Posted on July 6th, 2016 by wombwithaviewblog.com

I’m so sorry here for the pun! I am..or maybe I should say I DO! Yes, we’re finally getting married after several beautiful years together and my girls could not be happier!

So, firstly and regrettably, this post is not about ultrasound and I realize I may have left you hanging for quite some time. If anyone knows what I mean, it’s you moms out there who have ever planned your own wedding or maybe you do this for other people for a living! (God bless your souls.) I used to think you people were only for the rich and famous. You really should just be bestowed a PhD for maintaining our damn sanity. It’s a million little activities that rob one of precious sleepy time. And does my family know I need THAT..

Leave it to me to take on the world at once. Not only is it stressful and labor intensive to get married but to plan a wedding, to sell one’s house, to pack up one’s house, to attempt to sell one’s house while living in it, to leave a job of 15 years and a kid (ok, so she’s not a kid at 21) to relocate someplace entirely new.. Get the picture? Whew..I’m exhausted just writing it!

We do have friends and family in the new place..it’s about starting anew and breathing life into our lives. Some of the planning is actually beginning to be a little enjoyable even though I have lost a few brain cells along the way. Who stores cheese in the spice cabinet? Anyone planning a wedding and moving and leaving a career all at the same time! Yes, I said it. I believe I may be ending my career in ultrasound.  It’s not a definite yet. I do still really enjoy some aspects of my job and I might even actually miss it enough to start over. Time will tell.

In the meantime, I am concocting all sorts of creative ideas for my blog. I’ve been wanting to publish a book about the blog and possibly a children’s book or two, get creative with baby shower gifts and accessories and sell them all right here on my site!

So, I beg of you, please forgive my absence until then. I may try to sneak in a post here and there but I plan on getting back into the swing of things after September! Please continue to email me with your  ultrasound questions and I’ll always try to provide you with some clear and clever insight!

Do I miss my babies and patients and readers already??

I DO;)

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Posted on May 12th, 2016 by wombwithaviewblog.com

What’s the worst position a fetus can be in if you want to determine fetal sex? You guessed it! Look no further than the image below to answer this question! The breech fetus compromises most of what both you and I want to see.

breech fetus

 

20wk facial profile

Above is an example of baby flipped over and looking up. How much better do you see baby’s face??

This post is really a continuation of the last, an example of just how much position plays a part in how well we see. The baby in the first image is not only lying in a breech position, or butt-down, but baby is also facing Mom’s back (prone). If the wait for your 20wk sonogram and whether you’ll be shopping for pink or blue has got you losing sleep, the LAST thing you’ll want to see is your baby looking like the image above. It spells one word..disappointment. If baby stays in this position throughout the examination, the possibility of seeing anything cute is essentially nada.

Here’s hoping you have more luck than this patient had!

 

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Posted on May 9th, 2016 by wombwithaviewblog.com

Determining fetal sex by ultrasound is not so easy a task as most think. Actually, this is such a misconception that I thought it worthy of yet another post.

Making a boy vs girl determination requires far more expertise than just sticking the probe to the belly. And babies do not just automatically cooperate, either. Not only does baby need to be positioned well but legs need to be wide open and other parts cannot be covering over external genitalia. If so, the chances of holding that reveal party are slim to none.

Another bit of misinformation is that we can force baby to move. Holy cow, if there was one magical button to push or lever to pull, I can promise you not a one of us would hesitate for a second. We would stand you on your head, send you into the hallway for a command cartwheel performance or bend you into a pretzel to make it happen! Unfortunately, babies are comfortable where they are most of the time and they only move into another position if they wish to do so.

It’s all about angles. Being far enough along and baby in the right position is only part of the task..when I’m the one scanning, that is! Most of my emails come from people who want a second opinion but, most of the time, it’s one I cannot give! Either baby is too early or the image is just plain, well..terrible. The truth is I just can’t comment on what I can’t see!

We don’t mind telling you your baby’s sex, by the way! The problem for us comes, however, when we can’t see what our patients want. Then what we’ve done is not good enough or we “didn’t scan long enough” or they become angry because they do not understand why we cannot see, even if we explain all the reasons. I have scanned tens of thousands of babies. Why would anyone assume that I cannot recognize when this information is obtainable vs when it isn’t?

So, here are a few recommendations for you for your next ultrasound of you are busting at the seams to find out boy or girl:

•Try eating or drinking something about 30 minutes prior to the exam. This usually gets baby more active. Now, I’m not condoning a double espresso and Snickers combo (yummy, yes; smart, no). We don’t want your fetus launching into orbit. Instead, try enjoying a hearty and healthy lunch or breakfast prior to your scan.

•Keep an open mind knowing that not seeing the sex this day is definitely a real possibility!

•Don’t shoot the messenger! In other words, don’t take out any frustration you may feel on your sonographer. We would never secretly communicate with your fetus to intentionally not cooperate;)

Believe me! We would love to help you plan your party, shop for baby clothes or decorate a nursery. It’s the most fun when we can! And when we cannot, it’s a real bummer..for you, because you leave disappointed and for us because we’re blamed as the party poopers.

I’ve posted these before but below are a couple of really great images of external genitalia, first boy then girl.

 

Also, if you send me an email asking me to confirm earlier than 18wks or if the image is not adequate like what you see above, you may receive the links below to other posts containing  very easy, no-mistake pics of boys and girls!

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/

http://wombwithaviewblog.com/boy-girl/

http://wombwithaviewblog.com/boy-vs-girl/

http://wombwithaviewblog.com/twin-gender-update/

http://wombwithaviewblog.com/third-trimester-male-gender/

Good luck on your next scan!

 

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Posted on May 8th, 2016 by wombwithaviewblog.com

In commemoration of Mother’s Day, I’d like to share a message with you, all my readers who are mothers or mothers-to-be themselves, from me, a mother of two myself. A mom and one of fame for being a great one, Brene’ Brown wrote a beautiful and inspiring letter of family law to her children. A very intuitive someone special introduced me to her Parenting Manifesto. Look it up if you haven’t already done so! I’ll give you a little dose today of my own passionate advice for what parenting means to me. If this offends some of you, I’m sorry you are offended. These are simply my personal observations and opinions! Enjoy!

We see it in the workplace and all around. Everywhere there are mothers of children of all ages. Some moms are good…really good. Good at much-needed discipline. Good at constructive criticism. Good at loving their children for who they are. Some, not so much. Some are aloof. Some over-attentive, much to the annoyance of everyone within earshot. “Do you want a game or a song? Do you want this song or that one? Oh, not this one? Do you want it louder? How’s this? Do you want a snack, too? Which one?..”

For Pete’s sake..just give the kids something and if they don’t like it, they get nothing. Two choices, that’s it. An old friend of mine always said this to her kids. “You get what you get and you don’t care a bit”. And there’s nothing wrong with the “this or nothing” style of parenting! Kids don’t need 40 choices to make them happy. They might need 40 choices to make you happy and them quiet. But what happens is, inevitably, the 40 choices are not enough and the parent ends up scrambling for more and more options, so the kid requires more and more and more things to make him happy. And quiet. The problem with this is it’s unrealistic to maintain throughout the child’s life. They cannot be accommodated to contentment in every place of business, education or leisure they visit. Nor should they be. I think what this leads to is an expectation from the child of the rest of the world to cater to their every need and whim. When they can’t have their way, they have a meltdown. This isn’t fair to their sitters, teachers, other family who have to be in their presence or the rest of humanity who has to bear witness to said meltdown. Is this the child’s fault?

Or how about this scenario. A 2-year-old is allowed to run up and down grocery store aisles or halls of a doctors’ office because “she’s not hurting anything” or “he just loves to run everywhere”. So what? There’s a time and place for everything. You’re going to feel differently if someone on a mission comes barreling around the corner and knees little Timmy right in the forehead, punting him straight into next week. It won’t be pretty! And I’ll feel really badly (because, of course, it will be me that will coincidentally do the punting) but the first thing I’ll think after Timmy is revived is why the hell this parent was letting her kid run around in a place of business, anyway?? I just don’t have much tolerance for lack of discipline or common sense.

Our job, first and foremost, is to love our children and, secondly, to prepare them for this thing called life. And loving them is not defined as giving them everything they want. Contrarily, it’s providing what they need and, if we/they are so fortunate, some things they want.

Our children are gifts bestowed on us. They are of us but they are not us. Even though we know they have their own personalities, likes and dislikes, we spend our whole lives pushing onto them our belief systems, mores, ideals, hopes, dreams and expectations. No one is perfect. I’ve done this myself. However, my own discovery reveals that one of the hardest but most beautiful things about being a mother is to realize how your child is different from you and then to embrace and encourage their strong suits in life. It’s an incredible thing to watch your child flourish. Flourish passionately. That’s what I want for them.

I was blessed with two very talented, driven and creative young women. As they have segued into adulthood, my only requirements are that they have a productive goal(s); that they work hard to achieve those goals; that whatever they do, they do it with 110% passion, that they work on their spiritual selves and that they make a positive contribution to society. With relationships being a give and take, my pledge to them is that I will always do whatever I can to help them reach their goals as long as they are doing their part. They both will make incredibly devoted wives and mothers themselves one day, if they choose, and a couple of spouses will find themselves very lucky and very happy, indeed.

My children know I love them both more than life. They know I’ll be honest in my opinions and that I’ll always act in their best interest, even if it’s not what they want to hear. My job or goal when they were adolescents wasn’t to be their best friends or the “cool” mom. I’ve made mistakes in judgement and have regret some of those decisions. What’s the old adage? Hindsight is 20/20? Any parent who ever really parented knows what I mean here. We want our children to forgive us when we make a well-intentioned mistake; we should do the same for them.

So, to sum up my lessons of motherhood, let me roll it into a nice, neat little ball with a few bulletpoints that worked for me and my family:

•Our children need love, structure and boundaries. They will have boundaries their whole lives so we must teach them what those look like from the earliest time they can understand it.

•Mutual respect is earned and cannot be demanded. They’ll grow to respect common sense decisions when you hear them out, demonstrating their feelings are important to you.

•Create family rules and consequences. Be consistent! Who can respect a rule that you allow to constantly be broken?

•Tell them everyday you love them. Hug your children and tell them how proud you are of their accomplishments. Don’t you want to work harder when you receive kudos for a job well done?

And, lastly, who cares what sex we have? Patients of mine who find this of the utmost importance, this is for you. We never have any guarantees in life what path our children will take. You wanted a child. You were blessed with one. There are no guarantees for healthy or heterosexual, football star, ballerina, doctor or straight-A student. If a child was sent to you, you earned the blessing or needed him or her.

So support him or her.  Encourage him or her.

And love him or her your whole life and beyond.

He or she deserves nothing less.

11wk fetus

Happy Mother’s Day to you all!😍

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Posted on April 17th, 2016 by wombwithaviewblog.com

Every once in a long while, or blue moon, I receive an email posing a phenomenal question regarding diagnostic ultrasound! And it’s not one about fetal sex, much to my sheer happiness. Keep reading to see what was on her mind..

concerned mama:  Hi there! I would love to get your opinion on something, if you don’t mind. I was born with bilateral congenital hip dysplasia, and therefore have a 1/12 chance of having a baby with the same issue. I was just wondering, is there any way to spot this on U/S? We have already had our 12 w NT ultrasound, but I was wondering if I should ask at our next one (19w). I know it’s not a major life threatening issue, but I just wondered if it would be worthwhile to ask about when we next see a sonographer. In case early U/S can help you spot red flags for dysplasia, here is a shot of my little one, I believe in spread eagle position, showing both hips (?). I’m no expert :)

Thanks for any info you may have! :)

wwavb:  Excellent question! In short, no. (Her image was omitted here since it is not relative to her case or this post.) Hip dysplasia is questioned by the pediatrician during neonatal examination and can be confirmed by ultrasound of the newborn by scanning the hip joint in a particular plane while applying pressure at a specific point to see if it’s pushed out of place. I did a few of them many, many years ago and cannot recall all the details of the exam, per se.

Thanks for the great question and I hope you will continue to read! Many blessings for a happy, healthy pregnancy!

wwavblogger
***

It has probably been something close to 20 years since I’ve performed just such an exam. Wow, time flies when you’re having more fun than one can stand in the hospital setting.

If I remember correctly, hip dysplasia is a repercussion of certain long-term fetal positions and I seem to recall a correction involving the newborn in leg braces for a relatively short period of time. Please, PLEASE ask your OB or pediatrician if you have questions about the most current and up-to-date information on the subject and treatment of this condition.

And KUDOS to this reader for asking me a question I’ve never gotten in my entire career!

Many blessing to all you expectant lil’ mamas out there and don’t hesitate to email me with your question by clicking on the ASK ME page above. Thanks for reading!

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Posted on March 14th, 2016 by wombwithaviewblog.com

It’s time for a post of the comical persuasion. I love those and they seem to sprout up all too infrequently in this business!

Kids, being some of the funniest people I know, also sometimes bring along their humor in the form of complete innocence as only untarnished young humans can do. Yes, more often than not they show off their bad-assness but those are usually the ones who haven’t yet mastered the English language (heck, there are many adults who haven’t accomplished that) but who have learned they can scream to be held or put down as only toddlers typically do. Those precious little peeps, as I’ve posted before, are better left with a sitter at home or anywhere than in my exam room:)

So, the other day as I’m scanning Mom, her son is watching intently. He is about five – and the perfect age to really get something out of his baby brother’s ultrasound. This baby was SO active that it was a little challenge to measure or image certain parts. Imagine chasing a moving target or that shooting game you see when the fair is in town. That’s a bit how scanning a busy baby feels when my caffeine level needs a boost.

A side note here – some patients will actually go on a sugar binge or leave no carb uneaten at the brilliant advice of some friend who said it would make the baby move more, thereby allowing us to more easily identify fetal sex. For the reason listed above, I do not recommend this! The only thing worse than a moving target in the 3rd trimester is a much smaller moving target in the 2nd. And though it is true a fetus that won’t move makes it difficult to determine sex, one that won’t stop bouncing off the walls long enough to get a good look doesn’t help, either.

Usually, when I’ve spent a little time chasing Baby around the uterus, I’ll sometimes make a comment about it like, “Wow, Baby is a little wiggle worm in there today!” or “Baby is running a marathon!” This day I made the wiggle worm correlation. Mom chuckled. Son was silent a few seconds. Then, with a very perplexed wrinkling of the face, he very sweetly and innocently asked, “How did a worm get in there?” 😂

Mom and I had a good laugh and Big Brother got a little explanation of the expression. I’m still not sure he understood the comparison, though. Hopefully, he hasn’t had nightmares about meeting his baby for the first time and seeing a swaddled chubby little worm peeking out instead!

If you have a funny such story to share, please email me, wombviewerblog@gmail.com, and share! Those pint-sized people know how to keep us in stitches, don’t they?!

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Posted on March 12th, 2016 by wombwithaviewblog.com

Everyone wants a healthy baby. It’s something we, as humans, take for granted unless we know of someone who experienced the misfortune of having a child with problems.

I think anyone who has ever come up against the discovery of a fetal abnormality on ultrasound can relate to the devastating feeling of receiving the news. No matter how insignificant the issue, even if your physician wasn’t worried, you sure were..not understanding fully what was seen and/or not being given a definitive diagnosis. Waiting on more appointments and tests and more results only adds to the anxiety. Sometimes the testing leads to a distressing diagnosis of a baby with life-long complications..a syndrome or some structural malformation requiring surgery after birth.

Sometimes, things we see may be cause for concern enough to warrant a referral to Maternal-Fetal Medicine (MFM) so that a Perinatologist can determine the nature or severity of a problem. They may know exactly what is seen, what to call it and how to follow it. For those who are very lucky, following a concern for period of time results in resolution of the problem. Hallelujah! Your constant companions, Worry and Anxiety, get kicked to the curb and you feel you can finally exhale, breathe again and no longer have to contemplate the what-ifs of your pregnancy, your newborn or how it might impact the lives of your whole family. You can finally get some well-deserved sleep and actually enjoy things like your baby shower, decorating the nursery or filling the closet with precious miniature clothing.

So, all this brings me to a patient who made me entirely livid yesterday. She had the audacity to complain about how she was followed with one of her previous pregnancies for a suspected problem pertaining to Baby’s pelvis and a mass seen on ultrasound. The area had been followed for months when it spontaneously resolved. They couldn’t explain it nor was there any further reason for them to see her again. She was released back to the care of her regular OB physician.

What’s that? Prayers answered, you say? Amazingly great fortune? Blessings galore bestowed?

Nope. Not according to this peach.

Her only comment was what a total waste of time it was..”months of anxiety and follow-ups for nothing”. So…would she rather it hung around? Would she have been happier had it enlarged to the point it required surgical intervention at birth? Believe me, she expressed not one iota of appreciation, relief or gratitude..just anger that we found something, she was inconvenienced and made to worry for “no reason”. Are providers supposed to have a crystal ball and magically know whether everything we see will or won’t be a problem? We’re not God.

I will make no apologies for the scope of my job..to look for and find abnormalities, big and small. We’re good at what we do so I won’t express regret that we found something others may have missed. I’m sure she was happy her baby was healthy. It simply would have been nice to hear as much.

Moreover, said peach also complained about a number of other issues. I wouldn’t let her bring in ten people during the exam, I was too mean to let anyone talk on the phone or video the exam and I didn’t give her enough images. Did I paint a pleasant picture here of Miss Mary, Quite Contrary? I think she needs to talk to a patient who didn’t get the good news she did…like the patient whose baby had three barely identifiable heart chambers instead of four and who has needed three surgeries so far in her short little life…one at birth and two more before she turned three.

Diagnostic ultrasound is meant to aid a physician in finding a problem and preparing the patient through education for what is to come. Life is all about perspective, isn’t it? We can either take up residence in the victim mentality or wear those proverbial rose-colored glasses. There’s something to be said for the glass-half-full frame of mind. At the end of the day, I will always prefer to catch an abnormality than to miss one!

Wishing you all happy and healthy pregnancies! ‘Til next time and thanks for reading;)

wwavblogger

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Posted on February 22nd, 2016 by wombwithaviewblog.com

A very common abnormality seen on an anatomy screening ultrasound examination mid-pregnancy is the presence of choroid plexus cysts in the fetal brain. Read an email from a very concerned reader and my response on the subject. Maybe you have experienced receiving the same anxiety-filled results from your doctor?! Try not to lose too much sleep. In the absence of other concerning findings, these cysts are very likely benign and usually resolve over time.

worried mama-to-be:  Hello there! I just stumbled upon your blog. It is so cool! I love your writing style and what you are doing. I have been thinking a lot about fetal ultrasounds this week. I am 21 weeks pregnant and last week had a routine ultrasound. They found bilateral choroid plexus cysts but didn’t mention anything else except limited views of the diaphragm. We even have a sonogram of her little thumb out which to me is reassuring even though it’s not all 5 fingers extended. However, we have to wait a little over a month for a level II. This week has been so so emotionally tough dealing with the unknowns. I’ve stared at our ultrasound images looking for a nasal bone (we didn’t get the coveted profile shot) and read about every single Trisomy 18 marker there is. Would love your perspective on this if you have any to offer.

Thanks for doing what you do to care for all the babies!

wwavb:  HAPPINESS!! Finally, an email that doesn’t ask about sex!! Your email is my next post:) You’re very welcome and I’ll be happy to lend you my two cents on the subject.

Firstly, I’m so sorry you are feeling so anxious and I know how disconcerting it can be to hear news that there are “cysts on your baby’s brain”! First bit of advice I will give you is to quit looking up info on the web. All it will do is fuel your anxiety because it will give you more information than you need while not answering the only question you have..about your baby. Trust me on this! NO DR. GOOGLE.

Secondly, I’ve seen these cysts for years on more babies than I can count. They are very common. The general thought is, and I can only speak in generalities here because I have no other information regarding your case, is that they are a benign process as an isolated finding. Possibly a duct becomes stopped up in the production of cerebrospinal fluid whereby the cyst develops and typically resolves by 26wks. This is likely why you are not seeing the perinatologist immediately. That AND the fact that everything else looked good.. Usually, if found in conjunction with a syndrome, other abnormalities are also seen on ultrasound like heart or other organ malformations. If no other hard or soft markers are identified, we usually do a repeat scan to ensure the resolution of the cyst(s) in about a month. I’ve seen them hang around only ONCE in all my years!! ..when everything else was normal-appearing, that is.

That being said, I cannot tell you all is okay but if my daughter was the patient, I would not be worried knowing what I do and if all other genetic testing was normal. The cysts may even be resolved by the time you see MFM!

Good luck to you, many blessings and try not to worry!! I hope all is great when you go for your next visit. Please keep me posted, won’t you?

Best wishes!
wwavblogger

***

To reiterate, of course I cannot assure anyone that their baby is normal. I can’t do that for my own patients! This is because I am not a physician or your physician, a perinatologist or geneticist. I can only say I see them a lot and most of the time they are a benign and non-problematic process.

If you have also had this experience and it turned out to be nothing, please comment to this post!

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Posted on February 8th, 2016 by wombwithaviewblog.com

Not all ultrasound images are created equal! I know I’ve said this before but it is difficult for many people to understand that not all images between a baby’s legs produce an image of fetal sex. It is a tricky business!

An image may include part of a rear, part of a leg or foot or part of a cord without ever including external genitalia. Sometimes part of the genitalia might be in the image but if not entirely or at the proper angle, determining boy or girl just can’t be done. This is why you may have gotten an email from me saying that I just cannot confirm your baby’s sex even if you had a sonographer who contrarily appeared very sure with her guess. In my professional and very discriminating opinion, if her angle isn’t great and the image is questionable then her guess carries just as much weight in my mind.

A good analogy is if you look at a closed fist as certain angles, can you tell if all someone’s fingers are there? If you look at someone’s foot from the back, can you see whether they have toes? The same can be said for any number of body parts, not to mention any other thing in the world. Looking at a person standing directly in front of you doesn’t mean you know what they look like from the back. Oh, you might assume but you truly do not know whether you would find a curly pig’s tail or a third arm projecting from his back!

This is why not all images people send me of fetal sex are good, nor are they obviously boy or girl. So many factors go into what makes a good image, angle being the most important of all these. But that, my friends, is a post for another day!

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Posted on January 20th, 2016 by wombwithaviewblog.com

How early can we detect fetal movement with ultrasound? The earliest signs of movement are typically seen around 8 weeks gestational age. Baby, who looks a bit more like a gummy bear at this point, starts to demonstrate the slightest intermittent wiggle every once in a while. It is such exhausting work!

Below is an image of a 9 week fetus taken with transvaginal imaging. With this type of approach, we are able to visualize a greatly magnified image, giving us also a better view than over the tummy. Baby is right about one whole inch now and tiny arm and leg buds can be seen slightly larger than just the week before!

9 week fetus/fetal movement

 

Now, below is a video which is quite entertaining of the same little tidbit breakin’ it down! Shall we dance?! She (or he) is making up a jazzy little tap routine right before our eyes. Click the link below to watch her go!

fetal movement at 9 wks

Isn’t the degree of movement incredible to watch? Of course, none of it is well-thought-out choreography but is instead the nervous system hard at work. What an amazing work of art we are:)

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Posted on January 10th, 2016 by wombwithaviewblog.com

Hi, all! Tonight’s post serves as just a reminder when you go in for your 18-20wk diagnostic scan.

Remember that, at the end of the day, we all get what we need. Boy or girl, sometimes it’s your child-to-be that needs you or you that needs this child for whatever reason which you may not understand entirely right now. Maybe you’ll never really know while living this life; maybe you have instinctively always known. Regardless, I do believe that most people at the time of delivery do not ultimately care about fetal sex, no matter the preference previously. We take one look at that face and stare into those eyes and most women fall in love instantly. This is the child whom you nurtured all along. You’ve finally met!

So, as I’ve said a million times, it’s OKAY to have a preference of one sex over the other so long as one remembers that healthy is more important than anything else. Just ask someone who lost a baby or who experienced a difficult pregnancy. Moreover, ask a couple who could never become pregnant or suffered infertility many years. Oh, they may choose to still find out with subsequent pregnancies but it’s not top priority on their list. Typically, when asked if they want a boy or girl, they are usually pretty quick to respond “Healthy!” It’s all about perspective.

As with anything in life, keeping an open mind about such things allows us to keep our priorities in line and provides us freedom from sweating the small stuff! (And most of it, like fetal sex, is small stuff..)

Best wishes for a happy and HEALTHY pregnancy!

Comments: 3 Comments »

Posted on January 2nd, 2016 by wombwithaviewblog.com

Ever wonder what all the black represents on a fetal sonogram? It doesn’t matter whether it is amniotic fluid, blood in the heart or vessels, fluid in the brain or urine in the bladder, all black structures on ultrasound represent fluid of some sort.

It all appears black because sound waves travel easily and quickly through fluid creating the black appearance. The more dense the tissue, the more gray the appearance. As a matter of fact, about 32 shades of gray are evaluated between the black of fluid and the white of bone, fat and some interfaces of different tissues.

See the images below for some examples of organs that contain fluid:

fetal abdomen/black ultrasound structures

Above are several structures containing fluid. The IVC or inferior vena cava, the aorta and the UV or umbilical vein are all blood vessels. The GB or gallbladder contains bile and the stomach holds the amniotic fluid that baby swallows!

 

fetal bladder/black ultrasound structures

Of course, the fetal bladder holds urine filtered by the kidneys.

 

amniotic fluid/black ultrasound structures

The amniotic fluid around baby is black.

 

Below, the blood within baby’s heart also appears black.

fetal 4 chamber heart/black ultrasound structures

 

Now, next time you watch a scan, you will be able to understand and read just a little of the examination!

 

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Posted on January 1st, 2016 by wombwithaviewblog.com

fetal profile

 

Happy New Year, wwavreaders!

I hope 2016 holds in store for you a happy and healthy 365 days. I also wish all you mums-to-be a year of uneventful pregnancies, easy deliveries and beautiful bouncing babies in the months ahead.

I hope you all will keep reading, emailing and referring your other expectant friends to wwavb for all your ultrasound questions. I’ll always do my best to answer your emails ASAP! If there is anything you’d like to see on my blog for the new year, anything you’d like me to address or any changes you’d like me to make, I invite all recommendations!

Come back tomorrow for a new post and have a prosperous 2016!

wwavblogger

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Posted on December 30th, 2015 by wombwithaviewblog.com

Now that our stockings have come down and we are once again staring Baby New Year in the face, it’s time to get back to ultrasound basics! Here is a recent email regarding that doggone nub theory. I just love emails that make me feel warm and tingly all over..or could that still be the egg nog?

hormonal mama:  Hello!! :) I just wanted to let you know that your blog has been a complete saviour to me and my sanity over the past few nights. It is brilliant and informative and just what I needed in my hormonal state.

I have one question that I have been searching the web for a definitive answer to and I was hoping you could shed some much needed light.

We had our 12 week NT scan and the US machine seemed to be a LOT better than the photos I have seen posted, videos I have watched, etc. We could see extraordinary detail of the baby. The sonographer was checking all the usual parts and suddenly without warning he showed us the perfect potty shot (I was 12w1d). Now I know from reading that people say they all look the same at this stage. But what I cannot get over was how much the image showed a perfect little penis poking out the top of a round bulbous structure.

I’ve googled and you tubed 12wk girl vs boy potty shots and I just cannot get a girl scan that looks like an actual penis.

I’m clinging to the smallest shred of hope that I may still get my girl after seeing this but it was just so obvious and so so so clear.

Thank you so much in advance for any advice or insight you can give me. I’m so disappointed in myself for feeling gender disappointment. I didn’t realise how much I wanted a daughter (this is our last baby) until I saw that potty shot.

Please tell me honestly; I can take it!!

Yours very gratefully,
:)

Ps. I think what you are doing for ladies like me is fantastic. I cannot believe I found you after all my searching for answers! An actual professional who answers silly hormonal women’s questions! Not a forum full of people who claim to know it all and actually know very little! :)

wwavb:  Thank you for all the nice things you’ve sent my way;) I appreciate it and am so happy you are enjoying reading my blog!

So, maybe you haven’t yet come across my posts on the subject. Cling away! Boys and girls can look EXACTLY alike early on. The links below will give you more information:

http://wombwithaviewblog.com/up-or-out/
http://wombwithaviewblog.com/early-gender-pics/

Check out the links below for my images of fetal sex which are textbook, classic, no-guesswork-needed images of both male and female sex:

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/
http://wombwithaviewblog.com/boy-girl/
http://wombwithaviewblog.com/boy-vs-girl/
http://wombwithaviewblog.com/twin-gender-update/
http://wombwithaviewblog.com/third-trimester-male-gender/

All that being said, it’s okay to have a preference but we all get what we need in the end. Having another boy means you needed one another for whatever reason! I hope you’ll sign up and keep reading at wombwithaviewblog.com;)

Best wishes and Merry Christmas!
wwavblogger

hormonal mama:  Thank you for replying; I’m so grateful! I have posted a link to your blog on our pregnancy group page. I hope it gives some other ladies peace of mind. (And a good giggle!)

I was recently told by an US tech in the group that there is a “nub” on my image. But I am notoriously useless at seeing them. Would you be able to confirm (or deny) if there are any genital parts visible? All I’m seeing is legs and a cord. I know the angle of the dangle is not a reliable theory (from your blog!) but for someone to say she can see it on my scan, it would be helpful if I knew if it was even visible!

Many thanks again and again :)

12wk fetus/nub theory

wwavb:  Thanks so much! I, too, hope they get some useful info and a giggle, also;)

Does the sonographer in your group practice OB? Experienced or new to OB? I question because I entirely disagree. Every baby has a nub at this age. You just cannot be sure what the nub is. If she is referring to the thing sticking out near the butt, that is too large to be the nub in question so my thought is it’s baby’s cord.

And actually, to see the nub, the plane needs to be centered between baby’s legs which means you would not be able to see the legs in this view. See the image below:

Suspected Baby Girl at 12wks/nub theory

No legs here! That could be a tiny foot way above the arrow, however.

This tells me the angle on your baby is not perfectly centered and is a little too far lateral whereby including the leg in the image. I hope this makes sense! What a cutie, by the way;)

Keep me posted!
wwavblogger

***

It’s entirely possible to get excellent images at 12wks and this theory is reported to be about 80% correct. If you do the math, that leaves 20% repainting a nursery if they believe it. Hmm..you decide if it’s worth it!

 

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Posted on December 25th, 2015 by wombwithaviewblog.com

Merry Christmas to all my readers!!!

I realize not everyone is an expectant mama but to all of you who are or who find my site today looking for information, I wish all of you many blessings for a happy, healthy pregnancy unless, of course, you’ve already delivered your special little stocking stuffer!

For those following Baby’s First Christmas ideas, no matter how you chose to deliver your news today, the most important thing is that you’re spending it with those you love the most. I hope it’s a fun and special day for you and your family! Share your story with me and other moms-to-be!

Thank you for your support, for reading my posts and especially for coming back! Thank you also for your positive and kind words and comments. They mean the world to me and give me the incentive to continue writing. When I started this, I had no idea I’d even reach one person. After over three years, I’ve received emails stretching all over the globe from Europe to New Zealand to India. So amazing!

MERRY CHRISTMAS, BUON NATALE and FELIZ NAVIDAD!!!

wwavblogger

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Posted on December 24th, 2015 by wombwithaviewblog.com

With visions of sugarplums dancing in your head and new babies growing in your bellies, Day 1 of Baby’s First Christmas leaves you with a final gift idea for your spouse, grandparents-to-be or friends!

What else besides Baby’s First Christmas ornament would be appropriate?

Check out some of the sweetest below:

Day 1 Baby's First ChristmasDay 1 Baby's First ChristmasDay 1 Baby's First ChristmasDay 1 Baby's First ChristmasDay 1 Baby's First Christmas

Merry Christmas to all and to all a good night!

wwavblogger

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Posted on December 23rd, 2015 by wombwithaviewblog.com

We’re so close to Christmas Day now I can almost smell the gingerbread. Just in case you are still racking your brain to come up with the most clever baby announcement ever for your spouse and if the other ideas didn’t float your proverbial boat, Day 2 of Baby’s First Christmas is sure to be a winner for the family of animal lovers.

If your family loves its pets as much as we do, they have their own stockings hung by the chimney with care, Santa fills them with their favorite snacks and you even share a little tidbit of Christmas dinner with them. So, why not incorporate your pet into the new baby newsflash? In other words, let your pet make the big announcement! Dog and kitty collars come in so many cute styles today. Choose one with a small frame attached including baby’s first image something like the one you see below, for example.

 

Day 2 of Baby's First Christmas

 

Imagine Dad’s surprise when Fido comes running in to wake him up on Christmas morning and he notices the new addition attached to his collar. And if new baby news will be a huge surprise, the delivery will be, too!

No pun intended;)

 

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Posted on December 23rd, 2015 by wombwithaviewblog.com

Shoes, shoes and more shoes! Where were all of these absolutely adorable can’t-live-without-them tiny foot facades when my kids were little? I swear they didn’t exist.

Day 3 of Baby’s Fist Christmas finds us gift-wrapping your favorite pair of sweet baby shoes. It’s so easy and makes a great gift for anyone you want to share the good news with this holiday season. It really doesn’t matter whether you know baby’s sex or not. Any positively precious pair will do. You can certainly go neutral easy enough but what the heck? Go with the newborn ballerina slippers if Dad has always dreamed of his Little Princess.

I Googled “baby shoes” and found some of my favorites below. Some are store-bought, some hand-made artistry. If you love these, look for them in Images and click there to learn where you can find them. Totally adorable!

Day 3 Baby's First ChristmasDay 3 Baby's First ChristmasDay 3 Baby's First Christmas
Day 3 Baby's First ChristmasDay 3 Baby's First Christmas

 

The best thing about this gift? You’ll get to keep it;)

 

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Posted on December 21st, 2015 by wombwithaviewblog.com

We are one day closer to Christmas so here are some ways to share some special news with the special partner in your life. Day 4 of Baby’s First Christmas is celebrating the professional or favorite pastime of your spouse with these creative options.

For the music man in your life, maybe attach baby’s first photo on a music sheet on his music stand or piano or inside his instrument case.

If he’s all business, hide baby’s image inside his briefcase. He’ll probably try to get some work in on Christmas Day, won’t he?

For your fisherman, attach baby’s pic to his new lure or fishing pole that Santa will deliver Christmas morning (only if he’s good, of course)!

Basically, just incorporate baby into whatever your spouse will be doing Christmas morning. Even if that’s simply being glued to the new big screen on the wall, use Apple TV (for example) to show baby’s first image as soon as he powers it on. Sweet!

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Posted on December 20th, 2015 by wombwithaviewblog.com

Merry Christmas, everyone, and I have to apologize for not posting the past couple of days. There’s nothing like being under the weather to keep you from completing the old to-do list. I guess Christmas bugs don’t care much that we have an extra long laundry list this time of year!

All that being said, Day 5 of Baby’s First Christmas is here with another gift idea for you. Most everyone loves cookies and even if you haven’t set them out for Santa in the past doesn’t mean you can’t start this year. It’s never too early to begin this tradition.

To set cookies out for Santa means you need a special plate to hold them. Try your hand at a piece of pottery. Paint the words “Cookies for Santa” at the top and “Love, Baby (Last Name)” at the bottom. Go to search engine images for all kinds of variation in design. Place three baby-themed gourmet cookies on the plate. You can frame your baby’s ultrasound image to set next to the plate or have your positive pregnancy test on hand.

What a great way to surprise your spouse Christmas morning! Serve up a plate of reality along with a great cup of coffee! Sometimes the best Christmas presents don’t require paper and a bow;)

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Posted on December 17th, 2015 by wombwithaviewblog.com

Tonight’s ideas involves Christmas dinner and a few ways to surprise everyone at your table! These should be pretty quick and easy.

For colorful mashed potatoes, consider dropping in a teeny bit of food coloring to serve a pink or blue side. You can add a couple drops to anything white or light in color..gravy, cake, icing, pies, cheese, sour cream, cream cheese, ice cream or bread, just to name a few.

Did you know you can die a hard-boiled egg from the inside out? Of course, you can! (Okay, I won’t pretend like I knew this before writing my post.) Think of it as a reverse Easter egg. Boil as usual, peel then color. Voila! Pastel deviled eggs.

Check out your recipe ingredients and simply add your shade of choice to whatever ingredient that will add the most interest to your table..sans the colored turkey, of course.

I hope Day 7 of Baby’s First Christmas made you excited for your grocery list!

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Posted on December 16th, 2015 by wombwithaviewblog.com

IS BABY READY FOR SOME FOOTBALL??

Day 8 of Baby’s First Christmas asks if you come from a long line of football fanatics.  Do you and your spouse cheer in front of your mega-screen TV Sunday afternoon in team-colored body paint playing host to forty neighbors, grill smoking and keg chilling? If you have a hard time choosing between a family vacation and season tickets, wrapping one of the items below might be the best way to share news of the newest little quarterback or cheerleader in your family! The options are literally endless and finding something adorable from your favorite pro or college team should be a piece of cake. Check these out!

Day 8 Baby's First Christmas

Maybe Dad might like to wake up to see your new nightshirt on Christmas morning! (Hopefully, you’re not this far along when you first discover you’re pregnant!)

 

Or maybe these?

Day 8 Baby's First ChristmasDay 8 Baby's First Christmas

You don’t have to be a Saints fan to think these are so cute! But hello. It’s NOLA. And who doesn’t LOVE Nola? If you don’t, you’ve obviously never been and you are no longer allowed to read my blog;) “Who Dat?!”

 

Maybe Nonna and Papa might enjoy opening something like this:

Day 8 Baby's First Christmas

 

And in in keeping with the spirit of all things Christmas decor, something like this might make a cute little announcement to the fam at Christmas dinner:

Day 8 Baby's First Christmas

 

Score! Christmas shopping was never so easy.

 

 

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Posted on December 15th, 2015 by wombwithaviewblog.com

We’re now into single digits! Tonight’s post will be short and sweet. Day 9 of Baby’s First Christmas gets us one day closer to Santa’s arrival (and Baby’s) with yet another idea for storage under the tree in fancy paper and bows.

Maybe you already know whether you are expecting a son or daughter and have already begun to fill the closet with some of your favorite outfits. Perhaps spending a little too much time at your favorite children’s boutique? Nonsense, right?

Maybe instead you have a cherished christening gown passed down as a family heirloom from one generation to the next. Monogrammed bloomers and bibs, smocked floral dresses and baby blue linen overalls are all adorable gifts that tell Dad or grandparents just who will be joining the family in the coming months. Of course, in my mind, nothing beats a first trimester ultrasound image but I am attempting to supply you with a plethora of unique choices!

Only once in my career did I have a couple who came to their ultrasound appointment with their children and two boxed newborn outfits, one for each sex. Instead of enclosing the surprise in an envelope as most do, they asked me to choose the appropriate color and simply tell them which box they needed to wrap. Cute idea. Then everyone is surprised on Christmas morning!

Come back tomorrow where we’ll look to pro sports for more inventive solutions to inspire the Santa in all football-loving moms-to-be!

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Posted on December 14th, 2015 by wombwithaviewblog.com

Ho Ho Hot chocolate! Everyone knows this holiday just isn’t without cozying up to a warm cup of liquid love..topped with melted marshmallows, of course! Chocolate is one of my most beloved things in the whole world. Solid, drinkable, intravenous..I’ll take it any way I can get it and so would most of my patients;)

Day 10 of Baby’s First Christmas countdown brings us one day closer to celebrating Santa, gift-giving and all the fun firsts of pregnancy (in keeping with the spirit of the season, we’ll exclude all the NOT-fun firsts). Here is another great idea to explore when trying to decide how you might share with family and friends whether they will be buying pink or blue for your shower.

If you’re hosting a Christmas celebration, consider serving hot chocolate with pink or blue marshmallows. They come in any number of shapes and sizes and thanks to our friend (sometimes), the Internet, your favorite shape and flavor is just a click away if you search Images. Aren’t the ones below so cute?

 

Day 10 Baby's First Christmas

 

Day 10 Baby's First Christmas

 

An even more creative idea, but a little more work, is using white chocolate and food coloring to tint the drinks the appropriate hue. If you’ve never used it, a little goes a long way! I recommend adding one drop at a time to the milk mixture until you reach the shade you want. Pastel looks best in my opinion with white marshmallows.

Add your favorite “It’s a Boy or Girl” napkin for service. If you’re going all out, I’m sure some company out there would print your kid’s adorable mug on them! Hopefully, you were one of the lucky ones who’s fetus cooperated with position.

 

20wk facial profile

 

3D fetal face 33wks

I’m such a sucker for a cute face;)

Come back tomorrow if you need more Christmas ideas for Baby!

 

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Posted on December 13th, 2015 by wombwithaviewblog.com

Day 11 of Baby’s First Christmas brings some of the greatest excitement in life..breaking the news to your spouse that you both are expecting! Regardless of whether this is your first experience together or not, watching the positive sign pop up is pretty mind-blowing!

I’m sure many who share this news via a Christmas gift have thrown a positive pee stick (or many!) into a box and slapped on some snowman paper. I have to throw the “Ew” flag on that play..not the most sanitary of presents! However, I do have a couple of suggestions if you insist on going that route.

1. Drop it into a small clear zip-top plastic bag. Wrap as you would any other present.

2. If you want to make it a little more festive, you can use a clear holiday plastic gift bag with a fun print on it. No gingerbread men or chocolate-covered pretzels here! Drop in the stick, tie with your favorite ribbon and add a gift tag that says something like “Merry Christmas! You’re going to be a Daddy!” Or, if this isn’t your first trip around the proverbial block, you can add “(again)” at the end:)

3. A slightly different approach in the selfie era would be to take a pic of yourself holding the positive stick. Print and wrap the image. Drop into a cute little holiday frame if you choose.

4. Some women never see the positive stick. Instead they are blind-sided with the news of another baby at their doc’s office with an ultrasound! Boy, have I seen a few of these:) So what they may get instead is even better and might look like this:

Day 11 Baby's First Christmas

8 week fetus

or THIS!

Day 11 Baby's First Christmas

8 week twins

A few ideas for presentation could be dropping it into Dad’s stocking, opening it as a gift together or hanging it on the tree and telling Dad he has to find his surprise. Maybe your spouse is working out of town or in the military. No problem! The age of technology as never been more of a friend to us for just such an occasion. Email a holiday card including your special pic.

No matter what approach you take, hopefully it yields happy tears and celebration all around! Congrats, guys! Getting this far is a big deal.

Merry Christmas and Happy Holidays to you both!

Stay tuned for more clever baby news ideas as the countdown gets closer to Santa’s big arrival (and Baby’s!).

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Posted on December 12th, 2015 by wombwithaviewblog.com

Let the countdown to Christmas begin!

On Day 12, we celebrate Baby’s First Christmas and it doesn’t matter whether he/she has made the grand entrance yet or not! You are busy this holiday season, racking your brain on creative ways to make breaking baby news a special event for family and friends. Maybe you want to share that you are expecting; maybe you want them to know whether to buy pink or blue!

Idea #12 is probably the most obvious but likely the most popular. The Christmas tree ornament is a beloved adornment for most celebrating this holiday. Many of them have special meaning or represent something unique to its owner. See below for a number of ways to work Baby into something cherished for the tree.

1. Fill a large clear ornament with a pink or blue filling of your choice. The filling could be crinkle shredded paper, for example. Use pink and blue filler together if you don’t yet know baby’s sex.

Day 12 Baby's First Christmas
Take a photo of your ultrasound image so that you have a JPEG saved. DON’T laminate it. It’s thermal paper and exposing it to heat of any kind will ruin your image. They also do not photocopy well. Print out several small images of Baby Sprout in the first trimester or a profile or foot, gently roll and insert into the ornament. A better option might be to use an ornament like this:

Day 12 Baby's First Christmas

Top it off with a cute pink or blue bow or pink and blue raffia if you are using both colors of filler.

2. Using a clear glass ornament, fill with white or iridescent filler, add baby pic and top with thin hemp ribbon. You can add silver glitter numbers with Baby’s due date on the back or simply 2016.

3. If you’re living life coastal, add white glitter to finger starfish. Top by tying pink or blue ribbon or raffia around the top finger. You can also paint the starfish with a very pastel pink or blue and top with an iridescent ribbon or thin hemp rope.

These are just a few ideas to get you started! Come back for tomorrow’s post when we dive right into Day 11’s bright idea.

Have fun making your ornaments!

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Posted on December 11th, 2015 by wombwithaviewblog.com

Often times my patients express some disappointment with prior ultrasounds because “baby wasn’t looking at the camera”. This isn’t something “baby does”. We have to intentionally obtain the front view of the face in order see it that way. But why? This is NOT your baby’s best side! I always tell them that seeing the face from the front mostly yields a skeletal appearance..eye sockets and triangular nasal bones..very jack-o-lanternesque. It’s a face only a mother could love!

The shot of the face I always strive for is the profile or side view. In this plane we can see the soft features of the face like the nose and lips that look more like a baby.

Since amniotic fluid is ultrasound’s best friend (and mine), we need a nice pocket of fluid in front of baby’s face to see it well. If baby is facing your back or has it smushed into the placenta, fahgetabouttit!! It will be a “no paparazzi” day for you which means you’ll likely get some precious images of hands and feet only to take home {“Oh, just look at that cute big toe!”}. Let me just say I love some baby toes..to image AND to chew! But patients feel a bit let-down when the little diva doesn’t cooperate.

So, if you’ve ever been shown a profile on ultrasound and thought you had no idea what you were seeing, check out the images below for a detailed annotation of two great ones! Both of these babies were just over 20wks.

 

fetal profile at 20wks

fetal profile at 20wks

In the image above, a little more fluid (the black stuff) in front of the face would have been helpful, as you can see the tip of the nose and forehead just barely touch the uterine wall and placenta in front of it. However, it’s still a great shot!

 

fetal profile at 20wks

fetal profile at 20wks

How about this one?! PERFECT! This is an absolutely beautiful textbook image of a fetal profile. Can you appreciate how there is more fluid in front of this baby’s face?

 

If only ALL the babies I scanned looked like this.. SIGH. Such is life. All issues are relative. I suppose if every fetus was as cooperative as the one above, I’d never get any real work done! Mama would sure be happy, though, with a string of pics a mile long;)

***

Ho, ho, ho!! That day is drawing closer and closer so keep a look out for the first installation of holiday baby reveal ideas in my 12 Days of Baby’s First Christmas posts! We’ll start the count-down on December 12 where I’ll share some creative ways my patients have shared new baby news with their families. Maybe you’ll fall in love with one that’s perfect for you!

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Posted on December 9th, 2015 by wombwithaviewblog.com

Merry Christmas, everyone! It’s a crazy and hectic time of year but I’d like to encourage everyone to stop and smell the pine sap. We moms are especially used to multi-tasking until we collapse but Christmas shopping and planning is not a fun addition to being pregnant right now!  It’s a special season filled with special surprises but let’s face it, when you’re carrying around one or more little gingersnaps in your oven, easier is ALWAYS better!

What’s fun about Christmastime babies at the office is when parents come in looking for some unique way to find out fetal sex or break the news to family. They’ve come up with some great options over the years! I think as long as two people share the moment together, any way they choose to share it could only be fun.

So, in the spirit of the season, I’m going to share the 12 Days of Baby’s 1st Christmas where each day I’ll post a different way to share the experience with your family and friends. Some may be dated ideas; some you may find clever and a perfect fit for you. Either way, I hope it creates a special memory this holiday for you and all your loved ones.

Regardless of whether you are shouting from the rooftops of a new addition or pink vs blue, creating these gifts can be fun for the crafty mom but also a great way to incorporate older siblings in the planning. Sometimes, they just need to feel included! Start looking for these posts on December 12. Get those glue guns fired up, people!

As a reminder to anyone tempted, I DO NOT recommend paying for an elective scan to determine sex at 15wks! I would estimate probably 85% will still appear equivocal at this point. Christmas is expensive enough! You don’t want to have to repaint a nursery, too.

Stay tuned!

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Posted on December 5th, 2015 by wombwithaviewblog.com

Two of the most feared words in any woman’s vocabulary..

ovarian cancer

Most people think of ultrasound as relative to OB and cute baby pics but every one of us humans walking the earth are only here via a once-inhabited uterus. That said, the specialty is nothing without the study of the non-gravid uterus, as well, thereby forever tying it together with Gynecology.

A large part of my career is dedicated to the fetus-free uterus and her companion ovaries. Call me crazy but it’s actually a nice departure from scanning many back-to-back uncooperative babies. A complicated pelvic scan can, however, be every bit as challenging as the moving target of an active fetus. Combine a difficult tilt to the uterus and multiple fibroids (muscular tumors) with moving intestines and lots of other pathology and, suddenly, babies are decidedly a little more fun to scan.

The hardest part of scanning babies is obvious. The occasional miscarriage and abnormality can be devastating. But another kind of trauma is finding the incidental ovarian mass with features that leave our suspicions high for cancer; a large cystic or solid tumor with septations and vascularity are a few.  Though we can never be tissue specific with our suspected diagnosis, I know when I am imaging and measuring this mass that the outcome is likely not good.

My heart immediately sinks and I feel an overwhelming sadness for this patient, especially at this time of year. Instead of enjoying the holidays with her family during what is a happy and celebratory time for most, I can’t help but think of what she must be feeling. I imagine she may have broken down in tears as she left the office. I wonder, just as I’m putting my head to pillow, if she is doing the same and praying tearful prayers. I imagine her having to break the news to her family who will lose sleep with worry that their mother, wife or sister may not be with them for next year’s Thanksgiving feast or Christmas dinner. I wonder if she is overwhelmed this season with too much information she doesn’t understand, unending tests and thoughts of all she’ll have to endure over the coming months..painful surgery, radiation and chemotherapy. I ask myself if she even has that much time. She’ll know very soon.

I ponder this stuff because I imagine this is the personal roller coaster I would be riding. But I write this not to be a downer, but to give cause for some inspiration. This IS the season for inspiration, right? Sometimes, it’s these very people who have been presented with just such a challenge that seem to be the strongest people we know. They have fight and positivity and realize their priorities. They know how to value what is important.  Too often we are way to busy to do the same.

So, if this isn’t the season for spiritual strengthening, faith, family and celebration of our time together, I don’t know what is. These little gifts can be something we put in our own stocking this year, right next to that cute little bundle Santa just delivered.  Merry Christmas and enjoy those you love this holiday!

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Posted on November 28th, 2015 by wombwithaviewblog.com

Every once and a while a reader sends me a great question that isn’t related to fetal sex. This one is related to GP or Gravida/Para as seen on her ultrasound report.  See the link below:

http://wombwithaviewblog.com/1st-trimester-dating/

curious mama:  Just curious on the report on the right where it says GP and williams in that box. What does that mean? I’ve seen on another person’s report the same thing but in the box beside GP it says male AB. Just confused what this GP stands for?

wwavb:  Hi and thanks for your great question! Look for it in my next post! GP stands for Gravida and Para, meaning how many times you were pregnant and how many live babies you have given birth to at the time of the scan. For example, G2P1 means this is your second pregnancy and you have 1 child. Williams stands for the program used to calculate age, named after the physician who developed the method. You are reading the two together but they are not meant to be. GP simply was not filled out on this report and most of the time isn’t because the information is redundant; it’s already in your chart so it’s not necessary to enter the info again on the report. All machine manufacturers’ reports look different so it would not be unusual for your friend’s report to say something different. Hope this helped!

***

I do have to say this is part of the pitfall to EMR. Hence the multitudes of patients calling in for explanations of non-urgent matters which have to be triaged by knowledgeable staff. Patients should have all their questions answered, however, it can be costly and time-consuming for practices, to say the least! Patients should be given results, just not reports.

Thanks, reader! Hopefully, others searching the same question find this post!

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Posted on November 19th, 2015 by wombwithaviewblog.com

“How sure are you?” I’ve heard this question probably more than any other in my career.

Every sonographer is different. One person’s sure is another’s iffy. I’ve seen images where a person was told one sex and the sonographer had “no doubts” only for me to scan later to confirm how very wrong she was. The fact here is that as long as people keep wanting to see fetal sex by ultrasound, there will always be challenges surrounding the guessing fetal sex.

As long as ultrasound-for-entertainment businesses are allowed to remain open, they will continue to take money from any person who wants to pay them. They will guess at sex because you are a paying customer. You paid for a guess; they’ll give you just that. But is it right? Who knows?

From my end, as long as new graduates and people with little experience are guessing sex, there will be incorrect guesses. Since we all practice differently, there will always be some sonographers, even experienced ones, who jump the gun and guess too early or despite suboptimal visualization. Others are more cautious, examining from every angle but still hesitant to commit.

I’m more of the latter persuasion. I want to be VERY sure, superduper sure, sure-as-white-is-on-rice sure. I need perfect views in more than one angle and textbook imaging. In other words, baby parts have to be ultra obvious for me to feel comfortable making a guess. There will be none of this 70% stuff on my watch. What does a percentage mean anyway except that someone is just really not sure! Does anyone really feel comfortable with buying pink or blue based on that? ..Or painting a nursery based on that supremely expert opinion?

What needs to happen is bipartisan cooperation (is that really a thing in the U.S.?????). People who cannot scan well should just put down the probe and walk away. Those who are new to ultrasound should not attempt to guess sex without first consulting someone else more experienced. Patients should not push to find out sex at the first positive sign on a pee stick nor should they pressure sonographers to guess NOR should they throw a fit when we refuse. And, last but most certainly not least, non-medical, non-necessary, thorn-in-my-side, bane-of-my-existence, menace-to-society-and-medical-communities-alike 3D cash cow businesses need a cease and desist from scamming the general public into believing they can actually provide a 100% guarantee on sex at 14wks. SO! If all the above happened, we would never have another incorrect fetal sex determination by ultrasound again. Unfortunately, there’s about as much chance as my waking up to a million bucks in my driveway. I think I’ll be going in to work tomorrow after all:/

And for those of you who have not yet seen them, check out the links below for my images of fetal sex which are textbook, classic, no-guesswork-needed images of both male and female sex:

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/
http://wombwithaviewblog.com/boy-girl/
http://wombwithaviewblog.com/boy-vs-girl/
http://wombwithaviewblog.com/twin-gender-update/
http://wombwithaviewblog.com/third-trimester-male-gender/

Best wishes for a happy healthy baby!

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Posted on November 15th, 2015 by wombwithaviewblog.com

These were such great fetal 3D images that I felt they should be reposted!  They are representative of the best of the best.

You’ll see from the captions that this baby was 33wks at the time of the scan. Just know this isn’t the norm! Most babies at this gestational age are not well seen with 3D because the head is typically pretty low at this point and fluid begins to diminish a bit. However, this mom had polyhydramnios (or extra amniotic fluid) and baby had his own Olympic-sized pool!  The additional fluid allowed better visualization of baby’s face which yielded these most beautiful pics!

In other words, Moms-to-be, the images you see below are an exception to the rule. The best time remains about 27-30wks. Enjoy! His mom and I sure had a fun time taking them:)

 

No paparazzi, please!

3D fetal face 33wks

 

Pucker up!

3D fetal face 33wks

 

Sleepy baby;) So sweet!

3D fetal face 33wks

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Posted on October 26th, 2015 by wombwithaviewblog.com

As an addendum to the this last published post, I am adding annotated images of the the video in the link below:

9 week fetus

amnion at 9 weeks

 

***

(Published 10/25/2015)

Ever see a real-time video clip of a 9 week fetus? Of a fetal heartbeat?  Well, here you are!  Just click on my link below:

9 week fetal heartbeat

This clip demonstrates a quick video of baby with transvaginal imaging. First, we see the head, then we see a long view of baby’s body and the incredible flicker of cardiac activity in the chest. The fetal head lies to the left of your screen and the small circle near baby’s bottom represents the yolk sac.  Also, notice the thin white line around baby. This is the amnion or amniotic membrane. Looking carefully, one can make out the beginning of arm and leg buds.

It’s so cute already!

Can anyone guess what the black represents? Yep! Amniotic fluid. You guys are so smart.

Come back tomorrow and I’ll annotate all the parts for you. Have a great day!

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Posted on October 20th, 2015 by wombwithaviewblog.com

I think most of you reading probably would believe that most of the emails I receive have to do with parents wanting me to confirm fetal sex..sometimes desperately so. And sometimes determining fetal sex is an impossible task.

I try to explain in my replies that my guess is only as good as the images they send me. I don’t believe it is quite understood what I mean when I say that ultrasound is entirely subjective but the person scanning has total control over the images obtained. The sonographer creates these images utilizing a number of controls to optimize the image and uses her own discretion to determine a good angle with the probe she is holding. Yes, there is a standard here but I have to brutally honest. Just as people excel in some areas of life and/or profession, some are also bad. There are good docs and bad, good nurses and bad, good cashiers and bad. That being said, there are sonographers who just do not do it well. This is a painfully obvious fact when I open these image attachments.

In addition, I sometimes use many angles, holding the probe in different places to obtain a different angle of the same area in order to determine sex. At times, just one angle is not enough to see well but only one angle can be depicted in one image at one time. I wasn’t there during your scan so I don’t know anything about the variables that could have made imaging difficult. One of my last posts on this subject can be read by clicking the links below:

http://wombwithaviewblog.com/fetal-sex/

I just know a technically bad image when I see one. Sometimes, I can tell there are measures that could have been taken to improve the image. In those cases, I can only assume your sonographer did not know how to use them or even that they existed. If the person scanning you is new to ultrasound or is a physician who isn’t trained on how to use the equipment fully (which they typically are not) the image may not appear optimal to someone who is experienced in sonography. Below are some great images of fetal sex that I’ve taken myself.

The above depicts an underside view of typical-appearing female parts from about 16-22wks. The side arrows point to labia, the middle to the clitoris.

 

Female labia in the 3rd trimester

 

Male genitalia, late 2nd trimester

 

Fetal male genitalia 3rd Tri

The above demonstrates a side view of typical appearing male parts from about 27wks on.

 

So, all that being said, if the image you send is not an optimal one, I may not be able to take a guess on fetal sex. Even if your sonographer felt she was sure of her guess, I may not be able to agree based on limitations of the image. That doesn’t mean your sonographer got it wrong, just that I cannot concur with the former guess because the image quality is not there and I didn’t observe the scan myself so I was unable to see from many different angles.

Below are the links I typically email on my posts regarding fetal sex:
http://wombwithaviewblog.com/early-gender-pics/
http://wombwithaviewblog.com/female-gender-on-ultrasound-2/
http://wombwithaviewblog.com/boy-girl/
http://wombwithaviewblog.com/boy-vs-girl/
http://wombwithaviewblog.com/twin-gender-update/
http://wombwithaviewblog.com/third-trimester-male-gender/

I hope this helps you understand a little more insight from the sound perspective!

Ta-Ta for now! Until next time, feel free to reply, comment or email with your questions on the Ask Me tab up top or at wombviewerblog@gmail.com! You can also subscribe to the right:)

 

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Posted on October 15th, 2015 by wombwithaviewblog.com

I have been on vacation for the last six days but I have a few moments so I thought I would use it to post a couple of precious 3D images and remind my readers what it takes to obtain these great shots.

Not everyone makes a great candidate for this scan. Firstly, a great pocket of amniotic fluid in front of baby’s face and baby facing up toward mom’s belly are two very important variables. Also, the less abdominal fat a mother has will make for a better signal due to the principles of physics as outlined in the last post. Some factors that will hinder a 3D are maternal, some fetal as described below:

*a fetus facing mom’s back
*a fetus with the face burrowed into the placenta or uterine wall
*limbs or cord directly in front of the face
*an anterior placenta
*an overweight mother
*decreased amniotic fluid
*late gestational age
*a very low or engaged fetal head in the pelvis

If the limitations are positional, we can roll mom to one side or push around a little and sometimes this does help. However, many times baby is quite comfortable and has no desire to change position, even if it’s just an arm over the face. The farther along you are, the less likely baby will move position which is why 27-28wks is the best time for 3D. A much earlier scan makes baby look too skeletal because it doesn’t yet have enough body fat.

All the other factors are some we cannot alter. An anterior placenta and/or belly fat means the sound has to travel farther, the resulting image grainy or with an out-of-focus appearance. And too little fluid limits visualization overall. Even if baby has lots of fluid by the butt, very little in front of the face will still yield a limited 3D.

The above are just a few tidbits of useful info to keep in mind before scheduling your 3D entertainment scan. It can help you prepare for or spare you some disappointment if you don’t leave with the same amazing images your friend may have gotten.

If interested, ask your sonographer at your next diagnostic exam if you are a good candidate for a 3D! We cannot ever predict whether your baby will work with us so do inquire as to the facility’s policies in advance in case of a stubborn fetus! In the meantime, enjoy these below from a very cooperative little one indeed:)

3D ultrasound image

 

3D ultrasound image

As always, thanks for reading! Feel free to reply to this post or click the ASK ME tab up top. You can also subscribe to the right or email me any time at wombviewerblog@gmail.com with your comments or questions!

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Posted on October 5th, 2015 by wombwithaviewblog.com

I hope anyone who is searching intently about what is required to see fetal sex will take a minute to read this post and behave accordingly at her future ultrasound appointment. Sonographers the world over will thank me if it results in even one less patient who leaves her department foaming at the mouth.

Firstly, determining fetal sex is not part of a diagnostic examination. Period. It may be information the patient desires but nowhere in any ACOG publication is it written as a requirement. This examination is ordered to rule out structural fetal malformations only. It’s a courtesy most practices provide their patients IF it can be seen but is wholly left to the discrimination of the sonographer. This is because we see fetal sex with ultrasound way more often than your physician does and most docs will tell you we are far better at this guess. Also, OB docs are well aware there are a number of variables that prevent good visualization for each and every ultrasound we perform for them. Some of these factors are as follows:

a breech fetus
a fetus with the rear against the uterine wall
a foot or feet in the genital region or crossed feet
closed legs
the umbilical cord between the legs or against the fetal body
body habitus or an overweight patient
uterine fibroids or contraction
a decrease in amniotic fluid
genital malformations
early gestational age

Even one of the above factors can prevent even the most experienced sonographer from determining fetal sex. This is what you want. What you DON’T want is someone who is inexperienced guessing anyway. Many times, it’s not just one but several of the above variables that limit what we see and we can’t change any of them. We can push around a little or turn a patient on her side but that is it. And, no, jumping jacks won’t help.

Another little fact I’ll add here is that a non-arguable truth of the modality is the principle of physics that refers to the attenuation of sound. The farther sound has to travel, the weaker the returned signal. The more tissue the sound waves have to penetrate, the worse the image. In other words, the more a patient weighs, the less we can see a fetus. And the worse our visualization of a fetus, the less we can see of important structures much less very small ones like external genitalia. Combine that with some of the other variables listed above and the possibility that fetal sex will be determined for some people at 18-20wks is quite unlikely.

What we cannot do is scan a patient indefinitely in an effort to gain this information. We are on a timed schedule and we work like hell to stick to it. The next patient deserves to have her ultrasound as close to her appointment time as possible, barring an unforeseen medical complication. We are required to scan a patient for only as long as it takes to determine what anatomy we can or cannot document. We also require time prior to a scan to examine a chart for an order and indication for the exam. After the exam we need time to write the report. Most of us are nice enough to take more time with a patient if the schedule allows.

An entirely repulsive action disgruntled patients take these days is to post their rants on social media. This is never okay whether it be a personal beef or not. I would advise against this method of revenge only if one would not want to find a new physician or appear grossly ignorant. If you are unhappy, you have the right to discuss it with the administrative manager but keep in mind that negative press will cost the practice future patients and you run the very real risk of being fired by your doctor. Yes, a patient can be fired. A practice does not have to tolerate any behavior deemed irrational or unreasonable. Just like one can fire an attorney, a plumber or your doctor, a patient can find herself in the same situation.

Being a healthcare provider can be the most rewarding but also the most infuriating of experiences. Our patients who are thankful and appreciative remind us why we chose this profession to begin with while others make us want to throw down the vinyl gloves in submission of a different calling..like a Whole Foods stock girl. Artisan cheese doesn’t talk back or complain when fetal sex can’t be determined.

Unfortunately, our society has become one of immediate gratification, even demanding it in the face unreasonable and ridiculous circumstances like the spoiled brat, Veruca Salt, of Willy Wonka fame. It’s comical to me that these people expect better behavior from their children but, themselves, scream and cry in a public setting, ranting and raving like a lunatic. Or it rather reminds me of the kid who throws a tantrum and holds her breath until she faints because she wants the candy in the grocery store cashier line. In my professional and motherly opinion, both behaviors are well deserving of a spanking and time-out…or a good firing.

I hope patients who have shown their immature side in the past over this same scenario might read this and reevaluate the series of events that led them to exhibit such embarrassing, high school-like behaviors. We cannot walk on water, we cannot move mountains and we cannot see fetal sex on a patient who fits into the above categories. It’s not because we’re mean or didn’t scan long enough, try hard enough, didn’t care or are incompetent. I treat all my patients the same and I try to determine sex for all those who want to know. It’s just that I cannot change the laws of physics.

On more than a few occasions, some patients mistakenly assumed that if we cannot tell them fetal sex, we must not be able to skillfully perform an ultrasound examination otherwise. It’s usually these people who are guilty of the aforementioned bad behavior. I suppose it’s too good to be true that those same people who didn’t see anything wrong with their actions to begin with might also read this and figure out my post is all about them.

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Posted on September 30th, 2015 by wombwithaviewblog.com

One of the highlights of parenthood for everyone is the day they hear the words “It’s a Girl!” or “It’s a Boy!”, no matter whether they are heard in the delivery room or the ultrasound room.  While no one ever invites news that something is not quite normal, it’s rarely expected that the problem will be with regard to fetal sex determination. I recently received just such an email about the subject of ambiguous fetal genitalia. Some of the technical information of the case has been omitted.

concerned mom:  I was just told by a doctor at the perinatal center that my baby’s genitals appear abnormal on my late 3rd trimester ultrasound. My only other scan was at 20 weeks and I was told “probably boy” but it took the tech a while to make that guess. I’m aware that there are a range of genital abnormalities that can occur so I asked my physician if she saw both male and female parts. She told me she thought it was a boy but admitted that it can be hard to distinguish labia from scrotum (because of the appearance of the presumed sac and questionable small penis). I was referred to get some genetic testing done but I sense the chromosomal info will still leave me with questions about the probable condition if there is a mismatch between genotype and phenotype.

I’ve gathered info on some of the more common genital abnormalities to try to come to overcome disappointment and find peace. I find myself wondering about this one doctor’s opinion and likelihood of accuracy. In your years of practice, do you find labia and scrotum difficult to distinguish towards the end of pregnancy? I realize you can not confirm or clarify the details of my particular situation but I’m still interested in your general thoughts.

Thank you for sharing your expertise.

wwavb:  Firstly, I will say that a perinatologist should be the most qualified physician to answer these questions for you. Her specialty being high-risk pregnancies qualifies her as the go-to for your general OB for all things presenting as unusual. Though it is one doctor’s opinion, it is a highly specialized one and she would be able to provide answers for you to a likely far greater degree than your general OB.

I can only speculate here, of course, but it sounds as though the perinatologist has questions, too, and ordered genetic testing to help clarify whether baby is genetically male vs female and to possibly rule out whether a chromosomal abnormality could explain the physical appearance of the genitalia. I imagine any information it yields could only help aid your physician in a diagnosis which can, in turn, aid you in the educational and emotional preparation of baby’s condition. I have to advise here to not consult “Dr. Google”, as we refer to the Internet in our office, because it only adds to your confusion and provides a whole spectrum of variables of potential diagnoses that do not apply to your case. I know it’s hard to wait but, truly, until you get genetic results, all of your time spent looking for answers can compound the problem in your mind and peace is the last thing you’ll find there…it typically only leads to more questions. The only time I find it’s good advice is if your doc has referred you to a specific site.

In my experience, gender typically becomes easier to distinguish as pregnancy progresses, fetal position providing. Your case, though not frequent, is the prime example for why we prudent sonographers do not throw out a random sex guess with a quasi peek. It’s why, also, I never guess prior to 18wks or any time if I cannot see well with respect to all the variables that can hinder that determination. Later on, the labia become more full and, sometimes, the clitoris remains visible. Testicles usually descend about 28wks which are typically easy to visualize, and though penis size does vary, it still is fairly easy to see in most babies.

Below are links for some of my normal-appearing male and female genitalia images at different times in pregnancy:

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/
http://wombwithaviewblog.com/boy-vs-girl/
http://wombwithaviewblog.com/twin-gender-update/
http://wombwithaviewblog.com/third-trimester-male-gender/

I hope my information hasn’t been entirely redundant and that I’ve helped in some small way. I wish you all the very best and, please, if you don’t mind, I would love a follow-up email once you have more answers.

Take care and please do not hesitate to contact me if I can assist you in the future!

Regards,
wwavblogger

***

Ultrasound and other antenatal testing was created, first and foremost, as a vehicle to education, understanding and preparedness when our pregnancies become challenging with information and events we don’t understand.  There has been no better time than the present for medical advances and those with the ability to use and understand them to hold our hands and help us navigate through the roller coaster of emotions.  The goal in the end is the most healthy baby and educated parent(s) to care for him.  And although what results for medical professionals is education through experience, it’s ONLY the experience of treating such patients that creates the empathy to care for them.

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Posted on September 14th, 2015 by wombwithaviewblog.com

Post-baby body is a very real reference to the tangible or perceived appearance of one’s body post-delivery.  Anyone who has ever carried a child and delivered that sweet little, or big, bundle of joy knows what this means.  Some women eat very carefully during their pregnancies, are fit to begin with and have no problem getting back to their (somewhat) original bod.  Some let it all go, eat whatever they want, gain a lot of weight and then either keep the weight or have a hard time getting it off after baby.  Either way, there are usually some subtle post-baby changes to our bodies after we spit out our pups..cute as they may be.  But these changes don’t have to be drastic or permanent!

I wanted to share a quick story about a patient I saw last week.  She’s the pregnant woman people envy.  You know the kind..beautiful anyway with long gorgeous hair, flawless skin, crystal blue eyes and a big toothy smile like a hammock between two big dimples.  And, no, she didn’t need a lick of make-up.  No hating here!  She was one of my sweetest and most fun patients whom we scanned more than routinely since she was carrying twins.  Not only did she look amazing during the pregnancy but when she stopped in for a doc visit at six weeks postpartum, I was amazed at how great she looked.  I would have never believed she carried these babies almost to term if I didn’t see it myself!  She looked incredible and I was super happy for her.

Please note this isn’t being shared to make anyone feel bad about themselves.  Conversely, I want it to be incentive for every pregnant woman out there that life can return to normal after Baby!  ..That is, unless daily trips to Marble Slab become as routine as those to the restroom!

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Posted on August 17th, 2015 by wombwithaviewblog.com

You know, I just don’t have all the answers. I know you may not be terribly shocked by this revelation. That being said, I get emails all the time with partial tidbits of relative info from which I am supposed to glean an opinion or diagnosis. Sometimes, it’s just not enough to read between the lines, especially with regard to early pregnancy questions. See the emails below to understand my conundrum..

vague mama:  Hi My name is _______.
Here’s my ultrasound.
Thank you in advance.~

The subject of this email read 12w6d ultrasound. Attached were a few crazy bright, quasi fetal bottom view images. Great ultrasound imaging can only be taught. Truly. I can only assume this person was curious about gender but how am I supposed to really know this is the question if it’s not asked?

twin mama:  Wow! So glad I found you. Can you please help with my twin ultrasound? We are confident that baby B is a BOY! However baby A is leaving us confused, we were told possibly boy as well, all guesses on other sites say girl. Just so confused. Thank you in advance for your help. Sincerely..~

So, clearly, this one questions gender, however, no gestational age is included so I have to guess based on how big the baby looks in the image. If you guys know me by now, I DO NOT guess gender before 17-18wks and if you’ve followed me for a while, you’ve read a hundred posts on why that is!

Too early = too much guesswork = an ^ in the % of complete wrongness.

This is my professional and VERY scientific formula on how to incorrectly determine fetal gender. Turns out these babies were 14w4d. In other words, you may as well flip a coin. You have the same degree of accuracy and it’s free.  There’s not much worse than paying someone to be wrong, right?!

concerned mama: I just have a couple questions I’m hoping you wouldn’t mind helping me with. I just had my first ultrasound abdominally and also had the internal, as well, for dating. I have a very irregular period so I don’t know my LMP. I had gotten lab work done the day before the ultrasound to check my hcg levels. The nurse said they were pretty up there but not yet 14 weeks. During my tests, my sonographer would not give me any info. I understand they formally cannot give an official diagnosis but she wouldn’t even show me the screen. Is it normal that they don’t give you a picture, either? If you could try and answer these questions the best you can, I would greatly appreciate it:) Thank you so much! ~

So, a layperson may not understand the difficulty here but what am I supposed to answer for this reader? With no images, no measurements, no LMP..virtually no concrete information..I cannot tell her anything she doesn’t already know about her case, which is almost nothing. I am not sure she even saw a heartbeat but without that being stated I can assume nothing. The only opinion I can state here is that it is entirely WRONG that her provider provided no information for this patient (not much of a “provider” in my book) and made her wait an entire weekend for some answers. I am a provider, too, but I answer to a physician. The physician, PA or nurse could have informed this patient about what was seen on the scan, even if they couldn’t yet predict if it would be a good pregnancy.

So, there you are, Ladies..an example of some of my emails! Sometimes I can’t help you very much but I always try!

Before I close out, feel free to check out the great ads to your right! I have vowed to only advertise good or services that you mamas-to-be might find useful or that I wished I might have had eons ago when I was birthin’ and raisin’ babies!

‘Til next time, wishing you a happy, healthy sonogram;)

wwavblogger

 

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Posted on August 2nd, 2015 by wombwithaviewblog.com

One of the greatest events in the first trimester, next to the pee stick plus sign, is seeing Baby and the little flutter of cardiac activity for the very first time.  One of the worst events is not seeing it at all.  A blighted ovum is where the gestational sac of a pregnancy develops but not a baby.  You still get the positive test, hormones and symptoms of pregnancy, but only a sac with no embryo or yolk sac develops.  The whole scenario, naturally, makes for a very anxious mom-to-be the next go-around.

The image below is an example of what a blighted ovum might look like:

blighted ovum

 

Read below an email I received from one such anxious mama.

nervous nellie:  I had a blighted ovum a couple months ago, so I’m very nervous about my new pregnancy miscarrying.

I’m 5 weeks 5 days and had my first ultrasound today. We saw a healthy yolk sac and a heartbeat (couldn’t hear it though), but the gestational sac was oblong. I know an ideal sac is perfectly round, but I don’t know how normal it is to see an oblong sac. Given everything else was normal (CRL: .25 cm) I want to hope for the best.

This puts us at 5 weeks 2 days. Is this anything to worry about?

wwavb:  This sac is beautiful!!! Congratulations on your pregnancy! These are all good things..a good sac, the presence of a yolk sac and an embryo with a heartbeat. Did they give you a heart rate? Not hearing it only means they did not use the Doppler feature which allows the sound. This should not be a concern.

And, no, the sac does NOT have to be a perfect circle! I see oblong gestational sacs all the time and it is strong walls that are most important. If you look at the longest measurement of the sac, it measures 1.6cm. If you add 4 to this number, you get 5.6, right? This is another way to calculate gestational age by a sac measurement. So, to me in this image, I would say the sac size is consistent with a 5w6d pregnancy. And once an embryo and heartbeat are seen, gestational age should be calculated by embryo size instead. This is because sac size can vary quite a bit and is not as reliable for dating. Very early, though, it’s all we have! Typically, a heartbeat is seen at about 6wks, not 5, so their measurement could have been off a little.

I know it’s very hard to face another pregnancy after a loss. It takes lots of courage! I hope these posts below help. When it doesn’t progress so early on, usually there was something very wrong from the beginning but it in no way means this one won’t be great!

http://wombwithaviewblog.com/miscarriage/

http://wombwithaviewblog.com/pregnancy-loss/

I wish you the best for a happy and healthy pregnancy! Try to enjoy it!  Thanks for reading and emailing. I hope I helped a little;)

wwavblogger

nervous nellie:  You are such a wonderful help! THANK YOU for responding and thank you for having this ability to check on little concerns. I can’t tell you how much you have put my mind at ease in these early weeks. You really are a blessing!

wwavb:  You are so welcome!  You know, I have to say that no one is out of the woods until that 1st trimester is done..12wks. The farther along you get with Baby growing normally and a good heart rate, the greater your chances of miscarrying decrease. If a demise happens after that point, you know something was very wrong with the pregnancy. At this point, however, there’s no reason to have any less hope than anyone else!!

Best wishes!!!
wwavblogger

***

No one can ever predict the outcome of a pregnancy unless we see very definitive signs early on.  A blighted ovum is one of those we know will not progress beyond a certain point.  However, like I said in my email to this reader, it in no way defines the outcome of future pregnancies!

Best wishes to all you for happy and healthy babies!!

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Posted on July 22nd, 2015 by wombwithaviewblog.com

First of all, I’d like to welcome my first two advertisers!  Us moms can never have enough access to products and services that make our lives easier.  So, check them out just to the right of this post.  You’re welcome!

Moms, friends of moms and family of moms-to-be..The Corner Stork has some of THE most precious baby shower ideas and gifts EVER!  Where was all this cute stuff when I was pushing out my little pumpkins?  They seriously make me want to run out and throw someone a party.

And for all you moms with little ones in tow already, Zoobooks is educational fun if your kids are fascinated with animals!  What kids aren’t?  These make great gifts, too, so if you’re in need of something for the fifth birthday celebration your child has received this month, check it out!  Our next generation of leaders is bound to soak up more useful facts and trivia here than that from a particular sponge I know.

Onward to my post of the day..

I read something a little disturbing whilst surfing this universal web of ours called the internet.  I don’t often search anything ultrasound related unless it is a medical reference for the purpose of supporting the diagnosis of a case.  I have been told, however, that if I want to increase my visibility of this blog, I must submit my two cents on other sites and provide a link.  It’s very disturbing.  Where do I start??!  There’s so much misinformation out there and it’s very distressing to know people are believing everything they read or are misguided in some way themselves.

Someone wrote essentially a one-liner about her miscarriage.  She stated that she will absolutely never have another transvaginal ultrasound in pregnancy because the one time she allowed it, her baby died the next day.  I was so saddened by this statement.  I attempted to reach out to her with a direct email but it wasn’t possible.  I hope someday, in some small, remote and very unlikely way, she may stumble across this post.

ALL OB PATIENTS!!  Please know that scanning with an internal ultrasound probe in no way, shape or form causes miscarriage or fetal demise.  If this were the case, we would not be allowed to perform the examination! Our docs are in the business of helping you carry a healthy pregnancy and, hopefully, to term.  Transvaginal sonography is the best addition to sonography for early obstetric care and gynecologic studies.  It provides so much useful information for your physician that just cannot be seen with transabdominal scanning.

It helps us find your Baby’s heartbeat and determine gestational age early in the first trimester. It helps affirm for your doctor that your pregnancy is progressing normally or whether it is threatened because of bleeding or a shortened cervix.

Most of you know that your OB/GYN doc has your best interest at heart.  It’s unfortunate and sad that the coincidence of this tragic event happened after her examination..but it was not the cause.  I want you all to understand that having this exam done is what can help your doctor SAVE your pregnancy.  The goal is happy, healthy, full-term babies!  Sometimes we can help you achieve this; sometimes we can’t.  Either way, transvaginal ultrasound likely played an instrumental role in  providing your physician with much-needed and highly valuable information.

If the medical community feels it is safe enough for ourselves and our own families, we certainly want to provide you with the same quality care!

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Posted on July 17th, 2015 by wombwithaviewblog.com

Every once in a while we have a patient who desperately wants to pin down the EXACT day she conceived so she can determine the father of her baby.  Ultrasound can give you a general time-frame within a few days of reliability early in the first trimester (about 8-10wks gestational age) but it cannot be specific to the day.  Moreover, ultrasound measurements become less accurate the farther along in the pregnancy you are.  Someone who shows up for dating at 23wks, for example, will get an estimate or “best educational guess” for a due date.  Determining paternity by ultrasound is not “cut and dried”.

Some would like us to pin it to the hour.  Sorry, ladies, you are SOL if you find yourself in this boat.  Only DNA testing after Baby is born will help you in this case.  Literally, a young girl in college be-bops into the practice one day hoping we could differentiate within one week between three possible candidates.  Really?  She was very cavalier about her dire straights but what threw me more was that her mother, who was with her, thought it was just as funny.  Personally, I have to say I’d be mortified if it were me and even more so if it was my daughter.  I’m not being judgmental here; I just think it’s a serious matter and not a laughing one. Being a little more selective in this department than this girl, both women AND men, would not be a bad thing!

The first thing your doctor will ask is when your LMP or last menstrual period started.  Most people ovulate between days 10 and 14 but some people have very short cycles and others have longer ones so the actual day the egg is released is quite variable.  Some people experience very irregular periods, oftentimes skipping several months at a time, which is totally unreliable for dating, unless you know exactly the dates you had sex.  Moreover, semen can live for a few days within the vagina (don’t quote me and I’m sure this is an exact science in some literature but I am not an expert in the life cycle of sperm) so it would be hard to pinpoint the exact day of conception.

Getting a good dating scan in the first trimester by someone who is experienced in determining the best measurement is the next order of business, providing Baby is easy to see. I personally feel a transvaginal ultrasound at 8-10wks is the best time to obtain a CRL (crown-rump length, measurement from head to butt) because Baby is not too small or big.  A 6wk pregnancy where the embryo measures a whopping 3mm can be very difficult to see well.  At 12wks the fetus is fully formed and very active which can make obtaining a good measurement challenging.

See the images below to see the difference in a CRL at 6wks, 8wks and 11wks!

6wk embryo

6wk embryo

Baby is so small here that it can be hard to see in some patients depending on how it is positioned!

 

8wk fetus

8wk fetus

This is the best dating here! Baby is usually pretty easy to see now at about 1/2 inch.  This measurement is accurate within 1-2 days.

 

11wk fetus

11wk fetus

Dating is still fairly accurate here within about 3-5days.  They move a lot and bend and one can imagine that a bigger measurement will yield a baby a little farther along if he/she is stretched out vs curled in a little ball.

 

I get it; things happen.  People who are in a serious relationship break up.  They see someone else during the pause..rebound, shoulder to cry on, etc., and then reconnect.  This can be a wonderful reunion! But it can still make for a bit of a hairy situation if these encounters happened within 2wks of one another.

On a final note, imagine yourself in this situation.. You’re pregnant with twins.  You’re in the throes of labor.  Out pops your first baby.  Joy! Success! Beautiful!  Baby B is right behind.  Big push!  He’s out!  Oh.  Wait a minute.  One is black; one is white.  Yes, this definitely happened.  Lucy, you have some ‘splaining to do.

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Posted on June 28th, 2015 by wombwithaviewblog.com

Today’s post is an extension of the last, expounding a little more on the technical details of the transvaginal ultrasound.  As I mentioned previously, this approach to the pelvic organs has been the most impressive addition to the modality and the best way to image these organs.

There is no prep for this exam unlike the dreaded filling of the bladder for the abdominal approach.  Moreover, an empty bladder is required since too much urine will cause the bladder to push the uterus too far back, yielding a limited image.

The exam typically takes me about 10-15 minutes in a normal exam.  Everyone’s organs are positioned a little differently so a challenging angle or needing to document a lot of pathology can certainly cause your exam to run longer.  The uterus tilted backwards, the ovaries too high in the pelvis and intestines in the wrong place all make for a difficult or limited examination.  The intestines, or bowel loops, contain air and gas through which sound waves cannot penetrate.  Therefore, bowel sitting on top of your ovary can obscure the view altogether.  Oftentimes I can push around a little to obtain a better view or I’ll look abdominally anyway in an effort to see something, anything I couldn’t internally.  If your uterus is REALLY large (as in the case of large fibroids), I’m going to scan you abdominally anyway.

We measure the uterus and ovaries and document any pathology we see.  Uterine fibroids (a very common tumor of the uterine muscle, endometrial polyps (like a skin tag in the lining of your uterus), ovarian cysts or masses and fluid in the fallopian tubes are just some of the processes we see on a regular basis.  The exams are typically ordered by your doctor if you are experiencing pelvic pain or pressure, if something is felt on your pelvic exam or if you describe any myriad of problems with your period.  There are volumes of other reasons to perform this exam but the above are some of the most common.  A regular misperception I have found with the general public is they don’t realize ovarian cysts can be functional..meaning this is what the ovary does normally every month when we ovulate.  A cyst forms, ruptures, the egg is released..voila!  Ovulation.  So many come in exclaiming ovarian cysts like they have a disease.  More often than not, it’s just a normal finding.

There are no side effects of the exam and it shouldn’t hurt.  Sometimes, if you come in with pelvic pain already, the exam may feel a little uncomfortable.  Most people complain of pressure on the bladder.  If it’s painful, let your sonographer know!  Sometimes “newbies” push too hard, unbeknownst to them.

When my patients come in stressed out about the exam, fearful because it hurt the last time they had one done or exhibit a little trepidation, I always try to lighten the mood with the same line.  “No, worries.. I just have to find your ovaries, not your tonsils!”  I always get a laugh and a thank you out of that;)

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Posted on June 23rd, 2015 by wombwithaviewblog.com

Transvaginal ultrasound was developed somewhere in the 1980s and, in my opinion, is THE best contribution to ultrasound, bar none.  It gives us a high resolution image because the probe lies closer to the organs and utilizes a higher frequency than with abdominal probes.  But, women, do you really need company to have this done?

Case in point.  A young patient comes into the office with an entourage.  I seriously had to check my memory twice, reminding myself that she wasn’t there for an OB appointment.  With her was Mom, Child and Boyfriend and Mom insisted on coming in for the exam along with the child.  Of course, I could care less as long as the patient wants them in there.  I have to ask all the same questions regardless of who else is in the room.  If you don’t want someone hearing all your personal GYN business, you better have them wait outside.  This wasn’t the case here on this day but, nonetheless, no truer statement has ever been spoken…well, typed, that is.

About 80% of the time, I get the same reaction.  I say the word “transvaginal” and I see people’s eyes get as big as dinner plates.  I realize the hesitation on several points.  If you’ve never heard of it, if you’ve never had one done or if you’ve never been to the GYN doc, I condone “the look”.  However, if not, I sometimes want to just tell women to get over it.  Come on now.  You’re sexually active, you’re in your 20’s or older and you may have even already had a child.  It’s not your first rodeo in stirrups but the transvaginal ultrasound just put you into a tailspin.  It’s an altogether different scenario if someone has had no sexual experience (and I don’t mean virginal by today’s standards) or if a patient has had a bad personal experience in the past which has left them emotionally scarred.  Usually, I know about these well in advance and we plan around them by having the patient fill her bladder or by simply explaining the exams and allowing her the choice if she is old enough to make one, of course.

It’s almost always awkward for the patient (though never for me) and having someone with her is most certainly recommended if she is at all anxious about the exam or results.  The most strange of these situations, however, is when she wants the husband or BF to come in for the exam when he has NO desire whatsoever to be there!  What the heck, Lady?  Do you drag him in for your Pap, too?

In my opinion, guys should be left at home unless you’re there for new-addition-to-the-fam care.  Otherwise, if none of the exceptions above apply, put on your big girl panties and treat yourself to some Haagen Dazs afterward.  Isn’t that the sole purpose for ice cream anyway?  I think it would make for an interesting new ad campaign.  Ice cream..the perfect post-stirrup consolation prize!  ..I’ll have to send that one in..

Stay tuned for the next post where I’ll expound on the details of having this exam done with some fancy shmancy pics, as well.  Thanks for reading and have a great day!

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Posted on June 14th, 2015 by wombwithaviewblog.com

For as long as the medical community has been utilizing sonography for OB purposes, so have there existed some on the operating end of the probe who have guessed the wrong sex.  This has created many a “Doubting Thomas” and “Negative Nancy” over the decades-old practice of the field.  Everyone knows someone who “used to be” the opposite gender before birth.  A lot of patients now just do not believe what they can’t see..or can’t read.  Here we’ll discuss all the many variables that contribute to not being able to determine gender vs incorrect fetal gender with ultrasound.

Fueling the justified fire is the unfortunate circumstance of unsuspecting parents everywhere who buy an entire wardrobe of monogrammed dresses only for Junior to pop out or Henry becomes Henrietta.  Most patients just do not really understand what it means when I say that ultrasound is entirely subjective.  Most lay people have no idea just how much this is true.  Honestly, most sonographers-to-be do not understand this, either, until they begin to practice it.  So, in an effort to not write volumes here, I’ll just say that if a sonographer is new to ultrasound, new to OB ultrasound or just not very good at determining gender, mistakes will be made. Parts look different between every baby, at different gestational ages and at differing angles.  First and foremost, it takes time and experience to be able to discern gender well.

Secondly, one factor which will most always result in not being able to see a great potty shot is Baby’s position.  If the fetus is breech (butt down), we don’t have a lot of room to work with here.  The uterus is like an upside down pear, right? There would be more room to work with if the butt was at the top of the pear than the bottom.  If the cord is running between the legs, parts can be obscured.  Sometimes a foot or hand is in the way.  At times, the rear is pushed up against the uterine wall or the legs are closed.  We can poke and prod all day long but there is nothing more we can do to force Baby to move into a better position.  And, no, jumping jacks won’t help.

Mom’s size is also a limitation.  It is a simple rule of ultrasound physics that the more tissue the sound waves have to travel through, the more unclear the image will be.  The more belly fat one has, the more fuzzy the image will appear.  A lack of resolution will always create a more difficult image to read.

Other factors include having an adequate amount of amniotic fluid around Baby (fluid helps us see better) and a gestational age over 18 weeks which is preferable.  Too early and parts are just too small, especially when boys and girls start out looking the same around 12-13wks. I don’t care what ANYONE advertises!  NO ONE can guarantee gender.  Sure, you might get your money back but that won’t pay for the new nursery or make up for the emotional transition.

All of the above make a difference in how well we can determine fetal sex for the parent.  One of these factors coming into play can make this task super difficult but seeing more than one or all of them and the job becomes impossible.  Ultimately, however, even the best of views doesn’t matter a hill of beans if the sonographer doesn’t know the difference.  At the end of the day, if the sonographer is too inexperienced or simply jumps the gun, you’ll be repainting that room!

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Posted on June 6th, 2015 by wombwithaviewblog.com

Patients, in general, tend to believe that determining male gender should be very easy any time and the only way to determine Team Pink is the lack of male parts.  Wrong!  Can we see the uterus and ovaries of a female fetus?  Read an email below from a mom with this very question:

mama-to-be:  Is it possible to see baby’s ovaries and uterus with ultrasound? I’ve read these organs are formed around 20/22 weeks. I was thinking it was possible to see them at 22 weeks or later?

wwavb:  A fetus is fully formed at 12wks. And, no, a uterus and ovaries cannot be seen normally anytime in pregnancy as they are simply too small and gender can only be determined by examining external genitalia.

***

On occasion, an ovarian cyst can be diagnosed on fetal ultrasound but is only a guess as these organs are just too tiny to know for sure.

See below for good female gender images!

This image is of a baby girl at about 16wks.  Here, a bottom is seen but not really the legs..imagine Baby is pulling her feet up to her nose. If you are looking up from underneath, only cheeks and girly parts will be seen, right? Note the three arrows which point to three white lines representing the labia on the outside and clitoris in the center.  Sometimes the lines look more like white dots depending on the angle.  As Baby gets a little bigger, she will start to develop some fat in her skin and the labia will plump up a bit, resembling the “hamburger” to which most patients refer!

This image is around the 16wk age, also.  You can see here how the top labia looks more like a dot and the middle and bottom white echoes look more like lines.

This baby is about 32wks!  Notice how the white lines have morphed into the labia you would expect to see on Baby Girl.  Most patients can typically “see” her parts for themselves pretty easily at this stage.

Next time, I’ll discuss all the things that make determining gender impossible!

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Posted on May 30th, 2015 by wombwithaviewblog.com

How many times has a sonographer pointed out gender to all you readers out there during your sonogram and you respond back with a “Huh, where?”  Even male gender on ultrasound can be difficult to discern if other parts are in the way.

Check out this recent email from a mom who had the same problem:

confused mama:  Hello! I just recently went in for a gender ultrasound which I was so excited to finally get. I had an uncomfortable experience with the ultrasound technician. The second she saw the baby she said I am 100% it is a boy. She didn’t show me, my mom, or my mother in law the penis or scrotum and she didn’t explain at all. I was 19 weeks and 2 days at the time of this ultrasound. I might be in denial it is a boy but I honestly am confused by the photo she gave that shows the penis and scrotum. I am confused because there are two lines underneath it but in all the boy ultrasounds I have seen, the penis and scrotum look more defined and those two lines aren’t there. It might be the butt, I’m thinking, but I don’t know. Can you please give your professional opinion? I had a friend who is also a RDMS and she said she could not tell the gender. I am debating if I should do another gender ultrasound. Please help (:

outside image

wwavb:  Okay, so check out the image below..

malepicjpeg2

You are seeing an underneath view of Baby.  Encircled in yellow is the cord which is running between Baby’s legs and obscuring parts a little.  You should be able to see boy parts a little better with my annotations.

I wouldn’t go for another, especially if it’s one of those ultrasound drive-thru cash cows.  Does your friend not do OB/GYN?  I felt it was pretty easy to tell, but I would have either not given this image to a patient or otherwise explained the parts.

Glad I could help!
wwavblogger

***

I think some sonographers forget that not everyone can figure this stuff out as easily as we can.  Even if you are an experienced certified sonographer but not in OB, it can still be quite a guess for you, too.  After all, experience is the teacher, right?  Experience is also the teacher eventually for ANY sonographer who is dumb enough to call anything between the legs 100%.  Sorry!  You know I’m right, medical community!

Switching gears a little, I’ll be quite frank here.  It gets to be pretty exhausting sometimes when those of us in diagnostic ultrasound have a fetal medical exam to do and the only thing the visitors can do is squawk on and on about what the baby is, who has bets on what and when in the world I am going to get to the “good” stuff..as if the brain and heart are not “good” enough.  It’s frustrating, to say the least.

But when ALL you do for a living is scan people for the heck of it with no real diagnostic merit attached, there is no excuse.  If you work for a 3D turnstile, you have all the time in the world to play, to have a little fun and to crack a few jokes.  Your ONLY job is make the doggone thing enjoyable for all who pay to be there!  If that is too difficult for you, try mixing the entertainment factor with the medical one and see how much fun you have doing that.

As sonographers, if we’re going to take a penis pic, we should at least narrate for our patients if Baby is feeling a little shy that day.  And patients, if you can’t tell a penis from a big toe, speak up!  When you pay for a 3D scan, you have the right to see it when you want and how you want; you paid for it!

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Posted on May 23rd, 2015 by wombwithaviewblog.com

You’re almost out of the woods! ..of the first trimester, that is.  Your baby is now just shy of two whole inches in length from head to bottom.  The 11 week fetus is looking more and more like a baby instead of a blob and, in real-time imaging, watching baby flop around like a little fish out of water always creates a chuckle for us spectators.

Transvaginal ultrasound is still usually the preferred method of scanning as it gives us the best resolution but we can adequately measure what we need with the abdominal approach in a thin patient.  Arms and legs are almost fully developed.  Baby’s head still looks bigger than its body but there is a lot of brain still growing in there!

In the image below, you’ll see the crown-rump length (CRL) measuring Baby from head to butt, a tiny little foot which is about 1/2 inch long and tiny pair of legs and feet.  So cute!

 

11 week fetus

 

Hit me up if you have any questions about the 11 week fetus or anything ultrasound-related at my email address, wombviewerblog@gmail.com, or by clicking the Ask Me page above.  You can also find me on Twitter, @wombwaviewblog.  Follow me!

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Posted on May 12th, 2015 by wombwithaviewblog.com

I want to take a little departure from 1st Trimester ultrasound to share the following email from a reader.  I’m sure many of you have received questionable images in the past.  Have you, too, shared this mom’s concern?  When reading my reply, take a moment to really try and visualize my explanation of how we obtain a good fetal profile!

nervous mama:  Hi, can you please help me?! At 37 and 39 weeks I had ultrasounds done and the profile looks so bizarre to me that I am nervous something is wrong. I have asked the sonographer and physician and they don’t see anything wrong with them. However, I can not find anything remotely similar on the internet. Can you please explain what I am looking at? The nose looks odd shaped and I cannot make out any other features such as the lips and chin. Please email me back before I give birth on Wednesday of next week.

fetal face images emailed to me

fetal face images emailed to me

Thank you!

wwavb:  Hi! Thanks for reading and emailing.  I’m sorry these images have you so worried!  These are good questions and I’ll share them with others in a future post.

Firstly, I need you to understand that because I only have limited information from these images and because I didn’t personally scan you, all I can give you here is limited information about what I see.  That being said, the profile in the top image is not a good one simply because of positioning.  Baby’s face is plastered against what looks like the placenta (they love to do this, by the way).  Because of this, there is no amniotic fluid between the placenta and the face, which is what is needed in order to define the outline of the face.  It’s the same principle in 3D imaging.  No fluid in front of the face, no image.  I never give images like this to patients..they don’t look like anything a patient (or anyone else) can discern and you would have been better off if she had simply given you feet or hands or the butt instead.  When I see babies in this position, I tell Mom that I just can’t see Baby’s face well to obtain a good image and I show them why.

You can see the difference in the second image.  Here, there is just a bit of fluid (the black) in front of the face.  The other thing that makes a great profile is actually obtaining one, which the sonographer did not do here.  This is not a “perfect” profile image, per se’.  Imagine taking a marker and drawing a line right down the center of your face starting at your hairline and on down between your eyes, bridge of the nose, tip of the nose, center of the lips and chin. This is a perfect profile and this is where the sound beam has to hit to obtain that view.  Now imagine drawing another line starting at the same place but this time you draw your line at a slightly different angle.  Imagine taking a ruler and holding one edge at the starting point in the middle of your forehead at the scalp and placing the bottom edge at your chin about an inch from the center.  If you drew another line to connect those ends, the line falls differently, right?  It might start in the middle of your forehead but then travels at an angle down your nose, cuts through a nostril, the side of your lip and part of your chin, right?  You should also be able to imagine now how that cut would look differently from the side than a perfect profile. It looks different because it is taken at a different angle.  I know this because the nasal bone is not in the image and I can see part of the nostril.  This may also be why the lips and chin look slightly different.  You won’t find anything online about it because everyone’s babies look as different at term on ultrasound as they do in real life.

ALL THAT being said, only your doctor can give you peace about this.  If you trust him and if he trusts his sonographer and if the sonographer is very experienced in OB and if they both feel a good look was had, all you can do is trust that all is okay!  If you can’t let it go, talk to your doc about it.  Perhaps, if they have 3D capabilities, maybe his technologist can do a quick sweep to show the front of the face and perhaps ease your fears.  Just remember you are quite far along so don’t be surprised if they cannot obtain a good face shot now.  If Baby is using the placenta as a pillow again, no chance.

At the end of the day, a perfect angle with great position and good fluid are the only things that help create a great image..well, that and a sonographer who is a stickler for detail AND a perfectionist! (like Yours Truly) Try to enjoy the rest of your pregnancy and focus on being ready for Baby.

I hope I helped a little and I wish you many blessings for a healthy baby, labor and delivery!
wwavblogger

***
This reader emailed me after she delivered saying Baby was beautiful..no unusual features or facial abnormalities. Thank goodness!  See below for my personal images of a great profile.

profile1jpeg profile2jpeg profile3jpeg

They say a photograph speaks a thousand words. This can be especially true in ultrasound. The images either say nothing or everything of which a new mom-to-be worries. Sonographers: don’t throw out a half-ass image thinking your patient won’t notice. Sometimes they don’t. We sonographers all know sometimes good images are impossible for many reasons. So, explain why a good profile is not achievable and just don’t take the shot. But when images CAN be good and they’re not because you didn’t take the time to make them that way, stop and think a second. Would you rather provide an image a patient will cherish her whole life or one that will cause her to lose sleep?

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Posted on May 10th, 2015 by wombwithaviewblog.com

HAPPY MOTHER’S DAY!!!!!!!!!

My blog is nothing without paying homage to the celebration of life and the incredible women who help to create it!  Thank you for reading and subscribing and I sincerely hope you all enjoy a wonderful day surrounded by your family.  Hopefully, they brought you breakfast in bed and are obeying every command with the tinkle of your handy-dandy little bell (or foghorn, whichever your prefer).  Contrarily, but no less enjoyable, maybe you’ve opted for the fam to disappear, leaving you to delve into your favorite book or hobby for a day without stinky diapers, PB&Js or laundry…or fighting!

Last week I included a 3D image of a 9 week fetus as shown below.

9wk fetus in 3D

You can see little arm buds and leg buds getting bigger.  What looks like a tiny lump on the top of the belly is just part of the cord.

Below is a 2D image of a 9wk fetus:

9wk fetus in 2D

Baby is upside down here and you can see from the dimension taken that it is measuring just about a whole inch now!

I don’t think it’s too much to ask to spend one day a year sans the multiple hats that come with motherhood..chef, chauffeur, maid, teacher, referee (for those of you blessed with more than one little angel). It’s the most difficult, most enjoyable and most important title any woman will ever hold.  Shaping and molding our future generation of leaders is no small task!

To carry them, raise them, care for them, discipline them and love them defines us as Mothers.  Any woman who puts her all into this job deserves to spend this day any way she pleases!  Enjoy it!

And for those first time moms-to-be..relish the peace and quiet now while you still can;)

HAPPY MOTHER’S DAY TO YOU ALL!

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Posted on May 3rd, 2015 by wombwithaviewblog.com

Hello!  I apologize for my lengthy absence.  Don’t you hate when life gets in the way of the things you want to do?!  So let’s pick up where we left off..the 8 week fetus.

In the last post I included 2D or two-dimensional images of the 8wk fetus.  Today, I’ll include a 3D image at about the same age so you can appreciate the difference between the two as shown below.

2D 8wk Fetus

8 week fetus

 

3D 9wk Fetus

9 week fetus

The 3D image looks more like a baby, right?  This is why two-dimensional images are hard for people to read and understand.  It’s just a slice-thickness of the fetus (or whatever we are imaging at the time) and we have to form a mental image of what we are seeing by moving the probe around. It took us a while to learn how to do this which is why it is so hard for you to understand the first time (or 10th time you see it!).

I’ll take you through the first trimester in the next few posts and then we’ll start to get into lots of emails I’ve received over the past month that may very well interest you!

Take care until next time..and I promise it will not be another month.  Thanks for hanging in there!

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Posted on April 4th, 2015 by wombwithaviewblog.com

Six days later and I can finally say I am feeling quasi-normal again.  I’m going to take a slight departure from the regular 1st trimester fun tonight to address the probable cause of my untimely illness.  Tis the season for allergies and the all-too-common stomach bug that loves to wreak havoc on the gastrointestinal systems of the entirely innocent.

Just such a germ crawled up from the depths of hell and finagled its way past obsessive hand-washing to make me wish for death.  Lo, I never did see a light.  Actually, it wasn’t Heaven but the ER where I found myself and it wasn’t death that I was begging for but IV Phenergan, instead.  I was the victim of the most horrendous and uncontrollable volcanic explosions of bodily fluids one can imagine.  It was like something out of a 70’s horror flick combined with that infamous toilet scene in Dumb and Dumber.  In retrospect, the mental picture is a bit comical, yeah? Of course, such bugs do not care about the timing of these ghastly events but I would have preferred to be within the comfort of my own home, face to my own bathroom floor (thank you very much) instead of that of a hotel while out-of-state for a family gathering!  Oh, yes.  I spent the following 24 hours at my sister’s house, taking over her uber-comfy king-sized bed (my ANGEL of mercy!).

Now, where could I have picked up this pesky little bug.  Hmmm..  S a t a n??  While believable, my thoughts do wander to the ridiculous number of people with noses running like faucets, coughs akin to TB infection and other flu-like symptoms who come in to the OB/GYN office every single day!  OR they bring their snotty, sneezy, febrile children in with them to so generously help spread this infection to the legions of already-ailing pregnant women we see on a daily basis.  Who thinks this is ok?  I’ve actually had patients wheel their sick kids into my room and say “I’m sorry I had to bring him with me today but he is sick and had to stay home from daycare”.  So….WHY IS HE HERE???!  This is what I’d like to shout.  What she was really saying was that she was really looking forward to her ultrasound that day and didn’t want to miss it.  Contrarily, I have to instead ask if he has a fever and then politely ask them to get the hell out of the office and reschedule for a day when no one is in need of antibiotics.  Or an emesis bucket (that means vomiting for you non-medical personnel out there). Another patient stated she thought she had the flu..after sitting in the waiting area for 45 minutes..around scores of other pregnant women..sharing the same air..AND her doctor was pregnant at the time, as well.  What was she thinking??

I do think the general public has the misperception that we, as healthcare providers, are immune to illness.  Tell that to my colon.  We are not a hospital or an urgent care facility and we are not your primary care or family doc.  People who do not use common sense in these situations put all staff and every other patient in that waiting area at risk when they could have simply rescheduled their appointment.  Sure, it may be inconvenient but such is life.  Is it really fair to expose masses of otherwise healthy patients because someone doesn’t want to miss her ultrasound or reschedule a doctor’s visit?  This is all about limiting exposure and reducing risk.  If everyone practiced such and just stayed home when ill, we’d have a much more healthy society.  The flu is no one’s friend but pregnancy and the flu are simply not a winning combination, especially when an expectant mom is so limited in the meds she can take anyway.

Let’s be real here, people, NO ONE enjoys violent diarrhea or projectile vomiting.  Honestly, I wouldn’t wish it on my worst enemy and hope I never in my life have to feel it again.  If you ever do, however, I hope you have a great sister who takes care of you like mine!  But I’m not sharing so get your own awesome little sibling!  Even though my sweet bro-in-law didn’t have a choice, he was such a good sport about being kicked out of his own bed.  Thanks, J!  Fortunately, the series of unfortunate events played out well after the family feast.  We enjoyed so much great food!  Too bad I had to see it again later.  I can promise you right here and now, there is one species of seafood that will never pass these lips again. The rest of the weekend and quality fam time was lost to sleep and nausea.  So..could I have contracted my little nemesis from the gas pump or keypad at any store register despite my prolific post-use of antibacterial gel?  Sure.  But it’s more fun to blame snot-nosed kids. I can say this because I raised two of them myself;)

I love you, Sis!!  A case of Lysol is on the way to replenish your stash.  Man, I owe you BIG for that one.  I guess the old adage really is true..blood is thicker than vomit.

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Posted on March 26th, 2015 by wombwithaviewblog.com

In the last post, two babies were finally seen, both measuring about the same at 6wks with great cardiac activity!  So let’s check out a few changes. The image below is of embryos at 7wks.

7 week embryos

You don’t really need a measurement here to see how much bigger they look compared to just one week prior!  You’ll notice that the gestational sacs are bigger, too, and yolk sacs keep the same general size and appearance although they are not pictured here.

 

Since I didn’t have much to post about Week 7, let’s skip ahead a little and look at 8 weeks, too!

a8wks

Can you believe the difference in just 13 days? Baby A is a whole 12mm bigger!  The more round area to the right is Baby’s head. We can even make out little arm buds and the little white lines you see on each side of Baby represents part of the developing amnion or sac of fluid around Baby.

 

Now check out Baby B below!

8 week fetus

Baby B is now a whopping 13mm bigger!  What an animal!

 

8 week twins

Not only is the 8 week fetus a site to behold but all the changes seen in every week of the first trimester are really quite unbelievable and it truly is one of the most favorite aspects of my job.  I love it!  It makes me realize what a privilege and honor it is to be able to catch a glimpse into this amazing world on a regular basis.

One day they’re 3mm; you blink, and they’re 16mm!  Wow, our kids just grow up so fast! (sniff, sniff)

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Posted on March 15th, 2015 by wombwithaviewblog.com

In the last post I wrote that we were able to FINALLY see a first trimester embryo in each sac in this twin pregnancy!

Lo and behold, they both measured 6wks!  We could not explain why the gestational sac of Baby A was smaller or why that of Baby B was larger.  We were still a bit concerned about that finding but the fact that we saw two strong heartbeats and two babies that measured essentially the same were both very reassuring!  See the images below for measurements of the embryos.

 

Embryo measurement at 6wks

Baby A Embryo

You’ll note here that Baby A was measuring a whopping 3.5mm!

Embryo measurement at 6wks

Baby B Embryo

Baby B measured about the same at 3.4mm.

Now check out the heart rates as determined by pulsed doppler so Mom could hear them.  Typically and with modern equipment, if we can see it, we can also hear it.

Embryonic heart rate at 6wks

Baby A Heart Rate

This is the heart rate for Baby A.  Note that it is just over 100bpm which is a great start!

Embryonic heart rate at 6wks

Baby B Heart Rate

Baby B’s heart rate was just a tad faster and a little easier to hear as you can see by the strength of the cardiac cycles on the baseline.

Stick around and keep coming back to read more about these twins!  In the next post they’ll be 7wks and you will be impressed at how much bigger they look in only one week’s time!

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Posted on March 9th, 2015 by wombwithaviewblog.com

A continuation of the early first trimester gestational sac seen in the case of this dichorionic pregnancy just five days later brings along a few more changes!  See the image below..

early twin gestational sacs

First Trimester Twin Gestational Sacs

 

For starters, the yolk sacs are much more defined.  Can you see that compared to the images of the last post?  Now the smaller gsac really looked larger than shown here; this is just a good image of both yolk sacs.

Note the dates and see the images below for a comparison of gestational sac size just two days later!

early twin gestational sacs

First Trimester Gestational Sac

 

Baby B

early twin gestational sacs

First Trimester Gestational Sac

 

Baby A

Notice how the sizes of the gestational sacs differ by nearly a full week!  Another way to measure the gsac is to measure it in all three dimensions instead of just the larger single measurement as previously discussed.  Measuring in all three planes typically calculates a tad more accurate estimation of age.  Baby A was the smaller sac measuring 5w3d; Baby B, the larger sac, = 6w2d.

At this point, if Babies were really over 6wks, we should have been seeing embryos in each sac with heartbeats.  If just over 5wks, we would not.  So….., did we??

Y E S!!  

I couldn’t keep you hanging another day!  (I’m nice like that.)  I’ll show you in my next post what the embryos looked like as well as heartbeats.

But something to ponder..since Baby A’s sac was almost a week smaller, did it mean A would not make it?  There was no way to predict.  Did they measure the exact same gestational age?  You’ll have to stay tuned to find out!

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Posted on March 4th, 2015 by wombwithaviewblog.com

So, just two days later, we see two minimally larger sacs as demonstrated below.  That one sac is appreciably smaller still has us concerned at this point.  Our nurse and new mom-to-be has resigned herself to the idea that she may have just one baby here eventually…if she was lucky.  Even though the dimensions came out a bit blurry (taken with a camera some time back), you can see that they differ by about 3/10 of a mm which seems SO tiny!  The other crazy factor is how much one can truly appreciate that tiny difference at this magnitude!  The larger sac measures 8.8mm and the smaller about 5.1mm.  Check out her images below:

gestational sac 5+wks

 

The biggest variable here that continued to give us hope was how, in just two days, we could visibly appreciate a very tiny yolk sac within each sac!  These are the little circles outlined in white along the bottom wall of each gsac which provide nutrients for the growing embryos until the placentas are developed enough to take over the job.

At this point, we knew there were some good changes going on.  But how far along was she, really?  There’s a general rule of thumb we use when measuring a gsac.  We take the one biggest dimension of the sac and add 4 to determine gestational age.  Applying that rule here, was she 4.5wks or 4.9wks?  Considering all these measurements are only general estimates until we can see and measure an embryo, we had to assume 5+wks GA (gestational age) based on the presence of the developing yolk sacs.

Still, the differences were a little worrisome for us both.  Would the smaller sac catch up?  Would we see embryos the same size at the same time?  We would scan her again three days after this.  Stay tuned to see the changes in these 5 week twin gestational sacs!

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Posted on March 1st, 2015 by wombwithaviewblog.com

Most women never get to witness this most amazing part of their pregnancies…the ultimate genesis of a pregnancy as can be visualized by ultrasound. Almost no one has an ultrasound performed every single week in the first trimester so I will share with you in the upcoming posts the astounding changes one can expect to see on a weekly basis.

Between 4 and 5wks of gestation, we begin to see the very start of a pregnancy as demonstrated by a tiny little sac of fluid called the gestational sac.  The changes from week to week are incredible as monumental changes take place with regard to growth of the gestational sac, yolk sac and embryo!  There is no way a physician can confirm with any real assuredness that a pregnancy will progress normally at this point and a vast number of them end in miscarriage..sometimes without a woman ever knowing she was pregnant at all.  I’ve heard my doctors say this is usually nature’s way of taking care of something that was genetically abnormal.  Each week a pregnancy progresses successfully, the higher the chances are it will continue.  For this reason,  your doctor will usually want you to wait until about 7wks before seeing her/him for a confirmation visit.

Your gestational age is determined by the first day of your last menstrual period or your LMP.  For example, if you are 4wks pregnant today, your LMP would have been 1/31/15 and you would have conceived 2/14/15.  Happy Valentine’s Day!  I know it seems two weeks off, however, everything is calibrated according to LMP.  Very few women know when they actually conceived vs most women who know when their last period started.

Sometimes a woman’s “dates” are off meaning you are really farther along or not as far along as you thought.  Maybe you gave us the wrong LMP or maybe you ovulated very late.  This can change what we would see on ultrasound.  If you are too early, there’s not a whole lot we can tell you about your pregnancy.  Until we see at least a 6wk embryo with a normal heart rate and normal-appearing yolk sac, anything goes.  Even then, your chance of miscarriage drops dramatically but the next few weeks are still critical.  Typically, one is considered “out of the woods” after the 1st trimester is over at 12wks.

If you are less than 6wks when you have an ultrasound performed, we may see only a thickened endometrium and no gestational sac (<4wks), only a gestational sac (4 – ~5+wks) or a gestational sac and a yolk sac (~5+wks – 5w5d).  The changes we see every week are dramatic and essentially the same in every normally-progressing pregnancy.  For instance, we know that if we see a sac that measures 5wks and you come back two weeks later, we should very well see an embryo that measures about 7wks.  The embryo measurement is the important one for dating here as the early gestational sac can vary in size by a few days or more.

The images I have for you today are a perfect example of this!  Below is a dichorionic pregnancy or TWINS!  Fraternal, that is.  I am not a geneticist and I believe there may be a possible variant here for identical but typically this type of pregnancy means you ovulated twice in the same month.  Two eggs were released at about the same time and both were fertilized.  SURPRISE!  Man, I just love seeing the looks on people’s faces when I give them this news.  It’s the best!!

This proud owner of this uterus and, eventually, a beautiful boy AND girl happened to be one of our nurses whom we scanned every couple of days in the beginning because she was a nervous wreck!  Alas, her anxiety brings you a peek into the life of a growing pregnancy starting at <5wks!  Enjoy!

5wk twin gestational sacs

You’ll notice the discrepant sizes of the gsacs. The smaller sac measured about 5mm and the larger equalled about 8mm.  We didn’t know at this point whether the two eggs were possibly fertilized a couple of days apart or if the smaller sac would likely not progress.  We both knew, however, that only time would tell.

5wk gestational sac

This gsac measures 5.7mm or about 4 1/2wks.  One criterion we note of a gsac is a brighter ring around the sac (the small black circle).  This ring is called a decidual cast or reaction which is inside the single arrows.  It should also be seen within the endometrium as you’ll see outlined by the double lines.

The next post will demonstrate how these sacs looked just two days later!

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Posted on February 25th, 2015 by wombwithaviewblog.com

..those babies, that is. I can scan them all day long but, I can promise you, no woman in this world would want me at home plate wearing the catcher’s mitt.  That being said, MOST docs (granted, not all) do not make the best sonographers.

We know our strengths, right?  At least most of us do.  As we get older and grow into our careers, we become aware of where we excel..and where we don’t.  Not one of us on this planet is perfect or even close.  We all have room for improvement and, if we do it right, we never quit learning.  The ultimate in humility is someone who is super educated and uber-accomplished who can admit he is not great at something.  The polar opposite is a similarly academic over-achiever who is terrible at something and doesn’t know it.  And it’s worse when everyone knows it but him!  Ah, the human ego.  It sometimes knows no bounds and does us no favors.

I have to say my docs are pretty great about this.  Some try to scan a little more than others and feel comfortable in some aspects of the modality.  At the end of the day, however, they call on their sonographers for reliable ultrasound information.  Docs, unless they are perinatologists (high-risk OB docs), are not vastly trained on the equipment to the extent of an experienced sonographer nor do they know how to obtain particular images.  We have an aviator’s panel of knobs and buttons that help us in obtaining quality ultrasound images.

Read an email below from a reader who was scanned by her doctor as he attempted to determine gender:

mama-to-be:  First of all, I love your blog.  It took me forever to find it!  I am a mother of three and expecting.  I have two boys and one girl.  I went in for my 17 week u/s scan just to make sure I was not further along.  My doctor said that by how the baby was positioned, he could “guess” 80% that it was a BOY. But it could also be the umbilical cord that’s in the way.  Baby was giving us his back at all times and my question to you is, based on these u/s pictures, can you tell gender?????!!!

one doc's images one doc's images

wwavb:  Thanks for reading and I’m so happy you are enjoying my blog!  I hope you’ll subscribe for future posts.  First, if you do a search for gender determination on my site, you’ll find several topics on the subject..especially ones that say if the image isn’t a good one, I can’t tell a thing.  I am sorry to say these images for gender certainly fall into that category!  Physicians are not always the best sonographers so don’t go painting blue yet.  And I can provide that advice with 100% confidence!

Please feel free to send me images again later in the pregnancy if they are able to get a great potty shot.  I’m sorry I couldn’t help you more!

Best wishes,
wwavblogger

***

I really hate it when I can’t help someone who has taken the time to write me for my opinion but, holy cow, let me count the ways in which these images stink.  Any seasoned OB sonographer reading this is laughing hysterically.  Oh, well, we’ll give her doc a C for effort but I am 100% confident that he should never be 80% confident about his scanning abilities and 100% confident that she should not paint her nursery in blue whales and sailboats just yet.  I’m also 100% confident that he has a good 50% shot at being correct.

I always joke with my doctors and tell them not to get too good at ultrasound because I need my job.  Make no mistake about it, I sure can’t do theirs.  And with images like the ones above, we’re talking serious job security for good sonographers everywhere!

!!Stay tuned for my next post where I’ll show you how we all start out..the very beginnings in growth and development of a gestational sac (via my magic wand)!!

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Posted on February 18th, 2015 by wombwithaviewblog.com

Yes, the title deserves a post all its own and screaming toddlers in OB practices around the country today are getting their due.

I think it’s no secret from prior posts how I feel about this situation.  Babies are precious and I can’t keep my hands off of them.  I want to smother them with sugar as much as the next person..only NOT when I am working.  Like most things in life, there is a time and place for everything (including your kids).  The GYN office is one of them.  The OB office, unassisted, is another.  Taking a toddler to an ultrasound is simply not a fabulous concept.  Today’s events were a perfect example of just that!

As I am minding my own business between patients and uploading exam reports and images for my docs, I become fretfully aware of a toddler in distress.  It continues.  And continues.  I realize the incessant, fever-pitched screams are coming from the room next door where my co-worker was performing an ultrasound and I couldn’t help but feel sorry for her knowing she was trying terribly to concentrate and failing miserably.

When another co-worker walked by my room and widened her eyes at me, I knew it was time to step in.  I called her extension and asked if she needed anything.  She said she could handle it.  At this point, I didn’t know if there was someone else with the patient besides the beyond-pissed child in tow.  I guess Dad got the picture because about a minute later, he stepped out with the red-faced, tear-soaked little dumpling.  All I could think in that moment was what in the world made that father stay put while his child freaked out for ten solid minutes like that?  Poor baby!  Who in their right minds think this is okay during an examination..or anywhere??  Mom.  She was upset they had to leave.  My co-worker apologized and explained she just couldn’t concentrate which, in my opinion, needed absolutely no explanation at all.  I know this probably happens 100,000 times per day at offices all around the country but the real question is ‘should it?’

This really should be a no-brainer for parents of any age.  We all know children are temperamental.  We carry diaper bags with us that hold everything but the kitchen sink in an effort to plan for any and every event we can imagine.  And when we have an important meeting, we hire a sitter or take Baby to Auntie’s house.  We don’t put Baby in a papoose for romantic date night, do we?  No.  This is because we want to focus on our spouse instead of spending the entire candle-lit dinner picking up the sippie cup off the floor or wiping a snotty nose with our linen napkin or silk sleeve of our favorite new blouse.  I am always amazed when parents don’t understand why a two-year-old won’t just “sit still” or why “he’s so fussy” when they scheduled their appointment right in the middle of his nap time…the very same nap time he has taken every single day at this hour his entire little life.

Most every woman knows to leave Baby home for a special evening with Daddy and Daddy is totally on-board with this idea.  Your ultrasound examination of the next member of your family is pretty special, too.  We know you want to relish this experience in every way possible and you totally should, too!  The only way to ensure you won’t be distracted from the most amazing movie you’ve ever seen is to let Little Princess crawl or run or fuss or eat or sleep as much as she wants…at home…just like date night;)

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Posted on February 12th, 2015 by wombwithaviewblog.com

One of the strangest enigmas of my job is the development of my warped sense of time.  I rarely remember patient names but I do remember certain exams and images and I most definitely know faces! I might see a vaguely familiar name on my schedule, then see the patient in the waiting room and immediately put the face with the name. What always blows me away is, in fact, the length of time which has passed since they last delivered!

Case in point.. I recognized a name today, entered it into my machine and was stunned as to why the name did not pop up in the search. After all, she JUST delivered (last year, I was thinking). So, I call her back and begin my usual “so good to see you” gab and asked how old Baby is now.  “Baby”, she informed me, is FIVE! And no, not in months.  I seriously needed a few minutes to gather my composure and I’m sure she could tell by the look of sheer dumbfoundedness on my face.  It was quite amusing to her, I must say.  We both laughed and discussed how incredibly fast time flies when we are moms.

No matter whether someone is coming to see me for their second pregnancy or their fifth, it seems that almost no time has passed since their last visit.  It’s sort of like judging age; I’m getting to be terrible at that anymore, too!

Is it the long career in ultrasound serving the general public or is it our kids that make us this crazy?! Hmm..

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Posted on February 4th, 2015 by wombwithaviewblog.com

I love it when patients call in to the office to schedule their anatomy screening and try to tell us their doctor wants the scan a week or two earlier than we KNOW they want it! I know most of you are a little smarter than that..alas, there are always a few who are not.

Each doctor has a designated time in your pregnancy when he/she feels gestational age is optimal for this test. Since we are discussing the practice of medicine, mind you, it’s important to note that all doctors practice a little differently but should do so within the same standard of care.  So as that applies to this examination, most docs will request you to have this exam performed between 18 and 20wks or thereabouts. As I’ve mentioned before, Baby is just big enough to see most organs well at this point with most patients.

For example, we know in our office that Drs. A, B, C and D will request this exam at 18wks or so. Dr. E will always request it at 20wks and asking for it at 19 will be like twisting her arm. Honestly, scanning a little later most always gives us a better look at fetal anatomy but Drs. A and C don’t feel like arguing this point with patients who are trying to plan the gender reveal party so they will allow their patients to come in at 18wks. Drs. B and D are easy going so they’ll schedule it whenever.

Recently, a patient calls in and says Dr. E told her she could have the scan at 18. Hmmm, really now. However it happened, she was scheduled for the exam. As I’m looking through this patient’s chart, I notice she had a dating scan earlier in her pregnancy that changed her due date..she was only 15wks! Needless to say, after conferring with Dr. E’s nurse, the exam was cancelled and the patient was furious…even though she knew she was too early for the examination. She simply elected to not divulge her true gestational age when making her appointment..like I or her doctor  wouldn’t notice??

My job not only entails scanning Baby for abnormalities at an appropriate time that they can be diagnosed but to also confirm the order by the physician and to ensure the exam is performed within the specified time frame in which the physician orders it.

“I don’t care. I just want to know the gender.” Well, your insurance company cares and they are not going to pay for it twice.

And for the 8,462nd time in my career, we will never confirm gender at 15wks. I’ll probably say it another 8,462 times before I retire!

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Posted on February 1st, 2015 by wombwithaviewblog.com

Most OB patients these days get a vaginal ultrasound when they present for establishing of care with their OB docs for a new pregnancy.  Most offices maintain requirements for when this first visit should be scheduled.  There is good reason for this.  Most patients want to see their docs AS SOON as the pee stick demonstrates that little plus sign but the problem is that very little can be determined by your doctor too early in the first trimester except, of course, that you’re pregnant.

Commercials of home pregnancy tests like to tout that you can determine as early as the first missed day that you are pregnant.  This isn’t always a good thing, especially for those overly anxious patients.  Naturally, the next question they all have is “Is everything okay?”  If you are less than 6wks (from your LMP or last menstrual period), we just cannot confirm this!  Even then, not many are entirely sure when exactly they conceived.  A week late with ovulation means we still aren’t going to see much at 6wks from your LMP.  That is to say, the earliest we can measure an embryo and detect cardiac activity is about 6wks. Even then, it can be quite difficult to see well or measure depending on position of the embryo and uterus. If you are even a few days earlier than this, we would only see a gestational sac and possibly a yolk sac. It’s not feasible to scan you every day and your insurance company will not allow it, anyway!  All the above reasons are why some docs specify a confirmation visit no earlier than 8wks for a 1st trimester dating scan, when we should be able to confirm a fetal pole and a heartbeat.  Coming in too early if your dates are off means your doctor will then have to order a follow-up visit for you in a week or two to confirm a normal early pregnancy.  Trust me!  This will feel like the LONGEST one or two weeks of your life!

Sometimes the dates conflict. Your LMP may say you are 10wks but we see a fetal pole that measures 6wks. This just means you really became pregnant a month later. When these numbers are discrepant by more than just a few days, your doctor will typically use the gestational age we obtain by ultrasound.  See the fetal pole and report images below.

10w2d Fetus

SONY DSC

Note that on the report, the patient should have been 11w3d by her LMP of November 10 but Baby measured 10w2d instead.  With dates = 8d off at this point, her doctor will likely go with the due date of 8/25/2015 instead of 8/17.

So, take my word for it.  The only thing worse than waiting to see your doctor for your first OB visit is going to see her and then leaving without answers.  Trust your doctor’s office when you call to make this appointment and they say it’s too early!  They know what’s better for you than you do;)

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Posted on January 24th, 2015 by wombwithaviewblog.com

I’ve written it a hundred times..or seems like it! Someone sends me an image and wants to know if I can confirm gender. Sometimes I can tell, sometimes it’s clear as mud. I usually have to write back and give my spiel about unclear gender on ultrasound and how, because I wasn’t the one who scanned, I can’t see the whole uterus. Some images are just bad!

In ultrasound, we have either images that are beautiful which belong in a textbook and anyone with an eye for the modality can tell you what is pictured. Then there are terrible images where we just shrug our shoulders and wonder what someone was thinking when she snapped the image.

I’ll share this email from a reader and her image and attempt to give you an example here of clear vs not.

unsure mama:  Hello! I’m on my 4th pregnancy and my first 3 were clear as day regarding genders, all done after 20 weeks. But this one, however, my sonographer seemed like she was struggling to get a potty shot. I’m not sure of real fetal age due to bleeding the entire time until 14 weeks. My sonographer said the baby was breech and sunny side up? Baby was also measuring at 17weeks 4days. She hesitated but then said girl. I didn’t ask questions but I didn’t see lines or a turtle. Here’s the pic she gave me. What would you say? Any information will be greatly appreciated. I have one girl who is oldest and two sons.

image

wwavblogger:  Thanks for reading and I hope you’ll subscribe! So, like I typically say, if it’s not a perfect picture, I just can’t sign off on gender. That being said, it could very well be a girl and this just isn’t a great image. It looks like the view is one of baby crawling away from you, if you can put your imagination to work. Right above the arrow is where you would see the 3 dots, however, the dots can blur together if the image is not entirely clear.

I’ll include a link below where I show a baby girl in a similar position, just a little more to the side. Idea is the same. This one is clear and you can clearly see 3 dots here. You can also compare it to the twin brother shot in the same post, too!

http://wombwithaviewblog.com/twin-gender-update/

I don’t see obvious boy stuff hanging down like I would expect to see here!

Good Luck!
wwavblogger

***

So, girl? Maybe! Boy? Sure can’t say it’s not!

My image in the link above that I sent her of girly parts you’ll find below. Which can you see better?

female gender

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Posted on January 23rd, 2015 by wombwithaviewblog.com

One thing Moms wonder about most while waiting for the big day is how much Baby she is actually going to have to push outta there!  If it’s not your quasi-friends telling you you’re huge or a perfect random stranger asking if there are two in tow, then it’s your bathroom scale not-so-gently reminding you of your ever-changing shape. You see the numbers creepin’ up like your too-tight fave pair o’ jeans. If you’re really lucky, you just failed your two-hour glucose. Just when you thought pregnancy was going to be your temporary ticket to Oreotown, your doc is telling you to find a new love for wheatgrass shakes and to hang it up on the Beautiful Bavarian you have a date with for breakfast every day…your husband should be jealous the way you eye those things. I know, I know. I could eat half a dozen of them myself and I can’t use the excuse of growing a human or “Baby wants it; he told me”. Of course, you could use the disclaimer my old Italian mother swears by..if you crave something and you don’t let yourself have it, your baby will be born with a birthmark in the shape of that food somewhere on its body. I kid you not; she really believes it. All I can say is it’s a good thing it’s only an old wives’ tale or there would be an awful lot of gestational diabetes babies out there born looking like pizza and french fries.  Hmm, I wonder what an ice cream birthmark would look like? A dripping cone? The whole carton?

I guess one of the favorite pastimes of Moms today in this age of quickly-changing technology is consulting the highly-revered but often-times inconsistent daily app. You want to know if your weight gain is normal, if it’s too high or too low. Was quasi-friend right to tell you not to have that second piece of cake? Personally, she’d be no friend of mine after that. Let them eat cake! Or it’s “Aw, my baby is an eggplant today.” Huh??

So, knowing we have this insatiable appetite (no pun intended) for knowing everything everyday or at least being able to look it up and get some sort of answer, is it any wonder we wonder at all about the weight of our babies, too? This is where one role of ultrasound is important. Even though very subjective (as ALL ultrasound is), knowing how to take good measurements of your baby provides your doctor with some really important information about fetal well-being.  Read on from One Confused Momma who was originally confused about gender then more confused about Baby’s size!

ocm:  Okay so new question!! How accurate are ultrasound measurements as far as baby’s weight?? I had my last one today and she measured him at about 4lbs and I’m only 29 weeks and 3 days.

wwavb:  Hi, again! It varies and it’s not an exact science. Generally speaking, the measurements we take of the head, belly and femur are subjective but have a standard deviation of 3wks in the 3rd trimester. The total weight estimation will probably be somewhere around +/- a half pound or so at this gestational age. If we get a measurement that is a couple of weeks ahead, it can still be very much within normal limits for size. We also see that babies can grow in spurts so if the belly measures big now, it doesn’t mean it will nearer your due date. We can also determine through serial scans if a baby is trending large or small and your physician will follow fetal growth accordingly. So! All that being said, if your doctor feels baby will be big, he or she will likely keep an eye on size. This is a good question for your doc at your next visit!

***

I don’t have one with me now but I’ll print a report of a 3rd trimester biometry (fetal measurements) with an EFW, or estimated fetal weight, and share it with you next week, if not tomorrow!

I’ll also add here that your doctor uses the fundal height or the measurement in centimeters to the top of your uterus he/she obtains when you go in for visits to determine growth in generalities. If your uterus measures really large, your doc may order a sonogram to see if Baby is big or if you have too much fluid, polyhydramnios. We see a lot of this, by the way, and don’t always have an explanation for why it’s there. Conversely, if you measure pretty small, your doc may want to find out if Baby is not growing appropriately and to ensure you have enough fluid. Mom’s body type can also influence how your belly looks, too! You can spend all day downloading apps but, as always, questions pertaining to you and your pregnancy and baby specifically can only be answered by your doctor! (And not Dr. Google)

At the end of the day, our shapes during pregnancy are as different as we all are different from one another. We have to quit comparing our bellies to those highly polished on the cover of Vanity Fair and even one another and know we are doing what is right as long as we are adhering to our doctor’s guidelines! Sometimes it’s out of our control and our babies end up too big or not thriving well. Either way, that’s why you have people like me around!

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Posted on January 21st, 2015 by wombwithaviewblog.com

I’m baa-aaaack! Yay! I’ve missed writing and I’m super happy to be back to post your questions and answers! I am truly sorry it took me so long to go live again but it is a process! ..and one I’ve discovered is not my strong-suit to attempt without technical help.

I have posted some “kids say the funniest things” in the past. Honestly, most of the time when parents bring their kids with them, especially for a lengthy ultrasound exam like the anatomy screen, it truly can be very distracting and disconcerting. Did I also mention irritating? I know I’ve explained myself here before but when I am trying to focus on my patient’s exam, the task is made twice as hard no matter whether a child is screaming, dad is constantly disciplining or grandma is reading a story. We one-track mind sonographers desperately need our quiet concentration!

Every once in a while, however, we have a child in the room who is simply entertaining…like the one who thought his baby sister looked “weally weihrd” from one of my most recent posts and he was NOT making the mistake of coming to visit me again. A totally precious little girl was in today with her Latino family. She must have asked me a million questions. The exam I had to do was pretty short and sweet so it didn’t require too much brain power, fortunately, and I could indulge her a little. Every time Grandma thought she was talking too much, she would tell her in Spanish to stop and pay attention. That would work for about 30 solid seconds before the onslaught of more questioning. She was so cute and smart and SO well-spoken for only four!

For those of you who have had a sonogram later in the third trimester, you know how big Baby looks on the monitor. My little guest sees the baby’s abdominal circumference fill the image. Out of total quiet she exclaims, “My baby cousin has a really big head..and her butt is GRANDE”!

Any kid who can make me laugh out loud can visit me any day of the week;)

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Posted on January 5th, 2015 by wombwithaviewblog.com

Hi, all readers!

My blog is currently undergoing a much-needed physical and bug fix so I promise to post again ASAP which will, hopefully, be tomorrow evening! I will surely keep you all informed on status on a regular basis.  I sure don’t want to be responsible for a wwavblog-withdrawal (this is a joke, by the way). Please, please stay tuned for more great info and images about one of our favorite subjects ever..our kids!

In the meantime, feel free to continue emailing me!   wombviewerblog@gmail.com

Thanks for your patience!

wwavblogger

 

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Posted on January 3rd, 2015 by wombwithaviewblog.com

Just a little note here before jumping into the subject o’ the day!.. Please know I am a stickler for grammatically-correct sentences and proper punctuation! I know, I know..you probably don’t give a you-know-what but it seems to be a lost art in this generation of texters, acronyms and run-on sentences. I do re-read several times before publishing but still find errors later that I ultimately go back and correct but not before you’ve read it..much to my chagrin. Sheez..like typing “you’re” instead of “your” or “it’s instead of its”. You get the drift. If you find a dreadful error and feel I should know, please feel free! Sometimes this editor-in-chief is quite tired, leaving such cringe-worthy errs in my wake as I make a bee-line to bed. Since it’s my blog and I can say what I want to, I suppose I can still use things like “Sheez” if I feel like it, as well;) I’m not sure we’d find that one in Webster. Okay..enough of the English class!

I will post an email I received from an anxious mama regarding an image she was given by her doctor. She didn’t see a yolk sac and was concerned one may not be there. My last post was directly related to this  concern. If you haven’t read it yet, please do!

anxious mama:  Re: Ultrasound photo confusion

I recently got an ultrasound at 7 weeks 5 days. My doctor said everything looked great and we were able to see its little heartbeat. When I got home and looked at the photo a little closer, I couldn’t find a yolk sac. I will send you the ultrasound from my email account since I can’t figure out how to attach it here. Would you mind looking at it and letting me know if you can see a yolk sac or anything else you may notice? Thank you so much. This is my first pregnancy after having a miscarriage and I am slightly protective :)

7w5d embryo with no yolk sac in the image

 

wwavblogger: Thank you for reading, emailing me and subscribing! I hope you enjoy the blog and pass it on to your friends!

So, if you haven’t yet read my most recent post, please do. It explains (to the best of my ability without being able to demonstrate in person) how ultrasound cannot capture in a single image everything that is in your uterus. No, there is not a yolk sac in this image. That being said, the yolk sac may be positioned on either side of the embryo, in which case, it would not be seen in this particular image.

Also, if you look up information on the job of the yolk sac.. type in yolk sac in my search engine and you should find a couple of posts on that subject ..you will learn that it provides nutrients for the embryo until the placenta develops. No yolk sac, no embryo. Baby cannot grow to even this point without it! So, if your doctor said all looks good and you see a heartbeat, there has to be a yolk sac in there. Yay!

I will also add here that I understand how frightening it can be and what an anxious time it is for you to try again. No matter how early someone miscarries, it’s still a loss and emotionally draining. Scientifically speaking, it’s nature’s way of taking care of something that was not developing properly. From a human, spiritual or emotional view, I like to think of it as Baby wasn’t ready then but maybe is now:) I always say our babies don’t necessarily come to us when we are ready for them..they have to be ready for this great big world, too!

I hope I answered your questions and you find a little peace and comfort in my response. I know you will be a bit anxious until you are out of the first trimester but I wish you many blessings for a great pregnancy and beautiful, healthy baby!

Warm Regards,
wwavblogger

**

I’m glad she emailed the image to me. The “Ask Me” page is good for a short question or statement. It’s better to email me if your question or concern is long and if you have images to share!

Sometimes we get the yolk sac in the same image with the embryo or fetus..sometimes not. If the yolk sac is parallel with the sound beam when obtaining a great shot of baby, it will be seen in the image. If not, it won’t! Check out the image of the yolk sacs on the twins below.

Yolk Sacs

Now here is an image below of the same pregnancy with just the embryos imaged.

6w6d Dichorionic/Diamniotic Twins

 

As providers, we don’t take special pains to give you an image of the yolk sac because it just isn’t as doggone cute as Little Sprout! :)

 

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Posted on January 2nd, 2015 by wombwithaviewblog.com

HAPPY NEW YEAR!!

I’d like to (again) thank all my readers, old and new, and hope you all find what you came to my site seeking in 2014 and in this new year, as well. I hope all your holidays were joyous and that your post-Christmas (or whatever holiday you celebrate!) scale didn’t demonstrate a “Please quit hitting the figgie pudding” alert.

Let’s hit the ground running with an answer to emails! Some I’ve received as of late include questions regarding what patients can or cannot see in an image given to them by their provider. I have been answering essentially the same way so I will address the subject in this post about how ultrasound works.

I have posted information at the start of this blog about the technology of ultrasound and how it works.  If you go to my first several posts, you’ll read on this subject to varying degrees.  First and foremost, ultrasound creates a two-dimensional image which is what you see in black and white images. However, when we look at any object, we are able to visualize three-dimensionally which allows us to perceive depth. When we look at an image on an ultrasound monitor, there is no depth. Example: Imagine looking at a tree. Its trunk is long and skinny, right? Now imagine cutting the tree down with an electric saw. When you look down at the stump, it’s round. All you can see is that one surface of the tree in that view. If you were to then cut 2mm slices of that tree trunk all the way down to the roots and you looked at every slice, this is essentially what we are doing when we look through your uterus when we move the probe up and down.

Now, if I look at the middle of your uterus and keep my probe still and take an image, I am obtaining one view of your uterus and that’s all. In that one plane, I can only see exactly where my probe sits. I have to physically move my probe all the way up and down to see to the top and bottom of your uterus and then from side to side to see all the way through your uterus to the right and left.  As we move through the organ we are scanning, we form a mental 3D picture of what is going on in the uterus. This means if we take a picture of your baby’s profile and the hand is resting near the ear, the hand will not be in the picture (and neither will the ear!). A profile can be defined as a side-view of baby’s face right down the middle, right? So all we would see is the outline of the forehead, bridge and tip of the nose and outline of the lips and chin. Now if Baby had his hand resting on his forehead, we would see it in that view. Make sense?? I hope so! See the image below of a great profile.

2D fetal ultrasound image Side view of Baby’s face

The utilization of 3D software has allowed us to capture the perception of depth. This technology aids us in more than just cute pics of the fetal face. A good example is how it helps us to see an IUD (hey, an idea for another post!). 3D allows us to take a sweep of several views at once when looking at Baby’s profile, for example, and put them all together to form a box of information which enables us to move through the information by turning a few buttons to see the front of Baby’s face all at once!  Below is the same baby as you see above in 2D. Where the face is cut off by black is where the box of information stops.

3D fetal ultrasound image

Front view of Baby’s face.

In conclusion, 2D imaging allows us to see in two planes only at one time..either top to bottom OR side to side but not both at the same time. This is why we can’t see everything in your uterus all at once! Now, hopefully, you understand a little better why we move the “camera” all over your belly. It also explains why we sometimes roll you onto your side or stand you on your head to get the angle we need!

I hope 2015 finds all of you with uneventful pregnancies and happy, healthy babies who sleep through the night! Many blessings to you all and I hope you keep coming back to my site to have all your ultrasound questions answered!

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Posted on December 27th, 2014 by wombwithaviewblog.com

I hope all of you enjoyed a wonderful holiday and all was merry and bright. Well, I guess they are not entirely over until the fat lady sings or the big apple in the sky drops.

Thank you for another great year of sticking by my blog and enjoying my posts! I hope I can continue to entertain you all with more ultrasound knowledge than you care to have and maybe a few funny stories along the way, too.  There is usually no shortage of those in a crazy work week.

My goal in the next year is to post more often..that is, if I have something to share on a daily basis, I’ll do it! I’ll find more images to share, continue to post your emails so others can learn from them, too, and maybe even grow my site with a little advertising! My hope is to continue to educate you about the scope of ultrasound as it pertains to my job with a little fun and humor.

As always, please share my site with your pregnant friends and feel free to email me anytime with your questions or comments! I will always try to answer ASAP!

Until next time, enjoy the 3D ultrasound image of the little pumpkin below..all was merry, bright and comfy-cozy as far as he was concerned!

Can you maybe spot a little dimple? Precious;)

3D ultrasound image

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Posted on December 23rd, 2014 by wombwithaviewblog.com

I’m a little Italian. Well, half. The other half is a Heinz 57 mix of German and Scotch with a little splash of Cherokee Indian. How about that concoction, huh? Most of us Americans are a jumbled gumbo of ancestry. So if you don’t understand the title of this post, you really do! Or you may comprehend “no comprende”. They both mean the same thing. “I don’t understand”. I know this of some of my patients without their saying these words..or a word.

The majority of this lack of understanding primarily comes from my really young patients..those under 20.  Sometimes it’s a blank stare (believe me, I get those from people over 20, as well) or sometimes it’s in the form of a series of inquiries which may begin with “huh?”. I reply with essentially the same answer phrased a little differently each time with an effort to break it down just a little further with each subsequent, unending series of the same question over and over and over.  See if you can follow the following conversation:

(I will preface this by stating that when I typically take a patient back for an Anatomy Screen, I will make their entourage remain in the waiting room initially so I can have some quiet while performing the examination. I say this to the patient as I walk her back for the test. Some don’t get it.)

***

“I’m going to take you and your spouse or one other person back first for the medical portion of the examination then you can bring in the rest of your family.”

“Medical examination.” (You know the questions that are asked more like a statement than a question?)

“Yes, I need to get the medical portion of the exam done first, then I’ll be happy to let your family back.”

“Medical portion?”

“Yes, I need some time to perform the diagnostic test on the baby first.”

“Test. What test? I’m not supposed to be having a test today.”

“Your ultrasound. It’s a diagnostic evaluation on your baby. I have measurements to take and lots of things to document first.”

“Oh. So they can’t come in now?”

O M G

***

Welcome to my career. Granted it’s not every day I have to attempt to impart wisdom in such a way and I can only jest because I was almost as ignorant at that age. However, it’s a  l i t t l e scary sometimes that certain people will be called “Mom” in a very short amount of time. I suppose it takes time to become a woman of the world!

Just a cute pic before I peace-out for the morning;)

11wks waving

 

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Posted on December 21st, 2014 by wombwithaviewblog.com

I’ve discussed in earlier posts the true scope and nature of what I do. I’m not a glorified photographer (“go out and get a real job”??). I have always had a problem with that line in Juno. I guess it’s because the words are condescending and diminish the work I really do.  I will add here, however, that the description would not be out of line regarding those who work only in the “elective ultrasound” business, the 3D peek, mommy and me, I’ll-take-your-money-and-guess-at-gender-too-early establishments. I have to wonder if they cannot get a “real” job in ultrasound. Shut it DOWN (in the words of Jess to all you New Girl followers – such a great show!) Okay, enough with movie and TV references, I promise. But whomever wrote the Juno line is either totally ignorant about my “real” job or, conversely, maybe he/she was trying to convey the ignorance of the character of Juno’s mother. Regardless and much to my dismay on a very regular basis, this is the general perception of my work to most lay people.

In a nutshell, my job is to rule out abnormalities. Structural abnormalities and pathology relative to the patient like the uterus, cervix and adnexal regions (out to the sides of the uterus) and of the fetus like the placenta, amniotic fluid, umbilical cord and the fetus itself. I am attempting to exclude some 200 disease processes and/or pathological conditions with the Anatomy Screen or the fetal ultrasound examination otherwise known as “the one where I find out the sex”.  Unfortunately, this IS the most important tidbit of information and we hear it on a weekly basis. Patients call in to find out the results of a chromosomal test asking only for gender results; comical yet sad.

So my job surely is not always fun as I do occasionally find problems but when it is fun, it is great fun. My motto is “Business in the front, party in the back!”. In other words, let’s take all the measurements and make sure baby looks great then have some fun..like the image below.

This little sugarplum is all snug in his bed.  Hope yours is, too!

image

Merry Christmas and Happy Holidays until next post!

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Posted on December 20th, 2014 by wombwithaviewblog.com

Here is tonight’s great 3D image..

Visions of sugarplums are dancing in her head!  Such a cute little thing to stuff in your stocking!

3D image

 

 

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Posted on December 19th, 2014 by wombwithaviewblog.com

One would think those words apply only to children. Not so much.  It also applies to a myriad of things in my room that a) a patient should not touch and b) that one would not want to touch.

One would also think that adults would automatically know what things they would not want to come in contact with simply by looking at them. Lo and behold, this theory does not hold water, either. Or oil..

Let me explain. For about the past month my electric table has been leaking fluid. While my manager is pricing options, I have kept a paper drape on the floor at the foot of the table to catch it. Every time I bring another patient in my exam room, I start into my spiel about the leak and instruct them to just step around it. Some people do not heed the warning or even hear me at all. Can I please tell you how many times people have actually picked up the damn thing? Spotted with hydrolic fluid and crumple up on the floor, I have heard everything from “Oh, you left something down here” to “Cover up with this?” and “Ew, there are body fluids down here!”

I don’t think there is an emoji to depict my face here.  It’s something between a “seriously” and “what the hell..” I’ve determined in my career as a mom and a sonographer that selective hearing is not just a childhood disease.

I promised you guys more cute 3D pics. If the above story was enough to make you wince, I think this 29wker shares your sentiment!

3D image 29wks

(Hilarious, right?)

Come back tomorrow for more too-cute images and feel free to email me any time!

Please share this site with your friends!

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Posted on December 18th, 2014 by wombwithaviewblog.com

Well, folks..I have been in full swing as most of you have also during this spiritual, joyous and crazy as a nutcracker of a holiday this really is.  The only place more chaotic  than your local malls and Targets this time of year is..you guessed it..your OB/Gyne office.  Yep, we got kids swinging from the lamp shades all hyped up on gingerbread and moms of all ages trying to get seen before the dreaded deductibles start all over again like the new year.  It’s crazytown in my neck o’ the woods.

Working late on top of trying to get my own shopping tackled (no kidding, I just decorated my tree last weekend) has made for one tired sonographer but I digress..the show must go on.  I promise to deliver some seriously super-cute 3D images over the next few days so please stay tuned!

Most every year I typically have several couples who request that we write down gender and seal it instead of telling them during their scan. They wait for Christmas morning and open the envelope together to find out boy or girl.  Sweet idea!  However, in this day and age of never-ending technological advances in the field of medicine, your modern day parent-to-be doesn’t need the sonographer to determine gender any longer. New antenatal blood tests for genetic abnormalities can include gender and are offered somewhere around 11-12wks. Don’t get too excited just yet!  Your doc will not perform them for gender only and the tests are not made for that purpose..it just happens to be a by-product of the true nature of the test.

That being said, I now have patients all the time who say they already “know” what they are having but still want to confirm it with ultrasound. I do laugh a bit here at that request. I tell them we can have a disagreeable baby but we can’t argue with genetics!

 

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Posted on November 30th, 2014 by wombwithaviewblog.com

I hope everyone had a great Thanksgiving and ate lots of turkey and dessert like I did!  Before the holiday, we had the experience of one unhappy mama! Let me expound..

I have my usual spiel that I deliver to patients when they come in for a 3D scan.  Like most other elective options in life, it’s a service.  You pay your money, the service is provided.  Now you may not be entirely happy with the results of the service (like the facial that left an oil slick behind) but you don’t get your money back. You may, however, receive a coupon for a free facial upon your next visit and 3D appointments work in a similar way.

What you are paying for, I typically communicate, is essentially the block of time on the ultrasound schedule for the use of the facility..the time, the sonographer and my experience/expertise required to perform the exam and use of the equipment.  We, and no one else on the planet, will ever guarantee that you will get the images you want. This is because we know obtaining the perfect images your best friend got are dependent on so many variables.  I’ve discussed this one before..fetal position, placental location and amniotic fluid volume are all make-it or break-it possibilities.

Baby can’t be facing your back or be plastered into the uterine wall or placenta. And an anterior placenta (one located on the front-side of your uterus) adds to the limitation so that if Baby faces up, the placenta is usually in the way. We need to see a good pocket of fluid in front of Baby’s face with no limbs or cord in front or blocking the face.  Also, the farther along you are the less likely we are to obtain great images.  This is because Baby starts to engage that head into the pelvis, Baby is growing bigger and fluid begins to naturally diminish a bit.  If we don’t get great images, we (and most other places) simply offer to have you come back to try again free of charge the following week.  This is pretty fair in my book. If you don’t go back, it’s your loss! ..so don’t expect a refund. We recommend scheduling at about 27wks.

Is it possible to obtain great 3D images later in the third trimester?! Absolutely! We just know the chances become more slim the longer you wait. I’ve gotten beautiful images at 38wks! This baby was 33wks+ but mom had polyhydramnios, a condition where excess amniotic fluid develops. For this reason, she was scanned every week but it gave us many awesome photo opps!

SONY DSC 3D fetal face, 33wks

 

So, if you want it, go ahead and try it! Just go into the scan with some education. Know you may not get what you wanted but you should be able to go back and try again. It’s also a good idea to ask about a policy before you have it done!

If all the stars align, you’ll get some fabulous images of your baby like the ones above!

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Posted on November 27th, 2014 by wombwithaviewblog.com

Happy Turkey Day to all of you expectant moms out there!  Today is a day for thankfulness for our blessings and to enjoy our families and all those whom we love.

Every once in a while I’ll scan a patient whose baby’s face is in a perfect position to see in 3D with a great pocket of fluid and no limbs or cord in the way. When I see this, it’s so hard not to play! I had just such a patient this week. We were able to get such cute pics and mom and dad were so happy..and thankful! ☺️ It’s just what the holiday is all about!!

She is about 28wks; see how cute she is below!

image

3D

 

3D

 

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Posted on November 24th, 2014 by wombwithaviewblog.com

The past week at work has been incredibly busy..chalk it up to a holiday week!  More than the fact that a holiday is approaching is that I have just seen a lot of pathology lately.  More pathology means more time dedicated to each patient’s examination and reporting.

I cannot remember a time when I’ve seen two cases of cancer in one week…one ovarian and the other was a suspected fallopian tube cancer which is very rare.  Either way, it is always a bit dis-heartening to see a mass in the pelvis with concerning size or features.  Sometimes we take one look and just know it is something bad for this patient.  It’s hard for me knowing I have to put a smile on my face and show this patient out the door. I think about how her life will be changed and what she will have to face in the upcoming months. I think about her family and how they must feel upon hearing the news and then facing the repercussions with her.

The only thing that makes me feel a little better is knowing it was caught but feeling a little sad the patient didn’t come in sooner.  We all do it.  We put off symptoms thinking they’ll go away or it’s nothing.  We can’t ignore the things our bodies are trying to tell us.  The best we can do is to address it sooner than later and hope it turns out to be nothing. If nothing is really something, maybe something can be done to treat you now vs having few choices later.

I have thought of those two ladies many times.  I keep checking their charts and with their doctors to follow-up for news.  I have kept them in my prayers.  It makes me a little sad to think of how their holiday might be changed for the worse.  Alternatively, it’s also quite surprising how such news can also be a Pandora’s box of unexpected blessings and thankfulness.  I wish them much of both.

 

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Posted on November 15th, 2014 by wombwithaviewblog.com

I’ve posted on this before and I’ll say it again..there are great ultrasound images and there are terrible ones!  Even the best ultrasound professionals can only decipher anatomy from a really good image.  The rest is guesswork at best.  This basic rule of thumb applies to so much of what we do but especially to determining male gender on ultrasound (or female!).

Case in point:

A reader emailed me with a questionable ultrasound image where “Boy” was the guess.  And truly a guess it had to have been judging by that quasi image of boy parts.  On the other hand, the only thing she had to compare it to was the image of her first Baby Boy.  Holy cow!  He was super-duper proud.  Now THAT image is a no-brainer, no-guesswork pic of boystuff, for sure!

confused mama:  Hi! I went in for my Anomaly scan at 18+4 and was given the following ultrasound picture stating that she’s “pretty sure it’s a boy”. I believe the arrow is pointing to the umbilical cord not a penis. But what’s throwing me off is the two very distinguished dots. Correct me if I am wrong but you can’t see testicles at this point in the fetal development on an ultrasound. I feel it’s labia and maybe too swollen to see the clitoris.

unnamed

My 3.5 year old son’s U/S scan done at 19 weeks looks so different and more recognizable as a boy (the scrotum bulbous and penis) as seen below.

unnamed_2

What do you think? Boy or girl???  Thanks in advance for any feedback!!

 

wwavb: So, 18w4d is a good time for the Anatomy screen but, as you see, being able to see well depends on fetal position and experience of the sonographer among other variables. “Pretty sure” sounds like she’s not been doing this long (I could be wrong, of course) but it’s simply not a great image as opposed to the gender image of your first child. Holy cow! That is a perfect, no-guesses image of boystuff!

There are great images which speak for themselves where all the variables that make a good image line up making the subject very clear. Take a few of those variables out and it’s an image which makes it hard for even professionals to decipher..which is what you have in the first image. No way to really know to what the arrow is pointing and no way to determine the bright dots are girly parts, either. I could have told you if I scanned you real-time but in a single frozen image provided elsewhere, it’s impossible to know. That all being said, it could be a penis; it just may not be a very good image of one.

I’m sorry I couldn’t help you more! If you get other images in the future, I’ll be happy to take another look. Look for your email in my next post!

Best wishes,
wwavblogger

***

What I forgot to add in my email to my reader is that she is correct in that one cannot see testicles in fetal development yet and not until about 27wks or so. Also, labia are not swollen yet as Baby does not develop much fat in the skin prior to about 26wks so no matter the angle, girly parts still look like two or three white dots or lines at this age.  Sometimes, the middle dot (the clitoris) will be higher than the outside ones but labia will look more like a girl later on.

Hope this helps others with ultrasound images that stink.  Thanks, confused mama, for your contribution!

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Posted on November 14th, 2014 by wombwithaviewblog.com

Gosh, don’t you just hate it when your words gets jumbled in a professional setting and what comes out is anything but? ..professional, that is.

It happened to me this week!  I can laugh about it now and I do have to applaud myself that I kept my composure because it was damned funny at the time.

So, routinely during a pelvic ultrasound, when I cannot find an ovary or see it well with transvaginal imaging I will scan the patient abdominally, as well, and explain this to the patient.  Often times they are surprised or concerned and inquire as to why it is that I cannot see it.  What I usually say is that there is gas and air in the intestines which gets in the way and ultrasound cannot see through that, obscuring the ovary from view.

However, this time instead of gas and air I said, “You know, in the intestines, we have ass and – gas and air..” I didn’t skip a beat and just continued with my spiel. Thankfully, she didn’t even blink!

Yeah, most people haven’t heard of ass and gair..

 

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Posted on November 10th, 2014 by wombwithaviewblog.com

Even though most patients know results need to come from their physicians, they still try to get answers. I guess one cannot blame them for the interrogation but sometimes it’s relentless.

When I routinely get the question, I give my usual spiel..”Your doctor will receive my report and images and she’ll have to review them, then give you call with results.” One would think this statement is self-explanatory but the inquiries continue. For those most persistent, the line of questioning goes like this:

  • Does everything look okay?
  • So what are you seeing?
  • What is that black thing?
  • Can you just tell me what you think?
  • So, you’re not going to tell me anything?
  • I know you’re not supposed to say anything, but what do you see?
  • I know you can’t say anything but, off the record, what is your opinion?

 

It’s hard not to chuckle a bit, especially when a patient will ask 2 or 3 of the above questions back to back. In the history of ultrasound and probably forever more, this will remain the protocol. It would be unusual that the physician disagrees with our assessment but results will always have to be delivered to you by your doctor. As experienced sonographers, there are a whole slew of questions we can address about ultrasound itself but until we are the ones managing your care, your doctor is the only person who can really answer all your concerns entirely and completely.

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Posted on November 7th, 2014 by wombwithaviewblog.com

Have you ever seen fetal eyelashes on ultrasound?? Either technology has become so good or it’s becoming a genetic fad to grow them longer. Any way you look at it, seeing long eyelashes with ultrasound is so cute and I just happen to have a couple of images to share!

These came from a reader who emailed them to me.  She is a sonographer, also, who said she had the specific permission from Mom to post these so, Mom, you may recognize your baby’s images surfing the net some day!  As always, we edit out personal information.

The first image, obviously, is a 3-dimensional image. The second is 2D that I’ve annotated for you. It’s not a perfect profile which is why you don’t see Baby’s nose. We would have to move out past the nose to see the eye, right? However, we can see Baby’s lips and chin here.

These baby’s lashes are SO long you can see them on 2D and 3D imaging. This baby girl will never have the need for “falsies”!  She was about 30wks here. PRECIOUS!

Enjoy;)

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Eyelashes on 3D ultrasound

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Eyelashes on 2D ultrasound

 

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Posted on October 29th, 2014 by wombwithaviewblog.com

Patients make the comment on almost an every week basis that I must be left-handed.  I always answer “No, and I am doing most of the work with my right!”

Very few of us humans end up ambidextrous and we typically feel quite awkward in trying to utilize our weaker hand for dominant tasks, like writing, for example.  Honestly, I can do almost nothing else with my left hand but I can definitely fly over my machine’s keys.  It is truly nothing more than typing..and knowing where all the buttons are placed.  Anyone who types on a regular basis knows one learns to type equally well with both hands and the same applies during an ultrasound examination.

Most of the work is done with my right hand as I tediously manipulate the probe where I need it to go.  It just seems as though my left hand is doing most of the work since we have about 400 buttons and knobs to tweak in order to make the image just so, to measure and to freeze and print.

I know it must be hard for sonographers who are dominant on the left unless they work in a single office where they can set up the ergonomics just how they’d like.  If you’ve ever noticed, most of us scan to your right.  The only technologists I know who scan on the left side of the patient are cardiac sonographers.  It’s easier to perform this very in-depth examination from the left since our heart tilts toward the left side of our chest.  In the same respect, the right-handed sonographer who loves Hearts has this challenge to overcome, as well.

I knew there was a reason I never did Echo!

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Posted on October 23rd, 2014 by wombwithaviewblog.com

A reader from Canada recently found my blog and is interested in a career in ultrasound.  She wanted to know about the job market in Canada, whether sonographers experience pain after several years and if pursuing the career is worth the time.

I’m going to post my response because I feel sure there are other young girls out there right now googling about the field and this will give them a good place to start reading some pertinent information..providing they find my blog, too!

Feel free to forward this to anyone you think is looking for these career tidbits.  I’m providing the site and my email address if they have any questions for me, as well!

wombwithaviewblog.com

wombviewerblog@gmail.com

***

Hi, Future Potential Sonographer!

I’m glad you’ve found my blog and I’ll be happy to answer any questions you have!  I am going to include several links to previous posts about what I do that should explain a lot about my job. I could go on for hours!

Also, just know that I am in the US so all I’ve written pertains to care here and not abroad, where OB care is managed much differently. That being said, I have no idea how healthcare is managed in Canada where you have socialized medicine or to what extent ultrasound is utilized there. Your best bet is to do some serious research..call hospitals and try to speak to someone in Ultrasound (a Dept of Radiology) and also OB physician offices and ask if you may speak with a sonographer (if private practices employ them there). Also, you can try to find a teaching hospital there and they can maybe give you some idea of the job market. I’m afraid I cannot expound on jobs there since I do not know to what extent sonographers are used there. If I were you, this would be my first order of business to determine.

I will tell you that no sonographer right out of school is very competent. It takes lots of supervision initially and guidance to build your own confidence in your skills. Once you have some experience and become certified (I’m thinking Canada probably requires some sort of registry exam as in the US though I am unsure), you will be more valuable to an employer.

Many sonographers do develop carpal tunnel or shoulder issues because of repetitive motion. I always try to not hold my probe very tightly and this helps.

Sonography as a career is only worth pursuing if you determine it’s right for you! Being in medicine means you have direct contact with a patient’s body and body fluids. It’s not all only OB or fun. This is the perception but it is actually quite difficult to learn and learning to do it well takes time. If you don’t mind working with blood, patients and being under the scrutiny of physicians, pursuing a career in sonography is a challenging one you may enjoy. Make sure you will have opportunities for work!

Have fun reading and best of luck to you!!

http://www.wombwithaviewblog.com/day-life-ob-sonographer/
http://www.wombwithaviewblog.com/new-sonographers-know-limits/
http://www.wombwithaviewblog.com/learn-ultrasound-days/
http://www.wombwithaviewblog.com/making-sonographer/
http://www.wombwithaviewblog.com/question-cant-answer/
http://www.wombwithaviewblog.com/lets-chew-fat/
http://www.wombwithaviewblog.com/biophysical-profiles/
http://www.wombwithaviewblog.com/how-much-will-my-baby-weigh/
http://www.wombwithaviewblog.com/putting-the-puzzle-pieces-together/
http://www.wombwithaviewblog.com/major-fetal-malformations/
http://www.wombwithaviewblog.com/ultrasound-facts-from-common-misconceptions/
http://www.wombwithaviewblog.com/diagnostic-ultrasound-in-a-nutshell/
If you have further questions after reading, please don’t hesitate to send another email:)

wwavblogger

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Posted on October 20th, 2014 by wombwithaviewblog.com

We all know kids say some of the funniest things.

We adults realize just what a different perspective of life they have when, on hilarious occasion, they express to us these tiny pearls of realism in a way we never considered. They see the world in just the simple way it is presented to them. Sometimes we can actually see those mental wheels turning, trying to make sense of what they see with their limited knowledge of the perplexing existence that surrounds them.

So, last week as I am scanning Mom, Big Brother of about 6 or 7 is watching intently. He was very excited to see Baby and had lots of questions about everything I was pointing out to him. I typically start with the head, try to demonstrate a great profile of the face and, of course, include hands and feet. It takes a minute for older children to really appreciate that it’s a baby on the monitor. After all, that black and white and gray blob on the screen doesn’t look like any baby they’ve ever seen!

If I can obtain a decent shot of the arm and hand, I’ll annotate on the monitor “hi!!” and tell the excited on-lookers that Baby is waving to them. It’s just one of those fun aspects of my job and the reactions are always cute.

0001Br

As I did just that, Mom laughed but Big Brother was quiet and we could tell he was deep in thought. After a few seconds he finally spoke up and asked, “Mom, the baby can already spell?!!”

Mom and I had a great laugh over that and Big Brother was happy to learn that his baby wasn’t smarter than him just yet!

**I would love to read YOUR funny stories.  Email me at wombviewerblog@gmail.com and tell me all about it!  Yours just may be my next post!

Thanks for reading!

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Posted on October 17th, 2014 by wombwithaviewblog.com

So I’m gone again for a few days but I do have a funny little story that falls into the “funny things kids say” category. Sometimes, they are just so darned cute!

It will have to wait until I’m home again so I can post an image with it but, in the meantime, have a good weekend and stay tuned for my next post!

Thanks for reading and entrusting me with your questions!!

wwavblogger

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Posted on October 12th, 2014 by wombwithaviewblog.com

As I’ve said before, ultrasound is one of the toughest things I’ve ever learned.  Watching someone else produce the images and then being handed the probe to reproduce them ourselves was one of the biggest hurdles…and it doesn’t come overnight.  Of course, we all learn at different rates but everyone experiences this difficulty in learning the modality regardless of education level.  So no matter whether you are a pending sonographer, nurse or even a doctor, you will all feel the challenges of becoming familiar with how to find and recognize anatomy.

That being said, read on from an L&D nurse who sent me an image and video clip for a gender determination.  Click on “Video” below the image to watch it.

I’m afraid a guess on my end could just not happen based on the information provided.  Read on to see why!

L&D-to-be:  Hi! I’m 15 weeks with my first baby and work in L&D. Perks of working there is we can pull out the portable US and make guesses about gender early! Most of my ladies are thinking that there is a little girl inside there! I have included a video of a booty shot and a still that initially started the “It’s a girl!” notion. I’d love your opinion!

 

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Video

 

wwavb:  Hi, Stevie! Thanks for reading! So since you’re familiar with ultrasound, you may also know that a single frozen shot or video clip may not reveal much to me unless it’s perfect.

That being said, the first shot looks like a cross-section of an abdomen and the video clip looks like an oblique of the head! Sorry I couldn’t be of more help this go around!!

Try me again around 18ishwks!

***

I cannot annotate the video but I did for the image so see below.

0001eB

 

Not to be graphic but for purposes of understanding this image, imagine being chopped in half and looking down at your abdomen. You’re round, right? In the back is your spine, your ribs come around each side and the opposite from your spine is the anterior or front of your abdomen. I am guessing it’s baby’s arms out to each side and that we are seeing just a cross-section of those, too.

Unfortunately, even though it was too early for a gender prediction anyway, there’s just no way to determine pink or blue unless we can actually see a potty shot! 😉

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Posted on October 11th, 2014 by wombwithaviewblog.com

..well, a gender puzzle for the reader but for me it was pretty straightforward.  I love receiving those images where I recognize in a single glance the parts in question.  This means whomever took the image is pretty good at taking them.  I cannot tell you how many times this isn’t the case.

I did write a post one time about how epically bad an image was that one reader sent to me.  It literally looked like nothing.  Let me sum this up in three little words..awful ultrasound skills.  Regardless of whether one is new to sonography, and especially if one is a veteran, there is no excuse for such terrible imaging.  It’s a slap in the face to the anally detail-oriented everywhere.  Now, if mom is very large, a very clear image can be difficult to obtain. But poor resolution is different from a bad angle and reprehensible gray-scale (you veteran sonographers out there know what I mean!). Check out this link below!

http://www.wombwithaviewblog.com/thats/

Moving on.  My email from a reader goes like this.

mom:  I had a follow up ultrasound to double check on baby’s size.  She is growing well and very healthy. =)  Baby measured 24 weeks and 6 days. The sonographer took a look at baby’s parts again and said looks like a girl but not 100%.  Now confused.  Attached is the photo that’s in question.  Appears to be clear labia with a very prominent clitoris? I did see your recent posting on swollen girl parts but the photo you posted looks clearly like labia and mine have a prominent center.  I need your opinion please!  Thank you!

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female genitalia 25wks

wwavb:  We’re never supposed to say 100%!! But totally looks girly. I’m still betting on Team Pink!

Hey, mom, maybe you should pick up a career in ultrasound.  Good job picking out parts!  I neglected to write that in my response to you :)

 

Read on below for an annotated description of the image.

0001LY

female genitalia 25wks

Did you guess all the parts right?  If so, maybe you should be a sonographer, too!

 

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Posted on October 5th, 2014 by wombwithaviewblog.com

Usually, one thinks of nap time in a doctor’s office as an occasion for the visiting newborn or toddler.  Wrong-o.

It’s not terribly unusual to find the spouse or exhausted pregnant mom with head tilted back as they catch a few Z’s.  I chuckle to myself when I see this because finding me in this position in any public place of business means I am dead. However, there do exist visitors who take nap time in our waiting areas to the extreme.

Sometimes, those of us in healthcare have patients at whom we shake our heads in wonder like those one might find on the PeopleofWalmart site.  You just know that these sad souls are simply victims of a classless society of family who never taught them how to behave in public places.  The result is a bewildering product which is, unfortunately, procreating another generation of such beings.

It’s bad enough when I have them all to myself for a half hour of fun times in ultrasound but what the rest of the waiting room has to endure beforehand and after is surely much worse.  The loud unfiltered cell phone conversations and chatter exploding with profanity, obnoxious laughter and crude humor is enough to make anyone want to reschedule.  It’s also circumstances like these I’m happy eye rolls cannot be heard.

A motley crew of the above-described sort came passing through my schedule this week.  Everyone in the office, staff included, knew she was having a girl as she shouted exclamations of “Hellz to the yeah!” with the combination end-zone dancing in the middle of the waiting room.  I guess it was all a bit too much excitement for the bf or assumed father-to-be.  I came around the corner to call my next patient and found him making himself entirely comfortable as he settled in for a bit of well-deserved rest, stretched out to the fullest extent and essentially face-down..on the carpeted waiting room floor.

And this, my dear readers, is precisely how I wrapped up my week.

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Posted on September 29th, 2014 by wombwithaviewblog.com

I received a comment to my last post from a subscriber and fellow sonographer about her experience in training.  She doles out a bit of advice for those in the midst or contemplating this education.  Read on!

Miss RDMS:   I just had a patient yesterday ask me about ultrasound school. Her daughter was in the program but quit because her teacher discouraged her by saying he didn’t think she would ever be good. I know how that feels because when I was in school my teacher said the same thing to me. I loved ultrasound, though, and remember my first day of clinicals was so exciting because I knew I wanted to do this. When my teacher said that to me, it lit a fire that I just had to prove her wrong. When I graduated, I remember feeling so inadequate and full of anxiety but that just pushed me more to get out my books. I just knew that if I worked hard and was proactive in learning everything I could, someday I would be an excellent sonographer. After 12 years, I feel very confident in my skills and I love to teach others so as to help them. There is nothing I’d rather do for a career and feel that I was meant to do this. Going back to the patient I had yesterday and talking about her daughter giving up  and regretting it, I feel so grateful that I didn’t. Especially in the beginning of this career, you will be discouraged but don’t let it get you down too much. Let it motivate you to get better.

wwavblogger:   I read your comment and I first worked with a radiologist who told me I was terrible. I was. But I was very new and green and what he should have done instead was show me how to be better. I have worked with students over the years that I knew would never be a good sonographer and were given certificates anyway because the school didn’t want the liability. There’s a fine line.. I do also believe people should be given a chance and they have to be able to cut the mustard!

***

I will add here also that radiologists are responsible for the sonographer’s work. Some are hell to work with and others are great. Some have been reading for many years and simply want the meat and potatoes of a case. They don’t want to spend time coddling a newbie or double-checking the work to ensure all is correct. Most cannot scan well and read only. Most of the time, they want the images to speak for themselves.  It can be a hostile atmosphere for the new sonographer, especially someone who is new to medicine altogether.  I do agree with Miss RDMS, however, that with lots of hard work, PROPER SUPERVISION and overcoming your shyness to ask the thousands of questions you need to ask to understand each and every case you encounter, you can be a competent sonographer over time, too.

I can make you a promise. Medicine is no place for the timid! (or the squeamish)

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Posted on September 27th, 2014 by wombwithaviewblog.com

The title of the post says it all.  I really cannot count all the times in a week patients make this comment as I begin to scan them.  Mostly it’s the GYN patients because, as we know, most parents initially get all googly-eyed with Baby and then later I get the “Gosh, how do you know what you’re looking at?” (Entirely off the subject but it’s such a peeve of mine for someone to end a sentence with a preposition. I know, I know. I drive my kids crazy with this, too..)

I’ll usually respond with a smile and something like “We get lots of experience here!” and “After 23 years, I better know what I’m seeing!” I typically add here that ultrasound was positively the hardest thing I’ve ever learned and I have posted on the subject before. Well, in the field of medicine and healthcare, we’re always learning and that never stops. I suppose this is true in all of life, as well! If a sonographer has “stopped” learning, it’s time for a new career.

Ultrasound Physics, anatomy and physiology of the fetus and inhabited uterus, neonatal heads, pelvic organs, adult and fetal heart, peripheral and cerebrovascular systems (arms, legs, neck and brain), abdominal organs, small parts (this is technically what they’re called) like the breast and thyroid and scrotum are some examples of the systems we begin to learn. Also, how they look normally by ultrasound, how to measure them, what dimensions are normal, what images to obtain and how many to take are part of this education. Then let’s not forget pathology. The hundreds of disease processes or benign findings and conditions associated with each of these systems, how they present, how they affect the organs around them, associated examinations and patient labs are an additional challenge. Another aspect of learning this modality is how to operate the equipment properly, write reports, what to write/not write, how to present to the radiologist or physician and what to say/not say to him/her..most of us learn this the hard way! There is also newer ultrasound technology working in the field of nerves and the musculoskeletal system.

Surprised?! I thought you might be.. For example, when we are performing a fetal anatomy screen (the 18-20wk scan), we are attempting to rule out some 200 conditions and disease processes.

The hardest part was becoming confident with what I was seeing to recognize and decipher normal from abnormal. As a sonographer, the machine does NOTHING on its own. It is the most operator-dependant modality of imaging that exists.  This is why proper supervision is so important. The first six months out of school and working were horrendous, the next six were better, the following six months to a year yielded a better mental picture of my job as a whole and I was then ready to take on some challenges and ask more questions.

There are typically two schools of thought floating about the general public with regards to learning ultrasound..either that it’s super hard or very easy.  Those of us who have been doing this a while certainly can make it look the latter.  After reading this post, however, you be the judge!

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Posted on September 25th, 2014 by wombwithaviewblog.com

It’s not uncommon for patients to share their colorful experiences of prior deliveries with me during their examination.  Sometimes they get all the words right…sometimes they don’t.

During the measurement portion of the scan today, a patient was concerned her baby might be too big.  Her last one was so big, she tells me, that her doctor had to use the forceps and vacuum cleaner to get her out.  Minus the “cleaner” and it actually becomes a believable story 😉

Hope this gave you a little chuckle, too.

Have a great night!

wwavblogger

 

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Posted on September 22nd, 2014 by wombwithaviewblog.com

Today’s post will be short and sweet.. In my last post I wrote a volume on urine samples and the difficulty some patients have with the instructions in providing us with this necessary little bit of bodily fluid.

I did forget to mention one thing we see all the time.  Unless you want a complete stranger walking in on you during toilet time, LOCK the door to the restroom, ladies!

None of us providers ever think to remind the patients to do this because it is something most of us learned at a pretty early age.  Maybe you don’t lock your bathroom door at home, however, you probably also do not have twenty some odd patients in your bedroom who might use it, too.

**As always, if you have any questions or comments for me you can always click on the ASK ME page, click on my email address and type away!!

Have a great day!

wwavblogger

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Posted on September 19th, 2014 by wombwithaviewblog.com

So yesterday I rambled on about how humanly slow a person could move and still call it walking. Today I’ll give you a little glimpse into the other side of the urine sample door.

It’s no secret that when you come into an office like ours, pregnant or not, you have to leave a urine sample.  If you’re expecting a little bundle of love, there are all kinds of things they have to test for each visit and if you’re not pregnant, they may or may not need it but you still have to leave it.  If you use the restroom and they need it, it’s pretty difficult to squeeze out some tinkle at that point. When patients first check in, they are given a cup with instructions to pee, where to pee, how to leave it and where to sit afterwards. This seems like a pretty easy order to fill (no pun intended) but you would be amazed at how many people screw this up.

Another reason we need you to go first is to save time. Especially for our GYN patients who are having a transvaginal ultrasound exam, it’s one less step and one less thing on which we have to wait. Typically, there’s not a whole lot we can do while most are using the john except twiddle our thumbs.  Notice I said most.  I sometimes wonder what my patients are actually doing in there, like digging an escape route.  I know TV exams aren’t every woman’s idea of fun but no need to excavate…it’s usually pretty quick!  We can always use the extra tinkle-time to scan, write up your report or play catch-up.

What I love is when I walk out, call my patient’s name and get no answer.  I know then she didn’t pee.  She checked in, took the cup and sat back down in the front waiting room. Now I have to look for her in a different area AND wait on her to pee.  I’ll ask if she has gone to the restroom and she’ll say no.  I’ll ask her if she was given a cup, she says yes and proceeds to pull it out of her purse.  Huh?  Why in the world would you put a pee cup in your purse? I know it’s still clean but why is it there? I am also always stunned to get the “Oh, I was waiting for you to call me first”.  (But, lady, this isn’t what we asked you to do!!)

Then I have the patients who come traipsing out of the restroom with open pee cup in hand, trying to give it to me. Nope. No, thank you and, by the way, what do you think that big metal door is for in the restroom wall?  Yep, that door…the one where we told you to leave the pee. The other rather unclean thing about this is our waiting areas are mostly carpeted.  An open pee cup and carpet simply aren’t a great combo.

My favorite is the thing I’ve experienced most this week.  I call a patient back and ask if she has just emptied her bladder, putting major emphasis on the just. “Oh, yes! Just went!” I then ask if it’s only been like five or ten minutes because I need a really empty bladder for the examination. Another “Oh, yes!” We get into my exam room and I start dishing my spiel and I get some variation of “Well, I went before I left the house so do you want me to go again?” So then the five or ten minutes I originally asked about is really 30 or 45 instead. In my head is silence.  Silence and a blank stare.  I can’t say what I’m thinking or roll my eyes here so instead I smile and say “Absolutely, let me show you back to that toilet!”

Whew.  I’m so glad it’s Friday and no pesky urine samples to deal with tomorrow.  Who knew I had so much to say about pee?

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Posted on September 18th, 2014 by wombwithaviewblog.com

So, to add to the list I started yesterday..the list of all things about my workplace that drive me nuts..I’ll expound on another!

Ask yourself a question. When you go to your doctor’s office and you get up when your name is called, how fast do you walk toward the employee? No, this isn’t a trick question. You wouldn’t run and you probably would answer with something like “a normal pace”. But a normal pace to most people is a snail’s to others.

I have called patients’ names in the past and literally watch them look at me for three solid seconds before proceeding to stand up in slow motion.  About 30 seconds later, after stretching and yawning and finishing their cell phone conversations (or not), they are ready to take their first step.  This patient is in positively no hurry to get anywhere in life and the same applies to my exam room.  I’m not talking about an elderly woman here, people.  I mean these are young twenty-somethings who have full capability of both legs.  I have actually watched in disbelief as these patients saunter toward me like they are browsing in a clothes store and stare expressionless as I greet them with my name. I sometimes get the urge to take a pulse, straddle them on the floor and start chest compressions. What’s more is they sit in slow-mo, lie down in slow-mo and wipe off gel in slow-mo. And when I finish up a transvaginal exam and step out into the hall waiting, they get re-dressed in super-duper slow-mo.  They add a good fifteen minutes to any exam.

Sadly enough, the only people slower are the boyfriends in tow. The guys are so lazy that they actually lag a good ten feet behind her! It’s really the craziest thing I’ve ever seen. Here I am trying to catch up from the patient who showed up late and now I have to wait on the tortoise and her FOB (father of baby, for those of you who don’t know).  One of the funniest stories of mine ever was one time when I waited and waited and waited and my patient finally made it to within speaking distance of me.  I whisked around the corner, showed her into the room, started giving her instructions on the exam and quickly threw the door shut.  My patient then speaks up and says “Oh, my boyfriend was coming, too.”  Apparently Baby Daddy was right behind the door when it closed! Oops! It was hard not to laugh and when I opened it, there he was..and “BD” was not smiling. Hysterical. Hey, if he is going to take his sweet time and walk slow as molasses to my room, I might just be done with your exam by the time he gets there 😉

Stay tuned to tomorrow’s post when I rant about peeing in a cup!

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Posted on September 17th, 2014 by wombwithaviewblog.com

There are many facets to my job other than the image on the monitor and diagnosing pathology.  A myriad of other trials, tribulations and straight-up irritations also accompany my time at the workplace so I have decided to dedicate the next few days addressing..or sharing..those with you.  If you do not identify yourself in these descriptions, you may chuckle a bit.  But if you do, I’ll just apologize now that you may not find it as funny, however, maybe it will spark a change at your next OB or GYN visit.  Either way, I am happy to contribute.  At the top of my list of laws I would pass as Queen (or Administrative Manager) refers to banning patients who bring unruly children to their doctor’s visits…ok, patients can come in but kids have to be left at the door.

My dedication tonight is to the wild little banshees (or rather their mothers), otherwise recognized as the screaming children of patients who run around the waiting room as if it is their own personal recreational area. I don’t get it. I NEVER allowed my children break bad in a business establishment. Is this a popular new form of social child-rearing for the younger generation of parents?  Have I been out of child-rearing so long that this is acceptable?  I somehow do not think so judging by the look on the faces of other patients and fellow employees!

On any given day we have kids screaming at the top of their lungs (whether happy or sad), toddlers running up and down the examination room hallways, pulling at table lamp cords, slapping at the walls and moving chairs in the waiting room. It’s a little difficult for us and our patients trying to get to us to dodge knee-high tots.  I’m just waiting to come flying around the corner one day on a mission to the lab or some such other task and send one flying like a three-pointer.  Hey, when we medical people get busy we launch into power-walk mode. It would be an ugly and unfortunate accident but I feel it’s inevitable.  It’s also one of those tragedies that can be prevented with either some disciple, duct tape or a baby-sitter at home.  This scenario does paint quite the picture, doesn’t it?

To make matters worse, we have parents who are either ignoring their deafening off-spring or parents who are yelling more loudly than the kids to stop…four hundred times. I don’t know what’s worse to have to hear.  Sometimes a good swat, and a well-deserved one at that, finally gets delivered. Do you think the parent takes the kid outside?  Nope.  Mom or dad leaves Little Mikey in the waiting room wailing loudly enough to burst an eardrum. Not very pleasant to our other patients waiting to be seen or anyone else for that matter.

Let me add here that I know some people say they don’t have a sitter or family in town.  I didn’t have family, either, but everyone needs a sitter and if you have friends, chances are they can refer you to a trusted sitter or be one themselves.  My policy is if the feet have to be in the stirrups, the kids stay at home.

Hmm..I think this would make a good sign for check-in!

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Posted on September 16th, 2014 by wombwithaviewblog.com

Below is an email I received from a reader today hoping for some “pink” confirmation:

reader:  Hi!  Please, can you confirm that this is a little girl? Why do the girl bits look so big on this 23 week 3 day scan? Thank you!

 

female genitalia 23wks

female genitalia
23wks

wwavb:  Hi and thanks for reading!  I hope you’ll subscribe for future posts.

So, yep, looks pretty girly to me (remember this is just one single frozen image I am evaluating!) and babies are just starting to develop a little fat now so this is why labia are starting to look more like typical little girl parts.  Also, keep in mind this image is HUGELY magnified!!

Congrats and have fun shopping for Team Pink!

wwavblogger

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Posted on September 15th, 2014 by wombwithaviewblog.com

People always talk about why they have to wait so long in doctor’s offices.  The amount of time we feel will be necessary is allotted but sometimes it still isn’t enough for the patient who decided not to mention all her reasons for her visit while making her appointment or the ones that have about 100 questions instead of two or three.

Then there are the patients who are late.  A few things will throw my schedule all to hell; one is finding a problem, another is lots of pathology and the one that irritates us all are the patients who can’t tell time.  She’s the one that saunters in 10 or 15 minutes late (or 25..or an hour and a half) and says she didn’t know or wasn’t told her what time her appointment was.  Au contraire. We schedule it, confirm it, print it out, confirm it and have an automated system call to confirm it once again..there’s just no way to get it wrong that many times.  Now, I’m not saying we are never incorrect as human error will always play a part in screwing up my schedule but these patients know who they are!

I usually have a patient scheduled every 30 minutes on a very busy and full day.  If one shows up at 15 after, I’m in a dilemma.  Do I try to scan the patient in half the time and hope for a totally negative, quick and easy scan? OR do I make her wait so the next patient doesn’t have to and then run a full 30 behind, requiring me to scan during my lunch break or stay late at the day’s end?  Neither one makes me a happy camper.  I’ll usually try to just get it done unless I have an open spot later.  We’ll politely inform her she was late and she is offered the next open spot.  Sometimes, patients understand and are super nice about it..sometimes, um, not and profanity ensues. Noooo, not by me! (at least not where she can hear)

Either way, we always try to be fair to the next patient. After all, she shouldn’t be made to wait when she shows up on time, right?  Then wouldn’t you know it.  Five minutes..ten, fifteen..geat, she was late, too.

And there you have it, folks, the story of my life every workday for the past week!

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Posted on September 14th, 2014 by wombwithaviewblog.com

I do believe this has been one the hardest and longest workweeks I’ve experienced in a really long time, maybe even years.  It was really a combination of so many things..full schedules every day, lots of pathology to document (which takes so much more time), patients not showing up on time and problems we see which require the physician’s immediate attention.  No, my job is not always “the most fun job in the world”, as patients will frequently refer to OB sonography.

The worst-case scenarios are those where we discover a serious fetal problem; fortunately, this is not something we see very often but is nonetheless always tragic when we do. I get asked a lot by patients if we tell a patient when we see something bad.  My answer is always “For the most part, no.”  And I go on to explain that it’s my job to find and document a condition or pathology and discuss my findings with her physician. It’s then her physician’s job to discuss the findings with her, answer any questions she has and discuss the course of management of her pregnancy from there.  All the questions a patient may have regarding the findings can only be answered by her physician.

However, there are times when we have to speak up.  When I set the probe on a patient’s belly and smear around the gel, I sometimes know instantly that I’m seeing a major fetal malformation and/or that there is no cardiac activity to be detected.  It’s these circumstances that require me to break this news to the patient, otherwise, she is expecting me to narrate cute images of Baby’s face, take measurements and show her a beating heart.  When none of this is possible, I have to be honest with her.

Typically, I will scan for a second, look at the heart and set down the probe.  I’ll direct my attention to the patient, express my sincere apology and tell her that I’m simply not seeing a heartbeat today or I’m seeing some serious problems with Baby.  I’ll say that her doctor is there (or not there) and that I will discuss what I’m seeing with her doctor who will see her next and answer all her questions.  Sometimes, the physician will come in and observe as I scan real-time, sometimes it’s not necessary as the images speak for themselves.  I have to measure Baby’s femur to estimate gestational age and take images of any identifying features or abnormalities as well as anything that appears normal so that your physician may be able to determine cause. At times the physician can assume a chromosomal issue; often times they have no explanation and will offer an autopsy after delivery.

Usually, as you can imagine, the patient and/or spouse and family are emotional and we take them immediately to her physician’s exam room or office so that they may have some privacy. It’s a sad and frightening time for mom and dad and dis-heartening for your physician, too.  I know that our physicians value the relationship they have with their patients. They want to grieve with you, console you and answer any questions you have. An unexpected fetal demise is one of the most difficult experiences for our patients. None of us ever want to deliver such news. Even though we seem stoic, sometimes whether with you or after you leave, we are crying for you, too.

 

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Posted on September 10th, 2014 by wombwithaviewblog.com

Sorry it’s been a while since I’ve posted but I’ve just gotten home from being out of town for a family wedding. While on the jaunts, one has the chance to catch up on all kinds of happenings..weddings, drama and new babies.

While on the subject of bouncing babies since a niece is expecting, I asked what the new little princess will be named. I was told “mums” the word..simply meaning it’s hush-hush for all my UK readers, though you may already know that. Mom and Dad decided not to discuss it and all will be revealed at delivery.

We discussed then how several patients have mentioned before that they do the same. It’s not because they don’t want to share their joy in naming Baby, it’s typically because they do not want any feedback on said name. I guess one cannot really blame parents..they receive all kinds of unsolicited advice regarding everything from colic to college.

Though family means well, it’s easy for some grands and greats-to-be to get their feelings hurt if a particular family name isn’t used as expected. Or, on the other hand, if you are from a vocal family like mine, you also get all sorts of opinions you don’t care to hear.  The baby name backlash can be fierce and why should feelings be hurt over such a joyous occasion? So, all that being said, I think parents have this right to exercise if they gauge potential ill-effects from the fam!

So, comment if you have an opinion or experience with this subject.  To share or not to share..that is the question!

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Posted on September 1st, 2014 by wombwithaviewblog.com

It’s not quite midnight yet where I sit so it’s not too late to wish all you mamas-to-be out there a Happy Labor Day!  Better late than never, right?  No pun intended but that was a bit funny, if I may say so myself..a tad early is way better than “late” in any pregnancy!

I’m sure somewhere some of you ladies are currently experiencing Labor Day laboring, in which case here’s wishing you an extra happy, quick, easy and fruitful Labor Day!!  ..Or should I say Birthday, instead 😉

Best wishes from wwavblogger

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