My OB is pushing a lot of scans for my low-risk pregnancy: how do I stand up for myself?

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Photo by Jenny Jimenez
Photo by Jenny Jimenez
I am 14 weeks pregnant with my first child. So far, everything looks good, and I am considered to be low-risk. My question is about how to say no to my OB. For various reasons, a midwife was not a good option for us. We chose an OB who has a great reputation for low-intervention deliveries and for respecting mothers’ wishes. I don’t agree with the over-medicalization of pregnancy, so I thought we were on the same page.

So I was surprised to find that at every visit, she has recommended some new screening test or ultrasound. I turned down the nuchal translucency screen at 12 weeks, but now she is recommending I get an initial anatomy ultrasound at 16 weeks, plus the quad screen and another anatomy ultrasound at 20 weeks.

I don’t see the point of the 16 week ultrasound, but it feels irresponsible to decline it. Any advice for how I can stand up to my doctor without feeling like a negligent parent? — Ash

Comments on My OB is pushing a lot of scans for my low-risk pregnancy: how do I stand up for myself?

  1. This doesn’t seem to be a huge amount of screenings. My OB explained that the 16 week ultrasound and other screenings were to help her prepare more for the delivery. Even though I was considered low risk, there could still be concerns with the baby. If there was something of concern with the baby during these screenings it tells the OB whether or not to induce early, recommend a C-Section, or have NICU staff on hand during the delivery. I wanted the very least interventions as possible but in the end knew that I would do what was best for the baby. Ask your OB why she recommends certain screenings before you turn them down.

  2. My current pregnancy is high risk so I am getting a lot of screens – biweekly ultrasounds, weekly shots, ect. But my first was not and like you I wanted to opt out of the elective scans and screens. At our first OB apt my doctor handed me a list of the screenings that she liked to have her patients have. We had a conversation about which ones were highest priority for a women of my age and medical/ family history. We also discussed what my husband and I would do if we had a bad test result. It turned out that only the 18-20 week anatomy scan was considered high priority since I was having twins. (There was another scan in the third trimester that she recommended but I ended up delivering early so I never had it and don’t remember when or what it was). She was very respectful but did say she was required to explain them to me. If you haven’t already try asking your OB to go over the suggested scans and discuss which ones she believes are the most important.

    • Oh I forgot to mention this. My current pregnancy is high risk due to a number of factors. Which requires a number of scans. My husband and I were still on the fence about whether or not we wanted the genetic screenings. We still didn’t really want excessive tests (above the already excessive testing) and we knew it wouldn’t change our mind on whether or not to continue the pregnancy. However this time we really wanted to be as prepared as possible for everything post birth since we were blind sided by extreme prematurity and the NICU last pregnancy. To help us make our decision we met with a genetic counselor who was really about to explain each screening, who was most at risk, etc. Since this was her specialty she was much better at explaining these genetic tests/ screenings then our high-risk OB. Ultimately, we decided to skip the genetic testing this pregnancy too. But we felt educated in our decision.

      If you feel like you need more information don’t hesitate to ask for a referral to a genetic counselor. My insurance covered it 100% and I was able to meet with her during my regular OB appointment time.

    • This is true but unfortunatly I feel like this is a problem that is likely to follow her to which ever OB she goes to.

  3. I have the same problem, so many tests to be run and I cant find the backbone to say no. I will say I had a 16 week ultrasound and we detected something very serious that we need to keep an eye on so we know how to treat it at birth, so sometimes, it is a good thing, but I agree, too many interventions, usually things run smoothly.

  4. My current pregnancy was considered higher risk because of our history with in-vitro (two failed attempts), and because of my age (over 35). There are things that can show up in the scans that can’t be caught through other methods, and sometimes it’s important to catch those, and to talk about what my husband and I would do if some of the results were less than positive. It was also reassuring for us to know our baby was really in there early on (infertility issues can make some people – like me – very anxious), and that it is healthy (our quad screen/maternal serum blood test indicated that we had less chance of a genetic issue than a pregnant teenage girl).

    Ask your doctor why they’re important and what the repercussions might be if you do turn them down.

    In the end it is a personal decision, but keep communicating with your doctor and asking questions.

  5. Definitely speak to your OB. Ask why each scan, what is she looking for, what might you do if you found it, can it be picked up later/earlier, does it matter if it’s not picked up before birth, what are the highest and lowest priorities? And then, make your own choices.

    If it helps at all, as far as I am aware, standard in the UK for a low risk pregnancy is to have 1 scan around 12 weeks to essentially check dates/number of foetuses/basic stuff and then a further one at 16-20 weeks for any foetal anomalies, and then that’s you.

    • Why do you need a 16 week if you’re having the 20 week? My office does a 12week to establish due date a 20 to look for abnormalities and that’s it. Unless a “reason”. Are you also discussing the glucose test and blood tests? Non invasive tests I felt like what the heck if it makes the ob feel better okay. I do consider ultrasound to be invasive because the waves are going in and interacting with the baby. You can always keep looking for ob, but start with good communication. I have also hired a doula. And I should have taken birth ed not from my hospital

      • That may just be the list of what’s offered. I am trying to remember I’m not their average patient. So I don’t want to work on the assumption they are against me they probably aren’t. I just think they aren’t as used to natural birth.

      • I’m not sure if you meant to reply to me here but if you did, in the UK most people just have a scan somewhere between 16 and 20 weeks, not two separate ones.

      • Because they want to let you abort as early as possible if you decide not to keep the baby after certain defects are discovered. If you know that you won’t terminate the pregnancy no matter what, there really is no point in having the 16 week scan as eveything there will still be there at twenty weeks (or, in the case of things like your placenta being in thw wrong spot, may be betterby then).

  6. If declining the screenings makes you feel that way, then it is probably a sign that your doctor is not helping you feel empowered about your pregnancy. I would go see a different OB if you have this anxiety about feeling like a bad parent.
    I only got the 20 week anatomy scan. We were going to keep the baby no matter what, so I don’t see what an extra u/s at 16 weeks would have been useful for. With the high rate of false “positives” on the NT and quad screenings, you are not alone in declining those and it definitely doesn’t make you negligent!! But if that is the way your doc makes you feel, get a new doc… If you can’t change doctors, just say you don’t want the screenings and U/S, believe me that it is not the first time a mom has declined those screenings. The amount of unnecessary stress that those screenings cause is worse for your baby.

  7. ask for more information about the procedure so you can look it over and decide later. if she pressures you that could be a sign her approach doesnt fit your needs.

  8. I think there are different issues that can be detected at different timepoints, hence the suggested scans. My OB explained them all to me at the time, but I forget what each issue was. I was a paranoid ninny, so I took every scan and test they’d offer me that wasn’t invasive. But obviously, if you’re the mom and you are comfortable with as few tests as possible, I think that should be respected. Just tell your OB what you’re thinking. If her arguments for something make sense to you, do it. If they don’t, refuse the tests. Your insurance company will love you.;-)

  9. If you don’t want any further testing or you want to limit testing, I suggest having someone go to the appointments with you to help you stand up for yourself. He or she can be the person to say, “Why is that necessary?”, etc, to give you more time to respond the way you want.

  10. Ask for a list of all screenings, tests, and scans she will administer throughout your pregnancy. Sit down with your OB, talk about each one, and the necessity of them, and come up with a list that YOU will consent to. That way there is no last minute, end of appointment asides like, “Oh, and let the nurse know to schedule your “insert test here” for 20 weeks,” which put you on the spot and unable to plan.

    • Yes to this! Also, ask for data; what is each screening or test specifically looking for, what kind of information will it give, what exactly are the risks to you or baby, and what do you need to do to prepare? Get a schedule, and get resources before you decide. Then, decide how much information you actually want or need. Does it matter if your child has X, Y, or Z? Do you care if you show signs of this or that? If it matters to you, it’s worth getting the info, but if it doesn’t, or if knowing would raise other issues for you, remember the eons of women who have delivered healthy babies with nothing more than their own bodies to inform them.

      That being said, a 20 week ultrasound literally saved my son’s life. I opted for the nuchal translucency screening because I refused almost every other test, and felt like we were going to be more comfortable with at least a little data. We found several conditions that required substantial treatment after his birth, and knowing early gave us time to prepare. There is nothing wrong with information, as long as it’s the information you want and need.

  11. Are you worried that you’ll be dropped as a patient if you don’t do the tests?

    I loved getting ultrasounds because I could see my baby moving! I also wanted to find out the sex because I’m impatient like that 🙂

    I declined all of the testing and luckily my OB didn’t push me. I just told him that I wasn’t interested and he left me alone.

  12. This line jumped out at me “I don’t see the point of a 16 week ultrasound…” I think that’s the crux of the issue. Why don’t you ask the question “What is the point of the 16 week ultrasound?” I think that many people like the ultrasounds; I know that I found them very reassuring. So your Dr. probably isn’t used to people declining them. You also didn’t have the 12 week ultrasound, so your doc is probably just trying to get a firm grasp on whether you really are “low-risk” or are statistically low-risk.

    I also think that it would help your doctor if you could explain why you don’t want these tests. Just from this post, I don’t have a very good idea. I mean, I get the idea of not wanting to “overmedicalize” a low-risk, healthy pregnancy, but ultrasounds are non-invasive and carry virtually no risk and provide lots of information. I’m not sure that the doc would agree with you, but having the conversation about why you don’t want the test might help.

  13. Ask why they want to do the tests. Then if you still don’t want to do the test in question, ask if it is truly necessary. If you are ok with not having that information, decline. If it is information you’ll be happy to have say yes. This is where I found books really helpful. The Complete Guide to Pregnancy and Childbirth was especially good about talking about the various tests and interventions without getting too doom and gloom.

  14. I was offered an 8-week and a 20-week ultrasound, any other tests I passed on, even the glucose test. For me the tests were an invasion of my pregnancy and my body and I wasn’t feeling that. I educated myself by reading about the tests and talking with my doctor but in the end I went with my gut.

    • I hated the glucose tolerance test, which was also completely unneccessary given my medical history. I will refuse it next time around. There were generally too many blood tests for my taste. I had three big ultrasounds done (12 weeks, anatomy at 20 and growth at 38) and I would do those again.

  15. I switched OBs in the middle of my first pregnancy because the one I started out with treated me poorly and lost my trust. I switched to an OB that listened to and addressed my concerns. You need to trust your OB, so if you don’t, find one you do. Not all OBs push extra testing, mine gave us the information and left the choice up to us. I’d look around to find someone you feel 100% comfortable with.

  16. My last pregnancy was high risk due to age and twins. Then I developed Pre-E and wow what a balancing act it was at that point. I have a 4 and 2 year old as well and so the suggestion that I stay in the hospital for up to a month was just not going to happen. I spent a lot of time talking to my OB and frankly the entire staff at L&D ( by the time I delivered I knew the docs, the residents, students, and nurses all by name. )

    Here is what I was told. There is a “standard of care” that they have to follow, even if they may not personally agree with a test or procedure, they have to suggest it. When I declined to stay in the hospital I had to sign all sorts of forms that are meant to scare you, you could die! However my OB knew that I was making the best choice I could under the circumstances.

    I’m not a fan of test. My first two pregnancies where with midwives and I only did one 20 week ultrasound with each. I worked with my midwife to decided which were best for me and my circumstances. I guess what I’m trying to say is that you need to feel comfortable enough with your OB that you can have a conversation to find a “plan” that works for you and your circumstances. If s/he is not listening to you then its time to change. Do your own research, ask the OB questions and remind yourself that your not a bad parent because you don’t want every test under the sun, your a good parent because your making an informed choice.

  17. Feel free to change OBs. Better sooner than later. Call some offices and set up an interview with them, the visit will be free. If you feel uncomfortable with her decisions now, this early in the game when frankly, a whole lot of nothing is visibly happening in there, then what will happen later on when they baby is bigger?

    Early visits for low-risk pregnancies really only need to consist of measuring fundal height (womb/belly), listening to the heartbeat, and talking about the mother’s nutrition and energy levels, stress, etc.

    I have heard some women say they wish they could have a scan every week, so maybe this OB is just used to women asking FOR intervention, and until you tell her that you don’t want that, she won’t know.

  18. I am a midwife. The quad screen is highly unreliable. I never recommend it unless there is a family history or the result would change the family’s decision on continuing the pregnancy.

    The 16-20 ultrasound is a good for detecting abnormalities. Most baby are completely normal. But for those who have abnormalities know in advance can greatly improve their chances at survival and life. Standard of practice in this country is 1 ultrasound per pregnancy unless there is justifiable cause. But it is still the parents decision and only precautionary.

    I completely agree with the other if you do not feel comfortable declining unnecessary procedures and intervention you may not want to continue with this ob. The fact that they already wanted you to have 2 leads me to believe they are a high intervention practice. Mostly people/pregnant clients in the US think most is better, but actually it is the opposite. You could think about looking for a practice that has both ob and midwives. best of both worlds. 🙂

  19. If the doc. truly is low-intervention, she will be open to discussion about them. My first OB considered herself low-intervention, yet had never attended a truly natural birth. However, after discussing each “test”, and after we told her we would keep the baby no matter what, so it didn’t matter if they found extra chromosomes, etc., she was fine with it. We had just the 20 week ultrasound for both babies. If she’s pushing for more for no good medical reason, it’s time to switch, unfortunately. You don’t want to get to 36 weeks and realize she is actually much more invasive than promised – ie. inductions, etc. Good luck, and maybe you can find a group of women in your area (FB mother/BFing groups) who have used her and get their experience to confirm that she is as low-intervention as she says. Never hurts to do some research! Good luck:)

  20. Keep in mind that all these tests are non-invasive and pretty much risk free to you and the baby. Ask yourself why you’re refusing these tests, and be prepared to let your doctor know your reasons and be open to listening to her reasons for wanting them. Try to have a conversation where you can both understand one another. It’s hard to do in a short visit but well worth it. I declined a quad screen and found out my doctor wasn’t so much pushing for it so much as offering it, but the way many doctors communicate, they often don’t make it clear that you have a choice, I think because most people don’t respond well to that kind of presentation (makes the doctor seems unsure if she leaves the choice up to you). Open up the conversation rather than being confrontational and you might be surprised.

    • You might even try to book an appointment to discuss the plan for testing, so your OB will expect to take extra time with you. If more people did this, the waiting room time wouldn’t be so long! Make a list so if you’re nervous you won’t forget.

      There is such a thing as standard-of-care and physicians are required to offer that standard (which varies depending on where and who the medical person is) or, sadly, risk being sued when something unexpectedly goes wrong. That doesn’t mean you have to have every test. There is also an obligation to ensure you are giving informed consent or refusal for every test. Emphasis on “informed”.

      Ask four questions:
      1. what is this test screening for? 2. Is there anything we can do about it if we find something?
      3. Are there any adverse effects to the test?
      4. What might happen if I don’t have the test?

      Only you can decide if you want the information (or if your OB should have it — the 16-20 week ultrasound is good case in point — ), would act on it, or are willing to take the risk of not having any particular test, but you can’t do it if you don’t ask the questions. But please, approach it in the spirit of gathering information and starting from the assumption that your OB has your and your baby’s best interests at heart. A little mutual respect goes a long way.

  21. First of all – congratulations on being pregnant!!

    I’m 14 weeks pregnant and have had 2 ultrasounds so far, while I enjoy the ultrasounds so I can see the baby I have refused all genetic testing/screening.
    I turned down an NT scan, will refuse the 16 week chromosome blood test by dr offers and any other things that come my way.

    I will only do things that will affect the health of me and my baby, giving a urine sample to check for uti so I don’t get a kidney infection = fine by me
    Taking blood to see if the baby has risk of Down syndrome = not fine with me

    Best of luck with your decisions and I wish you a healthy pregnancy

  22. It’s hard to say why your OB might be doing this. Money might be a factor, or it could be they do this with everyone, or whatever. I found that with my pregnancies all I had to say was that regardless of test results I would not terminate the pregnancy, and they didn’t push me after that. But I did have an 18 week ultrasound both times and I’m glad I did because I didn’t need to worry if my babies would be born with the regular number of limbs.

  23. I just wanted to mention that not every “low-risk” case turns out to be that way. I’ve had 3 kids, and always was the poster-perfect low-risk pregnant person. However, during my second pregnancy, my son had swollen kidneys at my 20-week ultrasound. That in itself was a pretty minor issue, since it usually resolves itself before the baby is born. They scheduled a follow-up ultrasound to check on the progess since the condition CAN be serious. When I went in for the follow-up scan at 30 weeks, they discovered he had abdominal cysts in his bowels. This initiated a myriad of ultrasounds and tests that were basically inconclusive, but we knew that something was there. After he was born, he seemed fine (peeing and pooping like a champ) so the doctors concluded that his bowels were working fine and sent us home. When he was 5 days old though, he started vomiting his own feces (sorry for the gross mental image) and we went to the ER. They transported us in an ambulance to a bigger hospital, hooked him up to SIX iv’s and concluded that he had necrotizing interacolitis, an infection of the bowels common in preemie newborns that can be life-threatening. They were ready to send him home after a few days with antibiotics, but we said no, he only has a few of the symptoms, he’s still vomiting, and we know that he has abdominal cysts. The pediatrician didn’t listen, but the pediatric surgeon did. It turns out, after more testing, that my son had a partial bowel obstruction caused by the cysts seen on ultrasound. He was in the hospital for 3 weeks and had to have surgery to remove the cysts (along with 5 inches of his bowels and his appendix, apparently it was in the way). If we hadn’t already known about the cysts, the hospital pediatrician would have sent us home, and he would have very likely died before we could have realized that he needed to be back in the hospital (this is what the surgeon told us)

    Sorry for the long story, but basically, having extra ultrasounds before he was born literally saved my son’s life. Obviously his case was rare, but I had absolutely NO high-risk factors at all (mid-20’s, no medical conditions, not overweight, not diabetic, etc etc).

    I’d just urge you to consider the fact that ultrasounds are non-invasive and COULD aid in detecting something that would otherwise go unnoticed in your newborn. That being said, I agree with above posters that you want an OB you can trust. Mine this time around (I have a 12 week old) was wonderful when I asked for an extra ultrasound at 30 weeks to rule out the same thing that had happened with my son, since that was the earliest that it had been picked up by a scan. She didn’t even bat an eye, just scheduled it for me immediately. Whatever your particular concerns are, you should have a doctor who will address them properly.

  24. My aunt is an ultrasound tech and she is always complaining about how many unnecessary ultrasounds doctors are ordering for their patients. Some even ordering a ultrasound during the labor, even though the delivery is having no complications, the Doc just wants to know what the current size of the baby is.

    My feeling is follow your gut. If you feel uncomfortable voicing your concerns, I heartily agree with the commenter above who recommended bringing an advocate with you. I’m naturally prone to anxiety, specifically in situations like this, so when I bring my husband or cousin (we call her the “mean” one… lol) with me, everyone jokes that I’m bringing in the “BIG GUNS”.

    • That’s wonderful to hear that the U/S sounds think it is ridiculous too. Research shows that fetal weight by ultrasound at full term are no more accurate than a hands on abdominal exam guess by an experience practitioner. LOL.

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