Should I have the ultrasound?

[Adrianne]

I just got back from the midwife and in addition to a borderline blood pressure reading, she wants to do an ultrasound.

 

My fundus measurement is 25cm and I am only 20 weeks along. She wants to confirm my dates and a single pregnancy ?! - she says the T word and wonders why my blood pressure is high.

 

I really did not want to have an ultrasound done with pregnancy and I am not sure if this is a valid reason. Money is very tight and I am tired of th medical community picking my pocket because their insurance company says they have to do a procedure. I understand she is going by protocol but I am having doubts. GGGRRR!

 

Obviously if the baby was in distress or something major was going on, I would have it no questions. But an inconsistent fundus measurement?

 

Can anyone offer advice/experience on this? Am I making a big deal out nothing? I would really appreciate any advice on this.

[Quiver0f10]

I have always measured big for my dates so for me to measure 25 at 20 would be normal. I think the more babies you have this can hold true and from your signature this looks like baby # 3?

 

However, I have always loved having a U/S and seeing the baby so I would probably do it just for that LOL.

 

Good luck and congratualtions!

[Melinda in VT]

Are you sure of your dates? If you are and you want to avoid the ultrasound, I would think you could safely put it off at least until your next appointment and see how you are measuring then.

 

I would keep taking prenatal vitamins and eating very healthy, just in case it is twins. If you are still measuring large at your next appointment, I would have the ultrasound. If it is twins, it really is best to know in advance.

 

With my last pregnancy, I measured large so we did an early ultrasound (11 weeks) to rule out another twin pregnancy. The baby didn't look normal, so that led to more testing and more ultrasounds, and a lot of stress before we ended up with a perfectly healthy baby. So I can understand wanting to avoid an ultrasound.

 

Good luck.

[Canada_Mom]

I usually always measure big for my dates and I tend not to get worked up about it unless it happens consistently from appointment to appointment. For me, I'll have one appt. where I'll be like you- really big for my date, but by the time I go for the next one I'm closer to measuring where I *should* be.

 

If you really don't want an u/s (which I understand, I avoid u/s whenever not necessary too) can you wait until the next appointment and see what you are measuring then? If you are still really big for dates, then have an u/s then?

 

That's what I would do. But, the blood pressure is a bit of a concern. That being said, with this last pg, the nurse I had always too my bp 3 times b/c it was always really high the first time. By 5 min later it would be back to normal. She would laugh and say, "must have been the walk down the hall!" I appreciate her doing that b/c if we'd gone with the initial bp each time my doc would have had a heart attack!

 

Congrats on the pg and hope all goes well...

[Mrs. H.]

Since you said money is very tight, I wouldn't do it. You could ask the midwife to check all over for two heartbeats, if that is what they are thinking.

 

With my 3rd baby I always measured a few weeks ahead. Turned out I just had a lot of amniotic fluid that time around. All others measured no more than a week ahead, but usually just right.

 

A borderline blood pressure reading isn't a preeclampsia sentence, but be aware of the warning signs that your bp is getting worse, and look for ways to reduce your bp if possible. I've never dealt with this, so I'm no help there, but it could be that you were just stressed, dehydrated, etc. Make sure you drink plenty of water and get lots of rest.

[Adrianne]

Yes it is baby #3. I really love seeing them too but for some reason this time I wanted a more hands off approach. I am not sure why I am against the ultrasound. I had ultrasounds with both of my boys.

 

Money is really tight and we have spent so much money in the past on tests the doc had to order because of protocol. Everything was fine, but he/she said we needed the test. I guess I am a bit frustrated about this.

 

My dh is a type 1 diabetic and he is always being prodded because he "might have this" or "we need to check for that" with the tests always being negative. I guess this makes me a bit sensitive.

 

I have heard that the fundus is not an accurate measurement again making me skeptical.

 

Thanks for your advice!

[Adrianne]

I usually always measure big for my dates and I tend not to get worked up about it unless it happens consistently from appointment to appointment. For me, I'll have one appt. where I'll be like you- really big for my date, but by the time I go for the next one I'm closer to measuring where I *should* be.

 

 

This is how is has been for me in the past too but this is a new practice for me. The midwife did not say anything about waiting. She said she just wants to do an u/s because I am measuring 5cm higher at 20 weeks.

 

I am aware of the blood pressure issue and I think I am going to get a home blood pressure machine just to be sure. I tend to have "white coat syndrome". She did take my bp a second time but this was just after she said mentioned the u/s and said the T word.

[Mrs. H.]

Oh, I forgot to say earlier that my CNP with my last pregnancy told me that you can get different fundal measurements depending on who is doing them, the position of the baby, etc. and since they are in centimeters, that can make a big difference.

 

Bottom line: if you don't want the u/s, hold off until the next appt., and ignore the ugly looks from the midwife. They're probably used to people asking when they can have an u/s to determine the gender. :001_smile:

[Adrianne]

She wants me to have the ultrasound within the next two weeks. What difference does this make?

[mommylaw]

I usually measure exactly right though. I'd be more worried about complications like polyhydraminous than I would about multiples. Either way I'd go for the U/S.

 

Good luck!

[Mama Lynx]

She wants me to have the ultrasound within the next two weeks. What difference does this make?

 

I can't think of what difference that would make. Certainly, though, one "off" fundal reading is not a reason for concern. The baby could have been lying strangely that day.

 

How is your diet? I dealt with hyptertension/borderline hypertension in two pregnancies, and have lots of information and tips on dealing with it. Feel free to PM me if you would like the info.

[Cathycam]

Completly agree with several things said here - it could be who is measuring (very subjective), how the baby is laying, etc. I wouldn't worry at this point in the pregnancy....last pregnancy I measured 4 and 5 weeks ahead until the last two weeks when baby moved down into "place" (and that was at 41 and 42 weeks)....she was an average, for me, 9 lb baby. It was clearly how she had been settled in and not related to her size (I also felt like my stomach got much smaller, maternity clothes fit better, etc).

 

U/S are pretty unreliable after the first trimester to determine size and I would think multiples would have had other indicators by now that would have made them more of a probability.

 

Here's a hint for "borderline" blood pressure by my CNM (I always have it)....ask for a larger cuff if you are the least bit overweight (even borderline overweight/larger than average women need a large cuff during pregnancy), ask to lie down in a still and quiet room for about 10 minutes before they take it, make sure you are off your feet as much as possible earlier in the day and avoid stimulents (food and drink) and drink lots of water. Ever since I followed her tips my blood pressure was always able to remain in the normal range...it's amazing what a difference just lieing still for a few minutes makes....if I got a slightly high reading even in labor I'd ask them to leave me alone and retake it 10 minutes later.

 

Good luck - I'd let it go at least a month before I really worried about it.

[PariSarah]

She wants me to have the ultrasound within the next two weeks. What difference does this make?

 

Just tell her exactly what you told us: you don't want any unnecessary ultrasounds, and she hasn't convinced you yet that this is necessary. Ask whether there are any other (cheaper? less invasive?) tests that can help her with whatever she wants to accomplish.

 

FWIW, if it were me, I'd do it in a heartbeat, b/c I'm information-hungry. It's an apparently low-risk way to get a lot of info in a hurry. And my insurance covers them, so it's not an incredibly high price to pay for that information. I also tend to believe that my OBs learned something useful during their years of schooling, and that they know things I don't. I'm happy to rely on their judgment until or unless they do something to make me question it.

 

But you should absolutely feel comfortable saying to your midwife, "I don't understand why you want me to have this, and I won't be doing it unless it's necessary for the baby." She should be willing to explain her reasoning to you such that you can understand it.

[Mrs. H.]

I also tend to believe that my OBs learned something useful during their years of schooling, and that they know things I don't. I'm happy to rely on their judgment until or unless they do something to make me question it.

 

 

PariSarah, you and my dh are just alike. I'm the one always going 'do I really have to do that?' 'what is that for?'. Also, I can tell dh something (about what is going on with his health), and then he goes to the Dr. and they tell him the exact same thing! I'm trying to convince him to save us some money and just listen to me, but it's not working. :D

[Kim in Appalachia]

:)

 

that 5cm is a big discrepancy at 20 weeks. Midwives are generally very conservative, and she would not recommend it if she didn't think it necessary. There can be a lot of complications with twins that she would not want to handle.

 

He also said, if you want, to calculate the price of gas. The drive down here might be worth it.:001_smile: (unless, of course, it would freak you out to have your brother do your ultra sound)

 

Kim (who would love it if you had twins. Aren't you glad I read the boards!!)

[Kim in Appalachia]

OT, but high blood pressure and that trip to Williamsburg sound like a bad mix.

[yvonne]

If she thinks there's a possibility of twins, I would definitely get the ultrasound. When you're pregnant with multiples, your babies can really benefit from modifications in your diet early on.

 

(Barbara Luke's book When You're Expecting Twins, Triplets, or Quads, explains it all, if you find you are expecting twins!)

 

Good luck!

yvonne (mom to twin boys, 7yo!)

[melissel]

Just tell her exactly what you told us: you don't want any unnecessary ultrasounds, and she hasn't convinced you yet that this is necessary. Ask whether there are any other (cheaper? less invasive?) tests that can help her with whatever she wants to accomplish.

 

FWIW, if it were me, I'd do it in a heartbeat, b/c I'm information-hungry. It's an apparently low-risk way to get a lot of info in a hurry. And my insurance covers them, so it's not an incredibly high price to pay for that information. I also tend to believe that my OBs learned something useful during their years of schooling, and that they know things I don't. I'm happy to rely on their judgment until or unless they do something to make me question it.

 

But you should absolutely feel comfortable saying to your midwife, "I don't understand why you want me to have this, and I won't be doing it unless it's necessary for the baby." She should be willing to explain her reasoning to you such that you can understand it.

 

ITA with PariSarah on all counts (including being information hungry). What would also concern me is this. Is your midwife connected to a OB practice, or is she independent? Mine is overseen (read: insured) by rather conservative OBs, and if I was measuring big and didn't have an ultrasound, and was going "overdue" at the end of my pregnancy, I'd have a fight on my hands over being forced to induce. They would give me a very hard time about waiting it out--you know, the old "it's harder to deliver a BIG baby" and "post-date babies have more complications"...yada yada yada. Having the US and reassuring all involved might go a long way toward making the end easier. Is that enough of a reason to do it? I don't know. But I lean toward the more conservative side in this, so if it were me, I'd have it done.

 

Also, your brother's advice means a lot too :D (How nice that your SIL is on here! At least, I think she's your SIL, LOL!)

[Jennifer in MI]

This is how is has been for me in the past too but this is a new practice for me. The midwife did not say anything about waiting. She said she just wants to do an u/s because I am measuring 5cm higher at 20 weeks.

 

I am aware of the blood pressure issue and I think I am going to get a home blood pressure machine just to be sure. I tend to have "white coat syndrome". She did take my bp a second time but this was just after she said mentioned the u/s and said the T word.

 

I had that white coat phobia too. My midwives always let me lie down for a couple minutes before getting a reading. It always worked in bringing my bp down to an acceptable level. But, I did buy a cuff to have at home. What a wonderful piece of technology!!! I always came in armed with my readings just in case I was high at the midwives!

 

I think PariSarah's advice about asking the midwife why she is ordering the test is a really good one. Ask if it would be possible to wait. Let her know that you are uncomfortable with it unless it's absolutely necessary. She may believe that you are like most women in her office that WANT an u/s!!

 

I was always leery of an u/s simply because I was afraid that they'd find something that ended up being nothing. But, I'd spend the entire pregnancy worrying. I didn't have u/s with my first two pregnancies. I did with my third because I was measuring big and they wanted to make sure it wasn't twins. I had a LOT of u/s with my fourth because I kept bleeding. I needed the reassurance that her heart was still beating in there!!

 

Good luck with your decision!!

[Gailmegan]

I agree that you should talk to the midwife again and find out exactly what the concerns/risks are. If the risks are minimal, and your gut says not to do it, listen to your instincts. If she has significant reasons, then I would trust her - midwives usually are less likely to request ultrasounds unless necessary.

[Adrianne]

OT, but high blood pressure and that trip to Williamsburg sound like a bad mix.

 

 

:rofl: I know, I know. Believe it or not I am very at peace with the trip. Mike and I have a plan all worked out.

 

I was going to call you tonight and get your take on it. I do not trust those docs (he-he).

 

I guess I am hesitant because of the way the midwife went about it. My blood pressure was 140/88 (borderline). It has never been that high before. I do suffer from white coat syndrome. She said to wait a while and she was going to retest it. Okay fine, she measures my fundus, says the T word, says she wants an u/s, and then retakes my blood pressure. At this point I am more upset than when she took it the first time!

 

I am glad you read the boards!

[Adrianne]

But you should absolutely feel comfortable saying to your midwife, "I don't understand why you want me to have this, and I won't be doing it unless it's necessary for the baby." She should be willing to explain her reasoning to you such that you can understand it.

 

I did ask her why and she only said because there was a discrepency with the fundus measurement. Also the referral sheet she gave me says for size and confirmation of dating. Unfortunately, I am not a fast thinker so I was not able to argue with her. I need to decide how I feel about it before question her.

 

It is my understanding, and I remember this coming up in earlier discussions on this board that the fundus measurement can be subjective and is not always correct. The last measurement I had at my last visit was fine.

 

As for docs knowing more than us, I would agree if she knew me for a while. This is the first time I met her and with one borderline bp reading, she was talking bp medication. This put me off right away and I am hesitant to believe her about an ultrasound too.

 

Thanks for your advice Parisarah!

[Adrianne]

Also, your brother's advice means a lot too :D (How nice that your SIL is on here! At least, I think she's your SIL, LOL!)

 

 

And he is a very good brother :001_smile:! I actually forgot that my SIL reads these boards. She is a fountain of information and gives good advice. I think I need to call her later!

[Kim in Appalachia]

Matt was more concerned over the fundus height. He thought that was a lot, but he is assuming that she took a good measurement. Also, she should be able to hear 2 heartbeats if it was twins. He would be happy to check it out for you! If he gets a chance, he will probably call tonight.

[TwinMominTX]

are reasons to get an ultrasound. Pre-eclampsia is nothing to mess around with and your risks increase quite a bit with a multiple pregnancy.

[sassenach]

I vote for getting the u/s. My second child had a birth defect that was caught at a 25 week u/s. He suffered a lot of complications, but without that u/s, he would be dead. That was the ONLY test that could have dxed his birth defect. So yes, I'm a fan of u/s's. They are non invasive and can give you information that you otherwise would not get. The reasons I can think of for wanting it soon would be the earlier in the pregnancy, the more accurate the dating and I think it's also easier to see all of the organs. Why don't you call her and talk over all of the questions your are now thinking of? I know my midwife was always happy to talk me through any doubts or questions I had.

 

The question to ask yourself would be, what would be the bigger regret- not getting it and having complications or getting it and spending the money for nothing?

[Storm Bay]

In light of the high BP along with this, I'd say get the ultrasound. I had high BP with my first, and it's nothing to fool around with. And do it when she says. Protocol can be done for 2 reasons: to avoid lawsuits and/or to prevent practitioners and/or patients from playing the odds. In this case, I'd say it's the latter. Really. And I hate unnecessary tests.

[battlemaiden]

I say yes. Get the ultrasound.

 

There are a lot of unnecessary tests ordered for a variety of maladies, but when it comes to the health of a baby I'm not sure you can do enough.

 

The ultrasound will check for many things that I find *BASIC* in prenatal care. But I'm a biased former L&D nurse, so you I fall on the conservative side. If everything is fine than you have a lovely vision of your precious child and you are reassured.

 

Honestly, I couldn't live with not finding out.

 

I do hope all is well with you and your little one. :) Keep us posted.

 

Jo

[Soph the vet]

My old roommate did not have any ultrasound with her first pregnancy. Her FIL kept teasing her about twins (he was one I guess) and she said "no way"LOL.

Well, she went into labor two weeks early. Delivered one girl weighing 3#15oz. Thankfully, the nurse guessed there must be another one in there. When they put the monitors back on my friend, they found the second baby was in distress so she was immediately knocked out completely and rushed into the OR for an emergency C-section. Both girls were fine, now they are 8yrs. old and doing great.

An ultrasound could have prevented my friend from recovering from both types of delivery simultaneously. Her clinic now performs an US on every mom.

I would get the ultrasound.

[Melinda in VT]

My old roommate did not have any ultrasound with her first pregnancy. Her FIL kept teasing her about twins (he was one I guess) and she said "no way"LOL.

Well, she went into labor two weeks early. Delivered one girl weighing 3#15oz. Thankfully, the nurse guessed there must be another one in there. When they put the monitors back on my friend, they found the second baby was in distress so she was immediately knocked out completely and rushed into the OR for an emergency C-section. Both girls were fine, now they are 8yrs. old and doing great.

An ultrasound could have prevented my friend from recovering from both types of delivery simultaneously. Her clinic now performs an US on every mom.

I would get the ultrasound.

 

I'm glad things worked out for your friend. Even with "known" twin pregnancies, it's not rare for there to be both kinds of deliveries. I braced myself for it the entire pregnancy.

[Adrianne]

I think the issue now is more about whether I should wait for more evidence of problem or jump to conclusions and have unnecessary tests. This is how I see it now:

 

Reasons for having ultrasound in the next two weeks:

 

1. one subjective fundal measurement that was off.

 

 

Reasons for for not having the ultrasound:

 

1. my belief that God is in control. No matter what happens, it is God's will. I nor the medical community have any control on the outcome of this pregnancy.

2. unnecessary stress on me with testing. ( I am already stressed b/c of this)

3. I can wait and have the ultrasound after next month's visit if things develop.

4. Spending over $200 for the test. (although at this point my decision is more based on principle)

5. after examining my belly for a heart beat we only found one. (although we were not looking for two).

6. My mother had a "larger" measurement with my second brother. It was just extra fluid.

7. Right now, today, if I am having twins, I cannot do anything differently in my pregnancy.

 

It seems reasonable to me to wait a little while. I eat healthy plenty of fruits and veggies, exercise regularly (walking 2 miles at least 4 times a week), and am very active.

 

I am calling the midwife today talk to her again about it but unless she has a compelling argument, I think waiting is prudent.

[Adrianne]

I just took my b/p and it was 110/76. Yeah!!!!!!!! I guess the borderline reading at the mw was white coat syndrome.

 

I also spoke to the midwife and she is okay with me waiting until my next visit to decide on an ultrasound.

 

God is good!

[Gailmegan]

Hooray! I'm glad your bp is down and the midwife isn't in a rush. Hopefully the measurements will be more "normal" at next visit. :grouphug:

[abbeyej]

I just took my b/p and it was 110/76. Yeah!!!!!!!! I guess the borderline reading at the mw was white coat syndrome.

 

I also spoke to the midwife and she is okay with me waiting until my next visit to decide on an ultrasound.

 

I'm so glad, Adrianne! Those are both great things! :)

[Kim in Appalachia]

I'm glad your BP is down. I couldn't imagine you trying to eat any healthier than you do, or getting outside and doing more.:) Maybe you could avoid stress?!! ha, ha!

[Storm Bay]

I just took my b/p and it was 110/76. Yeah!!!!!!!! I guess the borderline reading at the mw was white coat syndrome.

 

I also spoke to the midwife and she is okay with me waiting until my next visit to decide on an ultrasound.

 

God is good!

 

Excellent! Glad your B/P is okay and that you are able to wait.