Are you concerned about ultrasound exposure?

[Edensmum]

I have been reading, being pregnant and all, and there seems to be enough evidence that they are not harmless to give me pause, my practitioner dismisses this claim outright. I am concerned about how big an issue this is going to be. As a VBAC patient I am likely to face a huge fight to avoid continuous electronic fetal monitoring. This is hours of exposure. Not to mention she already has plans to track the growth of the babe while pregnant with this tool.
I don't mind intervention when it's necessary, but things like tracking growth which is really inaccurate and CEFM which has been shown not to improve out comes, concern me. It's intervention for the sake of policy and convention rather than need. I am already having an issue with this practice about not wanting a 3rd pap this year, so I am afraid I am quickly becoming that patient. The problem is, I would like a midwife standard of care but and forced to use an OB, this OB, because of the city I live in.
Do these things concern you?

One article I read:

[url="http://www.midwiferytoday.com/articles/ultrasoundrodgers.asp"]http://www.midwiferytoday.com/articles/ultrasoundrodgers.asp[/url

[Ceepa]

Have you already explained your concerns to your OB? If not, that would be my first step.

[Edensmum]

I have briefly, we will get to that point later, I was trying not to take issue with too many items on the agenda at once, and the pap was the issue of the day.
She simply said, "There is no evidence linking them to harm." From the reading I am doing there is some that suggests caution at the very least. I don't think I would go as far as saying no to all u/s but I would not go for extra ones.

[BabyMine]

I asked my Dr about this and she said the exposure was very low. My DS2 was a VBAC. Like PP said just refuse the extra ones.

[lorinick]

How many ultrasounds are you talking about? I had alot and would have loved to have more. I loved to see that the baby was doing well. I know as an Xray tech X-Rays exposure is over time a problem, not sure about US, but likely the same thing. I've not read the anything on it, but I wouldn't be concerned about it. IMO there is more of a risk of other concerns and comp. to a high risk pregnacy than to worry about us exposure.

But if you have an issue I would talk with your doctor and make sure your on the same page. If your not you may need to find another doctor that shares your concern and practices that way.

[MamaMolly]

Nope, concerned in the slightest. DD was conceived overseas and I had one at least every week. I have a flip book of that pregnancy! And she's fine. But you know, that is me. What works for me isn't necessarily ok for you or the next mama.

IMO it is a concern to YOU, then it ought to be important enough to your OB to not dismiss out right. They need to hear you out as a concerned, educated, rational patient and help you come to a level of comfort with your decision to either have more or less of them. Brushing you off is not good patient care.

When DD was born I had more intervention than I was expecting or wanted. (pitocin drip that was standard, then had to be immediately turned off because it was causing me to contract too much. I'd have preferred we see if the d@mn pitocin was necessary in the first place, rather than have to scramble to stop it) Now that I'm more experienced and educated I think I would speak up for myself to get a level of care that I was more satisfied with.

So if you have to be 'that' patient, so be it. Own it! ;)

[maestramommy]

No, I'm not particularly concerned. The most I had for a single pregnancy, including those really early ones, was 5.

[Indianamom2]

I'm not concerned either. As another poster mentioned, I'd be more concerned about the potential risks of an unmonitored higher risk pregnancy.

Could there be a potential for over-exposure? I suppose, but I suspect it is by far NOT the norm. Of course, you can find all kinds of horror stories on the internet about just about anything, but IMO ultrasounds are not a cause for concern.

Of course, your doctor should be willing to listen to you and provide you with any info you are seeking. If he/she isn't, then maybe you will need to find someone with whom you are more compatible, because that is important.

Christina

[wellyes]

Personally, no, I didn't worry about ultrasound exposure. After talking to my doctor I decided that the (known) good of them outweighed the (unknown, minimal, possible nonexistent) and risk by far, for me.

Go to the MDC boards, you will find plenty of natural childbirth, minimal-to-no intervention moms with kids with autism.

But if you're not comfortable with them, especially with the monitoring, I think it is very reasonable to refuse them unless absolutely medically necessary.

FWIW I had a midwife and an OB (shared practice) and honestly the only huge difference, to me, was the midwife's skill and attention for mothers seeking natural, drug-free childbirth. She'd stay with you and hold your hand for hours whereas the OB only comes in for problems and monitoring and the 'push' part. But for week-to-week checkups, they were pretty interchangeable in my experience.

[jk3]

Not at all. I had lots of complications in my first 2 pregnancies + ultrasounds were reassuring and a neccessity. I had a slew of ultrasounds during my third pregnancy. My stress level was more of a concern than the remote chance that there was anything harmful from the ultrasounds.

[american_mama]

Have you read more than that one article? I think you could tear the article apart on how it misuses statistics and conlusions to make its point, but as to that main point - the safety of prenatal ultrasound - I am not very concerned.

I think it's possible ultrasound is harmful to fetuses in some, probably minor, way, but I don't think the problems can be huge when there is such a huge sample of babies who've been exposed. I am not sure I buy the autism link: it's so easy to say anything causes autism.

I never thought about ultrasound exposure until my third pregnancy, when I read a few blips on various message boards, but blips don't have much weight to me. I didn't pursue it further. I thought I'd ask the ultrasound person in that pregnancy to keep the ultrasounds short, but I never did, in part because it is so much fun once you're there having the ultrasound. I also never had a lot: two with DD1, three with DD2 and DS. I have a highly irregular period, so need an early ultrasound for dating purposes and I think the benefit of the 20 week ultrasound (checking anatomy, organs, etc.) outweights any potential harm. So I personally would have to see very good evidence to skip those two scans.

I'd make sure you've read more than just this article and decide what really matters to you. Is it any ultrasounds, vaginal ultrasounds, long ultrasounds, 3D ultrasounds? intermittent Dopplers or continuous fetal monitoring during labor? (Are Dopplers and CEFM even the same?) (Note: I believe the alternative to Doppler is a fetoscope - big bell shaped stethoscope - and I don't know if providers typically own one or are familiar with using it. ) Is there a minimum number and timing of ultrasounds that seems to balance your wants and your ob's standard of care?

Or are there other aspects of your care that you want to take a stand on - for instance, how far past you due date or how many hours into labor you can go before your ob gets nerous? In terms of communicating with your ob, you may want to ask SnuggleBuggles if Marsden Wagner's book "Creating Your Birth Plan" or something like that is helpful. I believe she has read it. I have not, but heard him speak about it, and it seemed to address communication between patient and provider.

[doberbrat]

nope. I have them frequently due to medical issues. dd is fine and this one appears so as well.

personally, I think if there were harm, I think we'd have some proof by now. but if you don twant them, you should clearly explain that to your practicioner and or change drs/mw whatever to someone who shares your philosophy

[Snow mom]

My OB told me the only real concern with ultrasound is that it slowly warms the amniotic fluid but that was really only a concern for mall type ultrasounds where you pay for a long 4d video of the baby. Even that hasn't been shown to be harmful but I think most doctors wouldn't recommend ultrasounds for fun. I thought ultrasounds were pretty neat but if you are concerned about them talk to your OB about it.

[Hawkeyewife]

I had one ultrasound each for my first three kids, they were fun. We don't find out gender before birth so they were pretty short ~20 weeks along.

I chose not to have an ultrasound this time around. I am a little concerned with a few of the noted side effects, but for me, I have know a few too many expectant moms lately (inlcuding my SIL last year, whose baby they though had hydrocephely and even after over a dozen ultrasounds did not have it but was born with polydactyly, 12 fingers and 12 toes) who had scarry ultrasound findings which were incorrect.

I will get one if there is a true medical indication to have one.

[Raidra]

I think there is a possibility that it can cause harm, maybe in babies that have a predisposition anyway. I don't know. There isn't proof either way, to be honest.

I'm more concerned with the risk of an ultrasound making an OB induce labor unnecessarily. I can't tell you how many times I've heard of pregnant women being told that the ultrasound weight estimate is too high and that they need to induce right away, and then the baby ends up weighing 6 pounds (and some of them even end up having breathing trouble because they were too early). There's risk that them estimating your due date with a mid-pregnancy ultrasound could be way off and end up with you getting induced early because they have the wrong due date. There's the risk that they'll find an abnormality and counsel you to terminate, when there's actually nothing wrong.

I know women who have been in all of those situations.

You can say no to anything you want, remember that. You may end up being *that* patient, but isn't your baby worth it? I don't see the need for anything more than the 20 week ultrasound, and in the rare case that you have no idea when you conceived, a dating ultrasound.

Anecdotally, I had the most ultrasounds with my first and he had a speech delay. I had less with my second and he talked on time, and only one with my third, and she's talking early.

[lchang25000]

I'm not concerned about it either. I actually had my own doppler I would use daily for a while to listen to the baby's heartbeat. I also had quite a few u/s done at the doc's office and my hubby did one himself also.

[Carrots]

No, I am not concerned about u/s exposure. I can't be.

I was/am high risk during pregnancy due to cervical incompetence and am followed exclusively by a perinatologist in Maternal Fetal Medicine. I had an u/s every 2 weeks with my triplets, but that pregnancy was high risk for different reasons, and at the time, we didn't know about my cervical issues.

With DD, I had u/s every week to check my cervical length and we always peeked at DD. It was a good thing we did because I was suddenly 2 cm dilated at 28 weeks and spent the remainder of my pregnancy on bed rest.

What I am getting at is that u/s are 100% necessary for me to carry a pregnancy to full term. The risk of my incompetent cervix far outweighs any risk that an u/s may or may not have.

:)

[mudder17]

For the fetal monitoring, I wouldn't worry about there being an issue--I assume you're talking about the NST? I think the biggest issue for me with the NST was being strapped down so you couldn't move much. However, I was able to request and get intermittent monitoring during my second birth and it wasn't bad at all. They just had to get fetal heartbeats every 30 minutes or so, but they were willing to be flexible, depending on when the contractions hit. In any case, NST is not the same as u/s.

For the u/s, I don't think the energy waves themselves are a big deal. As someone said, if you were going to be strapped in with the u/s going on for hours at a time all the time, MAYBE you might get warming in the amniotic fluid, but I really don't think that would be an issue. BUT, I also think this is a personal decision you have to make for yourself because there just isn't enough info out there either way. From what my naturopath said, the biggest issue may actually be the noise for the baby. U/S basically use sound waves, so for the baby, it can get pretty noisy in there.

I just googled for u/s and found the following article:

http://www.acfnewsource.org/science/ultra_hearing_fetus.html
the
In part, the article says, "Based on his experiments, Fatemi concluded that ultrasound vibrations sound like the high tones of a piano, at about the same volume as an approaching subway train."

So my thought is that the biggest issue is one of stress for the baby, if it's happening all the time. One thing I plan to do after the u/s is basically do some yogic breathing--it'll relax me and I think THAT will transfer to the baby.

That said, I don't mind doing u/s that are prescribed by my doctor, but if there are any that are unnecessary, I'm not going to do it, kwim? But if it came down to the health of the child and needing to monitor something carefully vs. it just being a bit noisy in there, I'd rather go with the monitoring. If I had a high risk pregnancy, I would much rather take the chance with more monitoring. But as it is, I am not high risk so if the OB suddenly decided I needed a bunch of monitoring (he wouldn't, but I'm sure some would), I might look for someone whose philosophy is closer to mine.

Good luck!

[DebbieJ]

I do have some concerns about ultrasound exposure. It think they are overused by the medical community. The 3D ultrasounds are ridiculous--there is no medical indication for them.

I did not have a single u/s with ds. This time around I have had two and consented to them because of my previous loss. I do not plan on having any more unless my midwife deems it medically necessary.

[JenaW]

As a OBGYN PA (although not currently practicing), here is my two cents:

In the area where I practiced, it would be next to impossible for a VBAC pt to find a provider who would allow her to labor without continuous EFM (or near continuous). IME, the rare OB who will allow a VBAC wants to cover his butt as much as possible, and feels the risk of rupture is too great to allow a woman to go unmonitored. YMMV, and you probably would have better luck with a midwife, but I am not sure that I personally would feel comfortable with that. I know many women who have had successful VBACs, but I also know of several cases of uterine rupture, some with positive outcomes, some where the baby died. I also know of a case where a woman had to undergo a emergency hysterectomy to save her own life because of such an extreme case of hemorrhage after she ruptured. And cases of maternal death have been reported as well. Not trying to scare you, but just want you to be aware of potential consequences, however rare they are. My preemie (baby #3 of 5) was breech and I was told I would have to have a section to deliver her. Fortunately, I was able to deliver her vaginally. But if I had a c-section, I probably would have still wanted to attempt a VBAC with subsequent pregnancies, especially knowing that I had already had two full term vaginal births. However, I would have agreed to any and all monitoring to make sure both myself and my baby were as safe as possible.

With regards to your ultrasound question, I do not think that u/s for growth at every visit are necessary or prudent. As others have pointed out, EFW are notoriously inaccurate and inductions based upon them for "large" babies often end up with deliveries of 7 -8 pounders who could have easily been delivered vaginally. However, if you are measuring small or large by fundal height measurement, then an u/s is definitely indicated to rule out too little/too much fluid, growth restriction, or other potential problems. As a pt with high risk pregnancies (hx of multiple losses, a disorder that makes me prone to blood clots both in me and in the placenta, meds that make the baby at risk for growth restriction and placental insufficiency, hx of preterm delivery, hx of preterm rupture of membranes, cervical incompetence), I typically have early u/s and then frequent ones throughout the pregnancy. I would guess that I have had double digit numbers of u/s with all 5 of my pregnancies that resulted in living children. All of them appear healthy. For me, any potential risk from the ultrasound was outweighed by the other potential risks I brought with me to the table. However, if I did not have any of those risks, I would feel completely comfortable refusing extra scans. In our practice our low risk pts got one early (1st tr screen) ONLY if they had no clue about dating, or if they wanted the nuchal cord measurement. Otherwise, they got the anatomic scan around 18-20 weeks and that was it, unless something else came up during the pregnancy.

As for having 3 PAPs in one year, have you had abnormal ones? I can't think of any other reason why you would need 3, since all of the groups who make recommendations for cancer screening (ACOG, USPSTF, ACS) recommend one a year, and some say you can go three years if you are low risk and have had 3 negative ones in a row. I would definitely question that.

As pregnant patients, we have a right to be informed and question our providers. Not all practitioners follow best practice rules or evidence based guidelines. However, it is one thing to question something, but another to flat out refuse based upon something that we read online or hear from a friend. I am not suggesting you are in that category, but as a provider myself, I would get very frustrated when patients would question a medical decision I was making based upon something they misinterpreted from an unreliable source. I have no problem discussing it with them and taking the opportunity to explain my rationale. I would never flat out dismiss anything or anyone. But in the end, if I still felt my reasons were justified and they flat out refused something I felt was medically necessary, I would document the conversations and probably refer them to someone else as neither one of us will be happy with the situation and it could become medically unsafe for the patient and unsafe to my license to practice.

~J

[Raidra]

As pregnant patients, we have a right to be informed and question our providers. Not all practitioners follow best practice rules or evidence based guidelines. However, it is one thing to question something, but another to flat out refuse based upon something that we read online or hear from a friend. I am not suggesting you are in that category, but as a provider myself, I would get very frustrated when patients would question a medical decision I was making based upon something they misinterpreted from an unreliable source. I have no problem discussing it with them and taking the opportunity to explain my rationale. I would never flat out dismiss anything or anyone. But in the end, if I still felt my reasons were justified and they flat out refused something I felt was medically necessary, I would document the conversations and probably refer them to someone else as neither one of us will be happy with the situation and it could become medically unsafe for the patient and unsafe to my license to practice.

~J

The problem is that doctors rarely fully inform patients of risks. You went in depth about the risks of VBAC, without mentioning the risks of repeat c-sections. Personally, I'd much rather have a VBAC with an experienced midwife who will give me all sides of the story, even if it means doing it at home, than see a doctor who won't give me all the information I need. It's a terrible burden to put on women, to do all the research to find info that their doctor should be providing. That's why you get women with half-assed research on ultrasounds, because they don't have the skills to do the work, and their doctors just say, "Oh, no, it's safe."

[wellyes]

Interesting timing - Conn Gov just signed ban on "keepsake" ultrasounds. (http://www.boston.com/news/local/connecticut/articles/2009/06/24/conn_governor_signs_keepsake_ultrasound_ban/?rss_id=Boston.com+--+Latest+news) It does not say (or mean) that ultrasounds are dangerous, more about getting multiple ultrasounds at the mall instead of under a physician's guidance.

I keep thinking of when Tom Cruise bought Katie Holmes that ultrasound machine.

[kijip]

I have no concerns whatsoever about the safety of u/s. I wouldn't get them for fun but I am highly skeptical of claims that they damage the baby in anyway.

However, I did decline a late term u/s that the u/s doctor wanted to do based on my 20 week in-depth exam. He was concerned about the baby being at risk for slow fetal growth due to the cord missing an artery and he observed some markers in the head that "may indicate a risk for Down's Syndrome". Since I was planning a VBAC I did not want an inaccurate size guesstimate to undermine me AND my blood tests did not indicate even vaguely high or moderate risks for any genetic conditions like Downs. Also I was very busy and found getting to the u/s difficult AND I find the exams uncomfortable physically and this u/s doctor irritated me by dismissing the results of the blood work and the earlier u/s'. His perception was it couldn't hurt and my opinion was "What will it help". In my situation I felt like it would help nothing. My midwife agreed with me that a late term u/s was not needed in my case. I would not agree to have something done just to appease the doctor.

I have never understood u/s for fun pics. Am I the only one that is somewhat creeped out by u/s pictures? Honestly, the only ones I have any interest in whatsoever are my own and event hen I don't consider them framable keepsakes. I must sound horrible, but the only reason we kept ours was because T was interested in them.

[DebbieJ]

I have never understood u/s for fun pics. Am I the only one that is somewhat creeped out by u/s pictures? Honestly, the only ones I have any interest in whatsoever are my own and event hen I don't consider them framable keepsakes. I must sound horrible, but the only reason we kept ours was because T was interested in them.

ITA 100%. My SIL's 3-D u/s pic was her FB profile pic for a while there and it totally creeped me out.