3D ultrasound question.

"Nan" wrote

If I were in your place, with a previous healthy, uncomplicated
pregnancy and delivery, I'd opt not to have any u/s. It's an
unnecessary expense.

Nan


I've been pondering this. We are discussing having a 3D because it's
tempting, but to think of how much money we would save by turning down all
these unnecessary procedures especially now that insurance has changed, is
really compelling. I'm sort of 50/50-- turn everything unnecessary down, or
opt for the extremely unnecessary 3D ultrasound because it might be our last
chance. That sounds bad, doesn't it?

"Sarah Vaughan" wrote
Down's falls into the category of "I'll deal with that when and if", and I
wouldn't consider it sufficient reason to expose the baby to the extra
ultrasound. (In fact, Down's is something I would actively prefer *not* to
find out about until after birth, because I would find it easier to come to
terms with Down's in a baby who was already there than in a hypothetical
baby, IYSWIM.)


This is exactly how I feel. I wouldn't want to know ahead of time because I
certainly would not ever consider terminating for Downs, and there's nothing
that can be done about it anyway- I can't explain it but to say what you
just did- it would be much easier to come to terms with the baby who's
already here and in my arms.

My husband and I have been talking more about this as we try to find out
what has changed about our insurance coverage, so he's been quizzing me
about why someone would have the AFP test, and it's actually been making me
think. Why would you??? If you know you would not terminate for something
being wrong, then why would you pay for the AFP test?? Especially if in my
case you would decline an amniocentesis. I guess it's the same for the
ultrasounds- IF they think they see something, what does it change??

This thread is good for thought, it's making me reconsider a lot of things
actually. And maybe this is why insurance is starting to change what they
cover?

beyond the pale wrote:
"Ericka Kammerer" wrote

There is little
evidence that routine ultrasound leads to better outcomes.


I agree with you; it's, for some reason, the "standard" around here.
Absolutely everyone I've ever encountered gets the same 2 ultrasounds. 8-9
weeks and another at 18-20. I've talked with numerous OBs at 3 different
groups, and they all say that's what they do unless someone declines, and
not many decline. I'm sure someone declines occasionally, but of everyone
I've known to have babies in the past 10 years this is how it is.

But you don't *have* to go along with the herd, especially
if you have to pay for the privilege ;-) If you want the u/s,
then by all means that's your choice. And realistically, while
I'm sure we'd all like insurance companies to pay for everything,
*IF* it's a matter of there not being money to pay for it all,
I'd rather they short coverage on things that aren't proven
beneficial than things that *are* known to be beneficial ;-)

Best wishes,
Ericka

beyond the pale wrote:

My husband and I have been talking more about this as we try to find out
what has changed about our insurance coverage, so he's been quizzing me
about why someone would have the AFP test, and it's actually been making me
think. Why would you??? If you know you would not terminate for something
being wrong, then why would you pay for the AFP test?? Especially if in my
case you would decline an amniocentesis.

Some people feel that they are better off being mentally
prepared.

I guess it's the same for the
ultrasounds- IF they think they see something, what does it change??

As I mentioned before, there are some very uncommon
situations where you might find something where you can do
something about it (fetal surgery, etc.), but those are
very rare. In some cases, the results might affect decisions
about how to manage labor and delivery.

Best wishes,
Ericka

"Sarah Vaughan" wrote in message
...
Nan wrote:

I know it's commonly thought that u/s are/should be routine, but that
is not correct. You can date a pregnancy without exposing your baby
to the u/s. The viability argument just isn't valid, either. Your
pregnancy is going to be viable or not. An u/s won't improve that, it
will only cost you money you don't need to spend.

Medically, an ultrasound for viability doesn't make a difference to the
outcome. However, I really wouldn't want to be in the situation of
finding out my pregnancy was non-viable only when I was several months
into the pregnancy and had already told people about it. For me, that
would make it far harder to deal with the inevitable sadness of a
non-viable pregnancy. There is no way I'd want to go through that.
Whether that counts as a medical necessity that can be funded by others is
open to debate. But I paid for an ultrasound at the end of my first
trimester in order to establish viability, and, while that may not have
been money I *needed* to spend in the life-or-death sense, it was money I
considered well spent.

Similarly, I would have paid for my mid-pregnancy ultrasound had the local
trust not funded it (they did), because if my baby had had some defect so
severe it wasn't going to survive long after birth, I wanted to know that
and be prepared. Maybe there would be nothing I could *do* if an
ultrasound had shown anencephaly or renal agenesis or the like, but at
least I would know and could start preparing myself, and thinking about
the heartbreaking decision of whether I wanted to continue that pregnancy
to term or not. (Also, if I did carry to term in that situation, it might
affect my decisions in labour - I would be unlikely to opt for a Caesarean
section for fetal distress if I knew the baby wasn't going to survive
anyway.)

On the other hand, I wouldn't really want ultrasounds for reasons that
didn't boil down to "I want to find out whether this baby's going to live
or die so that I can be prepared." I know some people feel the same way
about diagnosing Down's syndrome, and opt for a nuchal fold ultrasound for
that reason. I wouldn't want to do that, because, for me, Down's falls
into the category of "I'll deal with that when and if", and I wouldn't
consider it sufficient reason to expose the baby to the extra ultrasound.
(In fact, Down's is something I would actively prefer *not* to find out
about until after birth, because I would find it easier to come to terms
with Down's in a baby who was already there than in a hypothetical baby,
IYSWIM.)

I agree with you in all this.
I will though add that the 20 week u/s I'm not just wanting to know about
fatal defects. When we were told #2 was missing her hand then it gave us 20
weeks to talk to specialist, meet others, and generally come to terms with
it. I have noticed that those who haven't found out till birth seem to have
had much more difficulty in coming to terms with it than those who knew
beforehand.
Debbie

Ericka Kammerer schrieb:

But you don't *have* to go along with the herd, especially
if you have to pay for the privilege ;-) If you want the u/s,
then by all means that's your choice. And realistically, while
I'm sure we'd all like insurance companies to pay for everything,
*IF* it's a matter of there not being money to pay for it all,
I'd rather they short coverage on things that aren't proven
beneficial than things that *are* known to be beneficial ;-)

I totally agree. Here in germany we're still undergoing a health care
reform and it's just idiotic. We get three ultrasounds payed for, but if
the doc says it's necessary they'll pay for as many as he does. Which
means I've had: 1 at the hospital, 1 at the gyn, one more at the
hospital, one at the gyn another one there, one at the hospital and a
lat one at the gyn, so that's about 7. And it bothers me! Especially
since I had wanted one to see the nuchal fold (? the fold at the neck)
to see whether or not there may be a risk for downs syndrome (I did tell
my gyn that I had been taking medication at the very start of my pg that
are not supposed to be taking during pregnancy, especially not during
the first weeks.) but he timed my two visits exactly around the weeks in
which that test makes sense.
Aynway, they pay for ultrasounds, but they don't pay for a glucose
tolerance test, even when there's an indication for GD. They payed for
my HIV test that was done in my first trimester (which I was not told
about, they just did it without my consent!) which totally doesn't make
sense, especially since the "reason" for this test is "Oh, in case you
end up wanting a water birth" bull****. I really hope hospitals don't go
by HIV tests as old as 8 months. Besides, I hated being in the tub when
I had Sam.

Grrrrrrrrrrrrrrr...

cu
nicole

On Thu, 12 Jul 2007 22:24:18 -0400, "beyond the pale"
wrote:


"Nan" wrote

If I were in your place, with a previous healthy, uncomplicated
pregnancy and delivery, I'd opt not to have any u/s. It's an
unnecessary expense.

Nan


I've been pondering this. We are discussing having a 3D because it's
tempting, but to think of how much money we would save by turning down all
these unnecessary procedures especially now that insurance has changed, is
really compelling. I'm sort of 50/50-- turn everything unnecessary down, or
opt for the extremely unnecessary 3D ultrasound because it might be our last
chance. That sounds bad, doesn't it?

No, it doesn't sound bad.... it sounds like the emotional thinking I'd
have if I were pregnant again :-)

Nan

beyond the pale wrote:

I agree with you; it's, for some reason, the "standard" around here.
Absolutely everyone I've ever encountered gets the same 2 ultrasounds. 8-9
weeks and another at 18-20. I've talked with numerous OBs at 3 different
groups, and they all say that's what they do unless someone declines, and
not many decline.

It's kind of like amniocentesis. My obstetrician
was sort of stunned when I declined it. I had to
tell him several times before he believed it.

-- Anita --

My husband and I have been talking more about this as we try to find out
what has changed about our insurance coverage, so he's been quizzing me
about why someone would have the AFP test, and it's actually been making me
think. Why would you??? If you know you would not terminate for something
being wrong, then why would you pay for the AFP test?? Especially if in my
case you would decline an amniocentesis. I guess it's the same for the
ultrasounds- IF they think they see something, what does it change??

I think that though there is some truth the idea that being prepared for
having a baby with Downs is a helpful thing, unless you're going to get
an amniocentesis, the AFP test, often seen as just blood test, no big
deal etc. can actually cause a lot of worry, as the numbers that come
back are just a risk factor and it's natural that anything that comes
back above your age risk alone is going to cause you worry, say it comes
back at 1 in 50, an indepth ultrasound might change that one way or the
other, but is very unlikely to either confirm, or lessen the revises
estimate of risk to your age related one, so for one baby with Downs, 49
women who spend the entire pregnancy worrying and quite possibly because
of focus on that, don't prepare well in other ways and may have poorer
birth outcomes. My personal conclusion was that if I wasn't prepared to
have an amnio, that the AFP test was more risk than benefit, being
young, it could barely come back with a lesser risk, I suppose had I
been past 40 and so very high risk, the chances of it coming back with a
lower risk would have been greater and it might have been beneficial.

Cheers
Anne

"Anne Rogers" wrote in message
. ..

My husband and I have been talking more about this as we try to find out
what has changed about our insurance coverage, so he's been quizzing me
about why someone would have the AFP test, and it's actually been making
me think. Why would you??? If you know you would not terminate for
something being wrong, then why would you pay for the AFP test??
Especially if in my case you would decline an amniocentesis. I guess it's
the same for the ultrasounds- IF they think they see something, what does
it change??

I think that though there is some truth the idea that being prepared for
having a baby with Downs is a helpful thing, unless you're going to get an
amniocentesis, the AFP test, often seen as just blood test, no big deal
etc. can actually cause a lot of worry, as the numbers that come back are
just a risk factor and it's natural that anything that comes back above
your age risk alone is going to cause you worry, say it comes back at 1 in
50, an indepth ultrasound might change that one way or the other, but is
very unlikely to either confirm, or lessen the revises estimate of risk to
your age related one, so for one baby with Downs, 49 women who spend the
entire pregnancy worrying and quite possibly because of focus on that,
don't prepare well in other ways and may have poorer birth outcomes. My
personal conclusion was that if I wasn't prepared to have an amnio, that
the AFP test was more risk than benefit, being young, it could barely come
back with a lesser risk, I suppose had I been past 40 and so very high
risk, the chances of it coming back with a lower risk would have been
greater and it might have been beneficial.

Cheers
Anne

My husband wanted to know: If *I* know 100% that I will refuse an
amniocentesis (And I do. I absolutely will not consent to one, I feel it's
too risky, period. I don't want to go through it.) ...then the AFP test has
no purpose, right? It's a waste of money and nothing more.

I ask because we received a bill and were slapped with paying for $300 worth
of tests that insurance didn't cover. I'm livid, as I told the doctors I did
not want any test not covered by insurance, and this is also when I received
another bill for the ultrasound and it's how I know it's not been covered
this time. It was a shock. I specifically recall that the insurance did not
cover a lot of the bloodwork they did at 8 weeks when they drew my blood
(one vial) and screened it. They checked my iron levels, and I declined the
cystic fibrosis screen although they tried to talk me into it because I had
it last time and I don't carry the gene. So why would they need to do it
again? They asked me what other tests I wanted to allow and I said any that
insurance covers, I guess....I didn't really WANT the tests, but I thought
the doctors seemed to want me to have them. The HIV and STD tests I knew
were unnecessary but I sort of thought, well, maybe the doctor would feel
better knowing for sure? But then insurance didn't cover it so we've had to
pay several hundred for that junk. My next appointment is when they want to
do the AFP and I plan on turning it down. It's very expensive and I won't
risk insurance not paying for it especially when I KNOW I will refuse amnio.
But i expect the doctors not to like this. Oh well, I find it easy, just say
no.

The ultrsound is not this easy to say no to. I haven't made up my mind. I
tend to think I might have it as I DO want to know the gender. I go back and
forth...unnecessary money and exposure. But I want to know so I can have fun
planning. I want to be able to talk about it with my daughter, and a couple
of people with kids of different genders have offered me some hand me downs,
etc. Plus, it's an emotional decision 100%.