There are a few routine ultrasounds that are indicated during pregnancy. They give us important facts about our pregnancy, and today we have a maternal fetal medicine stenographer who’s going to tell us what they’re for, and what to expect!
Today’s guest is Marybeth. She picked up an ultrasound probe for the first time in 1998 and has really enjoyed every minute of it. She has a Bachelor’s of Science degree from Southern Illinois University, and has worked in Hospitals, Outpatient imaging centers, OBGYN offices, and now in a private Perinatology office. She started in general ultrasound and slowly found her way into high-risk OB. Marybeth is certified in Ob/GYN, Fetal Echocardiography, Nuchal translucency screening, Nasal bone, Uterine artery Doppler, and CLEAR. She is a huge advocate for patient education and teaching new sonographers tips and tricks of optimizing their scanning.
Big thanks to our sponsor The Online Prenatal Class for Couples — if you’re looking understand more about pregnancy and labor, this is the class for you. I’ll take you and your partner through each step, both explaining and simplifying it — so you can have the confident birth you’re hoping for!
In this episode
What an stonographer does.
The difference between a regular stonographer vs one who does high risk OB ultrasound
When people have routine ultraounds
How they create a due date for the baby.
Why your due date matters
What the nuchal translucency test shows
What they’re looking for at the 20’ish week anatomy scan
Why you might end up getting another ultrasound to see a specific part better.
Other things that might interest you
My other podcast on ultrasound testing
Producer: Drew Erickson
Check out my other pregnancy podcasts:
[00:00:00.190] – Hilary Erickson
Hey, guys, welcome back to the Pulling Curls Podcast today on episode 131, we are talking about ultrasounds. Totally black and white. Let’s untangle it.
[00:00:19.110] – Hilary Erickson
Hi, I’m Hilary Erickson. The curly head behind the Pulling Curls podcast where we untangle pregnancy, parenting, home and eating, even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life tangled just like my hair.
[00:00:41.770] – Hilary Erickson
Okay, guys, before you get started, you know what else is black and white? Leaving me a review. There should be no question in your mind about how exciting and important it is to leave a review for the Pulling Curls Podcast on Apple podcasts. Thank you.
[00:00:53.500] – Hilary Erickson
Today’s guest is actually a friend of mine from my daughter’s school. She is an ultrasound tech at a high risk pernetologist office, and she is on Instagram on TikTok on the username Sono is she has all this information about ultrasound. So I want to introduce my friend Mary Beth.
[00:01:14.570] – Hilary Erickson
Do you feel prepared for your delivery in just three short hours? You can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all you guys are going to be on the same page from Bump to Bassinet. Join the online prenatal class for couples today. You can save 15% with coupon code UNTANGLED. You can find a link in the show notes.
[00:01:49.950] – Hilary Erickson
Hey, Mary Beth, welcome to the Pulling Curls Podcast.
[00:01:52.750] – Mary Beth
[00:01:53.540] – Hilary Erickson
Now, Mary Beth and I, we know each other from school. We knew that we ran in similar circles back in the day. Yeah, like we weren’t in school together. Our kids were at school.
[00:02:02.380] – Mary Beth
Our kids? Yeah, our kids, our daughters.
[00:02:04.960] – Hilary Erickson
Yeah, but she knows all about ultrasounds. And I have to tell you, a lot of people are like, Hillary, here’s my ultrasound. Can you look at it? I’m like that’s an ultrasound. It’s got that ultrasound shape to it.
[00:02:15.220] – Mary Beth
It’s black and white. Yes. Looks like an ultrasound.
[00:02:18.040] – Hilary Erickson
Oh, that’s beautiful. And they’ll be like, do you know what gender it is? I’m like, that could be an umbilical cord or it could be genitalia. I’m unclear.
[00:02:25.550] – Mary Beth
Yes, I can see a foot. That’s it, right.
[00:02:28.660] – Hilary Erickson
It is not the labor nurse’s forte. So that’s why we have ultrasound text. So let’s just explain quickly. What is your job?
[00:02:37.020] – Mary Beth
I am currently a sonographer with a maternal fetal medicine practice. So that means if you are deemed high risk in your pregnancy, then you would come to our office or a similar office, and you would have an ultrasound and you’d meet with a maternal fetal medicine specialist or a pyramidologist. So they are OB GYN, with an extra emphasis on maternal fetal medicine specifically.
[00:03:00.030] – Hilary Erickson
Yeah. We call them the high risk OB GYN. Basically, when we’re trying to talk to patients and your job is to do the work to get the pictures. Basically. Right.
[00:03:08.210] – Mary Beth
Right. So as a sonographer in a maternal fetal medicine practice, we work really closely with our doctors. So if you come to our practice, we have certain protocols, certain things that we need to get. We work really closely with them. So we kind of start stenographers at maternal fetal medicine. We have a lot more training and a lot more education. So if you are deemed high risk, you would come to one of our offices or an office similar. And it’s just a much more detailed exam. But our doctors just have more education on problems with the baby and maternal problems. So if you’re deemed high risk because of the fetus, either, like, for example, the baby is small or the baby has a chromosomal abnormality, you would see a maternal fetal medicine specialist or if, say, you have high blood pressure or you’re diabetic, then you would be deemed high risk due to maternal factors. So a sonographer is there at a high risk practice. We just have a lot more training and education on how to give you and the baby the best care during the pregnancy. Yeah.
[00:04:03.910] – Hilary Erickson
And you know more about which pictures to take versus just an ultrasound tech at the hospital that does appendicitis and babies and arms and whatever ultrasound OB itself is a specialty.
[00:04:15.690] – Mary Beth
So when you come into, like, pregnancy is a specialist. Gynecology is a specialty. Ob is a specialty. High risk OB is a specialty. So you wouldn’t go to your GP for a broken bone. You’d go to an orthopedic someone that specializes in that. So this is the same process as an OB. They’re good for your general everyday patients, not high risk. But if they need you or if you need high risk help, then we’re there for that. So we’re more indication driven, meaning that you would go to a general OB. But if you need us, we’re there.
[00:04:49.750] – Hilary Erickson
Yeah. And you’re the person taking the ultrasound. I think a lot of people think you then read the ultrasound, which you do not. You have a basic idea. Yeah.
[00:04:57.710] – Mary Beth
I mean, you have to know what you’re doing. So for a high risk sonographer, which is what I am, you do have to know, like, your pictures, they’re much more detailed oriented. So, like at your OB office, your sonographer at the OB office needs to know that your baby has an arm right. At a high risk office, I need to know that your baby has an arm, has all the bones in the arm has the hand. The hand is attached, all the fingers are there. And then the hand opens and closes and it works. So now take that thought process and then apply it to everything else, the brain, the heart, the face, the abdomen. And so it’s kind of like a way to level up all the details on your baby’s anatomy.
[00:05:35.390] – Hilary Erickson
[00:05:35.750] – Mary Beth
But yeah, it’s sonographers. Like observers. They have a tough job. They have to know if something doesn’t look right. And if they think something doesn’t look right, then they would send you to us. So that’s how that works. They have a hard job too well.
[00:05:48.460] – Hilary Erickson
And they’re just seeing more people. Lots and lots of people quickly.
[00:05:51.820] – Mary Beth
Lots of patients and quickly. Absolutely.
[00:05:55.350] – Hilary Erickson
Yeah. So in the hospital, though, when we call ultrasound at the hospital, all the hospitals I worked at, it’s just an ultrasound tech. So they do everything right. They do trauma in the Er, they do appendixes. They do us. So it is very different. And then we will call in the bigger guns if we need to.
[00:06:13.710] – Mary Beth
A general ultrasound program teaches OB GYN. So in a general ultrasound program, you learn thyroid, abdomen things like that. But then you learn OB GYN. So most of the sonographers are in hospitals unless they specifically work under maternal fetal medicine, are general observers. So their goal, again, is to catch something looks abnormal. That is their goal. So they also have a very hard job. But their job is to say, is something abnormal. Do I need to be concerned about this different registries?
[00:06:44.270] – Hilary Erickson
Yeah. Also, we sometimes order ultrasound on baby plus kidneys plus liver plus, you know. So they do need to know how to do all the things.
[00:06:52.220] – Mary Beth
And when I worked in a hospital, that’s what I did. We would do everything. Yeah.
[00:06:56.740] – Hilary Erickson
Yeah. So do most of them start in the hospital, like with just your basic do all the things I think the majority of them do.
[00:07:03.010] – Mary Beth
I mean, like, cardiovascular is a whole other thing. So if you’re only doing echoes, like adult Echo, pediatric Echo, you only go that route. But yeah, most stenographers start in a hospital or an outpatient imaging center. You learn vascular, you learn general. You learn OBGYN the majority of nograders. Yeah.
[00:07:19.730] – Hilary Erickson
Okay. So today’s episode, we’re going to talk about just your basic routine ultrasound that most people end up getting and stay tuned because March is ultrasound month, and we’re going to jump to ultrasound testing that your doctor might order again, something more high risk, like we’re talking about also. Okay. Your basic ultrasound. What one do? Pretty much everybody gets.
[00:07:39.130] – Mary Beth
So I know overall ultrasound, they can be intimidating. I think they’re hard for most people to read and look at and understand. And, sonographers, we’re not. Some of us talk a lot. And some of us don’t. And I think that I have found that when people are concentrating, they stop talking, which then you, as a patient, are like if something’s wrong. And I just think that we’re all different and some talk a lot, some don’t. But there are certain protocols and certain things. We look at depending on your gestational age. So most people do get an ultrasound in their first trimester. This can be anywhere from five weeks to typically, 1112 weeks. So what are we looking for at that first trimester ultrasound? The first thing we’re looking for is is there a pregnancy in your uterus? How many gestational sacks do we see? Are there more than one? Is there a baby in that gestational sac? Is there a heartbeat in that baby?
[00:08:33.090] – Hilary Erickson
That’s a big one.
[00:08:33.950] – Mary Beth
That’s a big one. That’s a big one. Is there a heartbeat? This should be measured by what we call M mode, which is just a motion mode. We’re just measuring the motion of the heartbeat. The Doppler sound we’re taught we should not use in the first trimester because we want to keep any power that could go into your baby. We want to keep that as low as possible. There’s been no proven effects from it, but we just don’t want to expose your baby to any unnecessary power. So you may or may not hear the heartbeat at this time, just depending on your practice and what they do. We also measure what’s called the Crown rump length. That also is CRL. We use that. And that just tells us how big the baby is. We like to look at your ovaries. We would like one baby in the uterus, please. We do not want one in the ovaries. And then we want to look at your overall uterus. How is the shape? How is the size, any fibroids, anything we have to be concerned about. So that’s what you’re looking for in the first trimester ultrasound. Now, if you were coming in for, like, an emergency, we want to see, is the pregnancy viable?
[00:09:29.890] – Mary Beth
If you’re bleeding, we want to know, is there a sub chlorine hemorrhage? Is there a reason why you’re bleeding? And if you’re coming in for pelvic pain, we want to make sure that it’s not a topic, meaning it’s in your tube or in your ovary. And we want to make sure that your ovaries look good.
[00:09:43.550] – Hilary Erickson
[00:09:44.000] – Mary Beth
So that’s kind of your first trimester.
[00:09:46.250] – Hilary Erickson
Now, a lot of people get this one at the obese office.
[00:09:49.500] – Mary Beth
[00:09:49.970] – Hilary Erickson
Especially if you’re in a absolutely larger practice that has a machine. Not everybody does it. Some obese will send you out for this, but a lot of them just do it in the office, mostly to make sure there’s a heartbeat.
[00:10:00.930] – Mary Beth
Right. And you’re dating like this is when your due date is best determined in the first trimester. So there are guidelines for your dating. The dating is most accurate in the first trimester, because all babies grow exactly the same in the first trimester. So your genetics do not play a role. So if you come in and you’re under eight weeks, if the baby is more or less than five days, we keep your due date based on your last menstrual period. We do not change it. So once your due date is established, that tells us how big the baby should be going forward in your pregnancy, what your due date is. So we don’t keep changing it. It could be a couple of days off. That’s fine. If it’s more than say you come in, you think you’re six weeks and you’re really ten. Well, then we would change your due date based on ultrasound date, not your last month period. And this is really helpful for people that don’t have regular periods that don’t track. Maybe people that have PCOS and don’t ovulate regularly. This is really important as soon as possible to date you. So that all your testing from that point on is accurate and that’s blood work, ultrasound, all of that.
[00:11:04.150] – Mary Beth
Some of it is very particular to how far along you are. So it’s best to be dated and to know, is there one baby in there two or three. That’s when we find out multiples and we can manage your care from that point on.
[00:11:17.150] – Hilary Erickson
Yeah. That first ultrasound is super important. I see a lot of people are like maybe the doctor saw a heartbeat in the office, but they want them to go in to get dated because the doctor doesn’t do that in the office and they’ll skip that. But it really is important. Just so we can know if you have a problem in your 37 weeks. It’s really different than a problem in your 39 weeks.
[00:11:35.070] – Mary Beth
Exactly. Or 32 weeks.
[00:11:36.640] – Hilary Erickson
We really want to know how far along you are as accurate as we can be because it just depends on so many things later on. That first one is so much better, so important. Yeah.
[00:11:46.190] – Mary Beth
Absolutely. And then the further along you get, the less accurate your dating gets. So in your third trimester, we’re not changing your due dates, because if you have a small baby, we then don’t keep you pregnant longer to grow the baby. We don’t keep you pregnant for a year. Right. And if you have a bigger baby, we don’t say, oh, 30 weeks is fine for you, because then we just have a big, immature baby. So we keep the same date, hopefully based on your last menstrual period confirmed with an ultrasound. And then that is our expectation of how big the baby is. And it really does make a difference at the end of the pregnancy. That’s what I think it really matters. And unless you have complications, we need to know how big is this baby supposed to be? It creates a common denominator for us or how developed.
[00:12:27.720] – Hilary Erickson
Because then that shows us how our lungs. That’s always our big one. Like, how are we going to breathe on the out of sides?
[00:12:34.090] – Mary Beth
Yes. It makes a big difference at the end, for sure, it can. Absolutely. So that’s really your first trimester. That’s really what it’s meant for. Is there a baby? How many babies are in there? Is it consistent with your dates or what is your new due date? And how does the heart rate look? So that’s the most important thing.
[00:12:51.710] – Hilary Erickson
And it’s pretty quick. I think a lot of people are like, oh, it’s really short. And I’m like, well, there really isn’t all that much. It’s tiny. It’s a very tiny little thing.
[00:12:58.850] – Mary Beth
It’s really nice. I mean, it’s adorable, but really, there’s not a lot to do. There’s no anatomy involved. It’s just is it there. Look at this cute little baby. That’s what we hope for. Cute little healthy baby all the time.
[00:13:09.840] – Hilary Erickson
That’s every single hope. Yeah.
[00:13:11.810] – Mary Beth
Every hope. Absolutely. So that’s normally, like, your first ultrasound up until about twelve weeks now, typically, a lot of OBS recommend the neutral transistency or the first trimester ultrasound. And that can be done anywhere from, like, twelve to 14 weeks. This is a very timed test because the first trimester combined screen blood test, the baby can only be so big. So if you come into early, you don’t qualify or if you come in too late, you also don’t qualify. So it’s very specific around that twelve weeks of pregnancy. Most insurances that I know do cover this. Some people do blood work prior to the ultrasound, like a NIPT and noninvasive prenatal testing or nips, noninvasive prenatal screening. And that’s for chromosomal abnormalities. Some people do the ultrasound with the first trimester combined blood screen. That’s normally what happens. The blood work part with that ultrasound, this twelve week ultrasound. This is when your baby really starts looking like a baby. They have this cute little profile, and their head and their body are proportionately sized. Meaning, like at the beginning, the head and the body are like, the same size, like little gummy bears. But now they look like a normal human.
[00:14:23.440] – Mary Beth
So we see arms and legs. And I read somewhere once that at twelve weeks, the baby is the size of a Matchbox car. So they’re tiny. And it’s amazing that we can see all this detail. But the test is so that we measure the skin on the back of the baby’s neck. And that’s called a neutral fold. And so if their skin fold is increased, that increases your chance of having a baby with a chromosomal abnormality. So I like to think, like, at the twelve week ultrasound, we’re hopefully able to rule out the big stuff. Is there a brain? Do we have arms? Do we have legs? Do we have any swelling around the baby? This can catch a lot of major abnormalities really early. So I really like this test. I think it’s a great kind of intro to. Is your baby progressing normally? Does your baby look normal? Do they look healthy? And it’s a really good test to see that right at the twelve week time.
[00:15:15.820] – Hilary Erickson
Yes. And this is one that your mom, if she got older, sounds probably didn’t do because they just came out with it when I was pregnant with Pageish. So probably around 20, 06, 20 07.
[00:15:26.890] – Mary Beth
[00:15:27.590] – Hilary Erickson
Was when it started.
[00:15:28.490] – Mary Beth
I don’t remember. Yes, it’s a new thing, but it is fantastic. And the more sensitive that our ultrasound machines get, the better these images are. So they’re starting to see new studies have come out that say, if you’re at higher risk for spina bifida, there might be something that we can see in the baby’s brain at twelve weeks. That would make us concerned for that. Whereas before, we wouldn’t do that until 20 weeks. So as more information comes out, more studies come out around this twelve week ultrasound, the better we get in diagnosing these big defects early.
[00:16:01.210] – Hilary Erickson
Yeah. I know a lot of people don’t want to do the nuclear translation because they wouldn’t abort. Either way, they’re happy with whatever baby God gave them.
[00:16:08.580] – Mary Beth
[00:16:09.170] – Hilary Erickson
But it can. Also, as you said, it gives you just more time. Like, if you found some issue with the spinal cord or something like that, then you have more time to make a plan as to what you’re going to do after the baby’s born. We’re not saying that this is a reason to abort or anything like that. This doesn’t have to go hand in hand with anything like that. It just gives you more information and more time.
[00:16:26.510] – Mary Beth
Right. I don’t ever think of this in that setting of this as a termination thing. I look at it like we want you to have as much information as possible so that you can make the decisions that best suit you and your family. If people come in. Well, I wouldn’t have worked anyway.
[00:16:42.770] – Hilary Erickson
[00:16:43.380] – Mary Beth
That’s awesome. But if your baby has a heart defect, the earlier you can find out the more of it. More information, the more information you can get. Groups what hospital you can meet with surgeons. I mean, it opens up this. I have more control and I can do something about it instead of when the baby is born. Now we have a heart defect, and now we’re scrambling. So I look at all these ultrasounds like this. None of this is termination stuff. This is all as sonographers and as a healthcare team, we are here to provide whatever the patient wants to do in her pregnancy. If the patient wants to go through, then we support that decision. If they decide to terminate. We also support that decision. So as healthcare providers, we are there for whatever the patient decides to do.
[00:17:24.950] – Hilary Erickson
Yeah. So make your choice based on how you could get more information. Not like your pro life stance. That’s what I always tell people in this situation because it’s just more information. And also, this doesn’t entirely rule out a problem either. People can still have all these ultrasounds, and then the baby comes out and you’re like, Whoa, how did we miss that?
[00:17:42.950] – Mary Beth
Right. And there is, like, a certain percentage of babies with down syndrome that will not show anything on ultrasound so you can go through. And if you don’t do I know the NIT is 99.6% accurate, but some babies, they don’t show anything. So this never doesn’t rule out everything. It’s just the best that we have, though. And this is what we want to do with it. We want to give you as much information as we possibly can. Yeah.
[00:18:07.860] – Hilary Erickson
Okay, then let’s move on to the big one. Well, it’s not really the big one, but everyone thinks it’s a big one because it could tell us the gender.
[00:18:14.370] – Mary Beth
Yes, that anatomy ultrasound. Now, I want to circle back. So some people do go between that twelve to 17 weeks and they do an entertainment ultrasound just for gender. That’s great. I think that’s wonderful. If you want to do that. Great. That’s cool. I’m cool with that. But the anatomy ultrasound. Yes, it typically includes gender or sex, depending on how naughty or not naughty your baby is. But it really is. This is the big one. I was at a conference a few years ago. Well, probably ten years ago now. And one of the doctors said if he could pick one test to do through the entire pregnancy, it would be an anatomy ultrasound if he didn’t have the choice to do blood work. It didn’t have the choice to do any monitoring. The 20 week ultrasound would be his choice. He was also an OBGYN radiologist.
[00:19:05.430] – Hilary Erickson
I might take blood pressure, right.
[00:19:07.880] – Mary Beth
But he was like, if I could choose one, this is it. But the fetal anatomy ultrasound. So this is the one that most people do find out their baby’s gender at.
[00:19:17.790] – Hilary Erickson
Wait, let me go back to entertainment ultrasound. Is that one you’d get at the mall?
[00:19:21.590] – Mary Beth
I don’t think they’re at the mall. I don’t think they’re at the mall anymore. Now. They used to be.
[00:19:25.560] – Hilary Erickson
I’m so old. I’m dating myself.
[00:19:27.360] – Mary Beth
A few of them actually did used to be at the mall. Yeah, but I think we’ve kind of cracked down on those because those were typically done with people that were not registered sonographers. So they didn’t have any experience. And what happened was people would think, Well, I had an ultrasound. There might be a major defect, but that person, your skill that’s not registered, not licensed. They’ve missed things. So most entertainment ultrasounds are done by registered Tomographers now.
[00:19:56.080] – Hilary Erickson
[00:19:56.780] – Mary Beth
I don’t know many companies that don’t hire or don’t have people that have gone through a program, and that can prove that they know what’s going on with your doctor. Order that or find that out on the is it mostly cash pay. You do that on your own. Some OB offices actually provide that service for $50. You can come into your OB and do just a gender scan at 16 weeks until they’re wrong. I kind of appreciate the OB doing that because it’s like if they’re going to as a patient, you want to know and you’re going to spend the money anyway, why not go to your OB who you trust? A sonographer that you may already know is already skilled, and you want to find the gender early? I actually am perfectly fine with that. And I feel like, great. I’m good. I’m good with that. So I know that we call it the anatomy is like most people refer to it as the gender ultrasound, but most people find out either by an NIT like the blood work or they do an entertainment ultrasound prior to that.
[00:20:54.740] – Hilary Erickson
Man, I am old. I always waited for that. Although at Kaiser, they did this ultrasound between 16 and 18 weeks. I always knew early with the two that I had Kaiser in California. Who knows?
[00:21:06.640] – Mary Beth
Well, anatomy scans are typically done after 18 weeks. Now, if you’re diabetic or there’s an issue, you might do one earlier. So typically, though, is that 18 weeks and a lot of people do wait for that. But there are some that don’t want to. They want to do the gender early. That’s fine. I’m here for that. I think it’s great. And I’m glad that you go ahead and go do that. And then I’ll do the hard stuff.
[00:21:28.890] – Hilary Erickson
Well, the more love and excitement you can have for your baby for that, because it’s a very exciting and a big moment.
[00:21:34.490] – Mary Beth
Totally is. And the more if you want to know the gender early and you feel more connected to your baby and your pregnancy, I’m all for that. That’s the whole point is that you’re happy and you feel more connected and that is a part of the ultrasound as well.
[00:21:50.100] – Hilary Erickson
We’re not saying that it’s all just one sterile medical procedure, but I think both mom and dad, all of a sudden realize there is a human inside my body. Oh, my gosh.
[00:21:56.990] – Mary Beth
Totally. And when you have a good ultrasound and a good experience, that just increases that for the patient and their family. Absolutely. Yeah, I agree.
[00:22:07.070] – Hilary Erickson
Okay. What do we see in the 18 to 20 week?
[00:22:11.370] – Mary Beth
Some abnormalities are easier to see. Some are harder, some are more finer detailed. Some are trickier. Some don’t show up until the third trimester. So we do our best with what the baby shows us. Sometimes, if the baby is not in a good position, we may bring you back to recheck anatomy, but a basic, detailed ultrasound includes the brain, the face, the chest, the heart, the baby’s abdomen, the stomach, the kidneys, the bladder. We look at the umbilical cord. We look at where it comes inside the baby’s belly, and we look at how many vessels there are. There should be three. There are two arteries and one vein. We look at the spine, we look at the arms and we look at the legs. We also look at the gender, even if you don’t want to know that is a part of your baby’s anatomy. And we would like to see that that is normal. We always do measurements. We call them the biometry that tells us how well the baby is growing. We look at your placenta and the location of the placenta. We look at the amniotic fluid, typically before 24 weeks. It’s not measured.
[00:23:13.390] – Mary Beth
It’s just subjective. Does it look normal? Does it look high, low. We always look at your ovaries. We look at your cervix. We obviously look at where the baby’s position and how many babies are in there. So that’s kind of your general overview of what we’re looking at and that’s in a basic anatomy ultrasound, like when you would get done at your OBS office.
[00:23:34.330] – Hilary Erickson
Yeah. And I’ve seen problems with all those areas.
[00:23:36.480] – Mary Beth
All of them.
[00:23:36.910] – Hilary Erickson
Some are big. Some are not a big deal.
[00:23:38.600] – Mary Beth
[00:23:38.990] – Hilary Erickson
And some come out, and there’s absolutely nothing wrong.
[00:23:41.680] – Mary Beth
Right. Well, in some of this, some of this stuff kind of we may see it the anatomy scan, but by the time the baby is born, it’s gone. So sometimes we can see small little holes in the heart. But by the end of the third trimester, the baby has taken care of it, and they’re born without one. So it does happen that things look big at the anatomy and then slowly get better over time. So there’s a lot of monitoring whenever we see something, because we just don’t want to assume, like, oh, we see it now. It’s probably not going to be a problem later. We do a lot of let’s make sure it’s still good. Let’s make sure your baby is still healthy. Which kind of leads me into follow up ultrasound. And this is something that we do them when we’re monitoring the pregnancy. So this would be after your anatomy scan. Typically, it’s after your anatomy scan. So for the baby, we might be monitoring the baby’s growth. Is your baby big? Is your baby small? Are we watching baby’s heart? Are we watching the kidneys? If it’s a maternal reason, it’s more like, are you diabetic that can be prediabetic?
[00:24:43.090] – Mary Beth
That can be gestationally diabetic. Do you have high blood pressure? We monitor for your amniotic fluid if it’s low or if it’s high. And we also like, if you have placenta preview at the anatomy scan, we want to watch that placenta and see that. Is it changing? Do we need to adjust your delivery based on the placenta location? So a lot of these, a lot of the later ones are just kind of follow up because we’re looking at something very specific. So that’s different than you’re an Adam ultrasound, but we’re always looking for, like, how does the brain look? How does the heart look? Stomach, kidneys, bladder. We’re always looking at that. And, like, the amniotic fluid, it’s something that’s constantly rotating through your baby. Right. So your baby lives in a bubble and they eat, drink and pee in the bubble. So when I see fluid in the baby’s stomach, I know the baby can swallow. When I see fluid in the bladder, I know the tube from the kidney to the bladder are open. And when I see fluid around the baby, I know your baby can pee. So we just eat, drink, pee, eat, drink, pee all the time.
[00:25:37.190] – Mary Beth
Now, before 15 weeks, the mother’s body makes amniotic fluid for the baby. But at 15 to 16 weeks, their kidneys start to take over that production. So we’re always monitoring the kidneys because we want to know. Okay. We got good amniotic fluid around the baby. The kidneys are working. We look like we’re healthy, and we’re moving right along. So there’s always things that we’re looking for and evaluating for all throughout the pregnancy.
[00:25:59.940] – Hilary Erickson
Yeah. And that’s usually when I get the freak out ultrasound for my friends. And a lot of those follow up ultrasounds is maybe because your baby is not cooperating, they can’t see the four Chambers of the heart. Or there’ll be like, a shadow on something, and they’ll be like, we couldn’t really tell you. We want you to come back, and hopefully your baby’s in a new position that stays so that we can have a better view. Because on a regular ultrasound, we just tell you to turn over. But your baby does not listen at all at all.
[00:26:26.690] – Mary Beth
They are. And they’re living their best baby life. And just like kids, they do not care what we want. They don’t care. They’re like, I think I’ll just stay right here with my hands over my face so you can’t see my nose and my lips. They don’t care. So there is a part of it. Like, if you cannot clear the anatomy, let’s say it’s your anatomy scan, and we cannot see the heart. We do not assume it’s normal. We just have you come back. Baby gets a little bit bigger, gets in a different position. Boom. We got all different pictures, and I like, I personally, like, in anatomy stands and follow up scans, I want your baby moving. I know it sounds crazy. Like, I don’t want them flipping all over the place, but every position your baby gets in shows me that that’s normal. Right. So if your baby’s right, and then we’re left, and then we’re breached, and then we’re transverse, like, I want to see your baby looks normal in every position. So when they move around a lot, I can see multiple positions of the baby. So I would like them to move and then hold still, right.
[00:27:17.950] – Mary Beth
Like, move, pause, move, pause. That doesn’t always work, but that’s my ultimate goal. But sometimes babies just don’t move, and we just will not clear it. If we can’t see it very simple. We never assume we want to see it. We want to see that it always looks good and that the baby remains healthy. Always. Yeah.
[00:27:35.350] – Hilary Erickson
So I always tell people ask, like, was this just because the baby was in a funny position? Or are you seeing something that made you nervous, right? Because sometimes they’re just like, we’re going to have you come back for a second one. And that’s not helpful, right?
[00:27:47.840] – Mary Beth
It’s not because if it’s explained to you, hey, I can’t see the heart. So we’re going to just have you come back and I try to tell my patients I don’t think there’s anything wrong. It’s just a physicianal thing. I’ll try to give them that, especially if they see that, like my detailed exams, they take an hour to do for maternal fetal medicine practice. So if I’ve tried for an hour and I cannot get your baby’s heart, we’re done. We’ll have you come back in two weeks. But I feel like that should be well explained to you the reasoning. And as a patient, if you see it like, boy, that baby didn’t roll over, then you kind of understand the need for it as well. So it’s important to ask a lot of times when patients come in for their follow up. I like to ask them. So what is your understanding of today’s appointment and that kind of opens up for the patient to say, oh, the last time we didn’t see the heart? Oh, that is also my understanding. Okay. So it’s kind of nice to get a patient’s perspective before I come in bulldozing with what I think my reason is, does that make sense?
[00:28:42.500] – Hilary Erickson
Yes. Versus they just told me to come back, right.
[00:28:45.420] – Mary Beth
I want you to think about it because being knowledgeable is empowering in your pregnancy, being aware of what happens in your pregnancy, why you need certain tests. It just gives you more information, and it gives you more empowerment. You’re just that knowledge itself. And I think as a patient as you have that I think it’s better for you.
[00:29:05.800] – Hilary Erickson
Yes, for sure.
[00:29:07.370] – Mary Beth
[00:29:07.940] – Hilary Erickson
Because then you don’t worry about needless things about, like, your baby’s just obstinate. Good luck.
[00:29:13.230] – Mary Beth
Right. Or if it’s a growth issue, then you know, okay. My baby is small. I’m looking for this thing. This is why antinatal testing is so important. This is why it’s important to come to my ultrasound or I’m diabetic. So I know I have to watch my sugars more. It’s knowledge of just the health of you, the health of your body, the health of your pregnancy, the health of your baby. And that kind of leads you into. Then you can understand why the next parts are so important.
[00:29:37.720] – Hilary Erickson
[00:29:38.500] – Mary Beth
It’s a big deal.
[00:29:39.480] – Hilary Erickson
Mary Beth and I were talking about this in advance a lot of times. Maybe your doctor will say we didn’t see the heart very well. But all you hear is something’s wrong with the heart. And if you get home and you’re like, I literally have no idea what they said. Sometimes, then my husband will be like, Well, what did they say? And I’ll just be like, heart. You only remembered one word you can always call back say, I just didn’t understand what was explained or if your appointments in the next couple of days, maybe they just wait for that. But if you had, like, a counseling by the provider and then you have no idea what was said. And then again, you’re turning to people on Instagram and TikTok, maybe call your provider, ask them. They want you to understand what happened, and they understand that sometimes it’s just a fog, especially if it’s a big deal.
[00:30:24.260] – Mary Beth
Absolutely. And I think it’s important that patients feel comfortable telling their providers. I just need you to explain it to me again, or I didn’t quite understand it. You should never feel bad reaching out again and asking for more clarification ever. Isn’t there some statistics that we only remember, like, 30% of what is said in a visit? It’s some kind of statistic. I’d have to look it up. So if you get big news or what you think is big news, I think it’s hard to understand and retain all at one time. So I think it’s perfectly normal for people to come back and say, Please explain this to me again, or I don’t quite understand it. Could you explain it in a different way? I think you should always be able to do that with your provider. Always.
[00:31:04.210] – Hilary Erickson
Yeah. And if you can’t talk to the parents or just maybe you don’t have their number or whatever, you can call your OB, and they most likely can explain it. Or if they have any questions about how to explain it, they can call the perinatologist as well. So you have lots of providers that you can reach out to and definitely reach out because they want you to understand this. It’s not like they didn’t just walk in the room and say Hi and walk back out, even though that’s all that you understood or took in which we totally get these are big, overwhelming, life changing things sometimes. And a lot of times they’re not just FYI. Yeah. I have so many people freaking out from ultrasound that I’m like, let’s just wait. Let’s just wait.
[00:31:40.890] – Mary Beth
Very true. And I think really, of all the pregnancies, congenital abnormalities only make up 3% of pregnancies. That’s the latest data. So yes, typically it’s not a big deal, but sometimes it is. But you should know that statistically, it’s actually very low.
[00:31:56.630] – Hilary Erickson
Yeah. And so many are super flexible. It’s amazing.
[00:32:00.430] – Mary Beth
Oh, my gosh.
[00:32:01.150] – Hilary Erickson
What they can do, right?
[00:32:02.500] – Mary Beth
You got an extra finger. Take care of that. That’s no big deal.
[00:32:06.150] – Hilary Erickson
[00:32:07.190] – Mary Beth
Yeah, it is.
[00:32:09.510] – Hilary Erickson
All right. I’m going to let Mary Beth go right now, but stay tuned. In two weeks, we are going to talk about testing, which is going to be awesome, because as you get into your third trimester, you may see that ultrasound tech more than your husband. Thanks for coming on, Mary Beth.
[00:32:24.040] – Mary Beth
[00:32:24.650] – Hilary Erickson
Okay, guys, I hope you liked that episode. I thought it was so helpful to talk about what to expect in an ultrasound, because I think all of us just kind of think heartbeat gender. But there’s so much more that they’re looking at and can tell us. And just like she said from when I started labor and delivery until now, the ultrasounds are night and day about what can be seen on them. Now, the ultrasound at your provider’s office may not be that good, but the ultrasounds that techs use in big offices are amazing.
[00:32:51.190] – Hilary Erickson
Be sure and stay tuned for Part two, which will run in two weeks. Where we’re going to talk about like third trimester testing. And next week we’ve got a fun one coming up about what to do when you are really mad at your kid. So always a little something for everyone here on the Pulling Curls Podcast.
[00:33:05.680] – Hilary Erickson
Thanks so much for joining us on today’s episode. We know you have lots of options for your ears, and we are glad that you chose us. We drop episodes weekly. And until next time, we hope you have a tangle free day.