36 week growth ultrasound? Thoughts requested.

[kam]

UPDATE:

I had the Ultrasound on Friday. Baby is measuring 6 lbs, 8 oz, and they said her position was "optimal" for getting accurate results. The biophysical profile was perfect, and we have no further ultrasounds/stress tests scheduled. From here on, it's just blood pressure checks and cervical checks if I'm curious.


When I saw the OB, I asked about why she ordered it. She said that it's partially about growth, but that she also orders it because she wants to get a good look at heartrate, movement, position, and cord/placental insertion. We also talked about the practice/her standards for induction: For a 1st time mom with no risk factors other than dates -- 41 weeks. For a 2nd time mom with a proven pelvis and no issues oher than dates: They don't induce before 40 weeks, 4 days. She said "I'd much rather wait for mom to go into labor. For a second timer, if she's walking around 3-4 cm dilated, effaced, baby is engaged, I'll consider allowing (not offering) an induction the 2nd half of the 40th week. It's likely to be successful rather than be a failed induction --> C-section, which no one wants."


So, I just thought you would all think this was interesting. Thanks for all of the advice!


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Hi all.

I'm 34, almost 35 weeks, and my OB told me to schedule a 36 week "growth ultrasound." I had DD in early 2009, and did not have this. In fact, it was never mentioned. She was born after SROM and 12 hour labor at 37 weeks and 6 lbs, 14 oz, 21 inches. The ob said that this is "standard practice" now. I'd heard that the +/- of these ultrasounds is huge, and thus they aren't terribly reliable.

I went on their website to schedule the appointment (because I'm generally compliant if I don't think it's a big deal) and noticed that she'd coded me "excessive fetal growth."

I've gained 26 lbs, but am carrying all in front (it looks like someone stuffed a basketball under my shirt). DD wasn't big, and in fact was the smallest baby in 2 generations across both families, so I was sort of expecting an 8 lb-er. (And am again).

Does anyone think I need to worry or should be inquiring further?

[SnuggleBuggles]

I think that you can easily get yourself psyched up on the wording and even the u/s and that can add unnecessary stress...that's why I'm not a fan of these things. Plus, I think that those things can lead you to make birth decisions that you wouldn't if you never had them brought up. Around the holidays I always get suspicious when they bring up "big" as it is a great excuse to induce or do a c-section, thus ensuring no interrupted New Year's Eve plans. I'm a bit jaded sometimes though. The reasons could be totally legit though and they could be fabulous care providers.

How have your fundal height measurements been? Those are what they are likely basing growth on more than your weight gain.

I was 1-2w ahead in the end and ds2 was 9lb 9oz. It was a fast, easy, great birth experience and I had only a tiny tear and no problems. Sometimes big doesn't have to be a big deal. I think that baby's position (anterior, posterior...) and your birth position all make a bigger difference in things than baby's weight.

Those are just my thoughts on it all. Go since you want to go with the recommendation but try not to internalize and stress one way or the other. Baby will be the size baby is meant to be and odds are super good that you'll be fine.

Beth

[lowrioh]

My OB's office does a 36 week growth ultrasound as a standard practice.

[kam]

That's the thing -- my practice doesn't do fundal measurements. So I have no idea what they are. And it's a big practice, with every doc doing a mandatory in-hospital call every 8 days, so I can't imagine that's a huge issue. That's why I'm trying to figure this out. Is it just a new thing for our practice and they're coding something to get it through insurance? Or do they really think I'm going to have a "big" baby?

I'm not really scared of a big baby, so if that's what this doc is trying to do, she's barking up the wrong tree. I'll consider induction at +/- 40 weeks, but not before unless they can show me something other than "big." (Though I am getting sick of being pregnant!)

DD was posterior for the entire labor/delivery, which SUCKED, and I still delivered in 12 hours with a 1st degree tear. She also had a head circ of 80%. So I figure, if I can deliver her, I'll be ok with an 8-9lb baby. Especially if, as you point out, the position is better.

Again, I don't really mind the ultrasound -- I don't think there's any risk to the baby, and I'd like to see her! But I'm wondering about the why, and want to be prepared for whatever the OB says after she sees it.

[WolfpackMom]

My first thought is that they coded it like that to get insurance to pay for an ultrasound that is to simply see how big the baby is. To get it through insurance they would have to come up with some reason since a size measurement is not usually medically neccessary - an since your doctor didnt bring up a specific issue to check for I would wonder if it is in this case. I know a lot of practices do that that type of US whether neccesary or not. I would be inclined to call them up and simply ask what the deal is.

[mom2MandC]

Please don't stress too much!! I had to go for growth scans every few weeks the last trimester due to gestational diabetes and I am not so sure I would do them again, because they were not accurate!!
Plus I knew I was having a csection (my DD1 was an emergency csection) - so I knew that was already determined.
But at I believe 36 weeks they told me my DD2 was at least 8lbs15ounces- and would likely be near 11 pounds if we went to 40 weeks- well I had my csection at 39 weeks and my daugther was 8 pounds 6 ounces!!! That did seem big to me since DD 1 was only 6lbs 14oz (they told me she would be around 8 pounds) but I was sure that DD2 would be over 10pounds- and they made me really worried for no reason at all!!!!
So whether you do it or not- just know that they are not that accurate. The ultrasound at the hospital was slightly more accurate for DD1 than the one at the maternal/fetal medicine facility for some reason!!
Good Luck and try not to stress too much- you are heading down the back stretch!!
Are you due in January- my DD2 is a January baby- maybe they know they need a little more insulation due to the winter weather!! :-)

[stinkyfeet]

My first thought is that they coded it like that to get insurance to pay for an ultrasound that is to simply see how big the baby is. To get it through insurance they would have to come up with some reason since a size measurement is not usually medically neccessary - an since your doctor didnt bring up a specific issue to check for I would wonder if it is in this case. I know a lot of practices do that that type of US whether neccesary or not. I would be inclined to call them up and simply ask what the deal is.

When I was experiencing resistant ductal thrush while nursing DS1, my OB recommended a visit with a breast specialist. The specialist wrote me a referral to an imaging center and wrote on the referral "breast mass" for the reason why to have the procedure done. I got scared when I saw this and asked him about it. He said that he needed to write something generic down so that insurance would pay for the ultrasound.

[daisymommy]

Whaaat? They don't do fundal measurements? You're kidding me?! What is this world coming to .

I've had 3 babies, and always only one ultrasound at 20 weeks. I've never even heard of a 36 week growth ultrasound.

I personally would be a bit sketchy with this practice, and wonder if they do this to tell you your baby is big, so be prepared you might need a C-section. But of course, ultasounds can be as far off as 2lbs. in either direction, so I wouldn't take the results with any amount of accuracy in my plans.

If you have only gained 26 lbs. and don't have gestational diabetes, I would pass on it.

[Edensmum]

Hi all.

I'm 34, almost 35 weeks, and my OB told me to schedule a 36 week "growth ultrasound." I had DD in early 2009, and did not have this. In fact, it was never mentioned. She was born after SROM and 12 hour labor at 37 weeks and 6 lbs, 14 oz, 21 inches. The ob said that this is "standard practice" now. I'd heard that the +/- of these ultrasounds is huge, and thus they aren't terribly reliable.

I went on their website to schedule the appointment (because I'm generally compliant if I don't think it's a big deal) and noticed that she'd coded me "excessive fetal growth."

I've gained 26 lbs, but am carrying all in front (it looks like someone stuffed a basketball under my shirt). DD wasn't big, and in fact was the smallest baby in 2 generations across both families, so I was sort of expecting an 8 lb-er. (And am again).

Does anyone think I need to worry or should be inquiring further?

I'd worry that they are setting you up for unnecessary and risky intervention. Doing a sizing u/s is not recommended by ACOG, nor is intervening due to large fetal size. Position has much more to do with delivery outcome than size. Many doctors now estimate fetal size and it's very inaccurate. At 36 weeks I had the u/s because my midwife wanted to make sure my placenta was not near my cervix, it had been low but moved up nicely. The doctor went on and on about how big my baby was, "well over 8lbs already at 36 weeks! He will be gaining at least a pound a week and he'll be 10 to 12lbs! It would be much safer for you both to have a c-section scheduled." Bull****, all of it. Risky, and utterly irresponsible bull****.
My son was born at 40 weeks at just over 7lbs 10ounces. So no where near 10lbs. Remarkably average actually.
It's irresponsible for them to schedule induction or section based on this. Beware.

[Edensmum]

That's the thing -- my practice doesn't do fundal measurements. So I have no idea what they are. And it's a big practice, with every doc doing a mandatory in-hospital call every 8 days, so I can't imagine that's a huge issue. That's why I'm trying to figure this out. Is it just a new thing for our practice and they're coding something to get it through insurance? Or do they really think I'm going to have a "big" baby?

I'm not really scared of a big baby, so if that's what this doc is trying to do, she's barking up the wrong tree. I'll consider induction at +/- 40 weeks, but not before unless they can show me something other than "big." (Though I am getting sick of being pregnant!)

DD was posterior for the entire labor/delivery, which SUCKED, and I still delivered in 12 hours with a 1st degree tear. She also had a head circ of 80%. So I figure, if I can deliver her, I'll be ok with an 8-9lb baby. Especially if, as you point out, the position is better.

Again, I don't really mind the ultrasound -- I don't think there's any risk to the baby, and I'd like to see her! But I'm wondering about the why, and want to be prepared for whatever the OB says after she sees it.

They do not have any real idea how big the baby is. They are off by at least a pound in either direction, often more. Please research this before intervening based on a recommendation due to baby's size. Induction adds risks that there should be really good reasons to undertake, like greater risks of remaining pregnant with a true complication.