Early testing

28 posts / 0 new
Last post
Joined: 05/24/05
Posts: 944
Early testing

Since my first child was in 2006 and my second 2008 I didn't think a lot would change in childbirth during that time.. but I certainly don't remember all of this testing at 5-6 weeks on my previous birth boards. Very early ultrasounds, serial BETA HCG tests...

When did this become so common place? I can see it with women that might require supplemental progesterone (or similar medical indications).. but it seems that nearly every woman with an OB is getting these tests, and some even have a midwife.

And the worry it causes! My heart aches for the women that have an u/s at 5 weeks and they don't see a heartbeat.. or they're stressed over their HCG levels not being perfectly doubled in 48 hours.

I can't imagine being so medically scrutinized right from the beginning. I have to wonder what benefit can be derived from this with most women? It's not as if a m/c can really be prevented at this stage. It seems to cause more concern than it's worth? What are your 2 cents?

jooniper's picture
Joined: 08/27/07
Posts: 780

It kills me too. To the point if I were offered a free ultrasound at 6 weeks, I'd turn it down. I've seen it go wrong far more than I've seen it go right- to the extent that one poor mother was told by her doc that there was no fetus in the sac, and to take a pill to help the miscarriage along... only to find in the aftermath of the miscarriage a perfectly formed fetus, just as far along as she should have been. Talk about heartbreaking.
Like you said, a miscarriage isn't preventable at that point, and the stress of an ultrasound with less-than-perfect results (which is super common that early) is not going to help anyone!
I can understand betas and "dating" ultrasounds for certain cases, but that would be an exception, not a rule.

Spacers's picture
Joined: 12/29/03
Posts: 4100

Yes, it's definitely overkill, and I honestly think the majority of those tests are to pad pockets. :roll: I don't think we'd see them being ordered so much if we had universal healthcare; I belong to an HMO and they won't do those kinds of tests for just anyone. Because of my age, I wanted to have a CVS test, which is done between 10 & 12 weeks, so I also had to have a dating ultrasound between 7 & 8 weeks, to ensure that the CVS test would be within the proper timeframe. That made sense with Tiven when the pregnancy was unexpected, but with Weston I'd been TTC for 2+ years so I *knew* when I conceived, but they still made me get the ultrasound.

AJsmommy's picture
Joined: 05/08/07
Posts: 289

My perspective on this is a little skewed because I've dealt with recurrent losses. I do think that in most cases all that testing is more trouble than it's worth. Unless there is a reason to suspect a problem I think serial betas and early ultrasounds are unnecessary and probably do cause too much stress.

That said, because of my losses, I'll stress no matter what. With my last pregnancy I had 3 repeat betas done once a week (I have had low progestrone in the past) and then weekly ultrasounds from 7 to 15 weeks. For me it reduced my stress tremendously. I know it can't change the outcome, but all of my losses were "missed" so I worried all the time that something was wrong. Even in my case, my doctor won't do an ultrasound before 7 weeks. I personally think it's crazy to do it any earlier.

With my first two pregnancies when we didn't have a reason to suspect anything was wrong, I only had one beta to confirm pregnancy and one ultrasound around 8 weeks to confirm a heartbeat. I think that's a lot more reasonable and probably still more than is really necessary.

LMCH's picture
Joined: 02/05/07
Posts: 2031

I was surprised at all the early tests and u/s on my birth board. I was used to waiting, similar to with my DS's pregnancy in 2007, heard the heartbeat with the doppler at 14 weeks, got the anatomical scan around 20 weeks. This time around I heard the heartbeat earlier, b/c my MW was willing to try even though it was still a little early...but yeah, does seem like overkill. I understand the use of these tests in cases of a history of losses, fertility problems, significant bleeding, etc. but otherwise it does seem odd.

Joined: 08/22/06
Posts: 621

I do think it is a bit much as well, but I am also in the same mind set as Shannon. Because I've had a couple losses and my last pg with DS my progesterone plummeted, I was put on supplements and who knows if that's what helped me sustain the pregnancy or not, but I wanted it checked this time too. Now, the HCG was not as important to me, although it was nice to see as the progesterone.

And I am a bit surprised that my birth center is actually doing an early u/s (at 8 weeks). I was just assuming that they would do the 20 week one and that be it.

I am very surprised at the number of women who are having all of the testing done so early with it being their first baby. And the number of women who have early u/s and show no heartbeat and are super upset are upsetting to me.

I had a friend last year who had her OB try with the doppler to find the heart beat at 8 weeks and surprise, surprise, nothing. So she was worried (because the dr made her feel that way) until a few days later when she went in for an u/s. I am furious at that doctor who would try a doppler even though she was going to get an u/s already in a few days. ugh.

jolly11sd's picture
Joined: 02/02/05
Posts: 3327

I agree that in most cases it does creat more concern than it is worth. I totally understand it for those that have had a history, sounds like it give a better peace of mind. But for most without a history I think it is an overkill. I saw the same thing on my BB this time with all the stress some went through with numbers, levels, and testing. I don't think I could deal with that personally.

In 2005 they did the 1st scan at 12 weeks and last at 20. Didn't listen to HB till maybe 16 weeks. And no early testing was pushed. I had a feeling things had changed and are pushed more so I didn't bother seeing an OB this time because of that. Been with my HB MW since 8 weeks, with no testing other than HB and 1 scan at later dates, and what a great frame of mind it has kept me in. Its sad that the norm in care has become so over done with testing and extra stress to the mom.

celticbandgeek's picture
Joined: 06/14/10
Posts: 950

Looking at this from the outside (TTC, but no kids yet) I'll bet a lot of this does have to do with insurance...but not just mom's insurance. In the past 3-5 years the cost of malpractice insurance for OB/GYNs has multiplied dramatically. Many doctors are probably using every test at their disposal in order to try to prevent lawsuits later on. And, the pressure from moms-to-be probably makes doctors think that if they don't do a requested test or u/s, the family will come back at them if there is a loss.

As pp have said, they can't do much to prevent early on. I worry at what impact all of these early u/s may have on development. So many things are unsafe in the first trimester. Ya gotta wonder.

Illiana's picture
Joined: 09/29/05
Posts: 338

i did an early u/s because i wasn't sure of my dates and wanted to know for sure. other wise i didn't do any early testing or at least they didn't tell me about it if they did it.

faeriecurls's picture
Joined: 06/04/08
Posts: 790

I think that for most women, these early tests are not at all necessary. It causes way too much stress. I had lots of betas and an early U/S at 7 weeks, but that was because I was seeing an RE, had low progesterone and needed supplements, a chemical pregnancy and had done IUI with meds. I don't think that it should be standard for every woman to get all of that done.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

I agree with everyone that these things really should not be routine. They make sense if there is a reason for them (I had early u/s with both pregnancies, with DD, I had scary red bleeding during 1st trimester, and with DS I needed the pregnancy dated because I had no idea how far along I was. I have never had serial betas, though). I think women feel that getting all the tests somehow makes their pregnancy more important--I read an article once about how many American women actually want to be considered "high risk" because that means their babies are more valuable. People think "Why is some else's "high risk" baby more important than my baby? Doesn't my baby deserve all the same tests as a" "high risk" baby?"

It is not very rational, and it's really expensive. I think that having health insurance be only for emergencies and having routine care paid for by flex spending accounts or out of pocket would put patients back in control of where healthcare $$ go (taking out the "middle man") and would likely reduce use of unnecessary tests. I prefer the idea of decisions being made by individuals to the government run system, but I think my vision is unlikely to happen.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

I totally get what you are saying. I don't get it either. I personally have to go right away after a positive though. I don't necessarily need an u/s, but I do need to have my progesterone checked. It has been low (like 7.5) with all my kids. I was full out bleeding with my oldest. For some reason I just don't make enough. So, I am glad it is available, but it does seem like overkill to test everyone like crazy. Sometimes I wonder if it isn't just about $$$

alwaysamom's picture
Joined: 01/08/09
Posts: 23

When I had my babies (1983, 1985 and 1989) which thankfully all ended up fine there were no tests like nowadays. In 1983, after 1 year of trying (my cycle was 45-60 days and I only ovulated on one side!) blood tests were showing negatives but a urine test showed up positive and I was actually 10 weeks along at that point. We had no clue when my due date was as I hadn't had a period since March and my due date ranged from January 27th to February 8th. I ended up have a natural (no interventions/no drugs of any kind) birth on February 11th.

My second baby I was a week late for my period (after first baby my cycles actually became normal 28-30 day cycles after I stopped nursing). My first was 4 months old and I never used any birthcontrol and it did take my almost a year to get pregnant. I went in for blood work which came out positive only to be called a day later because my levels (not even sure what levels ... I think HGC or something) weren't high enough. So I had two repeat blood tests and then all of a sudden I started feeling sick as anything and my levels had risen. Then at 4 months along they decide I'm not big enough so I have to lay on my left side 2 hours a day with an 18 month old. No ultrasounds or anything. Had that baby in the hallway, again all natural, when I was being moved from labor to delivery.

Third baby, wasn't even a week lake and my boobs were killing me and grew a size) an ooops (was practicing pulling out and counting the days which apparently day 9 of my cycle wasn't safe). Went in for a test (no home tests back then) and they had progressed to almost immediate results (within 30 mins.) and came out to the waiting room handing me a prescription for prenatal vitamins. I burst out crying. Then my doctor stopped being an OB so from my first visit to my second he said, hhhhmmmm your uterous doubled in size in 4 weeks. Lets send you for an ultrasound. Only one baby but that is the only time I had one.

The only other test they did was for spina bifida and the dreadful diabetes drink! I am amazed at how many tests everyone has now.

marymoonu's picture
Joined: 03/15/08
Posts: 2183

I would tend to agree. I never had early testing during my pregnancy with DS (and I had an OB).

I wouldn't have had any early testing with my second pregnancy, but I was bleeding, so they did serial HCG's. When my numbers increased, but not by double, I did have an early u/s. I had some more betas drawn, which had started increasing by more than double. My doc thought everything was okay at that point, but I did still end up having a m/c. With that pregnancy, all the testing was very stressful, but it didn't help that I was bleeding and that I could tell the whole pregnancy was just bad. The whole experience was stressful all around.

With this pregnancy, I haven't even actually told my OB I'm pregnant yet, LOL. I don't want early testing this time around. The pregnancy so far seems healthier and more normal, more like what I had with DS. I don't know if my OB would have wanted me to come in for early testing, but considering the fact that there was no AF in between the m/c and this pregnancy, and their incessant need to "date" the pregnancy (why it matters so early on, I don't know), I had an idea that he would maybe want me to do all the early testing again, so I just haven't told him, hahaha. :rolleyes: I have scheduled my initial education/blood/urine tests with the office, but my OB doesn't really pay attention to those appointments, so I can assume he still doesn't know I'm pregnant. He'll find out in a month or so whenever I go in for my first appointment with him, probably around 9-10 weeks pregnant. Wink

I don't see any reason that the serial betas, early u/s, etc. need to be done in a standard pregnancy. That said, with my abnormal pregnancy, I did appreciate having an idea of what was going on in my body, even though in the end it did NOT predict my m/c. My numbers were still rising up until the end when I miscarried very quickly at home in late May.

Joined: 05/24/05
Posts: 944

"marymoonu" wrote:

I would tend to agree. I never had early testing during my pregnancy with DS (and I had an OB).

I wouldn't have had any early testing with my second pregnancy, but I was bleeding, so they did serial HCG's. When my numbers increased, but not by double, I did have an early u/s. I had some more betas drawn, which had started increasing by more than double. My doc thought everything was okay at that point, but I did still end up having a m/c. With that pregnancy, all the testing was very stressful, but it didn't help that I was bleeding and that I could tell the whole pregnancy was just bad. The whole experience was stressful all around.

With this pregnancy, I haven't even actually told my OB I'm pregnant yet, LOL. I don't want early testing this time around. The pregnancy so far seems healthier and more normal, more like what I had with DS. I don't know if my OB would have wanted me to come in for early testing, but considering the fact that there was no AF in between the m/c and this pregnancy, and their incessant need to "date" the pregnancy (why it matters so early on, I don't know), I had an idea that he would maybe want me to do all the early testing again, so I just haven't told him, hahaha. :rolleyes: I have scheduled my initial education/blood/urine tests with the office, but my OB doesn't really pay attention to those appointments, so I can assume he still doesn't know I'm pregnant. He'll find out in a month or so whenever I go in for my first appointment with him, probably around 9-10 weeks pregnant. Wink

I don't see any reason that the serial betas, early u/s, etc. need to be done in a standard pregnancy. That said, with my abnormal pregnancy, I did appreciate having an idea of what was going on in my body, even though in the end it did NOT predict my m/c. My numbers were still rising up until the end when I miscarried very quickly at home in late May.

I don't plan on visiting my doc until later as well. I've gone to visit around 5-6 weeks before and he honestly seems disinterested until we check for a heartbeat with the doppler around 11-12 weeks. I discovered last time that he doesn't even bill as a prenatal appointment until later in the first trimester.

marymoonu's picture
Joined: 03/15/08
Posts: 2183

Oops, I meant to add in my first post that the reason I had the early u/s with my m/c pregnancy was because the numbers were increasing, but not by double at first, so the doc was concerned it might be ectopic. So you know, if there's genuine concern, I don't mind early testing... ITA though... I don't get why they do it sooooo often in normal pregnancies? :shrug: Something extra they can bill for?

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

"marymoonu" wrote:

I don't know if my OB would have wanted me to come in for early testing, but considering the fact that there was no AF in between the m/c and this pregnancy, and their incessant need to "date" the pregnancy (why it matters so early on, I don't know)

The reason they want to do dating u/s's early is because it is more accurate early on since there is less variation in size at that point and they are changing quickly so it's easier to recognize the difference between a 6 week and an 8 week baby than it is a 24 week and a 26 week baby. The bigger the baby gets, the more inaccurate the measurement of gestation based on size is.

Of course if they didn't make such a big deal about babies needing to be born at the "right" time, it wouldn't matter so much. But it is good to have a relatively accurate due date so you know you aren't preterm or significantly post-dates.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

When I first joined my board at 7 weeks PG, I was like um... what's a beta? None of the literature I'd read while TTC discussed early testing. At my first MW appt at 9 weeks, testing was not discussed and I didn't ask as I didn't feel it was necessary. I was however given an unexpected U/S. The MW didn't find the HB by doppler (I was expecting she wouldn't) and offered to give us a sneak peak. I think she's used to dealing with women who must hear/see a HB in order to sleep at night. I also think she just enjoys giving couples their first peak at the "bean." We were very fortunate to have our first pregnancy stick. Had I already experienced a m/c, I may have discussed early testing. It has it's place but I think it causes so many women an inordinate amount of stress.

ETA: My center doesn't routinely do a dating U/S either. They asked me if I was certain about my dates and let it be.

marymoonu's picture
Joined: 03/15/08
Posts: 2183

"MrsMangoBabe" wrote:

The reason they want to do dating u/s's early is because it is more accurate early on since there is less variation in size at that point and they are changing quickly so it's easier to recognize the difference between a 6 week and an 8 week baby than it is a 24 week and a 26 week baby. The bigger the baby gets, the more inaccurate the measurement of gestation based on size is.

Of course if they didn't make such a big deal about babies needing to be born at the "right" time, it wouldn't matter so much. But it is good to have a relatively accurate due date so you know you aren't preterm or significantly post-dates.

True.. I guess I took it for granted that my belly always measured correctly in the later part of pregnancy. I guess it may not always work out that way.

mommys's picture
Joined: 05/08/06
Posts: 6264

I kind of gloss over it on these boards because so many moms posting early in pregnancy have had losses or fertility treatments that lead to more testing in early pregnancy. I do think it is more than necessary, but I don't really see it as harmful either.

As for dating u/s, it turned out with my first that I was about 2 weeks off with my EDD. But, the only reason they did the u/s was because there were other measurements off at my "10week" appt. Shrug.

mommys's picture
Joined: 05/08/06
Posts: 6264

"marymoonu" wrote:

Something extra they can bill for?

I wonder this sometimes.

DJMandyB's picture
Joined: 10/18/07
Posts: 68

I agree with what you ladies are saying.

On the note of extra billing, my last OB would offer all of the extra testing. Every time I would ask her if it was necessary and she would always say no, that it just helped keep some of the more anxious patients happy.

Joined: 08/22/06
Posts: 621

"DJMandyB" wrote:

Every time I would ask her if it was necessary and she would always say no, that it just helped keep some of the more anxious patients happy.

See, this is what bothers me about it. I think this is most OB's position and I think it's unnecessary (as we've been discussing). I wish they would just sit back and let the more anxious patients bug them for testing instead of just offering to everyone.

cmljll's picture
Joined: 11/28/06
Posts: 1409

My OB does an u/s at around 7-8 weeks to check for viability and confirm EDD. He does bloodwork at the first appointment (not sure what all he checks). Then the 20-wk u/s and GD test/CBC at about 24 wks. Between my two pregnancies he started doing another u/s about 36 wks because so many of his patients were having late problems. In the initial paperwork he lists all the other tests that are available upon request.

mommys's picture
Joined: 05/08/06
Posts: 6264

Wow, lots of worrying on our BB this morning. So many with early u/s that can't see enough yet so now they are worried. I understand some may have cause to worry, but most are just too early. Leaves me feeling a little frustrated...

Joined: 03/22/07
Posts: 259

I'm in New Zealand so things are done a little differently! Early testing does seem to cause a LOT of stress, almost the opposite of the reassurance that people are expecting!

My midwife just asked when I was due, I told her and I'll go for the nuchal fold US at 12 weeks (personal choice). My opinion (only) is that there is nothing I can do about anything now anyway....

Marite13's picture
Joined: 08/07/09
Posts: 3368

Unless you have a history, it seems kind of crazy to me too. I know when I got on my BB at first I was seeing all these posts and I was also all, "What is a beta?" I was in Angola, and not even planning on seeing any medical professional at ALL until 13 weeks, so then I was getting all worried that all these other people were having all these tests and I wasn't doing anything. I think that is why I kept POAS so often! I did have my first u/s at my 13 weeks appt, and it was great, because it wasn't just a bean anymore, but a whole tiny baby kicking around. But my OB at the time (in South Africa) used the u/s machine that she had in her tiny little office to see and hear the HB all at once- I don't think she even had a doppler.

ecoberry1's picture
Joined: 01/08/10
Posts: 250

"Marite13" wrote:

I know when I got on my BB at first I was seeing all these posts and I was also all, "What is a beta?" ...so then I was getting all worried that all these other people were having all these tests and I wasn't doing anything.

That was totally me! I'm a FTM and when I joined the September board, everyone was talking about their betas and u/s at 6-7 weeks and I was wondering why I wasn't getting all of these tests. I had to look up what betas were. At the clinic where I go, they don't do those tests at all. I didn't have my first real prenatal appt 'til 10 weeks. By that time, I was a little more informed (due to the pg forum and lots of reading) and the MW said I was measuring at less than 10 weeks, so she scheduled me for a dating U/S. That actually p**sed me off because I knew when I conceived (give or take a few days, but that hardly matters). After that, I found homebirth midwives and at my consultation with them, I asked them about betas, etc. and they were mystified. I'm actually still going to the clinic appointments because the providers at the clinic are the ones that do the hospital births at the hospital I have as backup, but mainly I just listen to my HBMWs. The clinic offers all of the genetic testing, but I declined all of them. I just don't like to be messed with. I don't even like when they use the doppler to listen to the HB - I request that they use a stethoscope instead.

I think that the offering of all of those beta tests and u/s at in early pg just reinforces society's obsession with medicalized births. All of those shows like Baby Story and all the others (that I've never watched) may have something to do with it as well. But, as I've never actually watched one, I suppose I don't have a case there. I do agree with all of the PPs who said that when there is an actual need for them, it's great that they're there, but I really don't think they should be routine. It just causes more stress.