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Pregnancy Labor and Delivery–A Labor of Love

Pregnancy Labor Isn’t Loved By All

pregnancy labor and delivery

Don’t worry that you’re all alone in this boat. Pregnancy labor and delivery isn’t fun for every mother. Some conquer it like Wonder Woman while others vow to never go down that road again. It’s all personal and relative, and no feelings are wrong or right … just your own!

I ran into a patient of mine who recently delivered her first baby. She couldn’t wait to show her off. “She’s finally here!” She was so sweet and told me how much she loved having me as her sonographer every week. I love it! And, of course, her baby was absolutely beautiful.

She took a minute to vent about her L&D experience, of which she was NOT a fan. She said, “Nobody told me what it was REALLY going to be like. I’m never doing this again!” I laughed and expressed I was not a fan of mine, either, but that it’s different for everyone. Some people actually call it easy or loved the experience. I guess this is why some beloved souls do the pregnancy thing over and over! Well, that and they must either have really good babies or the patience of a saint. God bless the fruitful mothers, but my personal limit was two.

Moreover, our kids are incredibly expensive, right? After diapers, extra-curricular activities, cars, insurance, and college, it all adds up to a luxury house in the end!

pregnancy labor and deliveryBut I digress … I love motherhood, love my kids, and I wouldn’t trade them for a thing in this world. Change that. Between the ages of two and four, I did consider either selling my younger daughter on the black market or investing in duct tape for her mouth. Alas, I opted for the duct tape, and (what do ya know?!) she became a hard-working, compassionate, and loving young woman.

You can read her blog post here!

And for those of you who don’t know me, said daughter would be laughing hysterically at this last comment. She can attest to the absence of duct tape for discipline–though it would have been effective. If what goes around comes around, I have no doubt she’ll need it for her own kids one day!

We go through pregnancy for ourselves, our spouses, and to create that family unit for ourselves. It’s the love we put in and the love we get back that makes it worthwhile. And when our kids are bad, we stick them in a corner because we sure can’t shove them back where they came from … not that we’d want that, either.

I sometimes say I’ve made my contribution to Mother Earth with my twice-inhabited uterus. For my patient and many like her, it’s one and done! So many of my 3rd Tri patients begin to express anxiety at the thought of labor. It’s understandable. Every labor can be entirely different from your prior experiences, and we always fear the unknown. My advice to them?

Nature has a unique way of preparing us to take on the unknowns of labor ~
the complete exhaustion of pregnancy!

Well, that and finally seeing our babies in living color.

EDD, labor and delivery

Happy and healthy labor and delivery, Everyone!

You can email your ultrasound and L&D stories to wombviewerblog@gmail.com!

 

Ultrasound Results–Why Can’t Your Sonographer Just Tell You?

Ultrasound results, twins, 8 week twins

8 Week Twins!

What’s the big deal about giving ultrasound results?

Your ultrasound results must always come from your physician! But why can’t your sonographer just tell you if everything looks okay? It’s so irritating when she won’t talk, right?

The most frequent question a patient asks is if everything looks okay, healthy, or normal. Usually, to the patient’s dismay, this is something we just can’t discuss with you. Read on for details about why we have to be so doggone tight-lipped!

Ultrasound Results Must Come from the Docs

Only your physician has the legal right to give you this information. My usual response when a patient asked this question was, “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.”

Yes, it is my job to know what I am seeing and to recognize it when something does not appear normal. However, sonographers are not physicians. We are trained to perform your ultrasound examination; we don’t manage the health of you and your baby. Your doctor studied for many years learning how to do just that. And only your doc or other healthcare provider can answer the multitude of questions you will positively have in the case of a suspected problem.

Our job is to share what we see with your doctor. Your doctor examines the information and concludes whether he or she agrees with our findings. The doc then shares his/her interpretation of the information with you along with what options he/she recommends next.

But, But …

Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something wrong or not.” I’ll admit that I do, but I always defer to the physician’s interpretation. We just have to stick to our guns! I know it simply comes from a place of parental anxiety. We do understand.

For the nervous patient, waiting for ultrasound results can feel like a lifetime. I do empathize. A previous pregnancy loss or abnormal ultrasound is enough to scare serious fear into the hearts of anyone. I want expectant moms to understand that if your sonographer says something inappropriate, she could lose her job. Only your doctor can calm your fears and reassure you about your pregnancy issues in a way that no one else can. Your results are part of the sacred and private relationship between you and your doctor!

Finally, on to end on a positive note, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

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Your questions and comments are welcome at wombviewerblog@gmail.com!

Ultrasound Facts–What’s True vs What’s Not

General Ultrasound Facts

Patients have asked me these questions on a regular basis for years. Let’s get some ultrasound facts straight, shall we? I hope it’s helpful!

What’s the difference between ultrasound and sonogram?

Technically speaking, ultrasound is the study of the subject (the field of ultrasound) and a sonogram refers to the examination itself. Although we’re really not picky about what you call it.

Is ultrasound safe?

Biohazard testing over the past forty years reveals no ill effects of ultrasound on the fetus, mother, or sonographer. However, increasing levels of heat after scanning for several hours in one area can cause cavitation or the creation of bubbles. This is much longer than the time required for performing a diagnostic test. Since no one can predict the long-term effects, only the prudent and diagnostic use of the technology is recommended by ACOG, AIUM, and ACR. The benefits of the information from diagnostic exams for patient and physician currently outweigh any known risk.

Is Ultrasound radiation?

Ultrasound technology uses sound waves, NOT radio waves. I dedicate an entire post to just that subject in the link above. No radiation is emitted by ultrasound equipment or Dopplers utilized by your physician to detect Baby’s heartbeat. X-Ray emits radiation which is why, for example, your pregnant belly would be covered with a protective shield at your dentist’s office for X-Rays on your teeth.

Can my baby hear ultrasound? 

Nope, Baby cannot hear the sound waves:) Ultrasound is just that…sound waves that operate at a frequency far beyond human hearing. Human hearing ranges from 20Hz to 20,000Hz. Diagnostic ultrasound operates in the millions of Hertz. Ultrasound probes range from about 2 – 13MHz.

True story ~ I became a little distressed once when a patient asked me if ultrasound sounded like a jet to a fetus. She had just read this in a pregnancy magazine in our waiting room! I reassured her this was inaccurate. This experience marked one of the many reasons I wanted to start my blog–to get reliable info to new moms like you!

What’s the difference between 2D, 3D, and 4D?

Almost everyone has seen the gray clouds of 2D ultrasound at one time or another. 2D allows us to see through organs and inside your baby.

Most people are familiar with 3D imaging as a fun way to see the outside of their baby. Additionally, the best and cutest 3D images are obtained later in the 2nd Trimester or early in the 3rd. Baby’s skin has developed more fat at this point which makes for chubbier cheeks! Occasionally, a high-risk practice (MFM or Maternal Fetal Medicine) will usually also use 3D to assist in visualizing a fetal abnormality. We also frequently use the technology for GYN scans to attempt a better look at uterine shape and/or IUD placement.

4D can be described as 3D in motion or a live 3D image. So, where 3D is a still image, a 3D video of Baby moving is actually 4D.

ultrasound facts, 3D, 9 Weeks pregnant

3D 9-Week Embryo

Ultrasound Credentials for Sonographers

What’s your title? Are you a nurse or in X-Ray?

We’re not nurses, though some of us do cross over from RT (X-Ray) or other areas of Radiology. Sonographer, Ultrasonographer, or Ultrasound Technologist are a few of our titles. We are specifically and formally educated in the field of Ultrasound.

RDMS stands for Registered Diagnostic Medical Sonographer. A sonographer earns these credentials through ARDMS when he or she has passed a registry examination in Ultrasound Physics as well as his/her ultrasound specialty. A certified sonographer typically has at least two years of experience under his/her belt.

DMS refers to someone who has completed some sort of formal or on-the-job ultrasound training but has not yet taken/passed the registry examination.

What do you think of those 3D places?

Having posted on this often, I understand a patient’s desire to go, but I’m not a fan. Not everyone who scans an expectant mom in a 3D non-medical business is a certified OB sonographer. Some have no formal ultrasound training whatsoever! I know you may be surprised by this little-known fact, and so was I.

These businesses are not regulated like medical practices. They may not be knowledgeable of or follow guidelines for equipment maintenance. Ultrasound equipment that is not properly maintained can be an electrical hazard for mother and/or fetus! Do your research and at least ensure your sonographer possesses RDMS or, at least, DMS credentials. Please read the post in the link above!

Performing Your Exam

When can I expect to have sonograms in my pregnancy?

Every practice is different. Most physician’s order a first-trimester ultrasound examination to date the pregnancy. This is usually performed with a transvaginal probe. If no other problems necessitate another scan, you’ll receive your next exam around 18-20 Weeks. Most women know this scan as the anatomy screen where we evaluate fetal and maternal parts for abnormalities.

*Your doc does not order this exam to determine fetal sex!* However, most sonographers will happily provide the info if at all possible (as long as policy allows)! Also, important to note here is that determining sex is never a guarantee nor should it be an expectation. Sometimes, those Little Sweet Peas just won’t cooperate! You can read more here about those limitations. Note of advice for moms: Don’t pre-plan your Gender Reveal party for the same day as your ultrasound! The health of your pregnancy determines whether you will receive more ultrasound scans later in your pregnancy.

Can you predict how much my baby will weigh at birth?

While we can measure your baby’s head, belly, and femur for an educated (called EFW or Estimated Fetal Weight) guess for weight at the time of your scan, a large discrepancy for weight determination exists due to fetal position and sonographer skill. We can typically track a trend for large or small babies. We know the average gained weight in the last few weeks is about 1/2 lb per week. However, every baby is different!

Ultrasound Facts About Fetal Sex

Most expectant moms today already know this little fact. The ultrasound machine is never “wrong” in determining fetal sex. Actually, it is the observer who is incorrect!

Guessing the wrong sex can be due to one or a combination of many factors. It is possible your baby was in a difficult position to see well. Maybe you were too early in your pregnancy for an accurate guess. In addition, an overall poor view can also limit fetal sex determination!

Facts About Your Results

Yes, the sonographer can read your examination. However, your OB/GYN physician or radiologist must ultimately interpret the images and report we create. Consequently, only your physician can legally give you results! Read more about why here.

However, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

~*~

Feel free to email me at wombviewerblog@gmail.com with your comments or questions!

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Becoming a Sonographer–A Tough Road

Oh, the adventures of becoming a sonographer!


sonographer, ultrasound technologist

Isn’t this facial profile precious? But it’s not just any profile; it’s a technically perfect 2D ultrasound example of a simply beautiful fetal profile. It’s what we sonographers strive to obtain on every baby we scan and reminds me of how I fell in love with the technology . . . with my own first baby. I was well into my college career at the time, but nothing else had quite piqued my interest like my first exposure to ultrasound. Boy, I had no idea what challenges lay ahead!

Becoming a sonographer, aka ultrasound technologist, was one of THE biggest challenges of my entire life. The training was challenging, but finding myself in a new field and technology where I was painfully ignorant and unsure? Healthcare is not a place for the timid.

A Sonographer’s Start – Whoa! (What a Challenge)

If I was going to work with physicians, I better learn what I was doing fast or go home. It took a while for the puzzle pieces to fit . . . a good 6 months to 1 year. Thereafter, little light bulbs of realization would flicker every time I put two and two together. It was a marriage of all things unfamiliar. I was learning to read patient charts, learning about labs and correlative examinations, interaction with the physicians and with my patients. All of these things were a recipe for growing my new career as well as learning the technology. In the beginning, it was more about “How do I not screw up?” rather than “Wow, that was a great case!”

I promise you, it’s not for the squeamish. If another person’s urine, vomit, or blood bothers you, Ultrasound may not be for you. I cannot emphasize that enough! It was a hard year, and I felt like I was walking a tightrope for the vast majority of it. Brutal.

A Sonographer’s Fear

All new sonographers will miss pathology. It’s a fact of the modality. Initially, you are too concerned with getting all the right images. You’re too inexperienced to notice minor pathology. This is why it is so imperative that a newly-trained sonographer has direct supervision from someone very experienced. With lots of experience comes confidence. After a while, a newbie will start to get a feel for his/her scanning ability and stop second-guessing herself. Was I not seeing an organ because it can’t be seen or because I just couldn’t find it? It’s an awful feeling. However, it is one that can be overcome with time and, again, experience.

The more normal examinations a technologist performs, the sooner she will know when a case is not normal. Ten to fifteen scans per day over the course of a year equals a good bit of experience. After the first few months of constant supervision (if you don’t have it, ask for it!), you will start to become a little more comfortable with the examinations. You’ll then only need a supervisor’s help when confronted with abnormal cases. You may not be able to pinpoint a diagnosis, but you know it’s not what you normally see. This is very important in your early career. Eventually, you will be able to put together differentials to possibly explain what you are imaging. It’s a good feeling when you get to this point!

A Sonographer’s Advice

It was a slow learning process, at least for me, anyway. Over the years, it became easier to work with the docs. More importantly, I learned how to better communicate with my patients, which has been the most rewarding. It feels really good to correctly diagnose a case. But it feels even better to have a patient sincerely thank you for your help . . . or give you a hug in appreciation. It feels good to know I’ve made a small but, hopefully, significant difference. It’s been a good career. And for those who are going into it, hang in there because it gets better. For those who have practiced a long time and feel the flames of burnout, take a vacation! We all need to step back and take a breather once in a while.

Every case is someone’s health and life at stake, and not a week goes by still without learning something new. What a sonographer sees (or misses!) will either lead that patient to other tests or lead to a missed diagnosis. It is sometimes intimidating to think that a patient is on your table and yours alone. It’s up to you to find the problem in question.

I always say I would never want to relive those earlier years, yet they have shaped who I am. They helped me become a better sonographer. So get out there! Become a sonographer, become good at it, research and read, and ask questions of co-workers and docs alike. Make a difference in someone’s life. Make a difference in your own.

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A Day in the Life of a Sonographer

What Your Sonographer is Thinking

Ever wonder what your sonographer might be thinking as she calls you back for your ultrasound exam? While I cannot speak for all, let me give you some insight into some of the heavyweights at the forefront of my thoughts with each new patient.

What’s in a Job?

Firstly, we have a job to do. While the patient may be wondering why she wasn’t called back at her exact appointment time, your sonographer is already very busy with the business of having you as a patient. We are busy with a checklist of items that must be completed before we ever call your name! We are examining your chart and looking for your doctor’s order (we cannot begin without this!). We have to determine why you are coming to see us in the first place, so we have to know what type of exam needs to be performed. Oh, yeah! Your prior pertinent medical history and testing are pretty important, too. In other words, we have to be able to answer the 5 W’s…Who, What, When, Where and Why:

    • Who are we scanning? Who (what provider..doc, nurse practitioner) ordered this exam?
    • What type of ultrasound exam are we performing? (Diagnostic ultrasound? Transvaginal?)
    • When was she scanned last and what was found? Do we have that report(s)?
    • Where are we targeting the examination?
    • Why are we scanning this patient?

Patients or Patience?

After spending so many years in the healthcare field and encountering a challenging personality type or two along the way, we sonographers wonder whether our next patient might be naughty or nice? The Rolodex of mental questions might look something like this:

  • Will my brain get picked for some interesting ultrasound facts or will I get the silent treatment? It is a bit awkward when a patient has nothing to say…I mean zero words.
  • Will she need to beat her dueling children because they won’t let her focus on Baby #3 (who may turn into Baby #1 if they don’t quit fighting)?
  • Siblings are sometimes the most comical addition to an exam, but will I have to listen to “Let It Go” on a tablet for thirty minutes – again?
  • Will her family sound like my Italian kin at Thanksgiving in that tiny. enclosed. room?
  • Will it be standing room only with Grandpa breathing down my neck for the whole exam? Gramps is really nice, but he’s gotta mosey on over to the other side of that table.
  • Will I have to ask Dad to take their screaming toddler back to the waiting room? We hate to kick anyone out. But our eardrums can’t take it, and admin typically frowns upon keeping rum in our exam rooms.
  • Will I get the evil eye if I say that I cannot determine what sex she’s having? And will she then rant on Facebook that I have no idea what I’m doing? I hate when this happens.
  • But seriously, and most importantly, will this baby look normal?

The Questions Sonographers Get Almost Every Time

Does everything look okay? Do you see anything wrong? Is my baby growing well?

These are all valid questions, to be sure! But as most patients know, they are ones that only your doc can answer. Legally, only your doctor can review the exam and determine its results. Only she/he can discuss these results with you even if they’re negative. Why is this? So that they can also provide you with the comfort and answers in the face of concerning findings.

My answer was always relatively the same. “So far so good, but your doctor has to review the ultrasound images and give you the results.” Every blue moon, a patient express that I must know what I’m seeing. I would always agree but reiterate the rules.

There are times and extenuating circumstances where you may know what your doctor is following. In these cases, we have to be careful with our words. Every practice is a little different with respect to how much your sonographer can say. It’s a fine balance! Too little, and we cause you to worry. Too much, and we lose our jobs!

Of course, every sonographer on the planet is happy when they enjoy the time they have with their patients and families and kids. Some of my favorites have also been the loudest, most fun, and the funniest! One thing is for sure…I can definitely sing the “Frozen” theme song with your kid the next time you visit:)

Many blessings and happy, healthy babies to you all! Feel free to email me at wombviewerblog@gmail.com with any questions or comments!

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Ultrasound Exam Guests

The Smallest Guests Make the Biggest Impact

When you bring family for your sonogram, your smallest ultrasound exam guests sometimes provide the best entertainment for us sonographers. I have posted some “kids say the funniest things” in the past. Most of the time when parents bring small children, especially for a lengthy ultrasound exam like the anatomy screen, it truly can be very distracting when they’d rather spend their time destroying a playroom. Who can blame them? I’d rather do that myself.

However, every once in a while, a child becomes simply entertaining–like the one who thought his baby sister looked “weally weird.” He informed both myself and his mom that he was NOT making the mistake of going to another sonogram. Hilarious.

On this day, a totally precious little girl joined her Latino family to watch her baby cousin’s exam. She must have asked me a million questions. The exam I had to do was pretty short and sweet, so it didn’t require too much brain power. Fortunately, I could indulge her a little. Every time Grandma thought she was talking too much, she would tell her in Spanish to stop and pay attention. That command worked for about thirty solid seconds before the onslaught of more questioning. She was so cute and smart and SO well-spoken for only four! I loved every minute of this education lesson.

For those of you who have had a sonogram later in the third trimester, you know how big Baby looks on the monitor. My little guest watched intently as I measured the baby’s abdominal circumference. It filled the entire image, and I waited in anticipation. She was just one of those kids who you couldn’t predict what in the world she would say next. Sure enough, it was well worth the wait. Out of total quiet she declares, “My baby cousin has a really big head … and her butt is GRANDE!” 🤣

Any kid who can make me laugh out loud can visit me any day of the week!
Hope you enjoyed it, too.


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Sonographer Advice

Ultrasound Advice for New Sonographers

New sonographer ultrasound advice is a topic that needs addressing for anyone new to the field. It’s a tough place out there for you. I know, I lived it, too.

A Fine Example of Negligence

I felt a bit distressed to learn something recently. It is an important lesson for any new sonographer, especially. A recent graduate of a sonography program landed her very first job out of school with a temp agency. With essentially no work experience, her recruiter advised her to “Fake it ’til you make it.” I thought I’d faint. She lied saying her recruit had one year of experience and placed her in an OB practice to work alone. The lack of responsibility of this recruiter left me surprised and horrified. The quality of exam a patient receives was obviously of no importance. This is unfortunate.

Moreover, the horror this new sonographer experienced is another story. Even though she had a brief period of training by the sonographer going on leave, she was uncomfortable with scanning or reporting anything on her own. With no experience to call on, she did not possess the confidence to call a case normal or abnormal. Where does someone even begin to construct a report when she is unsure of what she sees on the monitor? This is unfortunate and a precarious circumstance for all involved.

Don’t get me wrong. Everyone has to learn, and all new sonographers need the opportunity to become better. But, like so many things in life, there’s a right way and a wrong way to accomplish this task. It has to be fair to both the sonographer in training as well as the patient. Therefore, the following is a message to all sonographers who have just stepped out of the classroom and into the real world of practice.

Turn the Table…

From a slightly different perspective, please consider the following ultrasound advice. If it were you, your daughter, your mother, or your sister on the examination table, wouldn’t you want to know if it was the first exam performed by your provider? We all like to feel as though we are in good hands, competent hands when we seek medical attention or advice. Wouldn’t it be disconcerting to know the person scanning you is new, overwhelmed, and lacks the knowledge in all ways to perform your exam properly? Every patient deserves to have their examination performed by someone who is knowledgeable and properly trained. After all your hard work in school, you deserve to be properly trained!

Just in Case Your Instructors Didn’t Tell You…

You are not qualified to work alone. You need direct supervision from someone with qualified experience. You need direct supervision for all of your exams performed for at least three solid months. After that, you need to ensure you work in an environment with at least one other experienced go-to sonographer for questions..because you will have them. You will have a lot of them. We all did.

You should never lie about your experience, even if a recruiter tells you to do so. Potential employers need to ensure how much they can rely on your skill and experience outside the classroom. Your class time and clinical rotations count as experience toward taking your registry examinations, but it doesn’t go far toward real-world experience. You were in school and learning. You will still be learning volumes over the next few years. No one ever knows it all, and this is a field where you will continue to learn your entire career.

Students and new technologists, once you have scanned about twenty-five normal cases (give or take), you will be able to scan a normal exam on your own pretty easily. Tackling pathology is a whole other ball game. You will feel more comfortable you taking on the challenge of an unfamiliar process when you develop more confidence in your skill and ability. Everyone’s learning curve is different. If you learn new things quickly, you may feel more confident in your skills in less time. If you have a no-fear personality, you’ll have less problem jumping in with questions or presenting cases to physicians when you are unsure of a diagnosis.

What About a Private OB Practice?

Sonographers in a private practice need a great deal of experience. They need to be able to work independently and have enough confidence in their skills to tackle a challenging case without breaking a sweat. They should feel very comfortable scanning patients in every week of pregnancy with no question regarding the protocol of any exam. Do we still turn to our co-workers for a second eye from time to time? Of course, we do. It’s all part of continuing education and proactively learning where we have the opportunity to grow. It’s imperative. Remember, we never know it all!

In our office, we do not hire anyone who is not registered in OB/GYN with less than three years of full-time OB/GYN experience. How can a physician trust your work if you don’t trust it yourself? A physician relies heavily on the experience and ultrasound advice of his/her sonographers to provide competent and thorough examinations. How can they properly treat their patients otherwise?

Your job as a sonographer is to find pathology. You can’t diagnose what you don’t recognize, and you won’t recognize what you’ve never seen. This is just the nature of the beast.

Be Your Own Advocate!

I’m sorry if your educators failed you. They have a responsibility to not only teach you in the classroom, but what to expect outside of it. This is not your fault. It reminds me of an old adage which says that you can’t know what you don’t know. So, before you take your first job or any job thereafter, ask yourself if you are experienced enough to commit to it. Then ask if you will have supervision. Start out in a teaching hospital. Sonographers are thrilled to share their knowledge with you in such facilities! Learn what you need before you think about branching out on your own. You owe it to yourself in order to become a better sonographer. You owe it to your patient to provide a quality examination.

Patients: if this is overly concerning to you, it should be. You can always inquire as to the experience of your healthcare providers!

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Early Gender Pics

How Accurate Are Early Gender Pics?

early gender pics

Early gender pics can be deceiving. Many of you who want to know your Baby’s sex as early as possible with ultrasound may desperately wish to believe the tempting promises of your street corner 3D ultrasound business. Before you pay your money to one of these places, I encourage you to first read the above link! Some of their employees are not real sonographers–please do your homework first and ask the right questions before you go.

The early fetal parts of external genitalia can look different than they do later on–just as an embryo looks different from a baby or an embryonic chick looks different from a chicken! This is also the reason we do not perform the screening of anatomy until 18 Weeks. Structures like the brain are ever-changing until about that time. Even at
17 Weeks, the brain looks a little different. The same applies to external genitalia–later is most always better.

But Don’t We All Look Different?

Yes and no. Because these parts are just starting to develop at 12 Weeks, both boys and girls have little parts that stick out. Over the next month, your baby’s external genitalia are still developing and changing in appearance. That is to say, boy tissue starts to get bigger and girl parts shrink. Eventually, the scrotal sac and penis take a more recognizable shape, and the labia and clitoris take on the appearance of three tiny white dots or lines. Fetal boy parts can appear different from other boys, just as girls can appear different from other girls. We’re all different!

Please take my word for it. Any guess at 12 – 14 Weeks is simply a guess based on appearance, but that appearance can change. At 15 – 16 Weeks, the parts may be slightly more developed, but it’s still a guess. And SO many factors effect how well we can see those parts. Now, have I guessed gender at 16 Weeks? Definitely! But it had to be someone I was scanning personally, baby had to be lying butt-up in a perfect position with legs wide open, and I had to have a clear image otherwise. It just all has to be textbook perfect and not every patient/fetus is a textbook scan. I might feel confident enough to provide a second opinion of your baby’s gender if you are 17 Weeks with a perfect potty shot!

The Nub Theory and Genetic Testing

Even if the parts appear very straight-forward based on the nub theory, it’s only a theory and only about 73% accurate. That’s a lot of room for error. So, just because a girl might look like a girl based on the nub, don’t be surprised to find a penis at your anatomy screen! Only genetic tests like first-trimester blood tests for DNA or amniocentesis are 99+% accurate for fetal sex.

***

Want more great images of fetal sex?

Great! I’d love to share them.

Simply subscribe here and email wombviewerblog@gmail.com!

You are welcome to email me with questions at any time in your pregnancy. I’ll do my best to answer them!

Please know, a request for gender confirmation should be at least 17 Weeks and later!

Reading an image I didn’t take can be a challenge, and I can never be more confident than the person who scanned you. Especially if your sonographer said she couldn’t get a great shot, I likely won’t be able to tell, either. (Aw,💩 — I hate when this happens!)

Good luck at your next scan, and thanks for reading!

 

 

Ultrasound Questions–Email Me With Yours!

First, I’d like to extend a huge congratulations to a reader who recently delivered! 👶 I love answering your ultrasound questions. I love it more when I actually help a reader. This is what she had to say…

Hi! I hope you had a lovely time on your holidays. Just had to say I had a little boy at 38+5, and he was a MASSIVE 8lb 7oz! :)  Not half as bad as I imagined. Many thanks for your help to me!

 Feedback and Your Ultrasound Questions . . .

I’m always excited to get your feedback! The whole point of my blog is to answer questions you have about ultrasound accurately. Considering the vast forums on pregnancy where everyone chimes in on their personal experiences, taking to heart unreliable information has the potential to do harm to you or your baby. Everyone is an expert; everyone has an opinion. Though I believe most genuinely care and try to help, I have found much about ultrasound to be misleading or incorrect in some way.

I have loved breaking the news to expectant parents about whether they would be shopping for pink or blue!

female sex, 2nd trimester

Definitely Pink!

male sex, 2nd trimester

Definitely Blue!

And I’m happy to try to decipher someone else’s images for my readers (as long as you’re 17 Weeks and further–just click on the link, leave your email address, and email me!). In my effort to bring to you factual and truthful information about your ultrasound examinations, part of that truth is doing my best to help you understand your exam and info about results.

Ultrasound will always be, first and foremost, a medical examination of mother and child. Your sonographer needs enough quiet and concentration to ensure your baby appears healthy! Afterwards, break out the party hats, and let’s have some fun!  🎉 Of course, the level of fun completely depends on how photogenic your new addition is feeling that day. You can read more about that here. Poo, sometimes, it just isn’t what you expected, even when you lost sleep in anticipation. 😫 I hate when that happens!

That said, the highlight of many workdays revolved around very happy couples who were mindful of why they were there–so happy to be expecting and loaded with ultrasound questions! I love to impart ultrasound knowledge to anyone willing to learn it. If I could also deliver a few awesome keepsake images of the precious little bundle and enjoy a few laughs in the process, all the better. I still feel honored to have been a third objective party who was privileged to orchestrate it all!

Best wishes for a beautiful experience!

Just shoot me an email with your comments, questions, and suggestions!

~ I’ll do my best to answer them for you ~

Can’t find a book to help you understand ultrasound?

I’m working on one! (Though your baby might be three by the time it comes out . . . )

In the meantime, you can Subscribe here for updates and
visit My Shop for custom gender reveal and pregnancy announcements which are coming soon!

 

Ultrasound Questions Answered – Ultrasound Blog

Ultrasound – One Mom’s Opinion

I love receiving uplifting emails from readers! Your positive feedback inspires me to continue blogging and to look for more ways to inform you about your fetus and you! Accurate ultrasound information and the safety facts that you need to know for the health of mom and baby make up my highest priority for my blog!

facial profile, 18 Weeks pregnant, ultrasound

Additionally, your questions offer great content to share with other readers. I encourage all my readers (subscribers or not) to share your ultrasound stories, comments, images, photos of your fetus, and ultrasound questions at wombviewerblog@gmail.com. Furthermore, your experience may even help another mom-to-be with her search. I hope you’ll read, enjoy, and subscribe to my blog to find answers for all your ultrasound questions!

An Ultrasound Opinion from One Fellow Healthcare Worker to Another

nurse and mom-to-be:  Hello!! I must say I love your blog and wit!! Patients are so lucky to have such a skilled sonographer like you. I must say I’ve experienced both. My last one we met  (18 Week ultrasound) was great, 20+ years experience and worked with higher-acuity patients, too. She respected our wishes and wrote down the sex with a picture for us to open later. She asked us to leave the room so she could analyze the image. We also asked her track record and she says she does not reveal if not sure. She labeled every body part for us and thoroughly educated us, as I’m sure you do, too!! I’ve been a nurse for 10 years so I can only imagine the questions you get!  Love the idea of your site – you really utilize your talent and help us crazy pregnant ladies!!

Best wishes and I’m now a subscriber (and huge fan), yay!

wwavb:  Hi! Thank you so much for reading and your kind words! AWESOME!! I’ve worked two years on content, and I would love to make my site into a book one day!!  I think it would be an entertaining read for anyone and a great shower gift for new moms:) Your great feedback was a great Mother’s Day gift, by the way!

Subscribe for more accurate, reliable ultrasound facts and information for moms to be!

 

Fetal Sex Determination–Some Want a Surprise

Can Anyone Make a Fetal Sex Determination?

(The short answer is no.)

I LOVE IT! What a breath of fresh air I received from a reader–someone who actually wants to avoid fetal sex determination! Now, don’t get me wrong. Though I held off on the potty shot for my first child, I was a full-time certified sonographer working several years by the time my second came along. I personally couldn’t wait to see for myself. I even scanned myself in the process (we all do this, by the way)!

This post comes from someone who definitely fits into Club Minority. She wanted to wait for The Stork, but that was just not good enough for everyone else in her family–especially her sister.

distressed mama:  Hello, I’ve really enjoyed reading your blog. From everyone’s posts, I can see that I am in the minority–my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago, and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures. We sent my sister this picture in a text message.
unknown gender, fetal sex determination
Upon seeing it, she immediately said, “I think I know what it is . . . ,” and blurted out her guess. That really bothers me because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture, is the sex of the baby obvious to you? I figure that if you can’t tell, then my sister who is NOT a trained ultrasound tech can’t tell, either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!

wwavblogger:  I LOVE IT!! First things first. Absolutely, positively NO genitalia in that shot whatsoever! The black oval in the pelvis is Baby’s bladder, and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else! Tell your fam they have a 50/50 shot at guessing! 😉

***

Everyone the expert, right? And, yes, the desire is overwhelming for patients to know gender as soon as the pee stick shows the little plus sign. However, sometimes the desire comes more from the family than the patient!

From the other side of the wand, I can tell you people often believe what they want to see, not what’s really there. Distressed Mom, be sure to let us know what The Stork drops at your door!
Thanks for reading!
Have a similar story? Do you desperately want a surprise?
Is your family driving you nuts with constant harrassment to find out?
If so, email me with your experience at wombviewerblog@gmail.com!

For your most reliable ultrasound information, subscribe here.

 

Pregnant Belly Size – Don’t Dare Compare

The Pregnant Belly Comes in All Shapes

Pregnant bellies are as different as the people to whom they are attached. You just can’t compare your pregnant belly to anyone else’s, and no one else should, either. But that doesn’t stop some people from comparing pregnant belly size to their standards for small or big.

Why is it that one of the most sensitive times in a woman’s life is also the one total strangers choose to flood you with unsolicited opinion? Bank, grocery store, public restroom – you just want to pee, but someone you’ve never laid eyes on touches your belly, asks your due date, and (last but not least) chimes in on how your doc must have gotten it wrong. And just when you wonder from which aisle they found the nerve, co-workers and your not-so-favorite uncle aren’t much better. Considering we humans come in all shapes and sizes, why would our pregnant bellies be any different? Furthermore, if with age comes wisdom, why haven’t more people figured it out?

How Bellies Are Different

In my career, I’ve scanned bellies of every shape, size, and gestational age. No one can predict how far along you are by how you look. If we see them everyday and we can’t tell, neither can anyone else! There just is no perfect belly model into which to squeeze yourself. My experience with pregnant belly size can lend a few general observations. Hopefully, they’ll help you feel a little better about your own morphing baby belly.

Pregnant Bellies on the Small Side

If you are fortunate enough to be tall and lanky with a long torso, your uterus will have more room to grow up instead of out. This sounds like a blessing to most, but it usually results in women who don’t show very much. They end up getting hit with a barrage of questions like “Are you sure you are eating enough?” or “Is your baby too small?” or “Are you sure your baby is growing right?” These patients come in for their ultrasounds worried about their Baby’s growth and asking for confirmation of normal weight for Baby’s age.

Pregnant Bellies on the Bigger Side

Conversely, if you are one who is shorter in stature or with a short torso, your poor little uterus has only so much “up” room before it has no choice but to grow out. These patients are usually miserable by the end of their pregancy (of course, not always!). Your belly may feel heavier and can appear farther along. Sometimes, having too much amniotic fluid in the third trimester (quite common) can make your belly look bigger, too. Let me guess – you tend to get hounded with comments relating your belly to popping or exploding and questions like the old “Are you sure there aren’t two in there?” “Huge” is not a compliment.

Patients Vent Their Frustration

I always empathized with my patients when they expressed this frustration and worry. They end up questioning diet, weight gain, and their baby’s health. Maybe you’ve lost sleep or internalized someone’s thoughtless comments, too. I do genuinely believe most people mean well, however, they just don’t often consider the impact of their words. Of course, they should, but I guess that’s too much to hope for – a Utopia where everyone thought first and spoke second?

If you’re also inundated with insensitive comments, you should simply discuss any concerns with your healthcare provider. If your doc says you and Baby are just fine, let that be all the confirmation you need.

I jokingly suggested boxing therapy for my patients. What exactly is that, you say? I say if anyone is bold enough to hit you with unflattering, unsolicited, and unwanted comments, you have the right to blacken an eye, relative or not! Apologize profusely, and tell them hormones made you do it. Blame it on pregnancy reflexes (is that a thing?). I guess I really can’t encourage violence, but the thought is nice, right?

On the other hand, if you’re not into smackdowns, maybe a clever comeback will make them think twice. Hmm…how about something like, “Hey, how about that! My baby is almost as big as your beer gut.” Hopefully, the future sighting of any expectant mom makes them turn and run for cover.

I hope this helps!

Feel free to email me with your questions or stories!

 

Early Sex Determination

When Early Sex Determination Is Just Too Early

I find it comical when people ask me my opinion about gender and then don’t believe it. Especially regarding too-early sex determination. However, no matter how many times or all the ways they ask, too early is just that. Guessing too early leaves too much room for error!

Fetal sex is not well-developed until about 16 Weeks under normal circumstances. In fact, too early in the pregnancy, they both have itty bitty parts that stick out and can all look the same. The Nub Theory is just that–a theory. Only a guess. That’s it. Up, out, perfect image or not–just because said nub looks like it’s sticking up doesn’t mean Team Blue! That said, 12 Weeks is way too soon to guess, way too soon to get someone’s hopes up, and too often equivocal to call a gender guess at this age 99%. Just don’t believe the hype! Can they be right? Of course! It’s a 50/50 shot!

Read the emails from the grandma-to-be below!

grams:  Hi, I subscribed to your blog. I love it. These are my grandbaby at 12 Weeks 2 Days. Any guesses? The baby’s legs were crossed at the 16 Week ultrasound.

12 Week Fetus, early sex determination

12 Week Fetus

12 Week Fetus, early sex determination

12 Week Fetus

wwavb:  Hi! And thanks for reading and subscribing! So glad you are enjoying the info!

Okay, so if you’ve read any of my posts on the subject, you know that guessing at 12 Weeks is like flipping a coin. Just too early. An accurate guess can be made at 18 Weeks IF baby is cooperating! Any guess any earlier is simply a guess, and I just wouldn’t invest in paint!

Best wishes for a healthy grandbaby!

grams:  Thank you for your response! It’s just driving me crazy wondering what those two white ovals are between the legs. Doesn’t look girl or boy. Could it be fingers or an umbilical cord?

wwavb:  It’s definitely external genitalia, but boys and girls look the same at that age! Over the next several weeks, girl stuff shrinks to form labia and all her girly parts; boy parts get bigger to form the scrotal sac and penis. It’s all still developing on the outside even though chromosomally it’s already determined on the inside.

grams:  Thanks for being so helpful. I would think it’s a boy for sure if it’s genitalia! But, not if they look alike at 12 Weeks.

 wwavb:  Sounds like you’re not too far off from finding out. Happy shopping!
grams:  Really … No guesses? I know it would be a guess. I thought the pics looked pretty clear. Everyone thought boy.
~*~
This grandma earned an “A” for persistence! But it doesn’t change the facts. The professional verdict was not boy or girl but “too early to know.” It’s just not all formed yet! Could it be a boy? Well, of course! But there’s no way to say for sure by this ultrasound scan.
People have a tendency to believe what they think they see. As long as sonographers guess too early and continue to be wrong (and especially if they’re correct), I will have to persistently defend my stance on “too early” until the cows come home. It’s especially difficult when someone else delivers a “beyond sure” pink or blue guess to excited expectant families.

I’ll say it again!

It’s a guess. Just a guess. It’s only a guess.
There’s just no way to be sure one way or the other!

Weeks 12-15 are just too early for a guess that’s accurate enough to invest in paint–unless you’re going yellow!

Looking for a second opinion for your images of gender?

<<<Just subscribe and email me at wombviewerblog@gmail.com with your pics or questions.

Thanks for reading!

3D Ultrasound Pics

Great 3D Ultrasound Images

Sometimes, beautiful 3D ultrasound pics are just effortless! Well, when I was finally able to get this baby girl to flip over, she was more than happy to pose for the camera. We asked; she listened. What a good baby girl! Let’s hope she listens as well when she’s two! (My youngest one didn’t — such a little pill!)

The result this day was just great imaging. Mom was 27w3d here which proves an optimal time for a 3D scan. Of course, all the other factors have to line up, as well. Every mom hoping for some great 3D pics needs to have a nice pocket of fluid in front of Baby’s face.

2D facial profile, 3D ultrasound pics, 27 Weeks pregnant

Notice the black in front of her face here. This is one of the reasons we can see it so well with 2D imaging. But it’s also why we were able to obtain the beautiful 3D images you see below.

Babies have begun to develop some fat in their skin, so cheeks look a little more plump now.

3D ultrasound pics, 27 Weeks pregnant

 

3D ultrasound pics, 27 Weeks pregnantMom was happy to share:) Thanks, Mom! She’s a keeper!

Email your great 3D ultrasound pics! I’d love to post them on my site!

FYI – Before you visit a non-medical 3D business for your images, please read more on how to educate yourself before making your appointment and paying your money! It’s my mission to inform moms to ask about real sonographers. Make sure you get what you pay for!

Best wishes for healthy …


Thanks for reading my blog!

 

Mistaken Fetal Gender–Please Don’t Guess!

A Mom’s Guilt Over Mistaken Fetal Gender

It’s possible. We’ve all heard a story or two, right? A guess too early in gestational age is one way to ensure mistaken fetal gender guesses. When Baby won’t move from a difficult position, that doesn’t help, either. The message of this post is simple. What I really want expectant moms and sonographers alike to take away from this message is there’s more at stake here than just being “wrong.”

Parents start to identify with being a mom or dad to a new baby girl as soon as you speak the words. Thoughts jumpstart to dance recitals and her wedding day. Dads immediately daydream of the fishing partner they always wanted, or they run out to buy his first tiny baseball glove.

These are strong emotional ties that often get broken when someone casually throws out the gender card on ultrasound. Beyond the need to return some beloved items often comes with associated feelings of guilt or loss when the true gender is identified.

How “Mistaken Identity” Affected One Mom:

reader:  This is my second pregnancy, and I am 18 Weeks. At my 20 Week ultrasound with my first pregnancy, I was told by the head ultrasound doctor (radiologist?) that it was definitely a girl, and I picked out a girl’s name. I ended up going into labor early at 30 Weeks.

At the hospital while an ultrasound was being done, I kept asking if she was ok. The poor tech said, “Why do you keep saying she? Were you told it was a girl?” We said yes. She said, “Well, I see a scrotum. I’m going to get the Dr.” So, it turns out we were the first time this head doctor ever got it wrong, and now we are legend at his hospital.

We were already calling the baby by the girl’s name we picked, and I had a really hard time with the news. The only way I can describe it is like I had to grieve this little girl I had in my head that was suddenly gone. I wouldn’t change a thing about the amazing toddler boy I have now. But at the time, I was a wreck. Needless to say, I don’t want to go through that again. I was told today that the baby is a girl (again), and it is hard for me to believe. So, I just want to see what you think!

18 Weeks pregnant, female gender, mistaken fetal gender

wwavblogger:  Wow! Your story is EXACTLY the reason I implore sonographers to give careful and cautious consideration when determining gender!

I learned many years ago that even if I say I am not sure but give a “possibly,” parents are already thinking ballet slippers and pink tutus or sailboats and whales! It’s so true. It’s just an emotional attachment you begin to develop as soon as someone even mentions the slightest inkling of pink or blue.

Now, not having scanned you real-time myself, looking at one single image can be tricky. By this image only, it looks like dance recitals may be in your future! It does appear like the typical three lines we see in a baby girl. Just know that I can’t guarantee it, though! PLEASE, send another image of gender after your next scan. At least she already has the perfect name!
***
Did you or someone you know experience a case of mistaken identity by ultrasound?
If so, feel free to email all about it at wombviewerblog@gmail.com!

15 Week Gender–When Bad Images Happen

When 15 Week Gender Images Leave a Question Mark

Terrible images of fetal sex like these kill me. First, I know they could be as easily wrong as right. In other words, the best rate for accuracy for this particular guess is 50%–as good as a coin flip but cheaper! Second, these moms get so excited for what they’re told. It’s just not right! And these 15-Week Gender Pics make the perfect example.

I still can’t believe some of the emails I receive from expectant parents who’ve been promised the gender-equivalent of the moon and stars based on crappy images … and I don’t mean a little crappy. Who taught these people to scan? Hmm, maybe they weren’t taught?

Read more on elective ultrasound businesses here; they’re not required to hire real sonographers.

Moreover, most moms are WAY too early in their pregnancies to receive such big commitments on Baby’s sex. Read below an email from a reader who has experienced this very situation:

reader:  Hi! I just found your site, and I love it! I was hoping that you could just reassure me that what we are having is a little girl? My ultrasound tech said that he was 100% sure it’s a girl because there were definitely no boy parts. But I just wanted a second opinion! Thank you so much!

15 Week gender, unknown gender 15 week gender, unknown gender

All the Reasons Why This 15-Week Gender Guess is Just Bad

The first reason lies with my own image for comparison. Both sexes at Week 15 might look like this:

15 week gender, male and female gender

What do you think? I know what I think. No sonographer with any level of adequate experience, especially those who specialize in OB, would ever label these first two images a girl OR a boy, much less to seal it with a “100%.” We all know that a lack of seeing anything which looks like a penis can hardly be declared a girl. Furthermore, with a bit of a projection between the legs here, wouldn’t you think he would err on the side of male? Regardless, of all the images I would dare tack a label of 100% to, these fall super short.

All I could advise is that she not paint a nursery based on these images! And I would be leery of any sonographer who calls anything 100%. The first cardinal rule of ultrasound is that nothing in medicine is ever 100%. It makes me crazy when patients are given images like this and told it’s a definite. This is precisely how mistakes with gender determination are made.

I didn’t want to burst her bubble, and I couldn’t guarantee that her baby wasn’t a girl. Simply put, I wanted her to know that determining girl by those images alone was impossible. I did not scan her real-time, however, these images are not textbook images for girly parts at any age.
I can’t teach the world to scan. But maybe I can nip some mistakes in the bud … one crappy disheartening image at a time. Once again, my goal is to educate and inform!
You can email me with your stories here!

Latex Allergies – Let Your Sonographer Know BEFORE!

The Worst Place for a Latex Allergy?

You guessed it. If you think setting your feet in stirrups and scooting to the edge isn’t your idea of a good time, discovering your latex allergy in all the wrong places would definitely rain on your parade. It’s terrible when patients have to learn about this the hard way! You seek medical attention and end up with a terrible reaction to latex that you didn’t even know about.

Alternatively, you may know you have just such a sensitivity. You may not, however, realize you that latex would be your intimate examination companion. This is precisely why the burden rests on us providers to ask! Whether the unwanted outcome is hives, swelling, or itching…none of it is welcomed anywhere on our person — much less below the belt.

Universal Precautions

Of course, we exercise universal precautions when performing ultrasound examinations. This includes wearing gloves with every patient and washing our hands before and after. Most providers usually post signs throughout their facility reminding patients to speak up when latex is a problem. Most patients typically find this out early on in life, so we take extra precautions by highlighting the reaction in a patient’s chart.

The Dreaded Transvaginal Examination

Most of you ladies find yourselves all too familiar with transvaginal ultrasound exams. Though easy and fairly quick, they aren’t met with much excitement. Yes, these probes are a bit invasive, aren’t they? Pregnant or not, if you’ve ever needed a pelvic evaluation with ultrasound, it has likely been performed via this approach. Naturally, the probe is covered for each use.

Your sonographer or other healthcare provider can never assume you don’t experience such a reaction. Quite often, patients alert me well in advance. However, on many occasions, the patient warned me after I had already begun the exam. “That’s not latex, is it?” Thankfully, it wasn’t.

Today, practices can utilize many other options to avoid this potential problem. Enter vinyl! These latex-free gloves and probe covers can be made of other materials, as well. And using them exclusively takes the guesswork out of the equation, avoiding any possible unwanted exposure. The photo below is an example of what your probe might look like on exam day.

latex allergies

Transvaginal probe cover

Sometimes, I’ll use a glove instead of a probe cover. My patients usually watch with a little curiosity as I gel up a middle finger and slide in onto my probe. I have to admit the sight prompts a little laughter from both of us. Hey, we have to create a little comedy in medicine wherever we can find it, right?

Next time you find yourself about to come in close personal contact with a transvaginal probe, be sure to ask your sonographer about the probe cover if you have a latex allergy. An allergic reaction isn’t fun anywhere, but I believe all women can agree. The last place we’d choose for hives is the “South Pole!”

The Making of a Sonographer

What exactly do I do? Let’s break it down. This information will definitely be helpful to anyone interested in training for a career as a sonographer. Many are fascinated by ultrasound! So, this may also be an interesting read for those who are merely curious about what we do. This may also be a little long, so hunker down with a good cup o’ joe.

Ultrasound is very technical, so attention to detail is of great importance. We work in the millimeters, so spacial concepts and 3-dimensional thinking are necessary. We can visualize mentally what we are only partially seeing on the monitor. For new sonographers, this gets easier with improved scanning ability over time. None of us were great sonographers right out the gate!

So, what am I? I have many names…sonographer, ultrasound technologist, ultrasound tech or technician. A certified sonographer is someone with a couple of years of experience who has passed a Physics exam and one specialty examination (like OB/GYN). You then earn the credentials of RDMS, Registered Diagnostic Medical Sonographer. There are many other examinations for which one can earn more credentials.

We start off with some book knowledge. We learn medical terminology, A&P, pathology (disease) and how it presents, ultrasound physics, biology, and examination protocol, for example. In my particular training, we started clinical rotations where we visited different clinical settings for a period of time. We would follow other more experienced sonographers to observe examinations. I learned a little about the technologist/patient relationship like what to say and (most importantly!) what not to say.

We also learned how to present our examinations to the Radiologist, the reading physician. You better have all your ducks in a row here, people! They are tough. They can and will ask you a hundred questions, and you better have the right answer waiting. Like any other profession, some are easier to work with and offer more guidance. Some, well..don’t. After you are more experienced and have proven yourself time after time, the tough ones let up a little:) They know when a sonographer knows her stuff, and they know when they can trust your skill and ability. It just takes time.

We learned how to handle patients in hospital beds, how to transport them, and how to handle their catheters. Learning to keep urine, vomit, or blood off your person was a good time, too! We also learned what to do if it happened anyway and how to not get sick yourself. It doesn’t help your patient! If you have a good teacher, you also learn how to handle patients with dignity and respect. It’s hard for someone to feel that when they lie in a hospital bed. In an outpatient setting, you learn that patients are the lifeblood of a practice. When dealing with the general public, you can’t always say what you want, and you have to learn to filter.  This is sometimes VERY HARD to do!

A sonographer learns scanning ability with hands-on training with a machine and an experienced sonographer at the helm. Ultrasound machines are very much like most computers. They all have the same basic functions, but some have a few more bells and whistles than others. We learn what something looks like by watching someone else.  S…l…o…w…l…y over time we begin to be able to recognize parts ourselves. Then we take over the probe. We have to learn how to hold it and find the parts ourselves. We learn how to properly measure organs and how to adjust 40 knobs so that the image looks the way it should. Additionally, we have to learn image protocol which includes what images to take and how many.

Eventually, after a few months of scanning, these technical details become second nature. As soon as the probe touches the skin, we set about making our image look as needed without much thought. It is only then that we start to recognize pathology. Sometimes, disease processes present exactly as one learned from the book, sometimes not. Oftentimes, we see something we know is NOT normal, but we can’t exactly put a name to the process. What students need to know is that one of the most important things they’ll learn about ultrasound is to first learn what “normal” is.  Once one scans many normal exams, it is much easier to recognize when something is wrong.

We learn all the above for many different parts of the body! Some aspects of ultrasound include Intracranial and Peripheral Vascular (vessels of the arms and legs), Echo (the heart), Small Parts (breast, testicle and thyroid), Abdominal (all abdominal organs and vessels), OB or Obstetric (maternal and fetal), GYN or Gynecology (pelvic organs in a non-pregnant female), and many others. Ultrasound is also performed on the eyes and in more recent years, muscles and nerves. We also spent a bit of time learning about biohazard waste management and HIPAA regulations that keep patient information private.

Over time and with more experience, we learn how to better manage our patients and case loads. I say it’s a process with a long learning curve, especially for anyone starting out with no medical background. At times, I cursed my choice of career, place of employment, and certain unpleasant physicians. I sometimes cried before and after a particularly hellish workday or weekend of call. It was the hardest thing I’ve ever done. BUT I did it. And slowly but surely, the puzzle pieces came together. They began to fit in a way that brought light and clarity to every exam I performed. Suddenly, it just started to make sense.

When I began to ask more questions about something I didn’t understand, I received better response from docs I admired for their extensive education, intelligence, and knowledge. You can’t be afraid to ask questions! It’s important to your docs, their practice, and patients. It’s also important to you, the sonographer, for your own developing skill and ability. This confidence grows over time! It’s a great feeling when you finally get to this point.

To this day, I still get a rush when I recognize pathology and all the puzzle pieces come together. It makes me happy when I can explain something to a patient that gives clarity to her understanding. There’s nothing like a “thank you” (or even a hug!) by a patient. And who doesn’t love positive feedback by a physician who says you did a great job? As difficult as my career was in the beginning, I’m still at it after 23 years. And year after year, post all the blood, sweat, tears and pain, I feel I’ve come a long way:)

 

Anatomy Screen – Doctor’s Orders

Can you skip your anatomy screen?

Of course, a patient has a right to refuse any test! I’d recommend a discussion with your obstetrician, however, so your doc understands your reasoning. Your doc will want to clear up any misconceptions you may harbor and ensure you understand the consequences for your decision. However, students practicing ultrasound on your fetus does not constitute a replacement! Here are all the reasons why.

True Story…

A patient requested her anatomy screen examination be cancelled because she went to a facility where students practiced on her. She stated they already did the scan, so she didn’t need to have it done a second time.

 Students practicing on your belly is not a formal or official scan; it’s just practice;)

Your diagnostic examination was ordered by your physician and must be performed in a medical facility with a written order by your doc. No order, no exam. That examination must be performed by credentialed sonographers, must include specific documentation, and must be interpreted by a radiologist or your physician. Click on the link above for more info about what you can expect from your anatomy screen!

Can students practice?

Yes, ultrasound students routinely practice on pregnant bellies, and that’s okay — as long as it’s also okay with your doc! I always recommended they have written permission from your physician, but that isn’t carved in stone (just my opinion!) And I personally recommend waiting until after your real anatomy screen is complete — if anyone is going to question a problem, you’d want that to be your doc…not a student or instructor.

Holy cow…me as a student…you would not have wanted that to count as your official study! Actually, that goes for any student. They should have a supervising instructor guiding them, but their casual practice is no substitute for the real thing…medically, ethically, or legally. Students are still struggling to figure out what’s a head and a butt on your baby and how all the buttons work. “Hmm, where is that knob again to make the image brighter?”

Yep, there’s a L O N G learning curve to ultrasound, and no one knows that better than me! Whew,  excruciatingly painful.

The Art of Carving Patient Relationships

Who Should Consider Their Patient Relationships?

Anyone in health care, actually. But this one is for sonographers. I thought initially the patient might glean something from it, also, to understand what it is she should expect from her sonographer.  However, I quickly realized this isn’t something the patient needs to read to understand…it’s something she already expects. Every patient who walks into your room expects to be greeted kindly and with a smile. She expects that her examination be explained in a way that she clearly understands. She expects to be treated like a fellow human…and she deserves it.

Your only job isn’t to only look at the monitor.

You have to get out of the mindset that your only job is to look at that monitor and say nothing else to your patient beyond an explanation of exam. She has feelings.  Sometimes, she is even frightened and anxious about the examination she is about to undergo. Who really enjoys their feet in stirrups?

Sometimes, it’s not the examination she’s afraid of but the results. She’ll often even tell you so. You are the provider. You are the master and conductor of the environment in your room at that moment. You have to keep in the forefront of your mind that the exam you are performing requires “invading” the personal space of another individual and actual contact with that person. The exam is a very personal experience for that patient and, often, a very uncomfortable one. Your patients trust that you will do a good job for them because you are a representation and extension of her physician.

How To Break the Ice

You can ask her how she’s feeling today. If she says, “Terrible,” you can lend apologies and say you hope her day will be better as soon as the test is over! Patients often laugh at this as I’m gelling up the middle finger of a vinyl glove and slide it down over the vaginal probe. I always say, “Gotta have a little comedy in medicine somewhere, right?!” They’ll ask about your family, pictures in your room, your kids, your experience in your career. Talking to them during the exam helps most people to just get through it a little more easily.

Don’t be afraid to open a conversation for fear of being asked the question we all cannot answer — the one regarding results. The best way to respond to this is to simply state, “Well, my job is to take these measurements and images. Your doctor will want to examine them along with your other clinical information and then decide how your ultrasound fits into that picture. Only your doctor has all the pieces of that puzzle!”

For obstetric patients, you just about can’t get through an exam without Mom or Dad asking, “Does everything look ok?” I’ll usually say, “So far, so good! But, you know, your doctor will go over this entire exam with you, and you can ask her any questions you have.” I always found it helps to point out their baby’s parts as you take your images. Thank the heavens for post-processing, right? You can always go back and focus on things that need special attention after your patient leaves.

My Best Advice

There’s one really important piece of advice I’ve learned over the years. Anyone who works with the general public would agree that you can’t make everyone happy all the time. It’s just impossible. But it doesn’t hurt to try! Some people can’t be made happy. Try anyway. Go out of your way to make conversation with your patient. Make her feel comfortable and answer her questions that you can answer. She’ll leave feeling like you’ve given her an adequate examination. At the end of it, she may not even mind so much that she needed it to begin with.

It feels good to receive a warm “Thank you” and smile as you walk your patient out. If you can send her out with a good chuckle, even better. 🙂

Ultrasound – When They All “Ax” for You!

Aw, shucks…there’s nothing better than when my patients ask for me!

facial profile, 18 Weeks pregnant, ultrasound, ultrasound pictures

2nd Tri Facial Profile

If you’ve ever been to the hot and sticky…and beautiful…New Orleans, you might also be familiar with Mardi Gras and some of the best music ever. “They All Asked (pronounced “axt”) For You” by The Meters is one of my faves! If you’ve never been to ⚜️NOLA⚜️, add it to the bucket list now! You just gotta go for some of the best food and music anywhere in the world;)

Now for my topic of the day…

It makes my heart expand three sizes when a patient specifically asks for me to perform her ultrasound. Especially, when that patient is a physician. And her husband is a physician. And they are both super-intelligent. You have to guess that maybe you’re doing something right. I scanned them throughout their last pregnancy, and they wanted no one else for their second. They greeted me with hugs for every scan. We talk. They ask me questions about ultrasound, I answer. They thank me profusely, and declare “Sorry! You are stuck with us forever!” It’s a great feeling. Talk about the warm-and-fuzzies!

I was there for her miscarriages and when she was anxious at the start of her next pregnancy. I was there again when she needed weekly scans in her third trimester. “It’s not just another patient, it’s a relationship.” This  is a quote from one of my favorite docs. Patients like these reaffirm that we excel at what we do. We could all use this affirmation, couldn’t we?). They help justify the daily grind and remind us why we do what we do!

When someone says, “I can’t imagine anyone else doing my scans,” it’s the highest compliment a sonographer can receive. I sure don’t take it with a grain of salt. And suddenly, the ones who curse me when I can’t tell them their baby’s gender simply roll away like water off a duck’s back;)

Email me at wombviewerblog@gmail.com with your stories to share!

 

Ultrasound at 11 Weeks Pregnant

What can you expect to see at 11 Weeks?

At 11 Weeks pregnant, take a look at what you should expect to see by ultrasound!

 

11 Weeks pregnant

11 Weeks pregnant

 

These images depict Baby B at 11 Weeks! Both babies are slightly bigger = about 4.3 cm now or almost two inches! The second trimester starts at 14 Weeks. So, the first trimester, thought of as the most crucial one for growth and development, is nearly over. Babies can be seen doing a lot of quick jerky movements at this point. They can be quite active and actually mimic little jumping beans! In the second image, you can see little legs quite distinctly.

 

Amnion – Ultrasound Blog – Womb with a View Blog

The Amnion – What is It?

The amnion is another name for your fetus’ amniotic sac or amniotic membrane. Two great ultrasound images are seen below!

amnion, amniotic membrane, amniotic sac

In this first image, we can see the membrane (or the wall) of the amnion around Baby who is 9 Weeks. The fluid inside of this sac is black, as is all fluid in sonography. The amniotic membrane appears white.

 

amnion, amniotic sac, amniotic membrane

Above is another image of the amniotic membrane without Baby in the pic.

This is the thin line that kinda looks like a little bubble around your fetus. If you are having diamniotic twins, you will see this around each fetus. This simply means that each baby has its own protective sac of fluid. This is what we want to see!

Thanks for reading!

Please email me with your comments and questions at wombviewerblog@gmail.com and subscribe for more reliable ultrasound information!

 

Better Ultrasound Pictures?

“Can’t You Get Me Better Ultrasound Pictures?”

My patient asked me this question with a condescending tone and a tinge of nasty. Hmm, can I?
I’ve always heard you win more bees with honey.


ultrasound pictures

Sending a patient home with keepsake images is certainly not required, but most sonographers really do try to obtain the best ultrasound images we can for a patient. When they ask so sweetly (cue sarcasm), these patients assume we didn’t try our hardest. This is only slightly irritating–especially when the reason for the poor images lies with factors which have nothing to do with me.

I am more than capable of taking incredible ultrasound pictures of your baby … if all the stars align. Sometimes, however, the answer to that question is a huge no when all the factors that go into obtaining a good image do not exist. And those conditions are different for each and every scan, regardless of whether it’s the same patient or same pregnancy for that patient.

always tried to give a patient great ultrasound images and would usually give as many images as I could possibly snap. I’ve sent patients out with an au revoir and ten or twenty images when just the right circumstance presented itself. Fortunately for these expectant moms, Baby was showing off, the patient and/or her family were great to work with, and I had plenty of time to play (maybe the next patient cancelled)! I always loved those occasions. However, those three variables change swiftly and drastically like the wind from one patient to the next.

When Ultrasound Pictures Aren’t the Best

Sometimes, the images a patient wants either cannot be obtained at all or appear fuzzy. This can be due to a number of factors.

  • Fetal cooperation IS the name of the game. Without this, cute pics simply are not gonna happen. Especially when baby is facing mom’s back, it then becomes very difficult for me to see the specific organs and structures that I need to document, much less be able to get cute pics for the patient. The prone fetus might look something like this:

 

breech fetus, prone fetus, ultrasound pictures

 

  • Baby needs to be facing upward toward Mom’s belly in order to see the face well. But a few caveats exist. If a nice pocket of fluid is found in front of Baby’s face with no placenta, limbs, or the cord in the way, we can typically get some really great shots of the facial profile. After all, we meet someone’s face, right?! And this is what patients want to see most. Without this shot, the patient usually leaves feeling a little empty-handed. Poo. I hate when this happens. I usually apologize and just say their baby simply did not want to cooperate that day. With Baby looking, a great profile might look something like these:

 

fetal profile, ultrasound pictures

fetal profile, ultrasound, ultrasound pictures

 

If the placenta is anterior (front side of the uterus), Baby’s face is sometimes smushed into it, like a pillow (this usually depends on gestational age and amount of amniotic fluid). Additionally, if the operator is not educated in ultrasound (some 3D businesses) or if the profile is not perfectly optimal, a profile image might look a little freaky and something like this:

ultrasound pictures, fetal profile

Mom worried about this appearance but wrote me later to say her baby’s face looked entirely normal after birth. Yay!

  • Also, the one major thing that can hamper images … extra weight around Mom’s middle. The more tissue the sound waves have to penetrate, the more fuzzy the image will be on the monitor. Thank ultrasound physics, but it’s something we can’t change. So, unfortunately, the more a patient weighs, the less likely it will be that good images can be obtained no matter what position baby is in. Same for 3D. We would never advise a patient not to have a 3D scan, but we know (in some circumstances) it simply will not be a great one. All we can do is just try to optimize the images to the best of our ability.

I know that some sonographers can be just downright unfriendly in their jobs. Believe me, I’ve worked with some of them! I’ve also had just a few of my own patients say the same about me when they didn’t get what they wanted. Unfortunately, we won’t ever win over everyone. Sometimes, it’s the sonographer with the attitude … difficult patient load, difficult cases, difficult physicians, little time for play. All these things make it tough for a sonographer to maintain a cheerful disposition and give a patient everything she expects. Are those factors the fault of his/her patients? Absolutely not! Until the patient doesn’t hear what she expects …

It’s then that the patient sometimes brings the attitude. A mix of great expectations versus the impossible mission can create a very unhappy patient. But is this always the fault of the sonographer? Again, absolutely not. We have policies to enforce and limited time. And we just can’t always determine fetal sex–for all the reasons above.

So, at the end of the day, we can jiggle, we can belly-poke, we can roll mom from one side to the other and stand her on her head. Sometimes, those stubborn babies just won’t budge!

“Can’t you get me better pictures?” About twenty times a week, I would just smile, apologize, and regrettably send her away with only a hand and a foot. However, in our business, a heartbeat and healthy are what we care about most!

Wanna see some perfect images of fetal sex?

Great! I’d love to share them.

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As always, THANKS for reading!