth, and as little interference in the pregnancy as possible. with the 1st 2 pregnancies i was asked if i wanted an u/s just about every month. especially with my ds1 (the 2nd preg) cos he was so big and they were trying to determine if i "needed" to be induced, or a scheduled c-section. (in the end he was born vaginally and weighed 10lbs. easy-peasy!) i think NO ONE asks if its really necessary. where i live, you can get "vanity" u/s at the mall!! so its a weird thing.

i won't be submitting to one at all this time. i have had 3 totally normal pregnancies, births, and babies. i've only had 1 m/c in my life and it was during a really crazy period in my life, so i chalk it up to serendipity to be honest. i don't have any reasons whatsoever to fear abnormality in my baby. and if there was one that i should really be aware of, my midwife will be able to detect it from heartbeat irregularities, palpations of the uterus, or the 1 blood test i'll submit to. other than that, i'm confident that our baby will be just fine, all the better for not having had the unknown effects of an u/s.

 

[ursusarctos]

Thanks everyone for all your input!

It's been fascinating reading everyone's responses, keep them coming!
I am definitely leaning towards skipping all but the 20 week scan. My dates are only off by maybe a week and I feel that I don't actually need to see the heart beating, because if it is it is and if it isn't it isn't and seeing it won't help. Plus I would just keep worrying anyway

But that's just me.
I didn't actually think of the abnormality scans. I doubt they will offer them to me because of my age (22) but I would refuse them anyway because an abortion wouldn't be an option for me.
Haven't made any appointments yet though.

 

[umbrella]

It's becoming more common to have one in the first trimester, and one around 20 weeks, though not all insurance companies will pay for it/both. You tend to need a reason for other ultrasounds.

I was living in Asia when I was pregnant with dd2, and they typically did ultrasounds at every single appointment. The machine was just there in the exam room always, the doc was the one who did it, not this separate appointment with an ultrasound tech, with the doc checking out the results later. The first doc I saw there, I told her I thought that was excessive, and she agreed and was cool with not doing that with me. She said it was normal there, because the patients/customers really wanted it, and there wasn't evidence that it was harmful. However, the next doc I saw, she very much did want to do the scans every time.

 

[flapjack]

I've always been told that at 12 weeks a pregnancy can be dated to within 10 days, so I see absolutely no benefit whatsoever to a vaginal: plus you don't have the walls of your abdomen helping to protect baby from u/s exposure, plus the experience of a vaginal transducer can be really quite unpleasant. There is as yet no clinical evidence to support routine first-trimester u/s.
I do like having one at 12/13 weeks to confirm that the pregnancy is still there, viable, count the heads (I have a family history of twins, none myself) and that my dates are roughly right. I like the 20 week one to pick up on issues like placental position, any abnormalities that might cause a change in birth plans or so on- it's not generally about termination, especially not where the issue is quality of life rather than viability. Because my eldest son was exceptionally large, it's also useful to have the baby's measurements on file so that if baby appears to be very big or small late in pregnancy, you can start plotting centiles.

To clarify, I do think that babies intensely dislike ultrasound, and I'm 100% convinced that they are aware of them and react. It doesn't mean that I don't think that they have a clear medical purpose and to my mind, the benefits definitely outweigh the risks.

ursusarctaros, the midwife at our local childrens centre is Finnish and your antenatal care is comparable to ours: you'll probably be offered two (maybe three) ultrasounds, some variation of the triple test and will be offered screening for HIV/ hepatitis B /rubella/ several other things, and a urine test to identify infections.

(eta, at least this is what I've been told.)