Ultrasound alternatives / skipping 20-week scan?

[Feronia]

I’m nervous about ultrasounds and really want to limit my exposure (I’m 13 weeks). However, I’ve already had 3 scans due to a subchorionic hematoma and bleeding. Each time I thought I had miscarried, and it was a relief to see the baby doing well each time, but I feel a bit guilty about them nonetheless. Now I haven’t had any bleeding, spotting, or cramping for 5 weeks, so I really think the SCH has absorbed and my midwife agrees. However, now I’m thinking about the 20-week anomaly scan. My midwife gave me plenty of alternatives (like only checking the placenta and the SCH, or avoiding measuring the head, or avoiding all measurements, or not doing the scan at all). With my daughter, they belittled my request to keep the scan short, but my midwife said that if they put my requests on the report they will honour them.

(Note: I am planning my second home water birth.)

So my questions are:
-How important is it to check the SCH to see whether it has absorbed, and the placenta location? I know 98% of low-lying placentas diagnosed in the second trimester move up, so would this information be important?
-I am doing both quad screening tests (10 weeks and 16ish weeks), so how likely is it that an ultrasound would diagnose down’s syndrome, trisomy 18, or neural tube defects when the quad screen would miss it? I would really like to know about these things ahead of time to consider my option.
-Are there any other common (or fairly common) anomalies found on scans? I don’t care about minor defects, but I’d want to know about severe defects or conditions incompatible with life ahead of time… though I am a very healthy, 27-year old who doesn’t smoke or drink so I think my risks are low.
-How important is it to diagnose growth, or growth-related conditions like IUGR?
-What about checking the baby's heart if I have no family history of heart problems?

So conflicted! Thanks so much!

 

[Kittycat155]

I skipped all scans. Way I looked at it was I could not change anything till 24 weeks anyways and I felt there was little chance we would benefit. IT all depends on what you can live with far as would you abort for medical and would you beat yourself if baby had something you could have delivered at say 24 weeks.

I would not rely on scans only for IUGR. To many results of baby to big baby to small and when delivered find out it was off.

Personally I could not find a place that I felt comfortable going that they would honor my wishes and be a short enough drive. I was looking at hours drive one way and 1-2 hour wait and figured for what I can do better on my own and decided to to Unassisted pregnancy.

You could do a scan later on say 35 weeks where baby is bigger and in theory able to handle it better to check for some issues. Heart you will be able to hear on fetoscope(avoid doppler if you are concerned of US risks as same thing just more intense)

 

[Feronia]

Thanks, I appreciate your perspective!

I have wonderful midwives who honour my feelings, give me plenty of choices and options, and aren't condescending at all, so I'm not planning an unassisted pregnancy or birth. I would if I didn't have access to quality midwifery care, though.

I would only consider an "ethical prenatal loss" if it were a condition incompatible with life like anencephaly or trisomy 18. I think it would be heartbreaking to carry a baby to term who would die in labour or shortly after birth....

I've read that bone heats up much faster than tissue or fluid, which made me feel better about the early scans I had due to bleeding. Still, I would like to avoid exposure (and I'm avoiding dopplers, too).

 

[ttc126]

Feronia, i found this article you might like. It was very informative to me. I know from our February thread that we share similar thoughts on ultrasounds.

https://chriskresser.com/natural-childbirth-iia-is-ultrasound-necessary-effective-in-pregnancy

 

[Feronia]

Thanks, great article! That's exactly what I was looking for with the links to scientific articles.

 

[ttc126]

I really agreed with the article especially how it said pregnancies are treated almost as abnormal until proven otherwise now. I am someone who 100 years ago wouldn't have had healthy babies as a pregnancy outcome. So thankful for technology, but I'm the exception. I'm thinking for me, I'll let them scan quickly for placental function as that's the only major monitoring i need but i think I'll decline the long scan

 

[Kittycat155]

So agree. Even when all is clear there are more and more scans for IUGR and position(which is leading to a lot of c sections for breech when breech CAN be delivered vaginally). Keeping in mind position CAN change even as women is in labor.

 

[Feronia]

And if you're worried about ultrasound, scanning the placenta is most likely the safest since it doesn't directly target the baby.

I've decided to talk with my midwife to see what she says about either skipping the scan or doing a 30 second one, and then I'll choose one option from there. Thanks everyone!

Yeah, I'm grateful for ultrasound and medical intervention when it's necessary or when there are signs of abnormalities, I'm just wary about it for low-risk women. Midwives are very good at palpating for position anyway, so I'm not concerned on that front either!

 

[misspriss]

We didn't have a 20-weeks scan with DS. I had an early scan at 6+3 before I read up on it (and was fully intending to have a 20-week, plus a 3d/4d private scan or two) and then researched it and decided not to. I was under midwife care (lay midwife, different than UK midwife) when I switched to an OB because of pre-eclampsia, I don't think he was trilled that I hadn't had one. They made me get one to check size and stuff before they induced me (they said 4.5lbs, he was under 4) and I think they went through a lot of the checks they do at 20 weeks, heart, etc. The woman was really rough and not very nice, she made me cry. But point being, there was absolutely nothing wrong with DS, the ultrasound at 33 weeks revealed nothing. I would never terminate for any reason, so I saw absolutely no reason to do any scans. There are very few problems that require extra care during pregnancy or at birth that can't be detected in other ways, such as listening to the heartbeat.

I didn't avoid dopplers, because my midwife only used it for about 15-30 seconds each visit. If it were a 30-minute affair, that would be different. I will have OB care for my next pregnancy, and since I already plan to decline any unnecessary scans, I don't think I'll fuss about the doppler.

 

[Feronia]

Thanks for your story, misspriss. I am trying not to feel guilty for the 3 early ultrasounds that I had since I was bleeding heavily and thought I miscarried. Otherwise I wouldn't have had them... So sorry that you were coerced into more ultrasounds. Hopefully your next OB is more respectful of your wishes. Can you get a midwife with an OB consult? Here, higher risk women can choose to get a midwife but then also meet with an OB and have both involved. I'm sure it's different in the States with insurance concerns, though.

I'm also not opposed to short uses of a doppler since it takes a lot longer for the tissue, bone, and fluid to heat up. That's why I'm wary about the 20-week scan since it usually takes around 45 minutes.

I also asked both sides of the family if there were any congenital heart defects, chromosomal defects, or other birth defects that would be hereditary, and it sounds like we're clear. And you're totally right that not too many things can be prepared for ahead of time in any really meaningful way, either... I read about signs of heart problems after birth, like shallow breathing, blue lips and fingers, and short nursing sessions due to being out of breath, so I feel comfortable taking an expectant approach. Thank you all!

 

[misspriss]

Thanks for your story, misspriss. I am trying not to feel guilty for the 3 early ultrasounds that I had since I was bleeding heavily and thought I miscarried. Otherwise I wouldn't have had them... So sorry that you were coerced into more ultrasounds. Hopefully your next OB is more respectful of your wishes. Can you get a midwife with an OB consult? Here, higher risk women can choose to get a midwife but then also meet with an OB and have both involved. I'm sure it's different in the States with insurance concerns, though.

I'm also not opposed to short uses of a doppler since it takes a lot longer for the tissue, bone, and fluid to heat up. That's why I'm wary about the 20-week scan since it usually takes around 45 minutes.

I also asked both sides of the family if there were any congenital heart defects, chromosomal defects, or other birth defects that would be hereditary, and it sounds like we're clear. And you're totally right that not too many things can be prepared for ahead of time in any really meaningful way, either... I read about signs of heart problems after birth, like shallow breathing, blue lips and fingers, and short nursing sessions due to being out of breath, so I feel comfortable taking an expectant approach. Thank you all!

I don't feel like I was coerced, I had developed pre-eclampsia and they were considering inducing at 33 weeks. At that point, facing a premature birth and a NICU stay, I agreed to the ultrasound. Granted, they didn't learn anything except an incorrect weight guess, but it was nice to know everything looked well developed enough to induce.

I probably will use the same doctor, he did my c-section and he was very pro-vbac for my next one afterwards, he was kind and considerate of the fact that a natural birth was important to me. I didn't mean to paint him in a bad light, it's just, doctor's aren't used to having to do things different. I literally showed up at his office on a Monday, with midwife notes and a rising BP, was admitted and induced Tuesday night, and he had to perform surgery on me Thursday morning. Having more data to go on (like a 20 week scan he's used to seeing for every patient) or even his own records for the last 33 weeks of my pregnancy probably would have helped!

Anyway, no, we can't. Technically, I think it's in the rules, but doctors refuse to work with midwives here at all. You are required to have a DR check early and at 36 weeks to have a homebirth. You cannot find a doctor willing to even to a 36 week risk assessment check (that is required by law) because they won't touch you if you plan a homebirth.

If we move to Texas, which we are considering, I can have a homebirth VBAC and there are a lot more midwives there, and CNMs (which are like UK midwives) who do homebirths, not just lay midwives.

 

[Feronia]

Oh, sorry for the misunderstanding! I'm glad you weren't actually coerced. For a situation like yours, I would definitely get an ultrasound, too. I'm all for them in high-risk cases or if a problem is suspected, I'm just wary of them as routine for low-risk women or for frivolous reasons.

Cool, glad that your Dr. is pro-VBAC! I've heard about the situation with midwives in the States, and it sounds really unfortunate. I had no idea Texas was midwife friendly. Wow, I'm surprised!

 

[lynnikins]

my reasoning for the ultrasounds is one to date the pregnancy as my cycles can be really unreliable and my babies tend to get near the 42 week mark from the ultrasound dates. and 2 to check the placenta's position as if it is low and could abrupt I would want to know about it as that is life threatening in a homebirth situtation if its not picked up on ahead of time. My scans have never lasted more than 10 min and that was when the baby was being a pickle and not cooperating to get measured nicely mostly they are done with quickly

 

[Feronia]

lynnikins, I'm sure about when I ovulated this time, and since one scan was at 8 weeks the date at that scan matched up.

Also, I read a study showing that a low-lying placenta diagnosed in the second trimester has a 98% of moving up far enough by the time of birth, so I wouldn't want to stress over probably nothing! Bleeding during labour would be a sign for transfer anyway, and the hospital is down the street from me less than 10 minutes away!

 

[misspriss]

I read an article, which cited a study that said that there was no improvement in outcome for people diagnosed with placenta previa by ultrasound vs diagnosis during labor, so no reason to do an ultrasound to diagnose previa as it can be diagnosed during labor with no difference in outcome.

 

[Feronia]

Good point, I do remember reading about that one, too!

 

[Jim West]

I'm sad to see so many women who are seeking information belatedly. Ultrasound is highly controversial, and one must understand it, as well as medical politics in general. Read Dr. Robert Mendelsohn, etc. I hesitate to promote my own research because it is strongly against ultrasound. Search keywords harvoa and ultrasound.

 

[Feronia]

Yeah, a little late. I didn't end up doing any ultrasounds and baby boy was just fine. I'm glad I skipped them.