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It should be discussed. If someone wants to wait another week and do the testing, that is an alternative, but waiting is still associated with some increase in risk to the baby.
In the past, the concern about induction has been that some women are hard to induce.
That could lead to more Cesareans. With the medical options now available for "ripening" the cervix, a "failed induction" is less likely to happen.
Keep in mind that the whole idea of delivery before 42 weeks is to prevent an otherwise unexplained stillbirth of a healthy full term infant.
So, yes, based on the references I gave you, I think 41 weeks is better than 42 weeks.
I'd prefer to be offered the testing and wait until 42 weeks.
In Suzy's link, ACOG discusses the benefits of ultrasound and reccomends discussing the benefits and risk with all patients but they do not recommend the routine use of ultrasound testing as a standard part of care for low risk pregnancies. If you read it differently then quote exactly where they say in the article that they recommend ultrasound screening for all pregnant women. Otherwise you're wasting your breath and arguing about something that's a non-issue.
Suzy's link says that ultrasound is medically necessary in 75% of pregnant women, and most often recommended in the other 25% as well so there are no surprises such as a twin pregnancy at delivery. The fact that you are having homebirth makes it especially medically neccessary in your case, IMO, since there will be no emergency facilites ready and waiting should a surprise arise.
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Originally Posted by Dorthy
This is not about what "most" medical doctors, CNM's or CPM's say or do in regards to ultrasound. The reccomendation is that they all discuss the benefits and risks of ultrasound. That is the reccomendation and all of those people are supposed to follow the reccomendation. I also wish you would stop making so many assumptions. My midwife offers ultrasound testing and discussed the benefits of testing with me just like my CNM did in my last pregnancy. You have jumped to some majorly false conclusions in this thread and I really don't appreciate some of the things that you have openly assumed about me and my prenatal care.
You posted a link that says its not standard, I posted one that says it is. So who is right here? I know that every OB I've seen, and everyone I know that has been pregnant in this day in age has seen, has recommended an ultrasound even if they are low risk. As for making assuptions about you, you stated in the thread that your midwife is a CPM and not a CNM. That is not an assumption. You are correct that you never openly stated that your CPM said it wasn't neccessary for you to have an ultrasound and you also never openly said you aren't having one. If your midwife does feel ultrasound is necessary, and if you are having or have had an ultrasound, then I am confused as to why you are so vehemently arguing that they are not recommended in low risk pregnancies.
CIGNA is an insurance company who's priority is about profit and concerns are about liability, not health. Can you show me exactly where ACOG says that the routine use of ultrasound screening is recommended for all pregnant women, including those who are low risk and should be used as a standard part of prenatal care.
If a low risk women planning a homebirth lives 40 miles from the nearest hospital then yes, I could see that being more risky to deliver at home but if a low risk woman planning a homebirth lives close to a hospital then I disagree that planned homebirth for low risk women is any riskier then planned hospital birth is for low risk women.
OT: My DH is planning to trim the tree in our yard this weekend. he'll be using a ladder and a chainsaw (gasp!) Should we have an ambulance waiting in the driveway in case something happens?
I do not understand your fixation on the use of ultrasound in low risk pregnancy, but I think you will find most obstetricians consider it standard of care, even if ACOG tiptoes around and does not use that term. For those of us who have had to deal with Cigna, if they consider it standard of care, that is saying something. You are free to decline to have it, of course. Up to you.
You still have the opinion that if something goes wrong, you can hop in the car, be driven half a mile, then have someone fix it for you. Unfortunately, that may still take too much time. There is a reason that many OB units have dedicated operating rooms in the OB suite.
As to hubby, absolutely yes! Call a tree service instead :
Suzy's link says that ultrasound in medically necessary in 75% of pregnant women, and most often recommended in the other 25% as well so there are no surprises such as a twin pregnancy at delivery. The fact that you are having homebirth makes it especially medically neccessary in your case, IMO, since there will be no emergency facilites ready and waiting should a surprise arise.
No need to repeat what Suzy said, I can read. Please quote exactly where ACOG makes the reccomendation that all women should receive and ultrasound. Also please don't patronize me with your medical recommendations. Thank you!
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You posted a link that says its not standard, I posted one that says it is. So who is right here? I know that every OB I've seen, and everyone I know that has been pregnant in this day in age has seen, has recommended an ultrasound even if they are low risk. As for making assuptions about you, you stated in the thread that your midwife is a CPM and not a CNM. That is not an assumption. You are correct that you never openly stated that your CPM said it wasn't neccessary for you to have an ultrasound and you also never openly said you aren't having one. If your midwife does feel ultrasound is necessary, and if you are having or have had an ultrasound, then I am confused as to why you are so vehemently arguing that they are not recommended in low risk pregnancies.
You obviously don't understand the meaning of the word standard. You also seem to confuse anecdotal evidence with facts. That's unfortunate and leads to nothing but miscommunication. Here's what your link said:
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An ultrasound is generally performed for all pregnant women around 20 weeks gestation. During this ultrasound, the doctor will confirm that the placenta is healthy and attached normally and that your baby is growing properly in the uterus.
Please look up the meaning of the word, "generally". Your link proves nothing.
I'm not "vehemently arguing" I'm pointing out the fact that ultrasound is currently not recommended as standard part of prenatal care. Just because everyone you know has had one and every doctor you know offers them does not mean the same things as "ultrasounds are the standard and routine part of prenatal care for all pregnant women".
This is a discussion board regrading the topic of homebirth vs hospital birth. It is not about me. Your assumptions in this thread have been that my midwife doesn't offer testing and that I didn't get any testing. Pretty big leaps, I'd say.
I do not understand your fixation on the use of ultrasound in low risk pregnancy, but I think you will find most obstetricians consider it standard of care, even if ACOG tiptoes around and does not use that term. For those of us who have had to deal with Cigna, if they consider it standard of care, that is saying something. You are free to decline to have it, of course. Up to you.
I don't have a fixation. I would have preferred to drop this a long time ago but people keep trying to argue that what I said was false and as of yet, no one has been able to prove that. I guess I'm stubborn like that.
I'm not "vehemently arguing" I'm pointing out the fact that induction is currently not recommended as standard part of prenatal care. Just because everyone you know has had one and every doctor you know offers them does not mean the same things as "ultrasounds are the standard and routine part of prenatal care for all pregnant women".
This is a discussion board regrading the topic of homebirth vs hospital birth. It is not about me. Your assumptions in this thread have been that my midwife doesn't offer testing and that I didn't get any testing. Pretty big leaps, I'd say.
How did we get on the subject of induction? I agree that induction should be reserved for cases when it is medically necessary. I thought we were talking about ultrasound?
I never assumed your midwife doesn't offer ultrasound testing. What I am assuming is that you and your midwife don't feel it is medically necessary in your case. (I'm assuming it because you are arguing that ultrasound is not necessary in low risk patients.) I'm sure she does offer it to her patients when she feels it is medically necessary. If my assumption is wrong, I apologise. As for prentatal testing other than ultrasound, I don't believe we've discussed that in this thread.
How did we get on the subject of induction? I agree that induction should be reserved for cases when it is medically necessary. I thought we were talking about ultrasound?
I meant ultrasound.
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I never assumed your midwife doesn't offer ultrasound testing. What I am assuming is that you and your midwife don't feel it is medically necessary in your case. (I'm assuming it because you are arguing that ultrasound is not necessary in low risk patients.) I'm sure she does offer it to her patients when she feels it is medically necessary. If my assumption is wrong, I apologise. As for other prentatal testing other than ultrasound, I don't believe we've discussed that in this thread.
Apology accepted. My midwife offers education and information regarding benefits and risks of testing vs not testing. My midwife is very neutral and would never tell a patient that a certain test (such as ultrasound) was not necessary. She offers education and information regarding benefits and risks, just like any other doctor or midwife and she leaves the decision up the patient. I know another woman who sees her who has had several ultrasounds mainly for peace of mind reasons even though she is low risk. My midwife fully supported her in her decision each time.
CIGNA is an insurance company who's priority is about profit and concerns are about liability, not health. Can you show me exactly where ACOG says that the routine use of ultrasound screening is recommended for all pregnant women, including those who are low risk and should be used as a standard part of prenatal care.
Your comment about liability got me thinking. That is exactly why ACOG will never use the term "standard of care." It is a legal term and could be used for a lawyer to impute liability. That is why they use "guidelines" rather than "standard of care".
So if you say ultrasound is a "standard" in the sense that it is routinely incorporated into low risk pregnancy care, it certainly applies. If you want to use the legal term "standard of care", you will not see it applied.
I think Dorthy is accurate in what she is saying-this is what I have gathered, also. In fact, like I mentioned upthread, one OB practice I went to did not do routine ultrasounds at all for low-risk pregnancies.
Whether you see an OB or a midwife, if you feel that you desire an ultrasound, you need to ask ahead of time if they do routine ones, because not all do.
Here is some interesting information on routine ultrasounds. It does back up what Dorthy is saying, but not necessarily for the reasons Dorthy is citing. In general the debate over universal routine ultrasound in the U.S. is one of cost. The RADIUS study which was first released in the American Journal of Obstetrics and Gynecology in 1993 is the study that found no benefit of ultrasound screening among low risk women in terms of neonatal death or illness.
This study's exact findings:
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" Major congenital malformations occurred in 2.3% of the 15,281 fetuses and infants in this study. Antenatal ultrasonography detected 35% of the anomalous fetuses in the screened group versus only 11% in the control population (relative detection rate 3.1; 95% confidence interval 2.0 to 5.1). Ultrasonography screening did not, however, significantly influence the management or outcome of pregnancies complicated by congenital malformations. Specifically, only 9 abortions were performed for anomalies among 7685 fetuses in the screened group whereas 4 pregnancies were terminated for fetal anomalies detected among 7596 control subjects. Ultrasonography screening also had no significant impact on survival rates among infants with potentially treatable, life-threatening anomalies despite the opportunity to take precautionary measures such as delivery in a tertiary center ".
The findings of that study contradicted strongly against the findings of the EuroFetus Study which was published in 1997 appeared in the above cited Journal in 1999.
That study found:
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In the study, with 60 European hospitals participating, ultrasound screening performed on healthy pregnant women between 18 and 22 weeks of gestation detected 56% of 4,615 congenital structural anomalies, including 73% of all major abnormalities. 210 of 378 chromosomal anomalies were detected before birth. The findings strengthen the case for ultrasound screening and raise questions about the way it is done in the U.S. The study showed that European doctors found fetal disorders at strikingly higher rates than their U.S. counterparts. Looking back at 3,685 infants born with birth defects, the study found that defects in 61.4% of the infants were detected by ultrasound screening--twice the rate found in the U.S. study. And 56% of those defects were detected within 24 weeks of pregnancy, when it is still legal for an American woman to have an abortion. (It's rare that anything can be done to correct birth defects.) In contrast, in the RADIUS study, just 17% of the defects identified were found by the 24th week.
In the Eurofetus database, all sonograms were done in hospitals--usually by certified technicians. In the U.S., they're often done in doctors' offices. Even the RADIUS study, though it found a smalll U.S. detection rate overall, showed that hospitals and high-quality laboratories detected three times as many abnormalities as doctors' offices did.
Slavatore Levi published an influential paper on this topic in 1998 which stated:
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Results from ultrasound in low-risk pregnant women are significant when routine screening is performed on a large population because the anomalies are rare. Professionals expect from routine ultrasound objective information that cannot usually be obtained by clinical procedures. Parents seek reassurance about the absence of fetal congenital anomalies and overall fetal health. Therefore, Europeans view routine ultrasound as a part of obstetrical care, capable of filling important gaps by delivering much key information for improving obstetrical practice. Fetal anomalies screening (FAS) requires higher education and qualifications than obstetrical ultrasound. The health insurance systems support ultrasound screening and allow its spread in most European countries; approximately 98% of pregnant women are examined by ultrasound and, frequently, two to three times (usually once per trimester). Detection rate of congenital anomalies is about 28% in geographical areas (private practice and hospitals), 60 to 80% in Ob/Gyn's ultrasound labs. Routine ultrasound screening policy has not proved to result in an immoderate use of ultrasound; on the contrary, chaotic use of routine ultrasound can lead to an unproductive and excessive number of scans. New trends in FAS, such as the early detection of fetal defects and chromosomal anomalies, bring more arguments for routine screening. Effectiveness should increase by enhancing education and training and the systematic referral for FAS to accredited laboratories.
So, the debate really centers around cost-efficacy that was a central tenant of the RADIUS study. The EuroFetus study was a major eye opener and brought about much debate. However, what isn't debatable is that there are no negative effects from the procedure, only positive. In the U.S. it simply comes down to cost and your accessibility to a quality lab to do the test. I found it interesting as people were often citing the "European experience" and there lower rates of various issues. It just so happens that high qaulity ultrasound is provided to the entire general population in most of Europe and the tests are often done several times.
So, while Dorthy is spot on regarding the fact that it is not recomended in the U.S. for low risk women, that position is very debatable and is more or less centered around cost-efficacy and availability of quality ultrasound than it is about it showing no benefit as evidenced in the European study. Routine ultrasound screening in pregnancy
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