Just in case this season finds you mid-pregnancy and debating the question above, this post is dedicated to you. Despite what you’ve read in your favorite pregnancy book or online, please take into consideration some food for thought below. You be the one to determine the value of diagnostic ultrasound in your pregnancy.
But before we dive in, let me extend a Happy Holidays to everyone. I’m sure you’re as busy as me, filling stockings with cheer and a little fa la la to boot. It’s the most fun time of year with your babies! And the response for the canvas photo ornaments has been incredible! Hope your holiday is merry and bright!
What’s It Worth?
I’ve heard it said and seen it in black and white. Diagnostic ultrasound has not been shown to improve the outcome of pregnancy. This statement may hold truth in the grand scheme of pregnancies in the history of ultrasound and its application to obstetrics, but only where it’s applied to normal pregnancies and normal outcomes.
Everyone’s the expert, right? Books, parenting sites–they all want to be your pregnancy bible. What I find interesting, however, is that many of these authors have no medical background whatsoever. How much input did they really take from obstetricians and truly knowledgeable resources? If little to none, how can they counsel the expectant parent on anything … including ultrasound? Those who know so little about the technology shouldn’t be advising anyone on its safety or value.
Let’s present both sides of this coin so that you can make an informed decision regarding what you value most. Just ask the parent whose child enjoys life today because of an ultrasound diagnosis. Below are three ways in which ultrasound can benefit your pregnancy and three questions you can ask your doc. Let’s explore them.
Detecting an Abnormality
Sure, everyone wants a healthy baby, right? None of us ever takes the plunge into parenthood expecting the worst. And when it happens, the result is a devastating blow. No one knows this better than a woman or family who’s been through it. These are the couples who truly value the technology but who fear it the most–afraid of history repeating itself. Needless to say, they leave the entourage of family and friends at home. Or, at least, in the waiting room.
Alas, finding abnormalities represents the initial sole purpose of medical ultrasound’s contribution to obstetrics. It’s a mechanism for diagnosing a structural problem early on and clarifying a plan to manage mom’s and baby’s care to ensure the healthiest delivery possible. True–ultrasound with even the most skilled of eyes at the helm cannot detect every problem. No diagnostic test on the planet can boast that ability. But when sonography can ring the alarm, it serves as a vehicle toward a path of knowledge and understanding–a necessary preparation for what’s to come.
When an expectant couple does receive the unanticipated and unwelcome news of a problem, they may feel overwhelmed with information. Rocked by shock, you may confusion over what questions to ask. Everything else aside, you want to understand the severity of the issue.
A question for your doc might be:
“What does this mean for the health and safety of myself and my baby?”
Education and Preparedness
What’s the old saying? With knowledge comes power? I do believe in this. Yes, there do exist the moms who complain that something was detected by ultrasound, it was mercilessly followed, and she worried for nothing. Baby was just fine after all. To that I say GREAT! Someone did their job by finding a potential problem. Lucky for mom, the problem never progressed to the extent that intervention was required. Of course, I hate that any mom was fraught with worry an entire pregnancy, but imagine the opposite scenario. Discovering a serious problem after birth when you thought all was well is also crushing.
So, where’s the silver lining in all this? With a sobering diagnosis, hopefully, comes the education to plan for a little one with special needs. Whether those needs are short-term or long, the following weeks and months give way to arrangements of a different kind. You’ll take this time to mentally and emotionally prepare, connect with support groups, and learn all the ways in which the family will need to physically prepare for Baby.
A question for your doc might be:
“I’m on the fence. What happens if I decline a diagnostic ultrasound?”
If mom elects to forgo a diagnostic ultrasound, she also can’t take preventative measures to repair a problem that could save her baby’s life. I’ll give two examples here.
My former co-worker provides the perfect example. She found her own baby’s problem. Yes, we all do it! All sonographers scan themselves at some point. It’s a perk of the business! However, the ability then becomes a liability because we know just a little too much. This means we worry more than the average joe.
She opted for genetic testing which came with normal results. Thank goodness! But we still knew there was a problem. Her baby was developing an abnormal collection of fluid behind his head which is called a cystic hygroma. The beginning of an early hygroma might look like this:
NT stands for nuchal translucency. You may recognize this term from part of the genetic testing performed with ultrasound around 12 Weeks. The image below demonstrates the top of a fetal head at about 13 Weeks. The large black area with a webbed appearance inside and surrounded by arrows represents the back of Baby’s head where the hygroma is seen.
Many conditions can cause this development, but in the absence of a chromosomal abnormality, we knew the problem must be a structural one–some organ was not developing properly, probably the heart. Baby was too small yet to determine the cause. But over the following weeks, sure enough, we were able to detect her son’s serious heart defect.
You may already know that most of us are born with four chambers within the heart. This little love was born with barely two. It was a long and grueling pregnancy filled with Maternal Fetal Medicine and perinatal cardiology visits on a routine basis. No one could make promises for the future. No one held a magical crystal ball.
What a Difference a Test Makes!
The difference ultrasound made in the lives of my co-worker and her baby was the fact that discovering such a problem so early allowed many advantages. She needed to plan for a c-section so that his fragile heart would not have to experience the stress of labor. Secondly, there was no way she could safely deliver locally. Even though the largest local hospital was equipped with a NICU, they could not offer him what he needed immediately after birth–major heart surgery.
The above revelation meant she would need to travel six hours away from her home for delivery … well in advance of her due date. She couldn’t take the chance of delivering anywhere else. This baby had to be delivered in a hospital with neonatal cardiac surgeons and equipment to treat severe heart malformations like his. They were his only fighting chance.
Fast-forward to today. He’s a very healthy kid with more energy than you could ever imagine! He needed a couple of surgeries but has done so well. What a rocky start to life!
Maybe you can guess his fate if his mom elected to never have a diagnostic ultrasound? They would have never known about the problem, she would have delivered locally, and–most tragically–he would have never survived.
A Second Story
But this one is much shorter (I promise!). A fellow employee was pregnant with twins. They developed Twin-to-Twin Transfusion Syndrome. In other words, one baby was stealing blood flow from the other. This condition (in this particular patient) would have resulted in the potential demise of one baby. She traveled several hours away for intrauterine surgery. It was successful, and all three spent the remaining months of pregnancy thriving!
The value of anything is much like beauty, isn’t it? It’s the eye of the beholder, the love of heart, or the presence of mind which determines a given worth. How will a particular event impact your own life? We can’t necessarily know what we haven’t experienced.
So, my advice is as follows. Every parent has the right to decline any testing she doesn’t wish to have performed. But a parent needs to only understand what she won’t know when choosing to decline a sonogram. That’s a conversation to be had with one’s obstetrician or other healthcare provider managing her pregnancy. Weigh the pros and cons and make an informed decision–whatever suits your family best.
It’s not up to me that you have a diagnostic ultrasound. Especially, your decision not to have one shouldn’t come from a less-than-credible source. As a matter of fact, the advice should never come from someone with no medical background to support such a recommendation, who’s likely never suffered the diagnosis of a sick child where ultrasound made a difference between life and death.
Your life. Your pregnancy. Your baby. Talk to your doctor. Ask the important questions. Make an informed decision. You deserve to have all the answers up front!
Final question for your doc:
“What are the pros and cons for having a diagnostic ultrasound. What do you recommend?”