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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
i am in the uk here low risk women have 2 scans. 1at around 12 weeks the date scan and one at 20 weeks the anomalies scan. We only have extra scans if something is thought to be wrong. If you are worried just ask your doctor why they think the next scan is needed. If you agree go ahead with it if not say no.
I’m so torn in my reply to this issue. My first pregnancy was completely normal and we declined all testing other than the 20-week ultrasound. I, like you, feel pregnancy is overmedicalized and most of the time no interventions are needed, especially for a low-risk mama like myself. I’m 30, healthy, and have virtually no history of disease or genetic abnormalities in my family. As a result, we did the same with my second until abnormalities were found on my 20-week scan. It was recommended that I take a blood test to check for Down syndrome and it came back positive. From that point on, we had all number of ultrasounds, tests, and scans. I saw three specialists on a weekly basis, and each time they found something that could be serious. When my son was born last month, he did have Down syndrome, but all the other “somethings” they found turned out to be nothing. I spent my entire pregnancy stressed and worried for the well-being of my son, but on the flip-side, the prenatal diagnosis prepared me for my little dude’s arrival and I was able to experience the grief while pregnant (and, yes, there is grief after a diagnosis like that) and love him and accept him the moment he was born. So I guess I am a convert on intervention, but only to a point. In your case, I feel that your 20-week ultrasound would be more than enough to give your OB an idea of whether you are truly low-risk and then go from there. Modern medicine, while often helpful, causes its own share of problems and unnecessary worry, especially when it comes to pregnancy. Best of luck to you and congrats on your impending little one!
I agree that a prenatal diagnosis can be helpful, but also stressful! A lot of times docs think by looking and looking they are helping. My question is always, “well, what are we going to do with that information?” I really feel like for me I would want to know so we could have the NICU on hand at birth and go from there. I’m a postpartum nurse and sometimes we will get babies who had something come up on a prenatal scan (like water on their kidneys, a “large stomach”, heart defect), that really end up being nothing, but can cause a lot of stress!
I said no to an ultrasound for various reasons that are kind of long and boring. I went through a lot of the same questioning as you, including feeling like a negligent parent somehow. What I finally came up with was to ask not just why they wanted to do it, but be more specific: “What do we hope to learn from this ultrasound that we do not otherwise know?” and “How will that knowledge change our actions and the care we receive?” If the answer is “Nothing, really” then you can decline the test knowing that it wouldn’t have mattered.
That was my exact thoughts with the genetic testing – but you put it in much better words.
I asked if by finding out, was there anything that could be done to benefit the baby before birth and the answer was no – so I chose not to have genetic testing done.
Thanks for putting it in a much more eloquent way than me!
I agree that two ultrasounds at 16 and 20 weeks is a little excessive. The standard of care is really just one anatomy scan between 16-20 weeks to check for anatomical anomalies and look for soft markers for chromosomal abnormalities. I agree with others that you should ask your doc why she wants two scans. And, unless she gives you a good reason, I would tell her that you don’t see it as necessary and that you are declining. I also would encourage you to look for a provider whose philosophy aligns better with yours. I think this is a red flag for things to come. I know you said that a midwife isn’t an option for you, but it sounds like the midwifery philosophy and model of care aligns more closely with yours. You might be happier with a midwife.
We did NT scan with a blood test because of our ages, but if I wasn’t at slightly higher risk for birth defects I would have just waited until the 18 week anatomy scan. For me I wanted to know if there was anything going on that would make me want to plan a hospital birth instead of a home birth. There are good reasons for at least one anatomy scan so you can know if there’s an issue that might affect the birth. However one at 14, 16, 20 and who knows how many more seems very excessive. OBs in the U.S. tend towards more intervention, but there is not any evidence that their excess interventions improve health of moms and babies (just look at our outcomes compared to other countries).
My doula gave me a great nugget of advice re: delivering in the hospital that may be applicable here:
You have hired your caregivers. YOU are the consumer. You have the right to decline whatever treatments / interventions go against your gut and your research.
Is your doctor really pushing you into getting the various tests, or just presenting them to you as options? You should be able to decline whatever you want, but I feel strongly that your doctor should talk about your options to you. We opted out of the early tests and have since switched to a midwife/home birth, but even still the midwives keep us informed of all the tests we could get, should we want them. Both the OB and the midwives were/are respectful when we decided to or not to proceed with a particular screening.
Best wishes to you!
With my first pregnancy, I was exclusively seeing my homebirth midwives, who suggested tests, with no pressure at all. I had the 20 week u/s done, but anything that required I go to a separate lab, I skipped. They did the GBS test and some bloodwork in-house; I didn’t have the glucose test.
For this pregnancy, I am also seeing a Kaiser midwife. I was kind of blindsided by all the recommended testing. I asked her to explain it all to me, and then said, “I can’t make this decision right now.”
It’s stressful to try to make a decision about potentially life-/pregnancy-altering testing (and potentially expensive testing) in the moment when your practitioner is looking at you expectantly.
I don’t know if your mom was like this growing up, but mine would never let me ask if a friend could sleep over while that friend was standing right there. My mom felt like my friend’s presence made it more difficult to consider the decision without pressure. I think it’s fine to look at your OB’s suggestions as *suggestions.* You can say, “Okay, great. Let me talk to my partner and get back to you,” or, “Let me do some more research and get back to you.”
Here’s the thing. Everything is probably fine and the multiple ultrasounds are unnecessary.
But with me, everything wasn’t fine. The twenty-week ultrasound caught hydrocephalus developing; at that point, the ventricles were still “upper normal”, so we let it go until checking again at 32 weeks (because I figured that most pregnancies are probably fine). At that point, the baby’s brain had been entirely wiped out by the hydrocephalus and getting a late-term abortion was a nightmare.
You can say now that there’s nothing that would make you terminate a pregnancy, but a whole lot of women on the termination chat boards thought the same thing. Then they got horrible diagnoses of suffering and pain before an early death for their child, and they realized that there ARE diagnoses that will change their minds and beliefs. Downs is the LEAST of the potential problems, believe me.
Everything is probably fine. But IF things are wrong, I can tell you from very painful experience that you will be intensely grateful for every week earlier that it was caught. Every week where you aren’t showing in public; every week earlier makes a termination easier on your body; every week earlier means you can recover and re-conceive faster; every week earlier is far easier.
My pregnancies were comfortable and healthy for me. If I can conceive a baby without these genetic problems, I hope to have a birth at home. I know that our circumstances are very rare. But. Our circumstances happen, and when they happened to us, close monitoring was what saved us from worse torment.
Ohhhh…. please please please don’t turn down the ultrasounds!!! My daughter was born with severe congenital heart defects that they found when they did the standard ultrasound scan at 20 weeks or so. 1 out of every 100 babies is born with one of these every year. They do fine in the womb and won’t exhibit any problems until AFTER birth – a few hours to a few days. If there is something wrong, you want to know early so you can plan for it and have some knowledge on how to proceed. If I had turned down ultrasounds, we would not have known about my daughters issues until after she was born and turning blue and losing oxygen in which case we would have been looking at a 3 hour lifeflight to the nearest children’s hospital in Seattle. As parents, we want to make sure we are doing everything for our children, and I can’t imagine the guilt and sadness you would feel if there was a problem that could have been found if you had accepted medical intervention. If the scans all show normal, then by all means refuse further medical interventions – do a home birth, or a birth center or whatever, but you definitely need to make sure everything is a ok with the baby first.
FWIW, it doesn’t sound like she’s considering having no anatomy ultrasounds, just wondering what the point is of having one at 16 weeks *and* 20 weeks. It sounds like you (like me) had just the 20ish week one.
I am 16 weeks pregnant with my second, and I empathize completely with how you feel (for various reasons, we could not choose a midwife either). In both my pregnancies, I selected an OB who had a reputation for low-intervention, etc.
I was also surprised at the amount of screening tests and ultrasounds that are possible for a woman to do, and had to do some self-reflection the first time around. After reading through pamphlets and feeling a bit of guilt, I realized that I wasn’t thinking about the *purpose* of the screenings (as many others have commented) – which is to provide *information* about various possible risks.
My husband and I asked ourselves what we would do in response to any of these given tests. What my husband and I ended up deciding was that (1) we would not abort the pregnancy if we had risk of having a child with chromosomal abnormalities; (2) we were not comfortable risking a miscarriage from testing if we were found to be at risk for chromosomal abnormalities; (3) what was important to us was having enough information that we could prepare for the birth as necessary (if we were having a child with a physical abnormality that required surgery immediately postpartum, for instance, we wanted to be prepared for that).
I brought that list to my OB, and in turn he recommended a list of screenings that fit the amount of information that we wanted about our fetus. In our case, it turned out to be the 20-week anatomy scan and the quad screen blood draw (which gives information about spina bifida, in particular). We also did the 8-week scan to date the pregnancy. I turned down the other ultrasound screenings – which, in the end, generally give just enough information to recommend further testing or not – usually CVS or an amnio, which we had already decided against.
I also did the glucose test later on (again because gestational diabetes can cause problems prenatally and at delivery – part of our criteria), even though I had very few risk factors for gestational diabetes. In fact, I did turn out to have gestational diabetes, which turned my low risk pregnancy into a higher risk pregnancy. At that point, I changed my diet considerably and checked my blood sugar regularly, which controlled my diabetes (luckily). I’m really glad I had that information, as my diet changed my energy levels and mood drastically – even though I had been eating well before, I needed changes in my diet – and I had been affected by something that I wasn’t aware of.
So, in turn, I would give the following advice: ask yourself how the information each test provides will help you make a necessary decision. If it won’t help (or your decision is already made), then you should feel comfortable declining your OB’s suggestions – which is really what they are (not mandates). But I wouldn’t blanket decline all testing, even if the field is over-medicalized – because some information really can be useful.
You might also think through birth the same way, and how you plan to make educated decisions at the hospital – if you are offered an epidural at the hospital, for instance, will that make you nervous to decline it (even if that’s not something you want)? In what situations would you accept interventions? In what situations will you turn down your OB’s recommendation? At what point will you decide that perhaps an intervention is necessary? The decisions you are encountering now, while pregnant, aren’t so different from those that you may encounter at the hospital.
(PS – midwives often also recommend certain prenatal testing, especially if they pick up on risk factors. So this isn’t necessarily an OB vs. midwife decision, I don’t think.)
Just say no, no one knows what is best for you and your baby more than you. If she is the OB for you she wont push or be offended and if she is then it might be time to find another doctor. I changed doctors at 36 weeks due to an extreme difference of opinion and it was the best decision I made. Sorry to say it but you will have to get used to saying no to people’s opinions and advice, everyone will have something to say and you will get to the point that telling people no thanks is old hat.
With my first, I had plenty of scans. It helped. We were able to plan the delivery process around his position and keep an eye on the decreasing amniotic fluid. Opted out of a lot them for my second. Wish I hadn’t. We would’ve caught her heart condition earlier. Turns out she has Ventricular Septal Defect with a significant hole. We could’ve prepared better if I had agreed to the additional scans.
Ultimately, it’s up to you, but there may be a reason she’s recommending the scans. Ask questions. If you’re not up to saying a definite no, a simple, “I don’t know about that right now” might work. All else fails, get a different OB.
Hey all, we’re not totally comfortable with the amount of medical information being dropped in the thread without links to sources — I’m going to close comments, but encourage those inspired by this thread to pursue their own research.