When you choose midwifery care at our natural birthing center, you might wonder about ultrasounds during pregnancy. Use of this technology has become increasingly common in obstetrics, with the vast majority of pregnant people choosing to have ultrasounds.

The American College of Obstetricians and Gynecologists (ACOG) recommends that all expectant parents have at least one ultrasound during pregnancy for fetal anatomy, usually between 18 and 22 weeks. Meanwhile, the American College of Nurse-Midwives (ACNM) supports the use of ultrasound during pregnancy, but both ACNM and the National Association of Certified Professional Midwives caution providers about the overuse of the technology.

Just like all choices related to your prenatal care, the team at Magnolia Birth House encourages shared decision making when it comes to ultrasounds. While many people consider ultrasound to be standard during pregnancy, it is perfectly OK to question whether the technology is right for you.

We encourage asking yourself questions like:

“What is ultrasound?”

“How many ultrasounds are necessary during pregnancy?”

“Why is the 20-week ultrasound important?”

“What happens if I decline all ultrasounds?”

To help you, we’ve compiled the following information about ultrasounds for our midwifery clients.

What is Ultrasound?

Sometimes called sonography, ultrasound uses high-frequency sound waves to produce images. According to the ACOG website, “a transducer sends sound waves through the body. The sound waves come into contact with tissues, body fluids, and bones. The waves then bounce back, like echoes. The transducer receives these echoes, which are turned into images. The images can be viewed as pictures on a video screen.”

Some pregnant folks opt to have an ultrasound during the first trimester, which can be helpful for:

• Estimating gestational age, especially if the expectant parent is unsure of dates

• Screening for some genetic disorders

• Counting the number of fetuses

• Checking the baby’s heart rate

• Investigating concerns related to suspected miscarriage or ectopic pregnancy

First trimester ultrasound often is performed transvaginally, meaning the transducer is placed inside the vagina. It’s important to understand, however, that a transvaginal exam involves a higher frequency of sound waves.

A second trimester ultrasound, often called the anatomy scan, is the most standard use of imaging during pregnancy. This transabdominal exam checks the baby’s physical development, looks at the position of the placenta, and screens for major congenital anomalies. Depending on the baby’s position, you might be able to learn the sex.

While it’s not required, it is recommended. We suggest all Magnolia clients have the anatomy scan. Why? At the birth center, we do not have the ability to provide life-saving care for a baby with an organ abnormality. Participating in the 20-week ultrasound scan can reassure you (and us) that your baby will be born in the safest place possible.

In the third trimester and beyond, ultrasound is not common. However, some providers might order ultrasounds if there are concerns about amniotic fluid level or the baby’s size. In addition, if you go past your due date, ultrasound is part of the biophysical profile (BPP) that measures your baby’s health. The BPP monitors the baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid. This test may happen several times if your pregnancy continues past 40 weeks and 5 days.

Should I Consent to an Ultrasound?

In our practice, we believe wholeheartedly in the midwifery model of care — especially its focus on shared decision making. We view prenatal care as a time to foster connection while providing guidance, information, and resources. When making decisions about your care, you have the opportunity for informed consent or informed refusal.

According to ACNM, “Ultrasound has been used extensively in pregnancy for the past 20 years, and in population-based studies, there was no indication that prudent use by trained health care providers increased risk of fetal or maternal harm. Mechanical effects such as cavitation and thermal effects such as increased heat in dense tissues should be reduced.” The position statement goes on to say that “ultrasound should be used only when medically indicated.”

However, there are reports that ultrasounds can detect abnormalities that turn out to be false positives. In some cases, malformations end up being minor, and some conditions resolve on their own. All of this, along with repeated scans, can cause anxiety. On the flip side, some expectant parents experience anxiety when they don’t have ultrasounds because they worry about their baby’s health. In this situation, having an ultrasound can provide reassurance.

Just like all choices during your prenatal care, you have the right to consent or decline. And we do have clients who refuse imaging, often for religious reasons. All of this begs the question: What happens if I decline ultrasounds? To put it simply, we will support you. You will still receive safe, high-quality midwifery care at Magnolia.

It’s important to know that midwives are highly trained at using touch, often called palpation, to monitor your baby’s position and size. In addition, the Magnolia midwives use a handheld Doppler to listen to your baby’s heartbeat. While this is a form of ultrasound, the frequency is much less than with a standard ultrasound machine. Our midwives may also use a fetoscope, which is similar to a stethoscope, to hear the baby’s heart.

If you decide you want an ultrasound, we will provide you with a prescription. While we don’t perform them at the birth center, we partner with South Florida Perinatal Medicine a practice that provides ultrasounds under the supervision of maternal fetal medicine specialists. We would be happy to help you set up an ultrasound appointment.

For more information about Magnolia Birth House and to find out if our birth center is right for you, fill out our form to schedule a free consultation.