Deciding rather or not to have the 18 week scan

jennypolkadots · September 2014

Hi everyone!

We are working with a midwife practice. They refer you out for the 18 week ultrasound if you want it and I would need to schedule it for next week. They don't care one way or another if we get it or not, and don't really recommend it. We have to make a decision fast since 18 weeks is the best time to do it. Our insurance will cover 100%, so that is not a factor but right now we are leaning towards not having it. Here are our reasons (in no particular order):

-We do not want to find out the sex. I am worried they will slip and we will find out.

-We are very low risk being young with no family history of any abnormalities.

-The bean has a strong heartbeat since 6 weeks.

-We want to avoid false positives that just lead to unnecessary worry.

-We would not terminate no matter what the diagnosis.

-18 week ultrasounds have not been linked to better outcomes for mothers or babies. The things they check for can't be resolved before birth.

-My OB (before I switched to midwives) already scanned me at 6 and 9 weeks and everything was perfect.

-Based on my research ultrasounds are not comfortable for the baby (extremely loud, like a freight train to them) and cause bubbles in the tissue. They aren't linked to causing issues, but we really don't know 100% what putting a baby under ultrasound for 30 minutes really does long term vs. if the same baby never had the exposure.

-Our midwives will refer us for an ultrasound at any later time if it is ever medically indicated. Right now it's not.

The only reason we thought of having it is because we are planning an out of hospital birth and if by some rare chance an issue was found we would possibly choose a different birth plan.

Is there something we are not considering here? Are any of you not getting the optional ultrasounds? What would you do in this situation? I was going to post on the 2nd trimester board but I figured women planning a natural birth are more likely not to get the ultrasounds.

Thanks!

JaymeeLH · September 2014

I personally would get the U/S, even though you are relatively low risk, you still aren't "no risk". At my A/S they asked before they even put the wand on my belly if we wanted to know the sex, and quite honestly I think it's pretty rare for baby's organs to just be right there for you to see by accident. Because you're planning on an out of hospital birth I would say it's better to know for sure that there aren't any possible complications, especially more common things like placenta previa. But again, that's me personally.

MsMacual · September 2014

I agree- get one to more difinitively rule out anything that could prevent you from having the birth that you are planning. It is pretty fun to see LO at this point, too.

mb314 · September 2014

I would not opt out of the anatomy scan. It provides essential information about how the baby's organs are developing. That information is critical to make sure you and/or your baby don't need special prenatal treatments or immediate post partum treatments. You've already had two ultra sounds, so your concern about the ultra sound's affect on the baby doesn't make a lot of sense to me. Whether or not you choose to terminate is also a moot point - the fact is, if a problem is discovered, you have 20 more weeks or so to address it or figure out a way to address it post partum. And if you tell the technician that you don't want to know the sex, they will honor that.

Even though the anatomy scan is not "required" and is therefore "optional", it is different than elective ultra sounds in that it does provide critical medical information to you and your provider. hopefully everything is on track with your baby and the scan will just show that the baby is healthy and you're current birth plan is an option.

ark83 · September 2014

I would, have, and will always get the anatomy scan for all the above reasons. My biggest concerns would be if something was wrong with the location of my placenta and the baby's heart and lungs. If something were wrong with the above things, it would be critical to know about them before birth so you could plan accordingly and get medical treatment/help the second the baby was out.

jennypolkadots · September 2014

@mb314 - I understand what you are saying about me already having two scans. If anything, I think that is more reason not to have another. To limit exposure. They 6 and 9 week scans were not given as "optional" by my OB... we didn't even see her before being taken back for the scans and I also didn't have the information I have now. If I did, I would not personally have had either scan done. LO didn't have developed ears at that point either. You'll notice in many 18-20 week scans babies turn away and cover their faces because of the loudness of the US. The 18 week will also take about 3 times as long as our other two "quick see" scans that just checked for a heartbeat and basic growth measurements.

Just putting this info out there because others may be thinking about having or not having the scan and it is part of our decision making process

DH is on board no matter what I want to do but doesn't feel the scan is necessary.

Thanks everyone for all of the responses. I do agree with using US as a tool to rule out any complications, no matter how rare, that would make our birth plan more risky. We are not anti-hospital or anything like that and would be totally fine delivering at a hospital if we had certain risk factors. Lots to consider!

shellybean3788 · September 2014

Of course, no one on here can tell you what to do, but I'll tell you that I just got the all-clear results from my 20-week scan. Since I'm also planning an out-of-hospital birth, this was important for me and it makes me feel SO MUCH BETTER.

My advice would be, tell them just as soon as you walk in that you DON'T want to know the sex, and that if they are going to look in that direction, to tell you to turn your head. Sometimes, especially with boys, the sex is blatantly apparent, even to a non-expert, so it's best not to look.

Best of luck with your decision.

SchruteBucks · September 2014

I opted to have one ultrasound at 22 weeks with my last pregnancy. My reason for that was because of my age, I was 37 at the time, and that we were having an out of hospital birth. We also don't do any of the blood screenings for abnormalites so an ultrasound is the only way for us to know if there is anything wrong. We wanted to know if there were any issues we needed to prepare for, like Down Syndrome. We also had an out of hospital birth and would have wanted to change those plans if the baby had any obvious issues that would require special care after birth. We didn't find out the sex and made it clear when they started that we didn't want to know.

When I get pregnant again, we'll make the same choice for the same reasons.

marriedinaugust · September 2014

We had the option as well but we wanted to know the sex in addition to making sure baby was developing properly. If anything major had come up we wanted to know in case it was drastically safer to give birth at the hospital instead of the birth center. Turns out I have placenta previa so now I have to go back for a quick scan in a couple of weeks to make sure it moved. That has freaked me out more than anything but I guess it is better to know than not know.

catsinawindow · September 2014

I would not skip the anatomy scan. I'll include two ancedotes from people I know as examples of why I wouldn't skip it:

My cousin has a son who was born with a severe heart defect, discovered during his anatomy scan. She delivered him by C-section (the doctors felt that his heart might not be strong enough to withstand a vaginal birth) and delivered at the best children's hospital in the area with a wonderful pediatric cardiologist on stand-by to immediately assess his cardiac condition. He's now a happy and healthy 2 year old thanks to their care.

My friend has a son (now deceased) who had a condition called congenital diaphragmatic hernia (CDH). His condition was discovered at the anatomy scan. There is evidently a surgery that they can do in utero to better a CDH baby's chance of survival. When she found that her son had CDH she was evaluated for the possibility of this surgery, but unfortunately was not a candidate for it. She was scheduled for induction of labor so that pediatric specialists could be on stand-by when her son was delivered and he was immediately transferred to the best children's hospital in our area. He, unfortunately, passed away about a month after he was born, but they did absolutely everything they could for him.

These are, of course, rare circumstances but they do happen. In cases like these, knowledge is power and the anatomy scan gives that knowledge.

DebateThis · September 2014

jennypolkadots said:

@mb314 - I understand what you are saying about me already having two scans. If anything, I think that is more reason not to have another. To limit exposure. They 6 and 9 week scans were not given as "optional" by my OB... we didn't even see her before being taken back for the scans and I also didn't have the information I have now. If I did, I would not personally have had either scan done. LO didn't have developed ears at that point either. You'll notice in many 18-20 week scans babies turn away and cover their faces because of the loudness of the US. The 18 week will also take about 3 times as long as our other two "quick see" scans that just checked for a heartbeat and basic growth measurements.

Just putting this info out there because others may be thinking about having or not having the scan and it is part of our decision making process DH is on board no matter what I want to do but doesn't feel the scan is necessary.

Thanks everyone for all of the responses. I do agree with using US as a tool to rule out any complications, no matter how rare, that would make our birth plan more risky. We are not anti-hospital or anything like that and would be totally fine delivering at a hospital if we had certain risk factors. Lots to consider!

1. The bold is not true. Not by a long shot. They turn around because the ultrasound transducer pushes on your belly. The ONE study in 2001 that suggested a fetus could hear ultrasound waves was debunked as a total fraud.

2. If you are even remotely considering an out of hospital birth there is no question that you need to have an anatomy scan. There is NO way to ascertain if you are low risk enough to attempt that sort of birth without it.

3. It's absolute BULLSHIT that anatomy scans haven't shown to have better outcomes for mom and baby and that there is nothing that can be done w/ the info you have from that scan. There are numerous diagnoses and subsequent medical procedures for corrective surgeries that can be attempted while the baby is in utero. Mothers and babies routinely died from complications such as placenta previa before ultrasound. Further, there are hundreds of diagnoses that would require the presence of neonatology professionals at the birth of the baby, and you can only know that if you have the scan. Something like placenta previa, placenta accreta or chorioamniotic separation could be lethal for you, too, should you go into labor w/o knowing the location/health of your placenta or if your amniotic sac is attached.
4. Most of the body parts the anatomy scan is looking at aren't even developed at 6 or 9 weeks. In fact, even having the anatomy scan at 18 weeks is very early in terms of fetal development. 20 weeks is optimal, 22 weeks is a little better. There are even cardiothoracic (heart/lung) and kidney abnormalities that can't be clearly seen til closer to 27-28 weeks.
5. A 20 week ultrasound does not give you a "false positive". It doesn't give a positive or negative at all.
6. Please show me this study you've found about "bubbles in the tissue".
7. Family history plays ZERO role in hundreds of fetal abnormalities and other physical issues (such as the aforementioned placenta previa) - it doesn't mean your risk is zero.
8. We DO know that "thirty minutes of ultrasound" is safe. They've been around since the 80s and they've actually gotten progressively less strong than they were in the 80s. They're also not 30 minutes. I had probably a hundred ultrasounds during my pregnancy and not a single one of them was more than 10-15 minutes.
9. This is the Natural Birth board. We support evidence based medicine, not the notion that eschewing all modern medicine is bad for the sake of things being "natural". This is one of those times when modern medicine is a good thing.

iris427 · September 2014

If you're having an OOH birth, getting the anatomy scan is even more important. At one ultrasound I had before my home birth, the doctor discovered I had a placenta previa, so we had to monitor that to make sure it moved, otherwise home birth would have been deadly. They can spot a lot of problems that might require extra care for your baby, or cause serious complications at delivery, and knowing that ahead of time can be vital for good outcomes. 6 and 9 week scans cannot tell them anywhere near as much about your baby's health as an 18 week one, so it doesn't really matter if those were perfect. They don't even have all their body parts yet at 6 and 9 weeks.

As for finding out the sex accidentally, wouldn't you rather risk that than risk, say, missing a heart defect that could have been treated had you known about it?

Midwifery care and OOH birth done in a responsible way is one thing. But rejecting all modern care that has made childbirth far safer than it used to be is gambling with your baby's health and your own.

iris427 · September 2014

DebateThis said:

jennypolkadots said:

@mb314 - I understand what you are saying about me already having two scans. If anything, I think that is more reason not to have another. To limit exposure. They 6 and 9 week scans were not given as "optional" by my OB... we didn't even see her before being taken back for the scans and I also didn't have the information I have now. If I did, I would not personally have had either scan done. LO didn't have developed ears at that point either. You'll notice in many 18-20 week scans babies turn away and cover their faces because of the loudness of the US. The 18 week will also take about 3 times as long as our other two "quick see" scans that just checked for a heartbeat and basic growth measurements.

Just putting this info out there because others may be thinking about having or not having the scan and it is part of our decision making process DH is on board no matter what I want to do but doesn't feel the scan is necessary.

Thanks everyone for all of the responses. I do agree with using US as a tool to rule out any complications, no matter how rare, that would make our birth plan more risky. We are not anti-hospital or anything like that and would be totally fine delivering at a hospital if we had certain risk factors. Lots to consider!

1. The bold is not true. Not by a long shot. They turn around because the ultrasound transducer pushes on your belly. The ONE study in 2001 that suggested a fetus could hear ultrasound waves was debunked as a total fraud.

2. If you are even remotely considering an out of hospital birth there is no question that you need to have an anatomy scan. There is NO way to ascertain if you are low risk enough to attempt that sort of birth without it.

3. It's absolute BULLSHIT that anatomy scans haven't shown to have better outcomes for mom and baby and that there is nothing that can be done w/ the info you have from that scan. There are numerous diagnoses and subsequent medical procedures for corrective surgeries that can be attempted while the baby is in utero. Mothers and babies routinely died from complications such as placenta previa before ultrasound. Further, there are hundreds of diagnoses that would require the presence of neonatology professionals at the birth of the baby, and you can only know that if you have the scan. Something like placenta previa, placenta accreta or chorioamniotic separation could be lethal for you, too, should you go into labor w/o knowing the location/health of your placenta or if your amniotic sac is attached.
4. Most of the body parts the anatomy scan is looking at aren't even developed at 6 or 9 weeks. In fact, even having the anatomy scan at 18 weeks is very early in terms of fetal development. 20 weeks is optimal, 22 weeks is a little better. There are even cardiothoracic (heart/lung) and kidney abnormalities that can't be clearly seen til closer to 27-28 weeks.
5. A 20 week ultrasound does not give you a "false positive". It doesn't give a positive or negative at all.
6. Please show me this study you've found about "bubbles in the tissue".
7. Family history plays ZERO role in hundreds of fetal abnormalities and other physical issues (such as the aforementioned placenta previa) - it doesn't mean your risk is zero.
8. We DO know that "thirty minutes of ultrasound" is safe. They've been around since the 80s and they've actually gotten progressively less strong than they were in the 80s. They're also not 30 minutes. I had probably a hundred ultrasounds during my pregnancy and not a single one of them was more than 10-15 minutes.
9. This is the Natural Birth board. We support evidence based medicine, not the notion that eschewing all modern medicine is bad for the sake of things being "natural". This is one of those times when modern medicine is a good thing.

I seriously cannot like this post enough. Especially #9.

And yeah, how can you know if you are truly low risk enough to have a home birth if you don't get the kind of prenatal care that determines risk in the first place?

DebateThis · September 2014

@Iris427 the no ultrasounds group makes me absolutely ragey. I had a scary shortened cervix that was only discovered due to my anatomy scan. I was put on Crinone and varying degrees of bedrest/pelvic rest/restricted activity for the remainder of my pregnancy which kept my short cervix stable. Had I skipped that scan and subsequent scans, I am 100% sure DS wouldn't have made it to term.

And that's not even touching placenta/cord issues, fetal abnormalities, uterine issues etc. I know I'm preaching to the choir here but GAHHHH.

iris427 · September 2014

DebateThis said:

@Iris427 the no ultrasounds group makes me absolutely ragey. I had a scary shortened cervix that was only discovered due to my anatomy scan. I was put on Crinone and varying degrees of bedrest/pelvic rest/restricted activity for the remainder of my pregnancy which kept my short cervix stable. Had I skipped that scan and subsequent scans, I am 100% sure DS wouldn't have made it to term.

And that's not even touching placenta/cord issues, fetal abnormalities, uterine issues etc. I know I'm preaching to the choir here but GAHHHH.

@debatethis Yes. I'm all for giving birth unmedicated, with no interventions, if that is what the mother wants and it is safe. I've had two births like that. But the misinformation that gets peddled in natural birth books, websites, boards/facebook groups, etc. makes me absolutely crazy. It's downright dangerous. It kills mothers and babies. You can have a natural birth and still be safe. We don't have to give birth like it's the 1800s again.

deux · September 2014

I'm on the fence about ours. It's neither encouraged nor discouraged by our midwives, they just leave it to us. We have about a month to decide still. With DS we had to have a dating ultrasound at 13 weeks, and that was it.

sprky79 · September 2014

I think it is essential to have the scan because if there are issues that will need early resolution I want to know ASAP so that I can make sure I have the proper specialists hired.

And honestly? I wouldn't trust a midwife that would contemplate a homebirth without the scan. That puts her walking blind in to your delivery as well.

Finally, unless you are reading academic journals, be skeptical of the research you are finding on the internet. Just because a bunch of blogs by "natural baby experts" or whatever say that ultrasounds are somehow "bad" doesn't mean they are.

ltut · September 2014

The anatomy scan is the only one we have for reasons pp said. I had a friend whose little boy's intestines formed outside his stomach. I aalways think of scenarios like that, since we birth out of hospital as well. In the very rare case that something was very wrong, I would want to move to a hospital.

JCWhitey · September 2014

So I'm pretty anti early u/s. With my son we had one at 14 weeks which was required by our midwife practice when we switched. That scan showed a very serious heart condition as well as a potential kidney problem and placenta previa. I learned quickly not to worry since early scans are great for dating and checking some issues, but many things seen in those can correct themselves over time. Of course by the a/s his heart and kidneys were perfect and my placenta had moved. I wish I'd only done the a/s because I never would have worried for even a second, but I'm glad I had the a/s so I knew there were no serious problems. This time I have to have at least three scans because of where I am delivering (hospital that, by the doctor's words, is basically a home birth facility in the hospital) where they require you to have zero issues to deliver there. I'm not happy about the 13 week u/s and hope I don't even have to have the 40 week u/s, but I'm excited for the a/s.

DebateThis · September 2014

JCWhitey said:

So I'm pretty anti early u/s. With my son we had one at 14 weeks which was required by our midwife practice when we switched. That scan showed a very serious heart condition as well as a potential kidney problem and placenta previa. I learned quickly not to worry since early scans are great for dating and checking some issues, but many things seen in those can correct themselves over time. Of course by the a/s his heart and kidneys were perfect and my placenta had moved. I wish I'd only done the a/s because I never would have worried for even a second, but I'm glad I had the a/s so I knew there were no serious problems. This time I have to have at least three scans because of where I am delivering (hospital that, by the doctor's words, is basically a home birth facility in the hospital) where they require you to have zero issues to deliver there. I'm not happy about the 13 week u/s and hope I don't even have to have the 40 week u/s, but I'm excited for the a/s.

I'm really sorry you had an unnecessary scare and I'm kind of floored that they tried to DX heart and kidneys that early

Did your doc refer you for Level II u/s and fetal echo?

FWIW, those are the exact issues we were scanned for - I have a congenital kidney defect and MH had a congenital heart defect- so between those two things and my stupid cervix I had a LOT of ultrasounds.

JCWhitey · September 2014

DebateThis said:

JCWhitey said:

So I'm pretty anti early u/s. With my son we had one at 14 weeks which was required by our midwife practice when we switched. That scan showed a very serious heart condition as well as a potential kidney problem and placenta previa. I learned quickly not to worry since early scans are great for dating and checking some issues, but many things seen in those can correct themselves over time. Of course by the a/s his heart and kidneys were perfect and my placenta had moved. I wish I'd only done the a/s because I never would have worried for even a second, but I'm glad I had the a/s so I knew there were no serious problems. This time I have to have at least three scans because of where I am delivering (hospital that, by the doctor's words, is basically a home birth facility in the hospital) where they require you to have zero issues to deliver there. I'm not happy about the 13 week u/s and hope I don't even have to have the 40 week u/s, but I'm excited for the a/s.

I'm really sorry you had an unnecessary scare and I'm kind of floored that they tried to DX heart and kidneys that early Did your doc refer you for Level II u/s and fetal echo?

FWIW, those are the exact issues we were scanned for - I have a congenital kidney defect and MH had a congenital heart defect- so between those two things and my stupid cervix I had a LOT of ultrasounds.

I did not get a follow up until the a/s. Unfortunately what had actually happened was that I had the scan at a different facility and the woman told me the results would be online the next day. I thought she meant the image stills she took so I logged in to see those and instead got a list of issues (fourth valve defect, I can't remember the kidney issue name but Google made it sound bad, placenta previa, advanced fetal size/weight, and one other thing that escapes me now). It was three more weeks before I spoke with my midwife and she basically brushed it off and said she doesn't trust early scans for anything other than size and we'd wait until the a/s unless I wanted it. I decided I didn't and by the a/s things were clearly fine. So really the mistake was making the u/s tech's findings available to me before my doctor even saw them and could interpret them for me. As a FTM I didn't realize all of this. The midwife did say we needed to really look at the heart since I have a heart murmur but she otherwise wasn't concerned about the rest.

DebateThis · September 2014

Holy crap, @JCWhitey, I would've had a heart attack.

jennypolkadots · September 2014

Thank you everyone. I have read every single response. Over the weekend we talked and DH really doesn't care either way but I have decided to go ahead and have the scan. I am a first time mom, so this is my first rodeo. I didn't spend all of the last 4 months reading up on ultrasounds and have just found info over many different studies, websites, and directly from my midwife practice. Some here have questioned my midwife who is willing to do OOH births without ultrasounds. She is not anti-ultrasound but believes in informed consent so it is up to the parents to research and decide.

Calling today to make our appointment. Thanks for the insight and to all of you who provided information without acting as if I am some idiot

. Our child's health is more important to us than anything else, but I still see the validity of not having scans if the parent's don't want them. Hope everyone has a great Monday!

iris427 · September 2014

It's great that your midwife believes in informed consent. She should also give you guidance based on her own expertise. Parents can research all day long, but that is not the same as being a trained health professional. It can often be hard to determine whether a study is good or not if you aren't specifically trained to do that, especially if all you can access is the abstract. Furthermore, one study taken out of context might not be helpful or can even lead you to the wrong conclusion. The overall body of evidence about a topic matters too. Anyway, I'm glad you are having the scan.

I don't think anyone here thinks you are an idiot. Some of us are very frustrated with the dangerous misinformation that gets perpetuated as "natural birth" facts online and don't want to see anyone get hurt. We are all passionate about birth or we wouldn't be here.

What kind of midwife are you seeing? CNM, CPM, lay midwife, etc.?

jennypolkadots · September 2014

@iris427 - The practice is two CPMs, one lay midwife who assists, and a hospital RN who is getting her CPM cert. who also assists. My last prenatal when I discussed ultrasound was with the lesser experienced midwife who will not be our delivering midwife. She is pregnant with her 4th child and has never had an ultrasound. Our midwife had a baby to deliver that day and couldn't make our appointment.

There is a lot of misinformation out there unfortunately and I was not trying to spread anything incorrect. We ultimately decided that even with the risk being very small, there are a few things that could be seen at the ultrasound that would make hospital birth safer for our child. We ultimately just want the safest birth. Having the scan will make me more confident in our birth plan, especially since this is my first birth.

I already made the appointment. The earliest they had was in two weeks. I will be 20W3D. Fingers crossed I get the all clear!

jessandmike2013 · September 2014

I'm so happy you will have the scan. I think it's the smart and sane choice. That talk about bubbles in the tissue though.... Puh-lease. Let's remember to be savvy women when reading stuff on the internet.

jennypolkadots · September 2014

@jessandmike2013 - Most of what I posted, including the tissue/microbubbles actually came straight from one of my midwives. She has been practicing 10 years, and (not related) has a master's degree in engineering. She is very smart and research oriented, so I trust she has some basis for her belief. But I sort of take what she says with a grain of salt because she is much more extreme than we are in views about medicine and is very religious. I should have asked for her sources but it makes no difference now, we are having the scan.

My delivering midwife is not this way at all. She has been a midwife for 30 years and delivered over 1000 babies. Her stance is that ultrasound is a good tool but she is fine with the parents choosing not to have it. Ultimately it is left to us to research and make the decisions we are comfortable with, without judgement from our midwives.

Just wanted to throw it out there I didn't find that on the internet or pull it out of thin air

Someone else might have more info.

DebateThis · September 2014

jennypolkadots said:

@jessandmike2013 - Most of what I posted, including the tissue/microbubbles actually came straight from one of my midwives. She has been practicing 10 years, and (not related) has a master's degree in engineering. She is very smart and research oriented, so I trust she has some basis for her belief. But I sort of take what she says with a grain of salt because she is much more extreme than we are in views about medicine and is very religious. I should have asked for her sources but it makes no difference now, we are having the scan.

My delivering midwife is not this way at all. She has been a midwife for 30 years and delivered over 1000 babies. Her stance is that ultrasound is a good tool but she is fine with the parents choosing not to have it. Ultimately it is left to us to research and make the decisions we are comfortable with, without judgement from our midwives.

Just wanted to throw it out there I didn't find that on the internet or pull it out of thin air Someone else might have more info.

The bold makes me question her judgment as a professional. How can she ascertain that she is the correct care provider for you without an anatomy scan? Midwives, especially lay/CPMs are ONLY for the lowest of low risk individuals and it's her job to assess that risk, which she cannot do w/o an ultrasound. Leaving people to "research for themselves" is a disaster waiting to happen. And I mean disaster in the most literal sense of the word.

jennypolkadots · September 2014

@debatethis - Sorry if I haven't explained things well. You don't know my midwives and are entitled to your opinion of course but I trust her judgement in assessing real risk. This midwife has been practicing over 30 years and has delivered over 1000 babies, having lost only one when the mother refused to be transferred. She carries emergency medicine and has two collaborating doctors. She never attends births alone and is usually accompanied by an RN/midwife assistant. She does not hesitate to send women for ultrasounds if she sees a medical need, and will not allow them to have an OOH birth with any indication of issues. If you refuse a medically indicated ultrasound she would drop you from care. She answers all of our questions honestly and openly, and would provide evidence if we asked. But she does not require the 20 week ultrasound because she recognizes the risk of an anomaly that would complicate the birth is extremely low in the women she cares for and some of her patients either have no insurance or are opposed to u/s for religious reasons but still deserve prenatal care. The most probable risk is placenta previa; however, later in pregnancy most midwives can located the placenta by using the fetoscope to hear the blood flow. In all of her years she has never seen a case of placenta previa that did not show warning signs (lots of bright red blood) before labor began although I'm sure it has happened somewhere to someone. We are supported in choosing to get the scan or not, everything they do is with informed consent.

I hope this explains a bit more but I understand if somehow you still question her judgement, and in effect my own. Oh well, can't please everyone.

soulcupcake · September 2014

OP, I'll address each point individually within the quote box since I can't isolate each one individually.

-We do not want to find out the sex. I am worried they will slip and we will find out.

Plenty of parents opt to not find out, and don't encounter any issues of ultrasound techs or physicians telling them against their wishes. Just make it explicitly known that you don't want to know.

-We are very low risk being young with no family history of any abnormalities.

Being young and seemingly low risk does not exempt you from having a baby with abnormalities, especially since many of them are NOT hereditary, have nothing to do with your health, and are random events at conception. The trisomies are included in this. I was in my mid-20's when I had my first son, and I had a healthy pregnancy. *I* was low risk, and yet he had severe heart defects that led to him going into congestive heart failure the month before I was due.

-The bean has a strong heartbeat since 6 weeks.

This means relatively little. Miscarriage rates drop a lot at 8 and 10 weeks, but they don't diminish, and second and third trimester loss are not at all uncommon, as some might think.

-We want to avoid false positives that just lead to unnecessary worry.

And what happens if there *is* a problem and you don't discover until it's too late? I think it's important to have as much information as possible to be prepared and equipped for situations that may arise. There's no such thing as a "false positive" for either genetic screenings or ultrasounds. There *are* times where a diagnosis via ultrasound turns out to be wrong, or times when things seemed okay and turned out to be, well, not okay. Ultrasound is not always 100% accurate, but I'd gladly opt for said screenings and ultrasounds to rule out, as best as possible, anomalies that could affect my birth plans.

-We would not terminate no matter what the diagnosis.

While termination is still on the table at this point in cases of adverse diagnosis, the information gleaned from the A/S can prove to be useful, especially in cases of out-of-hospital birth. I opted for screenings and had multiple ultrasounds at a MFM practice during my fourth pregnancy to hopefully rule out gross anomalies (mainly the cardiac/pulmonary, as these were the issues my first son had) because the presence of a serious problem would have affected my homebirth plans. I wanted to be prepared, and also have options if there was a serious problem. And by options I mean that if we knew it was serious/fatal, I could opt for extra monitoring throughout my pregnancy and opt to induce early before things turned for the worse, as in my first son's case.

It also just isn't about possible anomalies. Verifying placental placement and checking your cervix to rule out possible IC, are important as well. Some issues may not present until after the first trimester, in which case you can put your health and your baby's health at risk. Having been part of many stillbirth and neonatal loss groups I've come across many mamas who developed issues that weren't observed until their A/S or later, or issues the baby developed later in pregnancy.

-18 week ultrasounds have not been linked to better outcomes for mothers or babies. The things they check for can't be resolved before birth.

It depends on the anomaly. But it isn't about "resolving" issues, it's about being prepared, especially when you're birthing in an environment without immediate access to specialized care. Baby can have a severe case of congenital diaphragmatic hernia, CHD, pulmonary hypoplasia, kidney defects, gastrointestinal defects, brain malformations, etc. I know a woman in an old support group who UP/UC'd (which I support -- her body/baby, her choice), and wasn't aware of her son's severe heart defects. He died just before or during birth. Some people are fine dealing with these sort of tragic events and news when they occur, whereas for others they can better process and grieve when they know ahead of time. You may be in the former category, in which case, you'll deal with whatever may come if it comes.

-My OB (before I switched to midwives) already scanned me at 6 and 9 weeks and everything was perfect.

Having a great early u/s means jack squat. And I don't say that to be unnecessarily harsh, but there are many women who see viable embryo at 7, 8, 9, 10 weeks and still go on to miscarry or experience a late term or birth loss.

-Based on my research ultrasounds are not comfortable for the baby (extremely loud, like a freight train to them) and cause bubbles in the tissue. They aren't linked to causing issues, but we really don't know 100% what putting a baby under ultrasound for 30 minutes really does long term vs. if the same baby never had the exposure.

But there are potential problems if something *is* wrong and you don't have immediate access to a NICU team. And if there's a serious issue even five minutes can make a huge difference.

-Our midwives will refer us for an ultrasound at any later time if it is ever medically indicated. Right now it's not.

Since a good chunk of anomalies will not present with symptoms in the mother, what will they "look" for? If your BP is fine, you're measuring within normal range, you're not spilling sugar or protein in your urine, you experience no swelling, preterm labor, or other issues, how are they supposed to know whether baby has a serious problem? In some cases baby will measure small, which can mean a smaller fundal measurement, or there's not enough fluid, which can also lead to a smaller fundal measurement, but outside these cases a mom likely won't present with external symptoms.

Is there something we are not considering here? Are any of you not getting the optional ultrasounds? What would you do in this situation? I was going to post on the 2nd trimester board but I figured women planning a natural birth are more likely not to get the ultrasounds.

There are more mamas within the homebirth/UC community that opt out of ultrasounds. However, there are many that don't. It's a matter of preference. I planned homebirths with #3 and 4, and am planning another. I had dual care for just over half of my third pregnancy, and a good portion of my fourth. I saw specialists for screenings and ultrasounds all the up to about 32 weeks. Due to my history it was important to rule out anything that could contraindicate a homebirth. And the same has applied this time. I had dual care right up to my A/S at a MFM practice.

jennypolkadots · September 2014

@aeonlux - thanks, these are all reasons why we are going ahead with the scan and feel good about that decision

My OP was typed up based on very limited knowledge. I thought there would be more women here who opted out of the scans and wanted more info. This is my first pregnancy and I have not spent a considerable amount of time reading up on ultrasounds. That is why I asked and am happy I did. It gave us more food for thought and we are definitely having the scan now, already scheduled. Thanks, everyone!

jennypolkadots · September 2014

Just wanted to update this post in case anyone was curious. We had the 20 week scan on Tuesday and I am so glad we did. The OB said everything looks literally as perfect as you could hope for, and baby is measuring within 1 day of our dates which is awesome at 20 weeks. Placenta perfectly positioned at the top. I actually liked him so much that I am going to do 2 more visits before my due date just to have an emergency backup in our local hospital. He also knows our midwives well and all of his nurses had the nicest things to say about them so that was great to hear.

We didn't have any issue with the U/S tech telling us the sex accidentally and I feel silly for that ever being a reason to not get the scan done. She did put it in an envelope for us in case we decided we wanted to know. DH wanted to keep the envelope just to see if she was right, because she said she feels fairly certain. Having that little mysterious envelope around was so annoying because it is very tempting to find out but I really don't want to know for a whole list of reasons. Anyways, I am giving it to my best friend along with $$ to buy a perfect take home outfit and blanket. She is going to wrap it up and we will have it to open after LO arrives so it just adds to the surprise/awesomeness of the day.

Thank you ladies for talking me down from the ledge. I am embarrassed for all of the misinformation I had on ultrasounds and the idea that we could have put our child at risk for no reason. Thank you all!!

DebateThis · September 2014

secondaryPULSE said:

Personally, I am still torn on the topic. Here are two interesting articles to came to mind in this discussion:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788813/
https://www.midwiferytoday.com/articles/prenatalultrasound.asp

As of today, I lean more toward the side of getting the anatomy scan. However, I also accept that ultrasound has not really been proven safe, and that some serious malformations can be missed.

::facepalm::

jennypolkadots · September 2014

@secondarypulse - I understand where you're coming from, I was there a few weeks ago with a lot of misinformation. The risk of something being wrong with the baby is very slim, but I consider that risk greater than the risk posed by ultrasound technology. Ultimately it is totally up to you and I won't judge either way. I know many women who have not had any ultrasounds through their pregnancy and delivered perfectly healthy babies at home, but those women didn't have healthy babies and births because they refused ultrasound... it was more or less in spite of the fact if that makes sense.

I also look around myself and all of the kids in my family are smart, happy, healthy kids who had multiple ultrasounds done throughout their time in the womb. My mom had ultrasounds with me and that was in the 80s when the amount of ultrasound exposure was way higher than it is today. If you have a bias one way or the other it is easy to look online and find researchers who also share the bias. Just look at all of the data and your own experience to make the best decision for your family.

Perhaps you would consider calling the place where you are considering having the ultrasound and ask the last date that the machine was tested/configured. This would make sure you are receiving only the minimal required dose of U/S waves to get the images they need. You can also say you don't want pictures or to know the sex to limit exposure time if this is important to you. If you tell the tech that you don't want to watch and would like her to just do her thing as quickly as possible I'm sure she would be happy to get you in and out in just 10 minutes or so.

Many things can definitely be missed in an ultrasound, but also very many can be seen. Hard markers for down syndrome, issues with the heart and other organs, spina bifida, and physical abnormalities like club foot or cleft palette that you may want to know about before the birth. We are not planning to deliver in a hospital and it gave me relief to learn that my baby doesn't show any signs of anything abnormal. I realize that doesn't mean there is 0% chance that something could be wrong, but I feel better having seen that all organs are in their place, the heart has 4 working chambers, measurements are right on target, and everything looks as perfect as can be hoped for at this scan. I was also concerned about placenta previa and felt relieved to see my placenta in the fundal position (right on top) and way out of the way of my cervix. Also, to be honest, we treasure the profile shots of our child and it was truly amazing to see him or her. There is also this adorable photo of the baby's feet side my side and it is just precious. I look at the photos every day now and just can't believe how amazing it is.

In hindsight I honestly think I was against the ultrasound mostly out of fear that something could be wrong. Of course, I would rather know if something were wrong but I was afraid. This is my first baby and there is so much information out there to sort through and figure out. Ultimately the decision comes down to you and your husband, and the consequences of those decisions are also yours to bare. Whatever you choose to do, I hope it works for you and you go on to have a healthy happy birth with no regrets!

iris427 · September 2014

danisgossipgirl said:

@jennypolkadots‌ I really respect how you came around, recognizing some biases that may have been subconsciously influencing you, but ultimately looking for trustworthy information to base your decision on. That's hard to do. I'm glad you're happy with the decision you made.

I agree. Glad to hear the ultrasound went well and that you are happy with your decision. It's also nice to know an OB that you like and trust.

jennypolkadots · October 2014

@secondarypulse - I understand your concerns and share some of them. Thanks for the articles. I guess I feel that although many things can be missed, many things can also be caught and the parents can be better equipped to handle the situation. I know personally if I gave birth out of a hospital (read: no NICU) to a child with a deformed heart, I would be kicking myself for not having the scan. Even if there was a chance the scan wouldn't have shown it, to know that we could have known and done things differently would be really hard for me to deal with. But everyone is different and it depends a lot on religious beliefs and medical knowledge.

The heating of tissues was a concern I had and after learning more was no longer concerned. With a properly calibrated machine, an external (not transvag) ultrasound, and a constantly moving wand the heating of the tissue is negligible at best. You can further reduce the exposure by explaining you don't want pictures or things explained to you, and encourage the tech to just check everything she can and be done with it.

If you complete your training and become a midwife, I hope you learn more about both sides and share facts with your clients without bias. I'm sure you will, and they will really appreciate it. I would guess most clients will choose to have the scan, if only to find out the sex of the baby. As I said before, if you choose not to get the scan I understand, and your risk of something being wrong that could have been caught is very small. It ultimately comes down to parents choosing what they truly believe is the best option, and being willing to live with the consequences of that choice.

Deciding rather or not to have the 18 week scan

Re: Deciding rather or not to have the 18 week scan

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