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Thursday
Jan072010

Are Canadians joyriding the ultrasound machine?

In the Canadian Maternity Experiences Survey released in 2009, 99.8 percent of Canadian women reported that they had at least one prenatal ultrasound and the average number was three (3) per pregnancy. A study released this week in the Canadian Medical Association Journal, which looked at data from the health care system, confirmed those findings and reported that in Ontario, the average number of ultrasounds in a singleton pregnancy in 2006 was 3.3 (a significant increase from an average of two in 1996).

There seems to be some confusion about what the guidelines say. In the CMAJ study, they say that "guidelines generally recommend that two ultrasound examinations be performed in a pregnancy without complications - one in the first trimester, for measurement of nuchal translucency to screen for aneuploidy, and one in the second trimester to screen for fetal anomalies." In a CBC article on the Canadian Maternity Experiences Survey, the author wrote: "For a normal pregnancy, guidelines in Canada support a single ultrasound to be offered at 18 to 19 weeks in conjunction with a discussion of its benefits." The article also mentions that the World Health Organization recommends ultrasound on indication only or one at about 18 weeks. So Canadian women in a pregnancy without complications should be getting one or two ultrasounds, depending on who you talk to, but they are getting more than three on average.

Why the increase?


One hypothesis is that the average age of pregnant women is increasing in Canada and that this means there would be more high risk pregnancies.  However, the CMAJ study found that:
In our study, rising utilization could not be explained soley by increases in maternal age, changes in maternal risk profiles or increases in uptake of first-trimester scanning for nuchal translucency. Hence it would appear that nonclinical factors may largely explain the increases in prenatal ultrasonography that we observed. These factors may include the practice of defensive medicine, the desire to reassure a patient that her pregnancy is progressing normally, patient demand and even the "entertainment" value of seeing one's fetus.

Unfortunately, the data set did not include information on the reasons why the ultrasounds were performed and, as a result, the researchers were not able to explore this hypothesis further.

Should we be concerned?


The obvious downside to more ultrasounds is the cost to our healthcare system. The CMAJ study found that the total dollar value of the additional ultrasounds conducted between 1996 and 2006 in Ontario was around $30 million.  But if those tests are truly benefiting women, then it would be money well spent. But is it? The CMAJ study noted that while the benefits of ultrasounds in high risk pregnancies are fairly clear, the value and safety of additional ultrasounds in low risk pregnancies is not as clear. The authors noted:
Prenatal ultrasonography is widely regarded as safe.However, some studies have suggested that frequent prenatal ultrasonography may be associated with intrauterine growth restriction, delayed speech and non–righthandedness. Moreover, when a prenatal ultrasound examination is performed in a low-risk pregnancy, unintended harmful consequences may outweigh any potential benefits. For example, incidental benign findings — which are becoming increasingly prevalent with advances in technology — can cause anxiety and can lead to additional investigations, some of which may be invasive, such as amniocentesis.

So perhaps in the absence of any true reason for additional ultrasounds, less really is more.

My situation, your situation


Personally, I had three ultrasounds in each of my pregnancies. I had the two standard ultrasounds mentioned above in each pregnancy. I had an additional early ultrasound in my first pregnancy due to a concern that it could be an ectopic pregnancy. My baby was turned around during our 18 week ultrasound and never gave any indication of his gender, so we had to wait until the birth to find out his gender. I had an additional second trimester ultrasound in my second pregnancy when I went to Emergency after experiencing a gush of fluid. So I had more than the usual number required, but still less than the average and both for medical reasons.

What about you? If you had a low risk pregnancy, did you have additional ultrasounds? Did you opt not to have any ultrasounds? I'm curious where my readers fit into the data presented here.

Image credit: -julianol- on flickr
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Reader Comments (82)

In BC we are not eligible for the first trimester nuchal translucency ultrasound. So, in my first pregnancy, I had one ultrasound at 18 weeks.

In my second pregnancy, I had 3. I had one in the first trimester because of some bleeding I was having. It wasn't completely necessary, but coupled with the fact I wasn't 100% sure about my dates they scheduled it and I was glad they did, it definitely put my mind at ease. I then had the standard 18 week ultrasound, at which my placenta was low-lying, so I had a follow-up early in the third trimester to confirm that it was clear.

I also had a different experience between my 1st and 2nd pregnancies because ultrasounds had moved out of the hospital and into private clinics. In my 1st pregnancy when I was in the hospital I had to put on a gown, I had a longer wait and the tech was not very 'talky'. In my 2nd pregnancy when I went to the private clinics I didn't have to change out of my clothes and the techs were far more communicative, gave more photos and so on. It was a much more pleasant experience and there are way more facilities, so I wonder if that might contribute to the increase as well (at least here in BC, I don't know what other provinces are like).

January 7, 2010 | Unregistered CommenterAmber

Having looked into this issue before my recent pregnancy, I opted to not have any ultrasounds unless clinically indicated. My reasoning was the studies have generally shown that ultrasounds don't improve neonatal outcomes (such as mortality) but do allow OBs to date pregnancies more reliably (thereby reducing prematurity caused when physicians induced pregnancies that were misdated), find multiples earlier and allow women to abort a baby if there was a deformity. We weren't worried about any of these issues so opted out of one.

However, by our 35th week, our baby was breech and we had an ultrasound booked to confirm her position so we could do an external version. When the ultrasound tech found out that we hadn't done an ultrasound yet she was extremely angry, first at us and then at our midwives (who she called on the phone to discuss this issue further). Knowing the research likely better than she did (my background is in research & epidemiology), we were shocked at her reaction.

I have to say, based on our experience alone, the use of ultrasound in North America really does need to be looked at far more closely and those results need to be shared with women in a clear and deliberate fashion. If women really knew what the ultrasounds do and don't do, then they may consider them differently. And, as pointed out above, the question of safety is still out there.

January 7, 2010 | Unregistered CommenterKelly

I'm not Canadian. :-)
I had a ton of ultrasounds with my first pregnancy. So many that I don't even know the exact number! I'm pretty sure it's at least 15 ultrasounds. I had the usual 8 week ultrasound, then one at 20 weeks. It was at the 20 week ultrasound that they discovered a two-vessel cord, so I was sent for a Level-2 ultrasound to confirm it and check the baby. After that, I had a biophysical profile (more in-depth ultrasound) every week during my last trimester. A few times it was twice a week, because I also had low amniotic fluid issues.

For my second pregnancy, I was initially under the care of a fertility specialist, and they did an ultrasound at 5 weeks and again at 9 weeks. Then I had a level-2 ultrasound at 21 weeks (which lasted 2 hours!!), and I had one more in my third trimester to check amniotic fluid levels again, but that was it. (Total of 4)

Both girls came out totally fine regardless of the number of ultrasounds. Both came out average size, the older one is right handed -???- (but I can't tell with the baby yet), both are crazy smart and the older one was talking in complete sentences by the time she was two. The youngest is only 11 months old, but appears to be following after her sister.

I'm definitely not advocating a ton of ultrasounds, but I don't think they're too terrible when there's a real medical necessity.

January 8, 2010 | Unregistered CommenterLoriNKY

Well, I counted, and in my first pregnancy (in the US), a not particularly high risk pregnancy, I had EIGHT ultrasounds! Some of the reasons were: we got pregnant on fertility drugs and the RE does routine early ultrasounds, I had some bleeding in late first trimester, and I went overdue and my midwives routinely did a biophysical profile every two days after 41 weeks. We used to joke that our fetus was a "celebrity baby", constantly being chased by paparazzi cameras.
For my second pregnancy, after conceiving spontaneously and having a very normal early first trimester, I was convinced that the number of ultrasounds I had had last pregnancy was completely ridiculous and that I was going to do without this time. But then (long story) I ended up having one at 9 weeks for no particular indication. It showed a 6 week embryo with no heartbeat. I waited nearly three weeks before doing the D&C, and in that time I continued to experience totally normal pregnancy symptoms and no bleeding, although the ultrasound before the D&C showed that the embryo had pretty much disappeared. That changed my view of early ultrasounds - if I hadn't had one, I would have ended up telling the world at 12 weeks and then going through a traumatic second trimester loss; if I had had one earlier, I wouldn't have needed to deal with all that annoying nausea and stuff for nothing.
My current pregnancy, in Israel, has been totally normal, but they are completely ultrasound-happy here. I've had 4 already and I'm not even 20 weeks yet. So now I'm back to thinking ultrasounds are ridiculous. I guess it's complicated.

January 8, 2010 | Unregistered CommenterChanna

Not a Canadian, so my response doesn't speak to your average of 3 necessarily. I live in the US and have insurance through the State of South Carolina. My insurance would only "pay" for the 1st ultrasound and any other ultrasounds that were "medically necessary." Basically they try to get out of paying for the "sexing ultrasound." Even though one could definitely argue that the U/S at 18-22 weeks is necessary for detecting any abnormalities and checking on babies progress, but why argue medical necessities with the insurance folks with all their medical degrees! Sheesh! I suppose the insurance companies only want us to wait until we bleed, gush or worse before seeking medical interventions. Forbid a preventive measure!

But to answer your question: I had two u/s and paid out-of-pocket to find out the sex and check development. I would not have paid to get the new 3D u/s because it creeps me out!

January 8, 2010 | Unregistered Commentersmoaksmom

I had a quick read of the article and read that the average for low-risk pregnancies was closer to 3 (still higher than the two recommended by SOGC), but not 3.3 (the average for all women, including high-risk). I'm being a bit lazy....but did the study include or exclude ultrasounds paid for out-of-pocket? I'd love to know how the rise in private ultrasounds (3d/4d), etc has influenced the rates, and particularly the increase in rates over the last 10 years.

Great post - and thanks for sharing the link to the article!

January 8, 2010 | Unregistered CommenterRomy

I had two low risk pregnancies, both supported by midwives, the first born in hospital, the second born at home. I had one U/S with the first - the nuchal fold test wasn't recommended at that time if it existed at all - the second pregnancy I had the standard mid term U/S, was thinking of the nuchal test and was too late to do it and had to get a second U/S a week before my son was born as my midwife was looking for reasons not to let me have a home birth (it was a mini scandal, actually) and thought my son was transverse, and he wasn't. Had I had any other midwife, the second U/S wouldn't have happened, and certainly not as early (36 weeks for a second pregnancy - transverse is common for multips right up until the end - the uterine muscles have more laxity, or muscle memory, whatever you prefer).

January 8, 2010 | Unregistered CommenterLeanne

I am not Canadian. I had an ectopic pregnancy before I was pregnant with our first daughter and probably had 3-4 u/s early on during that pregnancy. It took us almost 3 years to get pregnant with our 2nd daughter, had to consult an RE, and that pregnancy had MANY u/s, probably one a visit for awhile, after we transferred back to our regular OB. This was fine with me and quite comforting as I had extreme anxiety regarding that pregnancy. A surprise pregnancy with our 3rd daughter still brought anxiety and the same OB always offered an u/s at each visit which I usually took him up on. I would have had to pay out of pocket for a 3D/4D u/s and we never did that. Our 3 daughters are healthy and happy in spite of multiple prenatal u/s, and I don't have any regrets over having those u/s. My first child was born in the hospital, the last 2 at home with a midwife (did the OB visits for the prenatal record).

January 8, 2010 | Unregistered CommenterMarla Morgan

In my first pregnancy I had three ultrasounds. Heart defects run in my family so we had one in the first trimester for nuchal translucency and then another around 20wks to look closely at the heart. I had another one in the third trimester because I was measuring small for my dates.

My daughter was born small for gestational age, so with my next pregnancy I had three ultrasounds again. Again the early one as recommended, the 20 wk to check the heart and one around 30wks to verify that my son was growing normally.

I'm currently at the end of my third pregnancy and so far I've had a lot more this time 5 or 6 I think (pregnancy brain makes it hard to remember exactly). At my 20 wk ultrasound (the 2nd of this pregnancy) my daughter's kidney's were dilated, so we've been going in every 6-8wks so that they can monitor her kidneys and make sure she didn't appear to have my oldest's growth problems.

So I've had at least 3 each time, but all have been for medical reasons.

January 8, 2010 | Unregistered CommenterTiffany D.

I had more than three with my first, OB, birth. My insurance covered them, and the OB had his own machine and would fire it up seemingly on a whim. :) At least one of those times was for my benefit (concern about an ectopic early on); the others were... I'm not sure why.

I didn't have any with my second, which was a homebirth. I could have; there is an independent u/s place in town that does them for a lot of homebirthers (they also do the 4d ultrasounds, get-pics-of-your-kid-in-utero shtick) but I didn't feel like I needed one unless there was a reason for it.

I'd probably get the 20-week one if I were in a position to do so easily next time, but not otherwise.

January 8, 2010 | Unregistered CommenterJulia

Australian, private health care, sort of low risk pregnancy with minor bleeding first trimester then high blood pressure at week 31.

I got a LOT of ultrasounds - the 'official' type with film results (6) and smaller ones at each appointment. The official ones were: week 5 to confirm pregnancy due to bleeding, week 8 to confirm viability due to bleeding, week 20 for abnormalities (we also found out her sex), week 32 for high blood pressure growth checks, week 34 because they found an ovarian cyst on my daughter in utero and week 36 for growth and the cyst. Each time I saw my ob. in his office he'd do a quick heartbeat/cord/growth test with his machine in his office. They weren't necessary, particularly in the early days, but weren't an extra strain on the health system at all because it was all in house. The bigger ones were and there was certainly an aspect of private health care being ultrasound happy, but the first two were while I was still under GP care. My later ultrasounds were done by a super specialist (obgyn as well as ultrasound) and very detailed. Hence the ovarian cyst news.

I did opt not to have the 12 week nuchal fold test done at all, which my ob supported (when NO ONE else did anything but freak at me about). Next pregnancy I might (since I was happy enough for the 20 week one) but given how low risk I was, I really didn't understand how angry the doctor I saw got about me considering not having the test (which just pushed me to not have it). Before the 20 week scan my ob. did broach the subject of refusing ultrasounds as he does prefer his patients to have at least one done over the pregnancy. We also discussed what would happen if there were negative results or something that got missed because of the 12 week thing. Apart from that, the ultrasounds weren't really discussed.

January 8, 2010 | Unregistered Commentergeek anachronism

With my first, I had two - an early one for "dating" purposes (even though I was fully aware of when I conceived - but my doctor offered so I accepted), and the standard 18 week ultrasound. With my second, I only had the 18 week one.

I will likely continue to do the 18 week one because I appreciate the reassurance that everything is developing as it should (and, yes, it's just fun to see the baby!), but I would not do more than that without a medical reason.

January 8, 2010 | Unregistered CommenterCynthia

I am in Australia and with my first pregnancy I had two 3D ultrasounds and a few short ones in my Ob's office.

With my second pregnancy I was planning a homebirth and did a lot more research. I had a 12 week scan (and got annoyed at the ultrasound operator questioning my decision to have a homebirth) and then did more research on ultrasounds. I read Dr Sarah Buckley's article http://www.sarahjbuckley.com/articles/ultrasound-scans.htm on the risks of ultrasound and decided not to have any further ultrasounds, a decision for which I was questioned and made to feel like I was risking the life of my child for by several doctors and health professionals. None were willing to entertain the idea that ultrasounds just might be risky. I ended up having two more quick scans as baby was breech at 36 weeks, and at 39 weeks as I was about to be admitted to hospital as my blood pressure was skyrocketing and the hospital midwife and dr thought baby might still be breech (it wasn't).

If I had another child I'm not sure if I would have scans or not. There might be a risk of having them but at the same time if baby did have something in utero that could be treated if it was found out soon enough then I'm sure I would get a lot of sh*t from people for not having scans... I just don't know...

January 8, 2010 | Unregistered CommenterEly

I am not Canadian either :)
In my first pregnancy I had one at 18wks, I was a public patient, and that was offered to me by my doctor. He didn't offer the nuchal fold one, and the OB in the hospital later got angry that I hadn't been offered, but when asked, my Dr. said there's no point unless you either are happy to do further tests for an abnormal result, or would consider abortion, neither of which he knew I was interested in. (He has been my family's Dr. since my parents were only dating, so he does know me VERY well.)

This pregnancy, I am a private patient with an independent midwife, and am having a home-birth. I didn't want an ultrasound at all, not being convinced of their safety, or their reliability of giving accurate results. However, my husband, still being leery of homebirth, wanted one just to rule out things like placenta praevia, so I went along with him. Just the one at 18 weeks again.

January 8, 2010 | Unregistered CommenterLauren

Before I even start on this... I have to say I am really anti-intervention of any medical kind. Over here, in South Africa they offer and give ultrasounds at EVERY prenatal visit - EVERY SINGLE ONE, if you can believe that. And when I ask potential parents why they would want them they look at me like I am insane - why wouldn't I want one or five or ten??? Needless to say we have a mid-wife and one visit with a "obs" person per pregnancy. I avoid going mid-term... because they insist on you having a scan to prove that your baby isn't breech (like you need a scan for that), and the 20 week scan is when they measure and document everything and I would hate for my child to be labeled even before it was born. Sorry, long comment... obviously you touched a nerve!!! Why can't our babies just be who they are without every moment of their life being measured and documented etc, even from before they were born.... I understand if there is a medical reason or a potential complication to do all that is medically possible to help, but where there is no cause for concern why cause so much needless testing.

January 8, 2010 | Unregistered Commenterse7en

Not a Canadian, an Australian, but I'll tell my experience anyway!

First pregnancy I had 5 ultrasounds - one at 6.5 weeks to confirm viability after a heavy bleed; the nuchal fold one at 12 weeks and the big one at 20 weeks (my daughter's gender was visible at that scan); one at 30 weeks that was actually looking at my kidneys but checked in on baby as well; and one at 36 weeks (just before delivery) after diagnosis of pre-eclampsia. I paid privately for the nuchal fold and kidney scans; the other three were done in hospital as a public patient. I believed then, and believe now, that all were medically advisable, although the 12 week nuchal fold screen was not strictly necessary.

Second pregnancy I had 2 ultrasounds - the 12 week nuchal fold test (paid privately) and the 20-week big scan. No other scans were suggested or needed. Gender was established at 20-weeks too (another beautiful girl).

Third pregnancy, I had 4 ultrasounds - one at 7.5 weeks to check for ectopic pregnancy after severe abdominal pain; the 12-week nuchal fold scan (paid privately); a scan at 16 weeks after I was admitted to hospital with severe pyelonephritis (kidney infection) - the scan was concentrated on my kidneys but they did check in on baby; and the 20-week scan which showed my third delightful daughter.

So across 3 pregnancies I had 11 ultrasounds, but 2 of them were actually kidney screens (I have had several such scans in my life, not all during pregnancy, due to weak / damaged kidneys). Taking out those, I averaged 3 ultrasounds per pregnancy, with my second pregnancy (the least complicated of the three medically) attracting the lowest number of scans.

January 8, 2010 | Unregistered CommenterKathy

Not Canadian, again :) In the UK, where when I had each of my two, the standard was to have one ultrasound, at the 12-week booking appointment. So I had that, but in each case had additional ones. With my first, 3 additional u/s, due to growth concerns (I measured significantly small, so 2 were done a week apart at something like 33 weeks to check growth, which was fine, and then another at 39 weeks, again because of "under-measuring"). I was happy that there was reason to do those - at 40 weeks I measured 33 cms, so really below average. The u/s indicated the 7lb baby I in fact ended up having. With my second, I had a positioning scan at 36 weeks (I think), which I (and the midwife who did it) thought was over-caution because I was booked for a home birth and they were afraid of undetected breach. And the baby was, as expected, head down, and I got my home birth. Over half of women planning home birth seem to be referred for positioning scans round here, and that is pure over-caution and it annoys me. But, even though I was measuring almost as small with my second, the attitude was "it was fine last time, this is just the curve you grow on", no additional fuss, and I was glad of that.

January 8, 2010 | Unregistered CommenterKate

Austria - public healthcare - 3 u/s are standard and paid for by the system.

I had "normal" pregnancies, and my Dr. performed an u/s at every visit. I think he just liked looking at the baby as much as I did.

There was no extra cost, since the machine sits in the Dr.'s office anyways, and the Dr. did the u/s himself during a regular visit- no extra staff needed.

My first child was of average weight, left-handed, and talked early and a lot - even in 2 languages.
Second child - average weight (heavier than #1), right-handed and talked late.

Why is non-right-handedness considered adverse?

January 8, 2010 | Unregistered CommenterBirgit

Not Canadian AND "high risk" so I guess I am way out of your category. I had many ultrasounds but I wanted to say that the reassurance ultrasounds shouldn't be discounted. It started with my RE doing extra ultrasounds because of possible multiples which was a very scary week and a half. I have a history of recurrent miscarriage so in the beginning I did request extra ultrasounds because I couldn't sleep or think straight I was so worried. It was awful and I absolutely could not enjoy the first half of my pregnancy because of my previous pregnancies. More power to women who got pregnant easily and have not lost faith in their bodies with previous losses but when you are $15k in the hole for just that pregnancy alone and not sure if you can afford another chance at a baby and also have lost a couple of pregnancies it produces a lot of anxiety. On top of that I was on blood thinners so I got monthly then biweekly biophysical scans. So far so good with everything. I am not sure if there are speech delays since we aren't at that point but the kid knows how to get what she wants so I am not too worried.

January 8, 2010 | Unregistered CommenterNicole

Four in my first pregnancy, two in my second.

I wonder if the researchers took into account how often women get called back to repeat measurements? In both pregnancies I only wanted two ultrasounds (the first trimester screen and the 20 week anatomical). And it worked out that way for the second baby.

But with my first, for the 20 week anatomical ultrasound, I had to go back once because the baby wasn't cooperating and they couldn't get all the images. And then a week later I was called back again because they lost all my images! I didn't want that many ultrasounds, it just turned out that way.

January 8, 2010 | Unregistered CommenterAnna

I'm in Toronto. I can't remember, but I had 6, I think. I would have been quite happy with one! I had early bleeding and pain, they suspected ectopic, so had an internal U/S at 5 wks, then another one to confirm at 7 wks. No problems for a while - declined the 12 wk U/S, then had the 18 wk one, by my choice. At 36 wks, my midwife suspected that Owen was breech, so another U/S. He was breech! So that meant one more U/S to confirm his position just before they tried to turn him, and then one closer to my due date to confirm that he had stayed head down after the ECV. He was then born at home with no issues. With subsequent pregnancies, I would definitely keep it to only the 18 week U/S, barring any pressing reason for others.

January 8, 2010 | Unregistered CommenterLindsay

I'm in Ontario - low risk pregnancies but conceived with ART.

With DD, 3 I think? One at 7 weeks to check heartbeat (part of the ART treatment), turned down the IPS test, one at 18 weeks for the anatomy scan, and one in the third trimester "to check things out". An echogenic focus was found on her heart at one of the later ones, which turned out to be nothing, but yeah, it caused some anxiety at the time.

With this pregnancy (currently 35 weeks) - same 7-week and 18-week scans, and no others planned at this point. I am erring on the side of caution - that u/s are probably safe, but if there's no reason to do one, why would I?

January 8, 2010 | Unregistered CommenterJuliette

I'm in the U.S., and received midwife care at home so I can't speak for the typical O.B. experience. My midwife's standard is one ultra sound at around 20 weeks if the mother wants one. I had one at 20 weeks more out of curiosity than anythings else. It was nice to have the assurance that the baby looked okay, but what I really wanted was to find out the sex and see a picture.

I think it's common to have another u.s. late in the third trimester to get another look at baby's position and have a guess at the weight. In my case a late u.s. would have revealed my baby had her foot up by her head and probably would have meant a scheduled c-section. As I nor my midwife knew of my baby's position, I went into labor naturally and had a good, long trial of labor before transferring to the hospital, laboring and pushing at there before consenting to the c-section.

At first I felt like I would have liked another u.s. and to have just skipped to the c-section instead of laboring for over 30 hrs. But upon reflection, I think it is beneficial that I went into labor naturally and experienced pushing. I think it will ultimately help me acheive a vbac next time around.

January 8, 2010 | Unregistered CommenterOlivia

I have insurance thru the state of Indiana, and they paid for one ultrasound at around 20 weeks. We were able to find out the sex at that appointment, but if the baby had not revealed herself we would have had to wait until birth.

January 8, 2010 | Unregistered CommenterOlivia

I had my kids in Ontario - 2 ultrasounds with the first (at 12 weeks because of the possibility of twins (!) and at 18 weeks), just 1 with the second (at 18 weeks). I had midwives and homebirths both times. I would have liked to have foregone the ultrasounds altogether, but I also found them reassuring and kind of exciting.

Now, though, I live in Argentina. Here they start with vaginal ultrasounds as soon as a pregnancy is detected, and then ultrasounds at every visit if you're "lucky" enough to have an OB with a machine.

Get this though: Every year, along with their regular pap, women get an intravaginal ultrasound and a breast ultrasound! I wrote a bit recently about pap tests in Argentina, and learned about the routine intravaginal ultrasounds by talking about that post with some friends here. Needless to say, I am putting off my gyn visit until I can muster up the strength to fight with my doctor...

http://macondomama.blogspot.com/2009/11/on-lubrication.html

January 8, 2010 | Unregistered Commentermacondo mama

I had 4 in first pregnancy 14 years ago- one early for dating. It gave what I considered to be an inaccurate date, but 18-20 week ultrasound was booked based on dating from first U/S. Because that date was, in fact, inaccurate and I was only 17-18 weeks and choroid plexus cysts were identified. I had to have a "second" 18-20 week U/S two weeks later and everything was fine. Then had one at 41 weeks as part of BPP. Was under care of a GP.
I declined to have a U/S at all in second pregnancy 11 years ago. Was under care of a GP and a midwife.
I had one U/S 20 weeks for third pregnancy two years ago. Was under care of a GP and a midwife.
All were in hospitals and I was not interested in learning the gender early on. Just wanted to rule out major organ defects and twins.

January 8, 2010 | Unregistered Commenterradmama

I had four ultrasounds - one at 7 weeks, one at 14 weeks (for prenatal screening tests), one at 19 weeks, one at 39 weeks. I guess that's just over the average. I was surprised by the one at 39 weeks. I didn't think it would be necessary since my baby had a strong heartbeat and my blood pressure was good. I was still considered high risk so maybe that's why. It felt "routine" though so I don't know.

January 8, 2010 | Unregistered CommenterMelany Gallant

I had two ultrasounds with my first. With my second, I transfered to a homebirth midwife after my first ultrasound, so that was the only one I got.

With this pregnancy, I am again planning a homebirth and since my midwife doesn't do ultrasounds, I won't be having any. I could go and get one done on my own, but with all the recent findings and studies, i choose not to unless there is a valid medical reason. I find it hard personally to not know the gender of the baby before the birth, but I don't think the risks of an ultrasound are worth it to just find out the gender.

January 8, 2010 | Unregistered CommenterShelly

W/ this pregnancy, I had one @ approx 7wks to check for viability and date the pregnancy (I'd had two losses this past year); another @ 12wks to check dates and ovarian cysts (have one); and a third at 18wks for the usual baby check. I didn't get to see the gender, but am actually okay with that. I may schedule another u/s, though, for around 30wks to check the baby's kidneys (my youngest was dx'd in utero).

W/ #2, I had one @ 18wks. A choroid plexus cyst was found so we scheduled another for around 30wks. He was diagnosed with a kidney condition that necessitated bi-weekly u/s until about 36 wks, and then weekly - twice-weekly ones until he was born.

W/ #1, I measured far ahead of dates, so was sent for an u/s @ 12wks. Was dx'd w/ large ovarian cyst of unknown type -- looked suspicious, so we booked another for 16wks, where it was shown to have grown and I was scheduled for surgery to have it removed. Had that done at 18-19wks, and didn't have another u/s until he was about 7 days "past dates".

January 8, 2010 | Unregistered CommenterMelissa

I don't think they're saying "lefty" is bad, but that there's something going on if pregnancies w/ higher u/s rates result in more "lefty" kids -- there has to be something making that happen and it makes me wonder what other changes overuse of the technology could cause.

January 8, 2010 | Unregistered CommenterMelissa

Should state that my 1st u/s in my current pregnancy was through the fertility clinic I was using. Should also state that I'm in Ontario. ;)

January 8, 2010 | Unregistered CommenterMelissa

I'm Canadian, had a low-risk pregnancy. I had an ultrasound at 11 weeks for "dating" purposes, and then had another a week later for screening. I hadn't planned on the second, my midwife had told me it was unnecessary, but then the ultrasound technician had acted like I was crazy for not booking it. I, of course, thought she'd seen something on the initial scan that suggested something was wrong, so I booked it and was incredibly anxious. Turned out we had no problems. I had another ultrasound at 19 weeks, but the baby was in an awkward position so I had to go back the following week so they could get a better look at her spine. Baby ended up being breech and so I went for another ultrasound in week 37 just to confirm the position before they booked an external version. So that's five in total. And I guess two more if you count the ultrasound before the version and before my c-section (which was just to confirm baby still hadn't turned). But if baby hadn't been breech, I would have had four under normal circumstances. Which is a lot.

January 8, 2010 | Unregistered CommenterKC

The transvaginal ultrasound isn't terrible. It is less uncomfortable than a speculum and it is useful at catching ovarian cancer before it is terminal.

January 8, 2010 | Unregistered CommenterNicole

I am about to hit 42 weeks in my first pregnancy, working with a midwife, and I have had 3 ultrasounds in the last week, which as far as I can count means I've had at least 8 over the course of the pregnancy with another one on Monday if the baby hasn't come by then.

The baby has proven to be perfectly healthy in every way in each of these tests but there always seemed to be a reason for the test - we needed one at 8 weeks for dating, and then we had another at 13 weeks for the IPS testing, the 18-to-20 week ultrasound where we found out the sex, and another one shortly after that because they weren't happy with the visual they had gotten of the heart, I had at least two in my last trimester, one of which was to check baby's position and the other just seemed to be routine, and now the three for biophysical profile and to check amniotic fluid since I've gone past my due date.

I'm tired of them, but it didn't occur to me how many I had had until we were at the clinic yesterday, and since I've been with a midwife, I always assumed that these test were normal and routine. I guess I thought that being with a midwife we would go through less of the big medical enterprise stuff. I guess I was wrong.

January 8, 2010 | Unregistered CommenterAmy Boughner

I just had one in my first (only) pregnancy. It was at 19 weeks, I think. We didn't find out the sex, but I had this horrible fear that my baby's organs were going to be on the outside of her body. So I had to check. Having had a perfectly healthy baby, I think, if I have another, I'm not going to have any ultrasounds unless they are indicated by a problem. That is, if my OB will let me get away with it.

January 8, 2010 | Unregistered CommenterBrooke

I live in the US. I had 3 ultrasounds with my pregnancy. The 2 recommended, and one at 6 weeks. I had had a miscarriage the month before getting pregnant again, and hadn't had a regular period in between, so we had no idea how far along I was. The 6 week u/s was to date the pregnancy.

January 8, 2010 | Unregistered CommenterEmily

I had 2 ultrasounds in each of my 2 pregnancies. Both times, the first was around 19 weeks, and both times that was the only ultrasound I planned on having...but both pregnancies went almost 2 weeks post-dates and a lot of pressure was applied my health care providers (a doctor the first time and a midwife the second) to have an ultrasound around 10 days after my EDD. The "dead baby card" was played and I consented to the ultrasounds and to inductions a few days later.

January 8, 2010 | Unregistered CommenterStacey

I had several with my first, his left kidney was under developed and they wanted to track it's growth. So from the standard 20 week and on I had maybe 5 or 6. With Trey I had 1 to check gender and if he was healthy, with Saffron I had none at all. I guess that comes out to 3 kids and 6-7 ultrasounds.

January 8, 2010 | Unregistered CommenterSummer

Not in Canada, but I didn't have an ultrasound with my first and I'm not planning on it with my second. The first time around, I was very low risk (still am!) and my husband and I read the FDA guidelines for ultrasound use. They had a list of what things constituted medical necessity (Diagnosing pregnancy, Determining fetal age, Diagnosing congenital abnormalities, Evaluating position of placenta, Determining multiple pregnancies) from http://www.sdms.org/pdf/FDAKeepsake.pdf" rel="nofollow">this PDF. We concluded that it was obvious that we didn't need ultrasound to diagnose pregnancy, I knew the day I ovulated, so determining fetal age wasn't a problem. From the fetoscope I found the placenta very easily and it wasn't low and in danger of being a problem, and I was growing at the appropriate rate for a singleton, so we didn't feel multiples were present. As for congenital abnormalities, we concluded that knowing about issues wouldn't change our minds about continuing the pregnancy. We also live 2 blocks from a very well-equipped hospital, so if there was a dramatic abnormality that needed assistance at birth, we'd easily be able to reach help in time.

So since we couldn't find a reason for ultrasound that fit our circumstance so we decided to be on the "safe" side and not expose the child to radiation that wasn't medically necessary.

January 8, 2010 | Unregistered CommenterTopHat

In my first pregnancy, I had the recommended two - 12 weeks for "dating" (even though I knew my dates, they still moved me ahead a week & a half) and one at 20 weeks for adbnormalities & to determine sex. I then had one at around 35 weeks when my midwife thought baby was still breech. Probably another at 36 or 37 weeks, again to check position. I had another at 38 weeks, just prior to my ECV. One for the duration of the ECV procedure (which was an unsuccessful procedure). One while in labor, to be certain baby had in fact turned herself heads down. So total, at least 7. Probably a couple more because my midwife had a mobile one in her office (so a script or visit to the lab wasn't necessary; I don't believe they were separately billed - it was just part of routine prenatal office visit).

With my second pregnancy, I skipped the dating ultrasound because I had a feeling from conception that my baby would be early, and I know that my babies grow big quick, and I didn't want my dates moved ahead. I had the standard at 20 weeks. I had a semi-voluntary ultrasound at 36 weeks because neither my OB nor my doula were able to conculsively determine position, and I believed he was breech, and was concerned about being able to continue on my VBAC path. My OB wrote a script for an u/s but said it wasn't necessary. That ultrasound was fateful. It was determined during that ultrasound that my fluid levels were very low for that time in my pregnancy (5cm at just 36 wks). I had three more ultrasounds over the next four days, to confirm & reconfirm fluid levels (in four days it had gone from 5cm to an absence of a single fluid pocket of 2cm (oligohydramnios). Baby was in fact breech, and in distress from cord compression due to ultra low levels of amniotic fluid with every contraction & I had an emergency C-section.

I wonder if I hadn't decided on that ultrasound, how things might have turned out differently. I believe u/s is a valuable tool, certainly. I don't think it should be used for entertainment value - and the 4d ultrasound places in malls, etc. I find to be frightening. I honestly cannot believe people would use these places when the health of their developing baby at stake! The safety of that equipment in particular is not known, and the technicians do not have the same level of training as hospital/lab u/s techs.

January 8, 2010 | Unregistered Commenterkblogger

Hmm, I think I likely had 4 in my first, 3 in my second. In my first pregnancy I was with an OB who had an u/s machine in her office, so she did a quick one on my first visit, then I had the 12 w and 18 w tests. She also did one around 37 w to make sure baby was head down. Which seems kind of funny to me now, considering she probably should have been able to tell that herself without an u/s! :) (it was done as a routine thing, not because she couldn't tell any other way.) But, I didn't know better at the time and didn't know there were any questions about the safety of u/s.

With my second, I was more aware, and though I was with m/w, I still opted to have the 12 and 18 w tests done. I did like knowing that I had the choice though, my OB presented most things as routine and I really didn't question her (to be fair, she was clear that the 12 w testing was optional). I did also like that the m/w didn't try to talk me out of my choices either, though. I had almost forgotten, but did have another u/s at 41 w to help decide if induction was to be considered (it wasn't).

I do have to say I was not interested in having any additional "3D" u/s, just for fun. To me, that's going too far. I also (sorry! personal opinion only here!) think they look creepy rather than cute...

January 8, 2010 | Unregistered CommenterAndrea

I live in the states and had 7 ultrasounds. I was low-risk. So here's the breakdown.

*One at 8 weeks (they were concerned because I had a little bleeding).
*The standard 12-week check.
*One at 16 weeks using a portable, low quality machine the midwife brought in, just for fun.
*One at 19 weeks during a trip to the ER (I passed out while at the airport. I was dehydrated.)
*The standard 20-week check.
*Another "just for fun" at 24 weeks with the midwife.
*The last one was a biophysical profile they did after an inconclusive non-stress test at 38 weeks.

So we did those "just for fun" ultrasounds w/ the portable machine because the midwife suggested it and said it was safe, so we trusted her. So 5 of the 7 were paid through insurance. I didn't have a problem with having so many. I'm grateful for the biophysical profile as the tech discovered a duplicated system in his left kidney, which is something we need to keep a close eye on. We wouldn't have known about that otherwise.

January 8, 2010 | Unregistered CommenterHelen

To add, I am surprised by how often u/s seems to be used to guess birth weight, as from what I understand, they are extremely inaccurate in this, and could lead to unnecessary inductions/c-sections! Even my OB, with an u/s in her office, didn't want to hazard a guess at how big my first baby was, she figured average, 8 lbs, and never suggested an u/s to determine weight (he was 9.3).

January 8, 2010 | Unregistered CommenterAndrea

Wanted to add that I am in the US. Also, that the ultrasounds done at & after the 36 week mark were level 2 ultrasounds & biophysical profiles, so of much longer duration than a typical ultrasound. I don't know if there is more risk associated with level 2 ultrasounds. At the point when you're informed one is warranted, it seems the benefit outweighs the risk.

January 8, 2010 | Unregistered Commenterkblogger

In BC, I had five for a low risk pregnany. One for dating at 12 weeks, one for physiology at 20 weeks, a re-do for physiology as he was moving too much to see the heart clearly, and one to check fluid level at 41 weeks. I also had a private gender u/s as I was going mental, but of course I paid for that one. I was not aware at the time of any potential risks... but I did have a healthy 10.5lb baby, so I'm thinking his growth was just fine.

January 8, 2010 | Unregistered CommenterLorien

I once heard that guessing the weight of a baby from an ultrasound is like guessing the weight of a person standing behind a shower curtain.

January 8, 2010 | Unregistered CommenterTopHat

The doula that taught my pre-natal class told us about her sister's experience - the ultrasound put the baby at 13 lbs so she had a c-section and ended up with a 7 lbs son.

January 8, 2010 | Unregistered CommenterAmy Boughner

I live in the US and had three for a relatively low-risk pregnancy, but I think I had more than the norm for a couple of odd reasons:

1st ultrasound was standard anatomy check at 20 weeks.
2nd ultrasound was around 28 weeks because I hadn't gained any weight during my pregnancy and the doctor wanted to make sure the baby was, in fact, growing. She was.
3rd ultrasound was around 38 weeks because the doctor wanted to confirm that the baby was positioned properly. Apparently, she had a really firm little butt.

Under normal circumstances, I would only have had the 20 week ultrasound. I hope with my next pregnancy to have only the one screening, which I'd avoid except for the fact that my husband and I are on the older side and so I'd like a heads up on possible problems due to our elevated risk factors.

January 8, 2010 | Unregistered CommenterLustau

During my first pregnancy I had three ultrasounds - one when I first discovered I was pregnant, to assess fetal age based on the size of the lil' gummybear; the second for the nuchal screening at 12 or so weeks; and a third for the anatomy scan at 18 weeks.

My insurance refused to cover the last one, because apparently Aetna does not believe that a normal, low-risk pregnancy requires the anatomy scan (because things only go wrong in high-risk pregnancies, doncha know) and the representative to whom I spoke on the phone actually said that they did not cover "elective ultrasounds to determine the sex of the child." If that's all they think it is, no wonder they aren't covering it!

So this time around, I've had the first ultrasound (fetal age) but skipped the nuchal screening, and am going in for my anatomy scan at 20 weeks next week - hoping against hope that they'll cover it since they haven't already had to pay for two others.

January 8, 2010 | Unregistered Commenterlovepeaceohana

I had one with each. The first was a dating ultrasound, because I wasn't sure if my last period was actually a period or if it was implantation bleeding (it was the former, but far lighter than average). That was at around the 6-week mark. I had intended to have NO ultrasounds with my second pregnancy, but when I started bleeding at around 11 weeks, I just needed to know whether or not to prepare myself for a miscarriage (she was fine, btw).

January 8, 2010 | Unregistered Commenterplastikgyrl

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