by Lindsey Wimmer, MSN, CPNP
I LOVE pictures of my kids. I mark the major milestone dates with pictures, I try to get pictures of the little faces I don’t want to forget, and I send pictures to family members assuming they want them as much as I do! Those pictures tell us so much about them. We can see their personalities, we watch them grow, we remember specific accidents or events, we evaluate genetics by figuring out who they look like, and so much more. There are probably MANY reasons for this obsession (another blog topic in itself!) – but the bottom line is that I LOVE every picture I have of my kids.
That includes the ultrasound pictures I have of our son Garrett who was stillborn at 38 weeks. Sadly, the last pictures I have of him while his heart was beating are from the 20 week ultrasound. That is the only time in any of my kids lives that I have gone almost 5 months without taking their picture. Yet that is the standard of care during pregnancy. It seems crazy to me that we know so much is changing inside the uterus the last half of the pregnancy, yet we don’t utilize modern technology to watch and make sure mom and baby are healthy and growing as they should.
I believe at least one third-trimester (32 weeks to delivery) ultrasound should be a new standard for prenatal care. Some physicians and midwives have started this, but most have not.
1. How baby is growing and estimate current size
2. How much amniotic fluid is present
3. Where the placenta is, how large it is, and how mature it is
4. Where the umbilical cord is, how long it is, how twisted it is, if there are loops or knots in the cord
5. How the umbilical cord is inserted into the placenta
6. Blood flow through the placenta and umbilical cord to the baby
7. Signs of inflammation
8. Position of baby
Obstetricians know the end of pregnancy is critical – that’s why they start increasing the frequency of prenatal visits. Yet, most of these visits include very little exam of the baby. They will listen to the baby’s heartbeat and measure mom’s belly. The heart beating for 15 seconds is hardly an accurate determinant of health. Measuring mom’s belly with a tape measure does very little to tell us about what’s going on inside the uterus. That measurement can be affected by the size of the baby, the size of the mother, the position of the baby, the amount of amniotic fluid, and the size of the placenta. Once a baby is born, the pediatricians begin seeing that child on a regular basis. First at birth, then at 4-5 days, then at 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and 24 months. Not until a child is 2 years old does their growth and development slow down enough that physicians feel comfortable letting them go more than 3 months between examinations. We shouldn’t let a baby grow and develop that much before birth without watching more closely.
The major concern I hear is the cost. I understand that this would add to the cost of prenatal care, but I believe the potential benefit is greater. In most health care facilities, this ultrasound would cost the patient between $100 and $300 if their insurance did not cover it at all. To some this is not a problem, and to others it is. But I believe that physicians should offer it and let the patients decide if this is a cost they can incur. We recommend vaccines, mammograms, blood tests, medicines, and more even though we know many patients won’t be able to afford them. We leave the final decision to the patient.
The other argument from health care professionals is that they can’t do anything about the umbilical cord or the other factors they could see. But I disagree. Pregnancies that have been deemed “high-risk” have these extras tests on a regular basis to monitor the situation. The United States is actually very good at reducing prenatal and infant deaths among this population. It’s the “low-risk” pregnancies that have a higher death rate. Why?? Because the qualifications for high-risk are mostly characteristics of the mother. Many high-risk babies are in danger because they have a low-risk mother. The only way to find a high-risk baby is to LOOK at the baby with a third trimester ultrasound. If a concern is found, the pregnancy can then utilize high-risk pregnancy protocols and be monitored more aggressively.
If you are pregnant, ask your health care provider about a third trimester ultrasound. Anytime you are concerned about the health of your baby, particularly any fluid leaking, weight loss, excessive weight gain, change in baby’s movements or behavior, pain, bleeding, fever, or past your due date – ask for an ultrasound and non-stress test for a full evaluation of your baby. If you have concerns or symptoms, most insurance companies will cover the cost of these additional tests. Don’t let cost be a roadblock if you or your baby are experiencing concerning symptoms. Those extra pictures of your baby are not only precious keepsakes, but they might help save your baby’s life. That’s a powerful picture.
P.S. We are taking an informal, unscientific survey of moms to see how often women are having a third trimester ultrasound. If you have had a baby (alive or stillborn), click here to take our survey.
About the author:
Lindsey Wimmer, a Pediatric Nurse Practitioner, is Mom to four children; Garrett who was stillborn in 2004, Grant, Bennett and Austyn. Lindsey and her husband Trent founded the Star Legacy Foundation shortly after Garrett’s birth when realizing that the numbers of stillbirths in the US were staggering and that very little was being done to determine the causes or find prevention initiatives. Visit the Star Legacy Foundation to learn more.