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Ask A Childbirth Educator
Questions and Answer

Q. Hi my I am 5 months pregnant with a due date of Feb.22 with my first and I had an ultrasound at 2 mos because the doctors wanted to determine the due date. I thought I would be having at least one more ultrasound. All the people I have talked to say they had at least two. My doctor says he wont be doing another one unless he feels there are complications going on. I thought it was routine no matter what at this time in the pregnancy. I have concerns like is the baby developing alright and because I thought I would be having another ultrasound I figured I would find out the sex as well. I'm just curious if this is right or if I really should be getting another ultrasound. How can he tell just by the heart beat and poking around at my tummy if the baby is developing alright?

A. The new guidelines for ultrasound are that the procedure should be done for a medical indication. Establishing due date is one. Other than that is is becoming less common to have a second ultrasound. Routine ultrasound scanning without medical indications has not improved the live birth rate at all since it had been instituted, so it was decided that the costs did not justify the procedure as so little benefit was realized. Even if you had that second ultrasound, it would not be able to definitively tell you if the baby was developing properly. While it can identify major anomalies (which are also extremely rare), it may not be able to diagnose the presence of anomalies due to position of the baby and nature of the anomaly. Ultrasound can give one the general impression that yes, apparentally the baby is developing properly, but it is not a guarantee.

The fetal heart rate is a very good indicator of the baby's health and well- being. Through careful listening of the heart rate, the caregiver can ascertain how the baby is doing. Palpating the abdomen tells them how the baby is growing and how much fluid there is in the uterus. (Fluid quantity is often a sign of a possible anomaly of the fetus as amniotic fluid is largely produced by the baby.) Once the organs are formed in the early weeks, they usually will develop normally on their own, which is why so often women are told to avoid things in the first trimester that later on they do not need to be as careful about later on in the second and third trimesters. Other tests, such as the MSAFP done on maternal blood can point to indications that a baby may have a neural tube defect, such as spina bifida, or Down's syndrome. Unless there is a family history or symptoms to suggest something may be wrong, it is not unusual to only have one ultrasound or even none at all. It is very normal to be concerned about how your baby is developing when you are pregnant. Maximize his chances of proper development and brain growth by maintaining an excellent diet throughout pregnancy, and avoiding tobacco,alcohol and other drugs. And remember, the majority of babies develop just fine all on their own.

Karen Klimsak-Ungar, CCE has been a certified childbirth educator for Birth Works® since 1996. She is currently Managing Editor for the Birth Works newsletter, sits on the Birth Works Board of Directors, and serves on their National Trainee Review Committee. A happily married mother of two, she also continues to teach Birth Works classes as well as private classes.

Karen will answer your questions on fertility, pregnancy, birth, breastfeeding and babies. Her advice does not take the place of your practitioner. Personal answers will not always be possible.