Sometimes, it’s just Mission Impossible!
Fetal gender determination is not always a walk in the park for us sonographers. Ultrasound, like many technologies, has its limitations. There exist many factors which can make fetal gender determination mission impossible! Your OB docs understand there are a number of variables that prevent good visualization in every ultrasound we perform. Unfortunately, many patients do not.
So, if you’ve been losing sleep in anticipation of this long-awaited news, read this first! My goal is to inform expectant moms so that you go into your ultrasound exams with realistic expectations. I sincerely hope that through understanding these limitations, you’re able to leave your experience feeling happy. If all you can see is Baby’s heartbeat, it’s an opportunity to bond with your new addition that doesn’t come everyday.
Is Fetal Gender Determination a Requirement?
Definitely not. Fetal gender determination is not a routine part of a diagnostic examination. It may be information you desire, but it’s not typically information your physician needs. The anatomy screen at about 18-20 Weeks or so is ordered to rule out structural fetal malformations. Most U.S. practices do not mind providing a fetal gender determination as a courtesy IF the sonographer feels she can see well. And we LOVE to give you this information, if we can!
What Factors Impair Fetal Gender Determination?
Some of these factors that can get in our way of how well we see are listed below. They are very common! Actually, some of them confront us on a daily basis.
- A breech fetus
- A fetus with the rear against the uterine wall
- A foot or feet in the genital region or crossed feet
- Closed legs
- The umbilical cord between the legs or against the fetal body
- Body habitus or too much weight around a patient’s middle
- Uterine fibroids or contraction
- A decrease in amniotic fluid
- Genital malformations
- Early gestational age
Even one of the above factors can prevent even the most experienced sonographer from determining fetal sex. A good sonographer knows when the views are good enough to provide you with a guess. A good sonographer also knows when not to guess! What you don’t want is someone who is inexperienced but willing to guess anyway. Many times, it’s not just one but several of the above variables that limit what we see. Unfortunately, we can’t change any of them.
Can you appreciate the difference between the first two images and the third?
Another little fact I’ll add here is that a non-arguable truth of the modality is Ultrasound’s laws of physics. The further sound has to travel, the weaker the returned signal. The more tissue the sound waves have to penetrate, the worse the image. In other words, the more tissue there is around a patient’s middle, the more fuzzy the picture. The more fuzzy our picture is, the less we can see Baby’s parts. Any not just fetal gender, any parts. All it takes is one of the above factors to ruin the party. More often than not, a combo of factors will cause a little unwanted rain on your parade.
What Can We Do to Help?
We can try a couple of variables in an attempt to see better. Jiggling your belly or turning you to each side sometimes helps. We do this in the hopes that your change in position will also change Baby’s. Alas, it doesn’t always work. For some tips on how you can try to ensure Baby is a little more active during your exam, click on this link!
What We Can’t Do
Unfortunately, we can’t scan you indefinitely! In an effort for fairness, we always try to get our next patients in as close to their appointment times as possible. Sticking to this schedule can be tough when patients arrive late or when we find abnormalities. Most patients are allotted a 30-minute appointment for their ultrasound exam. However, not all of this time is scanning time.
Before we scan you, we need to examine your chart for your history, an order from your doc, and an indication for the exam. After the exam, we need time to type up your report and send it to the physician. Most of us are nice enough to take more time with a patient if our schedule allows. I always did. Unfortunately, some of my patients (not understanding ultrasound) didn’t think I did!
What You Shouldn’t Do!
An unreasonable action disgruntled patients take these days includes airing their rants on social media. Consider, first, that venting your frustrations reflects poorly on your physician and practice. And you could be fired. Yes, a patient can be fired! In other words, I would advise against this method of revenge. If you are unhappy, you have the right to discuss it with Administration. But just know a practice does not have to tolerate any behavior deemed irrational or unreasonable. Just like one can fire an attorney, a plumber, or doctor, a patient can find herself in the same situation.
A Modern-Day Problem
Unfortunately, our society has become one of immediate gratification, even demanding it in the face unreasonable circumstances. I’m reminded of a few former patients and a like-minded character from one of my favorite childhood movies. Anyone remember Veruca Salt of Willy Wonka fame? These patients actually got angry, yelled, cried, and ranted in a place of medical business, much like the toddlers they would have themselves in another couple of years – all because I couldn’t tell them the sex of her baby. This. Is. Unreasonable.
I realize some sonographers don’t try very hard. In most circumstances, however, most of us make a sincere attempt to obtain this information for our patients who want it. We cannot, however, change the laws of physics.
Moreover, some patients mistakenly assume that because we couldn’t make a fetal gender determination, we must not be able to skillfully perform their diagnostic examination otherwise. Please keep in mind that medical professionals never judge such as gross incompetence. Rather, ranting such on social media is reflective of the patient’s lack of understanding of how the technology works. So, please! Don’t do this. 🙂
We hate when our patients leave foaming at the mouth. Remember, this scan is about Baby’s health first! Just ask any mom who didn’t have a healthy baby.
Good luck for a great sonogram!
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