Posted on July 6th, 2017 by wombwithaviewblog.com
I’ve received questions lately regarding where to find fetal sex or gender in an ultrasound report. Can you always find this information in a report?
The short answer? No, not always.
Actually, we mostly do not record fetal sex, and it’s mostly not important to your doc. Typically, fetal sex is not pertinent information to the examination. Though parents may desire it, physicians don’t need this determination to manage your care and that of your baby if both are healthy. The above is true for most general OB practitioners in the US. However, every physician practices a little differently, and one can certainly dictate if he or she wants this info on all patient reports (if possible to determine). The case may be different if you are seeing a high-risk OB doc, aka a perinatologist. Their reports consist of much greater detail and may possibly include a fetal sex/gender guess.

Example of a Blank Report

In the images of a sample report taken from a monitor, you’ll notice there is a whole host of blanks to fill, but fetal sex is not one of them. On the first page where you see Sex: Other, this refers to the patient. Patient demographics were not entered here, so the Sex option defaulted to Other. We always include your LMP or EDC/EDD – aka baby due date. The larger blue space would be filled with fetal measurements, estimates of gestational age, and fetal weight as they are obtained.

OB ultrasound report

OB ultrasound report
In the pages above, you’ll note the list of fetal organs and structures we attempt to document on a mid-pregnancy anatomy screen. We only fill out the section called BPP in the 3rd Trimester when your doc orders this particular examination. And the CVP is usually only filled out when performing a Fetal Echo or detailed heart examination.

Exception to the Rule

There always seems to be at least one exception to every rule. Because the responsibility of a sonographer is to search out structural malformations, we also have to report suspicions of abnormal external genitalia. In other circumstances, we may see particular abnormalities that we might group together, as in the case of certain syndromes. Sometimes, knowing fetal sex helps physicians either support or rule out a particular chromosomal or structural problem. Some of these are gender specific. In the pic below, we have a designated space on a Comments page to expound on our findings. We can add fetal sex here if we feel it is pertinent information to the findings.
OB ultrasound report
In some countries, fetal sex is neither reported nor discussed with parents due to the cultural preference of one sex over another. And some facilities are beginning to incorporate policies against providing parents with this news due to litigious reasons. Unfortunately, such is life in the good ol’ US. Facilities want to limit their liability for guessing incorrectly by simply not allowing their sonographers to guess at all.
So, if you don’t want to know your baby’s sex (or even if you do!), don’t expect your ultrasound report to disclose that information. Your sonographer creates the images and report. We only include what is needed and leave out what is not!
Best wishes for happy and healthy!
wwavblogger, RDMS
wwavblogger, RDMS
PS ~ You can subscribe to my blog for automatic posts (you can always opt out)!
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As always, you can email me with your comments and questions at wombviewerblog@gmail.com.

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Posted on June 23rd, 2017 by wombwithaviewblog.com

Ultrasound gender determination can be tricky!

female fetus, 16 Weeks pregnant

Female Gender

male fetus, 16 Weeks pregnant

Male Gender

 

How many times have all you moms out there, young and old, heard the story that goes, “They told her it was a ‘this,’ and they decorated an entire nursery, and it came out a ‘that’! Those ultrasounds are wrong sometimes, ya know!”

A dollar for every one of THOSE comments would buy me my dream cottage on the Amalfi coast! However, I understand why this happens, and sonographers everywhere need to apply more discretion. First of all, you may already know that it’s not the machine that’s wrong. The sonographer or observer scanning you evaluates what she sees and determines Baby’s sex. And inexperience and/or caving to the pressure from persistent parents will often cause a sonographer to guess…and, unfortunately, sometimes guess incorrectly.

Advice Regarding Gender Determination for the New Sonographer

First rule of thumb for any newbie sonographer out there…IDON’T GUESS! I don’t put a percentage on my guess, and I don’t say “I think.” I also don’t say “It kinda looks like ‘this,’ but let’s wait until next time.” Parents may want you to guess, but they also want you to be RIGHT! And this last statement is what I typically will share with parents when they become red-faced by my unwillingness to toss out a quasi-guess based on a quasi-image. And, believe me, I’ve had more than my fair share of patients angry with me for something I have no control to change. We can’t just flip Baby in there at will.

The problem with saying “I think..” is that psychologically and emotionally most parents start to really become attached to this guess. They have already envisioned the first dance recital or baseball game by the time the next ultrasound exam rolls around. It’s so true. Mostly, someone else guessed incorrectly (usually, too early!), and I had to be the bearer of bad news. I decided to adopt a personal policy to ONLY offer a guess when I didn’t have to guess! In other words, Baby had to be in a perfect position with an easily seen penis and scrotum or labia/clitoris.

True Story!

One grandmother, so excited by the doctor’s early guess, flew right out and bought thirty-two dresses! Yep, 32. She did so despite the doc’s warning about his level of confidence and told her to wait for the sonogram with me. Fortunately, he got lucky with his baby girl guess, and grandma was a very happy woman (and a little less rich)! However, you can imagine the disappointment in returning all those frilly frocks if doc was wrong. I always hated giving such news!

Please, patients! Please remember your sonographer doesn’t withhold information about fetal sex just because. We’d actually really rather all our babies cooperate after five seconds of examination and that our patients didn’t leave the room cursing our existence. A button to make Baby flip on command? Now that’s a magic trick I’d like to patent:)

Thanks for reading, guys! You can email me at wombviewerblog@gmail.com and/or subscribe for automatic posts! >>>

wwavblogger, RDMS
wwavblogger, RDMS

Comments: 2 Comments »

Posted on March 13th, 2017 by wombwithaviewblog.com

Deciphering fetal sex can be a very difficult job, especially when trying to read an image taken by someone else! Sometimes, it’s a piece of cake.

So often, when readers send me their images for a second opinion on fetal sex, I just cannot provide a confirmatory guess. This is either due to too early gestational age, too poor an angle, or too poor an image. Sometimes, it is a combo of all three!

Ultrasound is such a different animal because it is nothing like just looking at a photo of someone and recognizing that person. In a photo, you can see what’s in the distance or up close to the camera. With ultrasound, we cannot. We can only see exactly what is directly under the probe. It is a 2D (two-dimensional) image only, and we have to move the probe around to obtain different angles to create that “photograph” in our minds. And there are so many variables that go into creating a good ultrasound image.

Since ultrasound is completely subjective and observer-dependent, some sonographers take great images and some..well..don’t. It’s much like comparing a professional photograph to an out-of-focus, too dark, cell phone group portrait where everyone has red or white eyes. You know, the ones you always see posted on social media?

I am too much of a perfectionist. This wasn’t always a good thing when trying to take keepsake photos for patients because it caused me to run late on more than one occasion. And everyone knows people don’t like to wait in a medical office! Factors to take into consideration are maternal and fetal position, angle, magnification, depth, as well as brightness and contrast of the image. It’s a learned skill and some are simply better at it than others. Some just don’t tweak all the knobs as much as they should. Maybe they were never really taught how to do so very well.

And some things that cause a poor image are just beyond a sonographer’s control..like an uncooperative fetus, extra weight around a patient’s abdomen, or a gassy patient. This has everything to do with the laws of ultrasound physics which dictate the further sound waves have to travel, the poorer the image; also, sound does not travel well through air or gas. I’ve scanned heavier patients where I could see pretty well and thinner, gassy patients where I struggled to see at all! That said, I can tell when an image is not great or when she didn’t work with all the knobs. This can make reading an image snapped by someone else extraordinarily difficult. One image represents only one angle. Scanning real-time allows me to look from all angles possible, where I can subjectively determine my confidence in fetal sex..or whether a guess is too risky at all.

ALL that said, sometimes taking a second guess is easy-peasy. Check out the email I received from a reader about whether her baby is a boy. Her images didn’t leave much of a question in my mind:) She was just over 20 Weeks along. Can you tell what she’s having?

mama: Hello, I’ve been following your blog, and I was wondering if you could take a look at my baby’s scans and give me your opinion on gender. We were told it’s a boy, but I’ve read that girls can have parts that look similar to boys? I agree that it looks like a boy, but wanted a second opinion. Thanks!

male fetal sex

male fetal sex

wwavblogger: LOL No ma’am! Little girls don’t normally look like that at 20wks! I will wager my bet on a baby boy:) Congrats!

mama: Lol! I wasn’t quite sure but I’ve had a feeling it’s a boy from the beginning of the pregnancy!

Reader mom! I forgot to mention in my reply to you that, yes, girls and boys can indeed look similar, but that is more true between the 12-16 Week range when parts are small, just developing, and when combined with other factors that come into play which result in limited visualization!

Did you guess boy? If so, I agree! Compare the images I’ve edited below.

boy parts1-jpeg

boy parts2-jpeg

Even though it would be quite unusual for this to be a baby girl, I’m still always a bit cautious about guessing fetal sex based on someone else’s image. When I’m casting a vote for Team Blue, I like to ensure I see a scrotal sac which requires a slightly lower angle. Sometimes, you can obtain both scrotal sac and penis in the same image, sometimes not. I get a slight impression of a scrotal sac here where I placed the circle. The sac at this age can appear quite small, and testicles are not expected to descend until about 26-28 Weeks. This is why scanning real-time helps; it allows me to see Baby at all angles possible, while moving and stretching and opening his legs more.

Stay tuned! My next post will be one where a questionable and poorly technical image comes into play. Mom wrote back saying she delivered the opposite sex. Oops!

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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.

What You Don’t Want to See

breech fetus

This image is really an example of just how much position plays a part in how well we see. This baby (above) is not only lying in a breech position, or butt-down, but baby is also facing Mom’s back (prone).

The wait for your 20 Week sonogram and whether you’ll be shopping for pink or blue may have 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.

20wk facial profile

 

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

Here’s hoping you have more luck than this patient did for her anatomy screen ultrasound exam!

Email me with your questions and comments at wombviewerblog@gmail.com

wwavblogger, RDMS

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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 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 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)!!

Comments: 2 Comments »

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!

Comments: 2 Comments »

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 August 12th, 2014 by wombwithaviewblog.com

On July 25 I posted images of twin gender at 16+wks, one a boy and one a girl..we were guessing!  I felt pretty sure (or I wouldn’t have said a word!) but still wanted to wait a couple of weeks to look again.  Babies are 18+wks now.  Lo and behold..still one of each!  Check out the images below and compare to the last post.  I included the link below for you.  Enjoy!

 

SONY DSC

This, of course, is a side-by-side of each baby with Baby Boy on the left and Baby Girl on the right.  It’s an underneath view so all we are seeing are babies’ butts and legs to the knees essentially.  All parts labeled for better understanding.  The “three white lines” for the baby girl are a little harder to see in this image but you’ll see it more clearly in the one of her below.

 

SONY DSC

This is the same view and very obviously a proud baby boy!

 

SONY DSC

You can see how much different this baby girl looks compared to her brother.  No wee wee here!

 

These are GREAT images of gender, people!  Clear potty shot and no question..just how I like to scan them! Below is the link for the first images at 16+wks.

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

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Posted on July 30th, 2014 by wombwithaviewblog.com

I have some great images for you today of male gender.  This baby is about 19wks and the images are of the side view of baby and bottom view.  See below:

SONY DSC

This is a bottom view of baby if you imagine baby sitting on a glass table and you are looking up from underneath.  I have all the parts annotated for you.  The arrows, of course, are pointing to the wee-wee (my technical term).  This is about as straightforward a potty shot as one will find.  No guesswork, all boy.

SONY DSC

Now this is a side view of baby.  The head is not in the picture; imagine it to the left.  Again, all parts are labeled.  Now the legs are not in this image.  Not to be graphic but for demonstrative purposes, imagine slicing the body in half lengthwise; this is the view we have right down the middle of the torso.

SONY DSC

The penis and scrotal sac from the side resemble a turtle sticking out of his shell.  If you can appreciate the tiny dotted line, you will see it is drawn around the “turtle”.

You can see how parts look different from different angles.  These, people, are great images of baby boy stuff…no question, no nonsense, no guessing..  Just all boy!!

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Posted on July 25th, 2014 by wombwithaviewblog.com

Okay now, readers, this is a perfect example of how sometimes I can determine gender < 17wks!   Not much less but at 16w4d, it’s pretty easy to tell on these twins they are one of each. ..Baby boy AND girl gender images in a side-by-side comparison. These were very easy potty shots..hardly an effort to obtain and you can see the side by side difference.  I’ve even labeled parts for you!

Check them out below!

SONY DSC

boy and girl gender determination

 

SONY DSC

female gender on the LT, male gender on the RT

 

Happy comparing and have a great day!

wwavblogger 🙂

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Posted on July 13th, 2014 by wombwithaviewblog.com

I think not. I was mailed a flyer from a 3D ultrasound businesses who offer 3D franchises and ultrasound education in a matter of days for anyone off the street with no prior ultrasound knowledge or training. The goal? To start their own entertainment ultrasound business. Before this, I had no idea such a business was even legal.

Firstly, I don’t want anyone to believe this nonsense. As a certified sonographer of over 23 years, I feel confident enough to say that no one can adequately learn ultrasound well enough in days or weeks to be responsible for the moms and babies they scan. And, furthermore, the people “teaching” haven’t learned it, either.

To Those Who Are Not Qualified to Scan..

Make no mistake about it. Waiver or not, if you scan a pregnant woman for fun and miss gross pathology, you can still be the subject of a law suit. Contrarily, how would you handle seeing something you feel is abnormal or you cannot explain? What do you say to the patient? Would you even know if a problem existed? If you do not have experience in the medical field, you also have no idea how to address a mother-to-be with a fetal abnormality. Most of us only get slightly better at breaking terrible news, but it is never easy. It is always a sad and difficult scenario. This unfortunate experience will inevitably be yours at some point. How do you explain to your this to your customer when you have no idea what you are seeing yourself?

Moreover, I will also add here that it takes a bit of artistry and (again) proper training and experience in order to obtain good 2D images, which are also needed in order to create good 3D images. Providing sub-standard images takes advantage of the customer paying for it, especially when they assume you know what you are doing. Anyone can set up a 60″ monitor and some comfy seating.

Good Luck Guessing Fetal Sex!

Now, let’s address fetal sex. I have what seems like hundreds of posts on this subject! These places market accurate determination of fetal sex guaranteed by refunding your money along with a gift certificate if they are incorrect. This is irresponsible. A guess too early in pregnancy is a toss-up. An expectant mom is better off flipping a coin than to pay these people to casually throw out any guess. For those of you who are entirely out of your realm of expertise, anyone can show you how to press a few buttons. It doesn’t mean that you providing a fair service or doing it well. It’s unethical, and you shouldn’t be doing it at all.

And to patients who utilize these facilities, please be sure to ask if the person scanning you is a certified sonographer with experience and not a former used-car salesman. You are paying someone real money for this service. It’s disgraceful enough that some of these places boast they are “mom and pop” shops. In my opinion, this is only a good thing if you are running a restaurant. They either employ those who are right out of school or with no formal training at all. Please do your research. You would be better off with this elective scan at doctor’s office instead. A sonographer there is far more likely to detect a problem if one exists. At least your doctor or another physician would be in-house to discuss it with you and answer your questions.

Please Do Your Research!

I’ve made it no secret in my past posts that I’m not a fan of these cash cows. I believe that non-medical personnel should not be scanning pregnant women or utilizing medical equipment.

Even though this can be a fun experience for the family, the potential for serious issues is real. Please do your homework first, educate yourself, and make an informed decision. Giving these places your hard-earned cash may not be worth your while.

Comments: 3 Comments »

Posted on July 11th, 2014 by wombwithaviewblog.com

We all know that our family and friends can be quite nosy, opinionated and sometimes even rude when it comes to all things pregnancy related.  After all, they’ve been there and done that and they know better than you because this is your first and you know absolutely “nothin’ ’bout raisin’ them babies!”  Hopefully, they don’t really speak like that.  I’m sorry if they do.  That is, sorry if I offend and sorry you have to listen to it.  (lol)

In the course of conversation during a scan, especially with my weekly patients, we glide from the political correctness and appropriate medical office pleasantries to cutting up about life happenings.  My patients take this opportunity sometimes to vent about just such personal offenses.  One of my readers recently did the same!  Read on about her dilemma..

irritated mama:  Hello!  Firstly I would like to say what a great blog you have and I’ve really enjoyed reading it.  Secondly I’m wondering if you can take a look at my scan pic from my 20 week scan. I’m now 25 weeks. We didn’t find out the gender as my husband didn’t want to but his family are convinced its a boy from the scan pic and are even calling it a he which is quite annoying.  I’m just wondering is there anything on this scan pic that confirms the gender? Obviously we didn’t get a potty shot.  I hope you can help.  Thanks

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wwavb:  This email cracks me up as you are not the first to be annoyed by in-laws who think they are ultrasound aficionados!  Everyone is suddenly an expert.  You’ll be happy to know gender is nowhere to be found on this image!  It’s a great side shot of Baby but when you get down to baby’s bottom, part of the hip is in the pic so it’s not a side shot between the legs.  So, now you can tell your in-laws to mind their own biz! Ha ha.

Best Wishes!
wwavblogger

irritated mama:  Brilliant thank you – that settles it I will tell them haha!

***

So just know, all you pregnant moms out there with in-laws who are driving you to drink..firstly, wait until Baby is born and secondly, you have to stick up for yourself!  There are nice ways to say anything so next time your mother-in-law (who doesn’t know what a femur is) attempts to read into your ultrasound image, kindly thank her for her oh-so-professional opinion and say something like “Wow, you are so good at this. Maybe they should let you do my next scan.”

Yes, I am a smartass at times but I blame it on my brother, the ultimate King of Smartassness, one-liners and wisecracks.  It’s a crown he wears proudly.

Comments: No Comments »

Posted on July 4th, 2014 by wombwithaviewblog.com

HAPPY 4TH!!!  I hope everyone enjoys some beautiful fireworks this evening to celebrate our freedoms!  (aka the ability to write this blog, for example!)  Enjoy some watermelon and bar-b-que..a must on the 4th:)  Now on to my post of the day…

***

I have responded to so many emails regarding this problem that I thought I’d address it with my next post!

First, ask yourself these questions. Does an embryo look like a baby?  Does an embryonic chick look like a chicken?  Of course, it does not. The same applies to fetal parts like the brain which is why we do not perform the screening of anatomy until 18wks or later. This is because the appearance of the brain is ever changing until that time. Even at 17wks, some of the intracranial structures have a slightly different appearance that make it difficult to document the parts we need in the way we need.

The same applies to external genitalia. It’s just starting to develop at 12wks so boys and girls can look alike. Over the next month, it is still developing and changing in appearance. That is to say, boy tissue starts to get bigger and girl parts shrink. Eventually, the scrotal sac and penis take a more recognizable shape and the labia and clitoris take on the appearance of three tiny white dots or lines.  Every baby is a little different, as all people are different.

Now, have I guessed gender at 16wks? Definitely! But it had to be someone I was scanning personally, baby had to be lying butt-up in a perfect position with legs wide open with perfect visualization otherwise. There are many factors that play into how well we can see at any point in a pregnancy. It just all has to be textbook perfect and not every patient/fetus is a textbook scan. We’re all made differently and such is life.

So, please take my word for it. Any guess at 12-14wks is simply a guess..you might as well flip a coin. 15-16wks is still a guess but I didn’t scan you so I cannot tell you even with an image if your sonographer was right. I might be able to confirm it if you are 17wks with a perfect potty shot!

Whew! That all being said, PLEASE PLEASE do not send me pics earlier than 17wks!! It’s not that I don’t want to help you when you have a less-than-pleasant sonographer. It’s just that I can’t technically provide any helpful information.  If your sonographer couldn’t tell enough to get a great shot, neither will I.

If you’re greater than 17wks and your sonographer has given you a potty shot where she’s annotated boy or girl, I’ll be happy to try and confirm!

Good luck at your next scan!

Comments: No Comments »

Posted on June 15th, 2014 by wombwithaviewblog.com

Firstly, I’d like to extend a huge congratulations to a reader who recently delivered!  This is what she had to say..read below!

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Hi I hope you had a lovely time on your holidays ,just to say I had a little boy at 38+5 and he was a MASSIVE 8lb 7oz :) not half as bad as I imagined ,many thanks for your help to mel

***

I’m so happy and the whole point of my blog is to answer questions you have about ultrasound accurately rather than your reading and taking to heart some of the garbage found randomly on the internet.  Everyone is an expert, everyone has an opinion..and MOST of them are wrong!  Especially when it comes to medicine, just because your cousin Becky had several ultrasounds during her last pregnancy doesn’t mean she can now read yours.

And this is not only in reference to gender, which is what most people question.  Though I can never provide medical advice to anyone, I can surely explain the why’s and how’s of ultrasound better than your aunt, mother or sister who just had one done.

As for gender, I think I’ve made it no secret that determining gender has become the bain of my existence.  When the only thing a patient is interested in is gender, everything I need to do to complete an exam is hurried, or rushed or simply ignored to get to the pink or blue, which may or may not be detected.  People have come to expect that they will in fact know what they are having at this appointment, make it a social event and become upset, sometimes enraged when it cannot be determined or if family is asked to wait outside for a portion of the examination.

Don’t get me wrong!  I love to tell people whether they are having a son or daughter!  The fact remains and should be respected that this is first a medical examination of mother and child.  The sonographer should be able to take the time she needs in a non-disruptive and quiet atmosphere to obtain all required information to complete this exam for your doctor.  This means excited grandmas who want to talk through the whole exam about the nursery and names need to stay out, as well as the toddler siblings, nieces and nephews who scream and squeal for attention.  Believe me, they have no clue they are looking at a baby on that monitor.  And, honestly, any noise in the room other than the sonographer talking is a distraction.

That all being said, I will say it is still the highlight of my day when I have a very happy couple come in for an exam who are mindful of why they are there, so happy to be expecting and are full of questions.  I love to impart some ultrasound knowledge, provide awesome images of this future addition to their family and am still honored to be this third objective party who gets to orchestrate it all.

Best wishes for a beautiful experience,

wwavblogger

 

Comments: No Comments »

Posted on May 10th, 2014 by wombwithaviewblog.com

…Boy!

It’s all whales, snails and puppy dog tails for the grandma who was so excited to find out pink or blue but was too early.  See the link below for the whole story.

http://www.wombwithaviewblog.com/but-but-but/

Not much question here!  Congrats!

20140508_103714

 

Comments: No Comments »

Posted on May 8th, 2014 by wombwithaviewblog.com

I LOVE IT!  What a breath of fresh air I received from a reader…someone who actually doesn’t want to know her baby’s gender.  Now, don’t get me wrong!  Though I held off on the potty shot for my first, I was a full-time registered sonographer working several years by the time the second came along and personally couldn’t wait to see for myself, even scanning myself in the process (we all do that, by the way).

But wouldn’t ya know it, someone wants to wait for The Stork but that’s just not good enough for everyone else!

distressed mama:  Hello,  I’ve really enjoyed reading your blog. From everyone’s posts I can see that I am in the minority — my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures.
We sent my sister the top picture in a text message. Upon seeing it, she immediately said, “I think I know what it is…,” and blurted out her guess. That really bothers me, because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture in the set of 3 I’m sending, is the sex of the baby obvious to you? I figure that if you can’t tell then my sister who is NOT a trained ultrasound tech can’t tell either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!
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wwavblogger:  I LOVE IT!!  First things first.. Absolutely, positively NO genitalia in that shot whatsoever!  The black oval in the pelvis is baby’s bladder and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else!  Tell your fam they have a 50/50 shot at guessing;)

Thanks so much for reading and I can’t wait to make this a post!! And, yes, the overwhelming desire of patients to know gender as soon as the pee stick shows + is ridiculous anymore. Patients drive all us staff crazy with wanting to know as soon as possible. God forbid if we can’t determine this at the anatomy screen. Most people are becoming obsessed and demanding…it makes me crazy!  I will not miss this aspect of what I do when I retire from clinical!  Some days my job is reduced from pathology finder to glorified photographer.

I’m so glad you are enjoying my blog and thanks for subscribing!!!

Best wishes for a happy and healthy baby!
wwavblogger

***
It really is comical to me how people deem themselves sonographers and declare this sudden newfound knowledge to be able to read images after having a baby themselves, especially when they didn’t even view the scan live!  Oh, well, everyone is an expert, right?!
What’s funny is her family believes the sister but I, an OB/GYN sonographer of 23 years who has scanned tens of thousands of babies, gets questioned “from the other side of the wand” (I had to use that!).  Hilarious!
Distressed Mom, be sure to let us know what The Stork drops at your door 😉

Comments: No Comments »

Posted on May 4th, 2014 by wombwithaviewblog.com

A reader asked me recently about a “nub” pointing up or out as a means to determine gender early on in pregnancy around 12 Weeks. You might know it as the Nub Theory.

Yes, there is some school of thought regarding the “angle of the dangle” as she put it!  I’ve said before that both boys and girls each have tissue that protrudes at this gestational age.  First, imagine a fetus lying on his or her back.  Now if this little bit of tissue is sticking straight up, the thought is boy.  If the tissue is sticking straight out, as in parallel with baby’s spine, the thought is girl.

Baby Girl at 12wks, but be careful! The Nub Theory is only about 73% accurate!

12 Week Baby Girl, Nub Theory

I can tell you from personal experience that this little experiment does NOT always..let me repeat..does NOT always turn out to be correct. Sometimes the tissue is equivocal in direction, meaning it doesn’t appear up or out but half-way.

As part of early genetic testing, my co-workers and I obtained certification for Nuchal Translucency testing. During our training, the sonographer providing the training stated that sex determination is about 73% accurate when Baby’s position is perfect. Hmm, is that really enough of a percentage to rely on to paint a nursery? Not for me.

There was one patient for whom I had scanned all five of her pregnancies. She wanted me to guess at 12 Weeks, and we talked about how it was early and the Up or Out Theory. Baby’s “stuff” stuck straight out like a little girl, no question; no equivocal findings, no halfway nub. Just like in the above image! Textbook finding for a baby girl as defined by the above method.

 

Boy, oh boy! Were we surprised at her anatomy screen! And I mean boy! His parts were very easily seen. No doubt. After this, I never guessed at 12 Weeks again!

My patient didn’t really care which sex she had. They had boys and a little girl so they were thrilled either way.  But I will caution the patient who is strongly desiring one sex over the other. You do start to become emotionally attached to this “supposed” baby boy or girl and if it’s determined later that the info is incorrect, patients tend to be sad for the sex they “lost”. So, for this very reason, I’ll stick to my guns on gender prediction before 18 Weeks.

And now you know why!

So, I’ll say it yet again..NOTHING, absolutely nothing in life or medicine is ever 100%! 😉

Comments: 2 Comments »

Posted on April 26th, 2014 by wombwithaviewblog.com

I love my readers!

Thanks for subscribing and emailing, too.  It makes my blog appealing and adds interest to be able to post your questions and images.  I would love to transform my site into a book one day!  I personally love paper or hardbacks and imagine a wall of white shelving loaded with books in my next house.  Yeah, I’m a bit old-school, I guess.  But for all those who love technology, don’t you think it would make a great Kindle read, too?!

Read below for some props (thanks!!) and a gender question from a new reader and subscriber:

reader:  Hi! I’m expecting my third little one in October. I just wanted to say, before I ask my question, I’ve been reading your blog for the past 3 hours while my kids are down for a nap. I love it! I went for a private 3d ultrasound on Monday, and he said it was a girl! We are so excited because we have two little boys already. I’ve heard so many horror stories since I got it done, and I’m terrified he was wrong. I clearly see ‘three lines’, but I’m no ultrasound technician. What do you think? Thanks in advance! I’ve already subscribed, and I’m excited for more!

unnamed

unnamed_2

wwavb:  Hi! First, let me say thanks so much for reading and subscribing. I’m so happy you are enjoying my (sometimes) sense of humor!  I really am very honored that you spent three hours of your own personal quality time reading my stuff!  Very cool.

So, I am going to guess that you are maybe 14wks?? 15? Please write back and let me know. Maybe you have already come across some of my posts and may already be familiar with my opinion of these ultrasound drive-thrus!  Baby looks a bit small in these images like you may be a little early to determine gender.

If you are less than 18-20wks, wait to paint!  That is really the best time (and later) to determine gender and those images are not proof enough to me to paint pink just yet!  Please know I am not telling you he’s wrong, I just cannot concur based on these images.

Warm wishes,
wwavblogger

reader:  You’ve guessed correctly! I was 14 weeks in this ultrasound. I have, in fact, read your posts about the drive-thrus. I must say, if I’d had know your opinion before, I probably would’ve waited. He told me he was 75% sure it was a girl and to come back in two weeks for another look for free. I’m definitely not convinced that it is a girl, nor have I bought anything pink. I do hope that it is, though! Thanks for your input!

wwavb:  I hope so, too!  Pink is so much fun to buy and you could use some estrogen in your family!

Feel free to email me again when you go back and then again when you go for your screen, the diagnostic scan with your doctor’s office at 18-20wks;)

I’d love to tell you pink, too!  Thanks again for reading!

Happy pregnancy,
wwavblogger

***
To anyone who is reading now or in the future, don’t let anyone take your money to guess gender at 14wks!  It truly is a guess and anyone has a 50/50 shot without looking at all, right?!  I say do it if you have the extra cash and if you can keep yourself emotionally neutral.  Check out my recent post to see what I mean by that!
http://www.wombwithaviewblog.com/want-guess/
Otherwise, wait to buy pink or blue, wait to paint and (by all means) wait for an ultrasound professional!  You’re not gonna find those in the 3D turnstiles.

Comments: No Comments »

Posted on April 22nd, 2014 by wombwithaviewblog.com

..or do you want me to be RIGHT??!”

This is the statement I make to all patients who pressure me for gender way too early in pregnancy.  Baby not being in a great position doesn’t help, either.  Ya know, there’s more at stake here than just being “wrong”.  Parents start to identify with being a mom or dad to a new baby girl.  Thoughts jumpstart to dance recitals and her wedding day.  Dads immediately daydream of the fishing partner they always wanted or run out to buy his first tiny baseball glove.  These are strong emotional ties that often get broken when someone casually throws out the gender card on ultrasound.

Read on to see how this case of “mistaken identity” affected this mom:

reader:   This is my second pregnancy and I am 18 weeks. At my 20 week ultrasound of my first pregnancy I was told by the head ultrasound doctor (radiologist?) that it was definitely a girl and picked out a girl’s name. I ended up going into labor early at 30 weeks and at the hospital while an ultrasound was being done, I kept asking if she was ok.  The poor tech said, “Why do you keep saying she? Were you told it was a girl?” We said yes.  She said, “Well, I see  a scrotum. I’m going to get the Dr.” So it turns out we were the first time this head doctor ever got it wrong and now we are legend at his hospital. We were already calling the baby by the girl’s name we picked and I had a really hard time with the news. The only way I can describe it is like I had to grieve this little girl I had in my head that was suddenly gone. I wouldn’t change a thing about the amazing toddler boy I have now, but at the time, I was a wreck. Needless to say, I don’t want to go through that again. I was told today that the baby is a girl (again) and it is hard for me to believe. So, I just want to see what you think!

probable baby girl-18wks

wwavblogger:  OH MY GOSH!  I HAVE to post this email!  Your story is EXACTLY the reason I implore sonographers to give careful and cautious consideration when determining gender! This is also why I won’t cave to the pressures of patients begging when it’s too early.  I quit the % thing a long time ago…the I’m 80% sure it’s a this or that.  No.  I learned many years ago that even if I say I am not sure but give a “possibly”, parents are already thinking ballet slippers and pink tutus or sailboats and whales!  It’s so true.  It’s just an emotional attachment you begin to develop as soon as an inkling of pink or blue is mentioned.

And any radiologist should know better.  Most of them can’t scan worth a stink anyway (yeah, I said it) and if he was not scanning you and simply observing the sonographer, she didn’t obtain a great image for him…but he should have known that. OBs just read OB ultrasound better than radiologists in my book.
Joke of the day..What’s the difference between a radiologist and an obstetrician?  The obstetrician KNOWS his/her sonographer is a better scanner!  I’m sure I’ll piss off any radiologist who reads this but I don’t care.  That’s why I work for obstetricians:)
On my table, gender has to be very obvious or it’s a no-go.  When patients plead, my motto is “Do you want me to guess, or do you want me to be right?!!”  Then they quit begging.
Now, not having scanned you real-time myself, looking at one single image can be tricky.  By this image only, it looks like dance recitals may be in your future!  Looks like the typical three lines we see in a baby girl but just know I can’t guarantee that by any means! PLEASE, send me another image of gender every time you have another scan in this pregnancy!  Especially since she already has the perfect name!
Best wishes for a healthy pregnancy and baby,
wwavblogger

Comments: 5 Comments »

Posted on April 11th, 2014 by wombwithaviewblog.com

Let’s attempt to clarify what constitutes a GOOD image of little boy or girl fetus parts and delineate from BAD images of said parts.  If you guys read my blog on a regular basis, you KNOW how many emails I receive from parents wanting a second opinion on gender images only to get a “huh?” out of me.  Most of the time, their sonographer gave the nod for male or female only to follow that up with a snowstorm quasi-leg/cheek shot with a ? in the middle…not quite the validation I can support.

I’ve posted other great gender shots throughout the site but let me add a couple more.

SONY DSC

Hello!  Any guesses?  I’ll give you one..one guess!  THIS is the boy shot patient’s want to see.  This is the holy-cow-look-at-that-wee-wee-he-is-so-proud shot we are after.  Is there REALLY any question in anyone’s mind here?  I didn’t think so.  This baby boy is about 20wks in this image.

 

SONY DSC

Anybody not see three lines here?  There’s a little dotted circle around the labia..three lines..girly..enough said.  She is about 22wks here.  She really didn’t want to move her legs for us but I could still see it quite well enough to reconfirm baby girl for this couple.

 

And this one I’ve posted before!  Labia are much more plump closer to that Estimated Date of Confinement.  This baby girl was about 38wks here and probably THE most clear female image I’ve ever obtained.

unnamed

 

See the difference?!!  Now compare to some of the images readers have emailed.  The only kind of gender images I like to gift to patients are the ones where anyone who reads ultrasound can take one look and say “Oh, yeah! No doubt!”  Even the most ultrasound-challenged won’t argue with these textbook images of fetal genitalia.  In my room, it has to be unequivocally wee wee or three lines/labia or you get the dreaded “I’m sorry but I just can’t tell today!”  My advice?  If you don’t have a shot similar to these, hold off painting that nursery!

Comments: 3 Comments »

Posted on April 8th, 2014 by wombwithaviewblog.com

Every healthcare provider knows that nothing in medicine is 100%…but somebody forgot to tell this joker.

I still can’t believe some of the emails I actually get from expectant moms who’ve essentially been promised the gender-equivalent of the moon and stars based on crappy images…and I don’t mean a little crappy. Who taught these people to scan?  One of the things all students should learn in ultrasound training is that any image one takes, another (reading professional) should be able to look at it and know what it is that he or she is seeing.  The perfectionist that I am scans (sometimes too long), striving for the perfect shot with just the right magnification, contrast and clarity with a “no question” angle.  Often times, it just ain’t gonna happen, but this is my goal!  It kills me when I see terrible images like these…and I don’t mean simply for gender.  There are a hundred other fetal parts that deserve the same attention to detail.

Moreover, most are WAY too early in their pregnancies to make such big commitments regarding Baby’s sex!  We’re talking 15-16wks here. No, it’s not an impossible task and I’ve done it myself before but the best of all imaging circumstances must be in order to make such a bold determination.

Read below an email from a reader who has experienced this very situation:

reader:  Hi! I just found your site and I love it! I was hoping that you could just reassure me that what we are having is a little girl? My ultrasound tech said that he was 100% sure it’s a girl because there were definitely no boy parts. But I just wanted a second opinion! Thank you so much!

unnamed unnamed_2

 

I took one look at these images and thought, ‘What the..?’  Really.  Are you serious.  No sonographer with any level of adequate experience, especially those who specialize in OB, would ever dare to label this a girl OR a boy MUCH LESS to seal it with a “100%”.  Maybe this is why the image isn’t annotated!

I could tell the fetus looked a little small..aka early gestational age ie, too early to determine gender..of course it was!

wwavb:  Holy cow!  All I can say is DO NOT paint a nursery based on these images!!!  And I would be leery of any sonographer who calls anything 100%!  First cardinal rule of ultrasound..nothing in medicine is EVER 100%..  It makes me crazy when patients are given images like this and told it’s a definite!  This is precisely how mistakes with gender determination are made.

 First, I have to know how far along you are.  Based on the images, I’m guessing pretty early??  Now, I don’t want to burst your bubble and this is not to say that you are not having a girl..let’s be clear.  I’m simply saying that determining girl by those images alone is impossible. I did not see your scan live.  However, these are not textbook images for girly parts.  Check out my link below to see a much better image of girl stuff!  It was sent in to me by a reader..
http://www.wombwithaviewblog.com/jenas-sweat-pea-update/  (it’s the second image you see that says “GIRL” on it)
Send me an image later on in your pregnancy and, hopefully, it’s better than the ones you now have.
Thank you so much for reading my blog, writing me and I hope you’ll subscribe for future posts.  Also, follow me on Twitter!  So glad you are enjoying!
Many blessings for a healthy baby,
wwavblogger
***
Ya know, I can’t teach the world to scan.  But maybe I can nip some mistakes in the bud..one crappy disheartening image at a time.

Comments: No Comments »

Posted on April 2nd, 2014 by wombwithaviewblog.com

..This is how you know you should NOT begin decorating Baby’s room after your ultrasound.. If your sonographer can’t decide whether you are having a boy or a girl like your 3-year-old can’t choose between strawberry jam or grape jelly for a pb&j, DON’T PAINT YOUR NURSERY! (No contest..grape, definitely, grape.)

Read on from a patient who experienced just this scenario:

reader:  Here is my 17 week ultrasound. The tech went back and forth between boy and girl and finally decided on boy after 10 minutes. She was also still in training. What do you think? Oh and the cord was between the legs. I’m so confused by this image. I go back tomorrow to look again. I love ur blog by the way!

unnamed

wwavb:  Oh, wow.  I see why you have to go back! lol There truly is no way to tell from that image what you are having..I can see legs. And I’m doubting tomorrow is going to be any better.  First, because you’re still early and, second, because the girl in training doesn’t have a clue. Anyone who waffles back and forth between gender for any period of time should not guessing to begin with!  People like her are precisely why patients drive me crazy questioning my guess a thousand times!!!

“Are you sure?”… “Are you really sure?” … “How sure are you” and my favorite, “What percentage sure are you?”

Tidbit of advice..even if she guesses, hold off on that favorite paint color!  Feel free to send me another image tomorrow but hopefully you’ll have someone more experienced?? If she is training, there should be someone with more experience there supervising her! Ask for that person.

Thank you so much for reading and subscribing to my blog! I hope you find it fun and informative and thanks for emailing me:) Please pass it along to all your expectant friends and fam!

Wishing you a healthy fetus,
wwavblogger

***

And by the way, readers, when patients ask me this most nagging and utterly exhausting, never-ending line of questioning, I always say “I don’t guess! Either I’m sure or I can’t tell!”

Holy cow, if I had a dollar for every time I was asked that question, I’d be living somewhere on the Amalfi coast right now and not deciding which scrubs I’m wearing tomorrow..

Comments: No Comments »

Posted on March 29th, 2014 by wombwithaviewblog.com

I thought this title was a very appropriate follow-up to yesterday’s post!  Not only is there sometimes a crowd in the uterus but also in the ultrasound examination room.  While this is an exciting time for the couple, it has become very much like a reunion where hoards of family show up for the occasion and actually expect to all pile into the room for the spectacle.  This is not okay.  You see, I LOVE the diagnostic, puzzle-piecing together of each examination.  The finding of pathology..how it presents..how I can learn from that.  The entertainment part of it..not so much..but it comes with the territory.

Over the years, as ultrasound has become more commonplace as an important diagnostic tool for the obstetrician, so people in general come to have expectations about these visits.  It has always been and will always be, first, a medical examination.  I am looking for abnormalities in or around your baby.  Occasionally, I find them.  This is the goal of my job and the scope of the practice of ultrasound.  When this is your first baby or if you’ve never experienced a fetal abnormality in the past, patients seem to be oblivious to the possibility of such findings.

If you bring your parents, grandparents, in-laws, siblings, cousins, aunts and uncles and all your nieces and nephews of all ages with carriers and strollers, expect to leave them outside.  Examination rooms are usually quite small and we need some quiet and concentration here.  We cannot focus on your baby and the task at hand with random loud chatter, jokes and laughter from the peanut gallery; people breathing down our necks and talking in our ears; a multitude of fingers pointing at the monitor; twenty questions of “what is that dark space up there” (one of a hundred dark spaces and I’m expected to point to the monitor until I find the area in question); the ringing and text alerts of ten cell phones and family carrying on their own conversations about everything from what they saw on TV last night to neighborhood gossip to what everyone wants for dinner.  This is exactly what happens when so many are present…distracting, to say the least.  But we know they are simply there for the fun and excitement of having a new baby in the family.  We understand this which is why we do business first and party later.

So, typically, I will take the patient and one person back first.  Do the important medical stuff.  I love to point out parts of Baby as we go along (without the help of random family fingers on my monitor) and patients usually desire and appreciate this narration.  When diagnostics are complete, I’ll allow family in and then do a once-over on Baby, pointing out all the cutesy parts I can find like little piggies, a cute profile and gender.  This is usually all they want, anyway!

So, when it’s your turn for an ultrasound, bring your spouse and mom if you want but lie to everyone else.  Tell them it isn’t allowed.  They can see pictures later.  It’s sometimes a pretty funny sight, though.  Once the exam is over, after being packed in there like sardines, I’ll open the door and all the family comes spilling out into the hallway like mimes or clowns pouring out of a VW bug.

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Posted on January 29th, 2014 by wombwithaviewblog.com

For all of you who read the link below and got a kick out of trying to make heads or tails..or a wee wee..out of Giselle’s gender pic, read on for her update!  For those of you not familiar, click on the link below to see the initial post.

 

http://www.wombwithaviewblog.com/?p=543

 

Giselle wrote back with the happy update, and (might I say) a one hundred times better image of her baby boy than that 2D square of visual snowstorm she was initially given as a gender pic!  See the recent image below..

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Now, that’s a proud a little boy and a great ultrasound image to boot!

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Posted on January 21st, 2014 by wombwithaviewblog.com

Or to many patients..the scan where I can tell the gender.  This scan is done typically between 18 and 20wks.  I know I have said this in the past but let me clarify!  This examination has absolutely, positively nothing to do with any need for determining your baby’s sex.  People usually want to tie the two together; “I’m having this scan and now we can find out.”  I have to stress here that you cannot ALWAYS find out gender at this scan and no one will ever guarantee that you can.  Most people understand this.  If any of you read my rant last week, you get it that some people (God help them) don’t.

Let me go back a little bit here.  Ultrasound was initially created as a means of complimenting your physician’s diagnostic puzzle…a little helper, a way for him/her to see a little of what is going on in there so that he can educate you and so that you can be better prepared to make some important decisions in the unfortunate circumstance that something is not developing properly.  Somewhere along the way, ultrasound got better and became the circus that it is today where people show up with herds of family and expect them all to come in for this examination.  At the end of the day, this IS still a medical examination; my job is to find problems and, hopefully, to rule them out.

We have a long list of things to document, meaning we have to find them on your fetus and take an adequate representative image of each organ and measurement.  Some of the things we look for on a routine scan are as follows:

Cervical length – we measure the length of your cervix.

Placenta – we grade it and tell your doctor where it is located.

Amniotic fluid – we do a subjective assessment, general eye-balling of how much is in there.

We measure your baby:

The head from side to side (BPD or biparietal diameter) and around (the HC or head circumference), around the belly (the AC or abdominal circumference) and the femur length (FL).  These measurements estimate a weight which is usually about 8ozs. at about 18wks.

We document internal organs and other structures:

Brain, orbital lenses, face, upper and lower extremities, heart (very basic views), spine, stomach, kidneys, bladder and umbilical cord insertion and vessels.  We check to make sure these things are present, located where they are supposed to be and look the way they are supposed to normally look.  Yes, we have to know the difference!  Some of the changes we are looking for measure literally in the millimeters.  If all parts look normal, we assume they are functioning properly.

After we take all these images, we formulate a report for your doctor in great detail regarding the above parts.  If something is not well seen or limited because your baby was not in a good position, he/she wants to know that, also.  Usually, if your baby doesn’t cooperate to allow us to see everything we’d like, your doctor will typically (at least ours do) send you back in about a month to attempt a recheck.

Let me capitalize the following statement.  ONLY YOUR DOCTOR CAN DISCUSS THE RESULTS OF THIS SCAN WITH YOU!!!!!  NOT me.  Never, never, never the sonographer.  For those of you who have had the terrible experience when we suspect something is wrong, you have a hundred questions and your doctor is the only one who can answer them for you properly.  Your doctor is the one with whom you have the important relationship.  He/she wants to be the one to give you unfortunate news about your baby.  These patients will usually be referred on to MFM or Maternal Fetal Medicine which are doctors who specialize in high-risk OB.  They will scan you again and give your doctor their opinion on what they believe is going on and how your pregnancy should be managed in light of the problem.

So!  Nowhere in the report is there a space to include gender.  That’s because it is not important to the health of your fetus and your doctor doesn’t really need this information.  We know, however, that it is important to those of you who want to know.  And there is nothing wrong with wanting to know!!!  Believe me, I couldn’t wait to find out myself!  I did have to scan myself for 3wks, though, before my own kid would cooperate!  True story.

We love a fun family and love being able to give this news when we can.  What we don’t like are the people who don’t care about anything else, are demanding of us to give them gender information and then ask us 400 times if we are sure of what we see.  As you can see, we have a big job to do which requires time and focus.

It’s okay to find out your baby’s sex.  It’s okay if you don’t!  It’s okay to even have a preference.  It’s just not okay when that’s all that matters.

Questions??  Great!  Email me and I’ll answer what I can!

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Posted on January 19th, 2014 by wombwithaviewblog.com

Read the email below from a reader who was really hoping for some estrogen in the family after two boys!  Sometimes, wishful thinking prevents us from seeing what is really there..

kb:  At my 17 week ultrasound the tech took a photo saying the baby was a boy pointing to what is clearly the foot in between the legs. She also said the umbilical cord was between the legs. At my 21 week ultrasound the baby was breech with cord between the legs. When asked what we’ thought we saw 2 lines and nothing else… Girl we guessed. The next view she said boy. The one photo has two dots next to each other on the top and one dot directly under the second like this . . . I have two boys already and you could see the scotum and tip clearly. I feel different and not even pregnant . The heart rate was 170, 171, 157. I can’t shake that it’s a girl. Am I wrong and just hoping . What do you think?

wwavb:  Thanks for reading my blog and sending your question!  Hmm, what do I think..  First of all, I think I have not nearly enough information.  Did you mean to upload an image?  I can certainly tell you what I think about the photos but without that it’s really and truly anybody’s guess!  I wasn’t there, didn’t see your scan real-time and don’t know anything about who did your scan or how experienced they are.

As far as “feeling” different, each pregnancy is a different universe in and of itself.  The way you feel with one has nothing to do with how you “feel” in another.  People historically want to contribute that difference to gender but there just is no relevance there.  And baby’s heart rate can vary quite a bit, just as ours does with respect to activity, so you can’t go by that, either.

It’s entirely possible that your sonographer could tell it was a boy but it wasn’t clear to you because the cord was in the way which made it not a textbook image of boystuff and more difficult for you to appreciate as someone who does not read ultrasound.  It’s also possible that you just want a girl so much that it’s hard for you to really “see” boy parts in the image.  If you would like to email me your images, I’d be a happy to try and give you another opinion!

Best Regards,

wwavblogger

KB then emails me the images below:

Image 1:

kb:  This is the first picture where I saw the dots

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wwavb:  This is not a great image but consider it sort of like a side view.  Baby’s boy stuff sort of looks like a snail.  Where the arrow is pointing is the tip of the penis which resembles the snail coming out of his “shell”, the scrotal sac.

 

Image 2:

kb:  Where the tech pointed as a pee looks like a foot to me

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wwavb:  

No foot here!  Where I have the arrows of the legs you are only seeing part of the thighs; the rest of the legs and feet are not in the image.  See edited image below..

babyboy

Image 3:
kb:  I don’t see the scotum because she said the cord was between the legs.
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wwavb:  Holy cow, Krissy, this is totally a boy!  I don’t see any cord there.  All boy!  See my edited image attached below..

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Congrats;)  I always say it takes a special woman to be a mom of all boys!  Little boys love their mamas and you have a the perfect opportunity to teach them to be loving, respectful and helpful to their future wives.  Your daughters-in-law will thank you!

Best wishes!

wwavblogger

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Posted on January 16th, 2014 by wombwithaviewblog.com

Okay, readers, if you are searching for the perfect shot of female genitalia in the 3rd trimester, check out this photo.  This image is shouting “Am I a girl or what?”

 

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This is a great image of labia as seen later in the pregnancy.  Baby has more fat in her skin now and looks nothing like the “3 dots or lines” you saw at halftime.  Now, granted, not every baby girl looks exactly like this one.  We are not all built EXACTLY the same, right?  However, I think no one can argue that this looks nothing like any little boy I’ve ever seen.  This mom and dad are so excited for their second precious baby girl and were so happy to share:)

Now, THIS, people, is a GREAT ultrasound image if I do have to say so myself!!  Doggies (thanks, Dr.C), I just LOVE a great ultrasound image.  I’m such a geek.

 

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Posted on January 14th, 2014 by wombwithaviewblog.com

You would vent, too, if it happened to you.  I know, I know; I just couldn’t resist.

So, it’s a RARE occasion that a patient really pisses me off.  Yes, I said it.  She is about 21wks and she was going on and on about gender after I said I couldn’t tell and baby’s legs were closed.  It was the usual rant..

“You’ve got to be kidding me I HAVE to know today I’ve been waiting all this time and I’ll just get up and run around or something but I have to know todayCan’t you move the baby aroundThis is ridiculous!!”  I think she spouted all this in one anxiety-ridden breath without pausing for air…one very looooooooooooong and irritating run-on sentence.

And then I go on MY usual schpiel (correction says this isn’t a word) about how determining gender is never a guarantee and we can’t always tell at this age and we need total fetal cooperation and we can push around and roll you to your sides but we can’t really make baby move and it’s not the purpose of the exam anyway.

Her response??  And might I add, the pièce de résistance..  

“WELL..(sigh), can you get somebody else??!”

OH..  NO..  SHE..  DIDN’T.  Like I didn’t know what I was doing and ANYBODY else would have been able to determine what I could not.  REALLY???  The sheer audacity.  Unbelievable.  I’m telling you that NOBODY in the country, right there in that moment, could have told her what she was having.  It doesn’t take years of experience to determine that the legs are closed, the feet are curled up under the butt and the cord is in the way.  The chic is very lucky I didn’t just set down my probe right then and there, throwing my hands up with a “DONE!”  But I didn’t.  I scanned her for probably ten minutes that I didn’t have to in order to try to find what she so desperately had to know.  Alas, I could never tell for sure.

My thanks?  ..A bitch “sesh” with the nurse because she still didn’t know her baby’s sex!  (I’m being told sesh isn’t a word, either.)

These are the kinds of people I have to deal with from time to time in my line of work.  They simply are the ones that no one can make happy…ever, no matter what you do for them.  These are the people I will not miss when I finally quit.

Welcome to a day in the life of a sonographer.

And if you like my blog, are a subscriber and avid reader and take my advice to any degree, take this tidbit, too, and PLEASE don’t ever be this person!

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Posted on January 14th, 2014 by wombwithaviewblog.com

Here are two images from a reader who questions if they really represent girl parts..

reader:  Hi!  I was just reading your blog and though I’d email you to see what your opinion is on my 20 week ultrasound picture.  It seems odd to me that her “girl parts” are sticking out a little bit.  Could this really be a boy?  I already have a bunch of girl things and this picture is just making me second guess myself.  Thanks!!

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wwavb:  Hi!  First, thanks for reading my blog and writing to me.  If you haven’t subscribed yet, I hope you will!

Now about that image…I have to say it’s not a GREAT image, BUT it does look like girlstuff.  Let me follow that up by saying that because I didn’t scan you live and all I have is this okay image of genitalia to go by, all I can base my guess on is what I can determine by the image provided.  Girlstuff looks like three lines or dots and if it were a boy, you’d see a wee wee (my totally professional term for it) to about where the arrow is located.  So, I am guessing pink tu-tus and dance recitals are in your future.
Check out my previous posts on gender.  You’ll find several images of girls and boys!  Hope I helped!
Thanks again for visiting!
wwavblogger

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Posted on January 10th, 2014 by wombwithaviewblog.com

Okay.  In all my years of scanning, I have to say this image from a reader takes the cake for awesomely bad ultrasound quality in the most EPIC of proportions.  Who taught this person to scan?  I’m totally serious.  Now, not only will my beloved readers at home appreciate the exquisitely limited value of this image but any sonographer for whom the resolution of an image is important would be absolutely ASTONISHED at how awesomely and epically and entirely bad this image is!  Read on from Giselle..

G:   First off – loved reading your blog – hilarious!

Seeing as you seem to be exceptionally good at your job, I thought I’d send you the image I received from my gender determination image from an elective u/s. I feel like the image is really confusing because I can see what are clearly legs and feet – and then I see the “penis” that the tech referred to – but it looks like it’s in the wrong place. It was a 15 minute scan and that included the 3D sneak peek where my baby looked like an alien lol (I was only anticipating the 2D images). He didn’t point out anything that we were looking at other than “100% Baby Boy Pecker” (yes he did indeed use the word pecker – in front of my mom and grandma no less!). I just thought his feet were at the top of the screen and couldn’t understand why the penis looked like it was far from where it seemed his legs meet his body lol… Is this even a good image to determine gender? I wish I could’ve gotten a good ole between the legs shot like the ones on your blog!

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wwavb:  Holy cow, Giselle!!

 That has GOT to be positively THE worst ultrasound image of gender I’ve ever seen! As I am reading this, I am laughing hysterically at your own hilarious comments AND in total disbelief of how awesomely bad this image is.  Let me count the ways.  Wow.  Before I go on, let me say THANK YOU for your lovely comments, thank you for reading and thanks for subscribing to my blog!!  I hope you’ll continue to enjoy hours upon hours of laughter and insightful words of wisdom. lol
First, the legs can barely be discerned from this so-called “pecker”.  And, it may very well be a pecker but you sure wouldn’t bet the family jewels on it (total pun intended).  Where he has the arrow pointed is likely the end of the “said pecker” and I am imagining that on each side is a bit of each leg but baby’s rear is not well seen which would be at the bottom of the image. So, it would make sense that the feet would be at the top of the screen, right?  I’m thinking this is supposed to be an underside shot like baby is sitting on a glass-top table and you are looking up from underneath so I’m doubting your baby will come out looking like a Picasso painting.

My best advice would be for all pregnant patients wanting to know gender to read my post below!
Since you’ve already had this done, though, my best words of wisdom for you would be to simply not paint a nursery yet!  Another bit of advice, ask for a different sonographer to do your next scan.  Just say you’d rather have someone else and you don’t have to say why.  And, I have to ask…was this in a hospital or doctor’s office?  I can’t imagine a male doing what I do in a private practice!  Or maybe it was one of those ultrasound drive-throughs?  Don’t get me started on those.. Well, hopefully, this guy doesn’t work for your doctor!
And as for ma and G-ma, it probably wasn’t the most professional standard of care and I do try my best to not say “pecker” in front of the grands.
Thanks, again, Giselle!  Oh, and keep me updated as to whether it’s really a boy when you get your formal ultrasound exam.  Take that image with you to your anatomy scan.  If she’s been doing ultrasound as long as me, she’ll get a kick out of it!
Best Regards,
wwavblogger
G:  I definitely have not purchased a single boy thing due to how little confidence the tech (and his images) instilled in me. Alas, t’was a “drive-through” elective u/s place lol. I will most definitely keep you posted as to the gender of my little bean (which will hopefully happen at the anatomy scan should the baby be cooperative), and you may absolutely use my email and images for a post – that’d be very cool!

Thank you so much for your kind words and prompt reply!
Giselle

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Posted on December 31st, 2013 by wombwithaviewblog.com

Let’s clear up a little misconception I heard a patient exclaim today..

‘If you’re told a boy, there’s more chance it’s really a boy and if you’re told girl there’s still a chance it could be a boy.’

No, no and no!  I’ll say it again.  If you have an experienced sonographer and if your baby is in a great position and if you are far enough along and if she can see really well, gender should be easily determined.  Of course, there’s no way for you, as the patient, to know all these things.  It’s a lot of ifs and no one will tell you to bet the farm.

Unfortunately, until we see the day that no one is ever told incorrectly and novice (or careless experienced) technologists quit doing the quasi sweep of the butt and taking a wild guess, patients will continue to question.

In my mind, I’m looking for mm (millimeter) abnormalities and I consider myself very technical and detail-oriented so if I am so bold as to say pink or blue then commence with the embroidered bloomers or sailboat motif!  Nothing gets my goat more than spending several minutes looking for gender, pointing it out with detailed explanation of fetal position and anatomy, marking it with arrows and taking multiple images…only for the patient to say “Yeah, but I guess it could still be a boy.”  No, in cases like this, unless your baby boy has a micropenis, no scrotal sac and labia, it’s a girl.  And, no, penises don’t automatically sprout at 25wks.

There lies the patient who had her heart set on sailboats.  Sorry, lady, I see lots of shoe shopping, tu-tus, truckloads of hair ties and a wedding in your future.

 

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Posted on December 24th, 2013 by wombwithaviewblog.com

So here’s an update from Kayla!  Remember?  She sent two pics and I just could not determine pink or blue.   Go back to the post entitled “Are You Sure?” dated December 11, 2013 and now check out her most recent email and pic to see what she is having!  Drumroll, please………….

image

 

 

 

 

 

 

Hello! Just wanted to update you with my recent scan. It’s a boy! Super happy to be having our third boy 🙂
Take care,
Kayla
wwavb:  Congrats, Kayla!  Now THAT looks like a boy:)  Merry Christmas and enjoy your baby boy!
 

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Posted on December 15th, 2013 by wombwithaviewblog.com

That would be AFTER your sonographer determines your baby’s gender..not before.  I know parents get excited and family and friends are dying to know what color to buy but does it really make sense to schedule this party for the very night of your ultrasound appointment?  I can tell you from experience that it does not..unless you can reschedule it at the last moment.

As I’ve said a few times in this blog and will, no doubt, at some point express again, gender determination is totally dependent on the cooperation of the fetus.  Sure, we can push around on your belly a little.  Sometimes a lot.  I’ve even spent as much time as 15 whole minutes just flipping mom around on the table in every position except for all fours or on her head.  That, by the way, is waaaaaaay too long for any sonographer to spend trying to determine sex.  I think the problem is this..  Americans are a people of choice and “we must have it now”.  Not everyone, but most patients I have who want to know the sex of their baby want to know yesterday or even better, at conception.  They want to schedule their ultrasounds early, as soon as possible.  Our schedulers, doctors and nurses get the question all the time, ‘Now, how early can we tell the sex?’ and ‘I want my ultrasound then’.

I know some of you understand.  Maybe even most of you understand.  But let me clarify that your anatomy scan is no way, no how, under any circumstances in this entire expanse of universe relative to the sex of  your baby.  It is NOT a routine part of this examination.  Nowhere in this report is there even a place to check a box that indicates either gender nor or we required to report such in comments.  In other words, it’s not important to our scan and it’s not why the examination is performed.  The ONLY reason the examination is done is to determine whether your fetus appears structurally normal so that your physician can properly educate you in the unfortunate circumstance alternatively, so that you can make informed decisions regarding your pregnancy or so that you can learn what to expect after delivery in the life of your child.

The only thing I really would like to accomplish here is for patients to go into their examination with a different type of expectation.  Expect a good examination, a thorough sonographer who guides you anatomically through your fetus and provides an adequate explanation of what she is going to provide for you for your visit.  I wouldn’t mind anatomy scans today if people didn’t come into my room with the entitled mentality of “I have to know today” or “I have all day” or “I’m not getting off this table until we find out”.  All famous last words.  Your sonographer probably has 30 minutes or less before another patient is expected to show for her examination.  Your sonographer is not required to spend even one minute determining gender.  So if she’s spends a few and she still can’t tell, believe her.  Cartwheels in the hallway won’t help.

So, if with your next exam you are hoping to find out the gender of your baby, I hope your technologist can determine this for you.  If she can’t, please blame your fetus instead and give that baby a smack on its hiney when its born:)

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Posted on December 11th, 2013 by wombwithaviewblog.com

If I’ve heard this once, I’ve heard it a million times.  As a matter of fact, I wish I had a dollar for every time I’ve heard this phrase in my career!  For the images below?  Heck, no!  There is just no way to be sure these images are of a baby boy and I’m totally not convinced!  Read on in an email from Kayla..

 

K:  Stumbled upon your site looking for answers of why I had “3 white dots” and told boy and why other moms I knew were told girl. Here is the image taken at 15 weeks 1 day. Was told boy and I believed it till I saw others with similar images and saying they were having a girl. None of my other two boys looked like this so just curious 🙂

Thank you,

Kayla

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wwavb:  Hi, Kayla!

Thanks for visiting my blog and subscribing!

And now about your images..first, 15wks is still a bit early.  Not that I’ve never been able to determine gender at 15wks but sometimes parts can still look a bit equivocal.  And since I didn’t scan you real-time, I just cannot determine based on these images!  Therein lies the problem with trying to guess sex too early and this is where mistakes are made.  I’ve seen the tip of a penis look this way early on and I’ve also seen the clitoris (middle white dot) still appear a little prominent in females at this gestational age.

My best recommendation is time!  Your anatomy screen which is usually performed between 18 and 20wks should reveal much more information PROVIDING baby is in a great position to see between the legs. I hope this helped somewhat and please upload images at that scan to keep me posted on what you find then!

“His Pee Pee” may turn out to be “Her Hoo Hoo”..hoo writes this stuff anyway?

Until next time!

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Posted on December 9th, 2013 by wombwithaviewblog.com

So below is an email from someone who paid for an elective scan at some ultrasound drive-through (these should be prohibited by state and federal law, in my personal and professional opinion).  She was only 16weeks!  Even though it is not impossible on every 16 weeker, it is difficult on most that age so my best advice for patients is to just wait for the sake of accuracy.  Read why below!

Mom:  Got this elective ultrasound done at 16w2d – sonographer said she was 80% sure girl – but had a hard time finding this shot.  Just felt like she was throwing something out there for us to go on.  She also reminded us that it was early and I should wait until my 20 week scan to be before buying pink.  Well, because of the holidays, I can’t get in until after New Year’s to do my scan at 22+ weeks and it’s driving me crazy now.  I spent $100 on this for her to tell me 80%.  I’ve been looking at other pictures and reading and just wondering what you think.  THANK YOU SO MUCH!

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wwavb:  Thanks for reading my blog and your question!  First of all, and this is just my professional opinion, no one should be offering gender determination scans at 16wks. She’s absolutely right..it is early so it would have been better to explain that first and then recommend you wait a couple of weeks more for the best chance of determination.  No one can guarantee gender 100% at any gestational age (NOTHING in medicine is 100%) and especially not at 16wks. It’s not that you can’t ever make a determination at 16wks, but it’s definitely harder then than at 20 or 22wks. I never give percentages.  Either I can tell or I can’t.  No guessing!  When a patient asks me to guess I always say, “Do you want me to guess or do you want me to be right???”

I can tell you that ultrasound is tricky and trying to determine from someone else’s frozen shot without my having scanned you real time is only a guess based on what I see in the image.  Your sonographer should probably not have added the annotation of girl and then tell you to wait for the next scan.  She probably felt it was a girl and just didn’t want to commit due to your gestational age.  What the image demonstrates where the arrow is pointed LOOKS like three little white lines and what we would say resembles female genitalia.  So based solely on the image I would have to say Team Pink has it.

SOOOOO…buy pink if you want and keep the receipts and hold off on painting a nursery!!  Feel free to email me an image of your next scan if you wish!  Hope this helped!

 

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Posted on December 4th, 2013 by wombwithaviewblog.com

…for gift giving and so in the same spirit do my patients request every year about this time to keep gender under secret wraps until Christmas morning.  It’s really a cute idea, isn’t it?  ..Waking up with the same excitement of a child and opening the envelope together to find out whether your future will be filled with sugar and spice or puppy dog tails, as the saying goes.

The parents turn their heads to the wall with great anticipation and wanting to peek so badly..one usually threatens the other not to look.  You can imagine, or you have lived, the scenario!  Hopefully, I can make the determination, take a pic or two and then wrap it in a little envelope on which congratulations are scribbled.  It’s really a fun part of what I do.

If you are looking for some clever way to share the surprise, this is a great one!  And if I do your scan, don’t try to hold it up to the light..it’s peek-proof!!

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Posted on November 26th, 2013 by wombwithaviewblog.com

So, if you all refer to the blog I posted with above said name on November 16, you’ll see a cute little sprout at 12 wks with mom, Jena, pondering my thoughts on a gender guess!  Let’s compare images..was I right?

Jena's Sweet PeaSweet Pea 20wks

Of course, I was!!  Well, okay, it was really less me and the fact that the criteria was correct for a girl guess.  I HAVE seen it wrong ONCE!  So it does have a fairly good rate of accuracy.  Read on for our conversation!
Jena:
Great news!! You were right – It’s a girl!!I was having such bad anxiety and excitement all at the same time that I decided to go get a 3D/4D ultrasound during my lunch break on Monday and it was very clear it was a girl.

Good thing I did it before the thanksgiving holiday because my second appointment got
Rescheduled now for the beginning of December.

We can tell our families at thanksgiving – yay!! I will email you the updated u/s photos as soon as I possibly can.

Go TEAM Pink!

Thank you,

me:
Congrats!! Yes, I’d love to see the images and upload them to the blog!  I hope you will enjoy all those dance recitals as much as I did:)
Jena:
I’m assuming by 20 weeks its very obvious if there’s a predominant penis or vagina, right? I’m just still in shock. It looked very obvious to me to be a vagina. So a very little swollen clitoris and the side lines were very thin.
me:
Sounds like what you are describing matches what we look for in girl parts.  By 20wks, external genitalia is very easily seen providing baby is in a great position!  And, yes, a small scrotal sac and a penis should be easily seen in boys and the labia and clitoris (we can’t see the vagina!) usually look like 3 white dots or lines at that gestational age.  Baby has very little fat in her skin right now so her labia will plump up and she will have much more recognizable girl stuff later!
Jena:
It’s been such a blessing to have crossed paths. I truly LOVE reading your blogs and I would have to agree you capture a readers attention just like Carrie Bradshaw. Lord knows, most girls / women love some good ol’ Sex and the City!
me:
So sweet of you to say and I’m SO happy to help!  And, yes, the image you sent could not look any more girly than it does!!  Congrats again!!!!!!!!

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Posted on November 16th, 2013 by wombwithaviewblog.com

My readers are just beginning to send me emails which is fabulous!  I love to get feedback.  Read Jena’s email and my response below:

 

Hi –

Any thoughts on the gender of our little one? This is around the middle of week 12. We’ll be going in for the anatomy scan next Thursday at 20.4 weeks. I look forward to your response.
jena hartman, mba 
***
Hi, Jena!

Congrats on your little one!  Great pic and he/she looks like a keeper;)
Well, let me say that both boys and girls each have similar external genitalia at that gestational age but the thought is that the tissue in a boy sticks up and the tissue in a girl sticks out (parallel with the spine).  We started to perform scans at 12wks on a regular basis a few years ago.  And I have to say that criteria held true for almost two years..except for one patient!  I said “girl” at 12 wks but there was a very definite penis there at 18wks and she did deliver a boy.  That was the ONLY case that had been wrong!  So, ever since then I won’t guess for my patients at 12 wks.  Nothing’s 100%!  Even an amnio is 99% reliable for gender.  HOWEVER, if we base a guess on the above criteria, I’d have to say pink tu-tus may be in your future!
Let me know what next Thursday reveals!!
Many blessings for you all..
wwavblogger
***
(From Jena)
Thanks so MUCH for your response! I will definitely keep you posted and appreciate your honesty. Have a great weekend! 🙂
***
(From me)
Awesome, thanks!! And please fill me in on gender next week.  Attach another pic and I’ll add it to the post so readers can compare the images.  If you haven’t already, I would love it if you would subscribe to my post!

Best regards,
wwavblogger

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Posted on November 9th, 2013 by wombwithaviewblog.com

Holy cow.  Another anatomy screen, another request to call someone, text someone or seal in a special envelope the gender of baby!  And we, as sonographers, better be able to determine this because our patient has planned a Gender Reveal Party and, by gosh, we simply HAVE to tell!  Moreover, your patient wants to do cartwheels in the hallway or have you, otherwise, magically turn baby into a better position.  David Copperfield, I am not.  And since we can’t reach in there and rotate the little sweat pea, sometimes we just can’t deliver (no pun intended).

How many of you are familiar with this relatively new event?  Gender Reveal parties have apparently become a big new way to celebrate how parents, family and friends find out the sex of their baby.  Someone bakes a delicious confection of some sort that when cut into reveals pink or blue cake.   I have to admit it’s a cute idea and must be totally fun.   But a word of caution!  Some patients schedule their party for the same night as their ultrasound.  I’m sure I have addressed this somewhere in this blog at some point in the past but gender cannot always be determined at the 18-20wk scan!

Being able to determine the gender should never be a guess.  We’ve all heard the stories from our patients..my cousin Martha was told 5 times it was a boy until a girl popped out..it must have been the thumb or the cord in the way.  I can promise you that if I can differentiate brain structures for my doc, I can tell the difference between a thumb and a penis.  I always tell patients either I’m sure or I just don’t know.  I won’t guess!  Guessing leads to a return of the dearly beloved tu-tu for a football jersey.  I simply do not want to be the reason for that!

I will say I have enjoyed taking a picture of cleverly-annotated gender and wrapping it up in a peek-proof envelope for my patients.  It’s a bit time-consuming in this age of electronic medical records but we do understand the excitement that goes along with that visit and we share that with you.  HOWEVER!  The point I’d like to get across to all readers is that firstly and most importantly, we have a very important job to do for you, as a patient, and for your doctor.  We have a hundred fetal and maternal parts to identify and accurately measure or otherwise document.  Please understand that this is first a medical examination that we must complete which requires a good bit of concentration.  I hope all sonographers do their best to give their patients gender information accurately, but in the event we can’t make this determination..don’t shoot the messenger!!  Maybe you’ll have to reschedule your party until next visit..apparently, nobody likes yellow cake anymore 🙁

 

 

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Posted on April 16th, 2013 by wombwithaviewblog.com

Sorry I’ve been away soooo long but I’ve been oh so busy with mom and work stuff and I finally have a minute to write a little!

Two weeks later, we are now 14w1d.  Moms and dads start to ask the question of “when” now.  “WHEN” will we be able to determine gender???!!  Well, truth is, if your sonographer can see VERY well, now is not too early for a guess.  In these images you’ll see our twins and what I guessed their gender to be at this point.  I’ll give you a hint..I was right!  Did you doubt me?  Take a close look at these images and you’ll see the difference for yourself.  This is a shot of each baby’s bottom so this is all you can see on the image.  On Baby A, you see three little white lines.  On Baby B, you can see a little something sticking out.  So, what is YOUR baby??  Pink or Blue?  Upload your images to share!!

Both babies..can you guess?

 

 

 

 

 

 

 

 

Look below..did you guess correctly?

 

 

 

 

 

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Posted on December 9th, 2012 by wombwithaviewblog.com

One of the things I love the most about this time of year and my job is how people come up with inventive ways of finding out their baby’s gender around Christmas.  Of course, most people who want this surprise will have me determine gender as they look away and then have me write it down for them enclosed in a sealed envelope.  They wrap it like a gift and place it under the tree to open Christmas morning!

What’s fun about this is that usually the couple is so excited and the anticipation is almost too much to bear, just like a kid who can’t wait to find out if Santa is bringing his favorite toy or game.  These parents could care less if they get anything material this year..  In my opinion it is the greatest gift they could give one another and share together during this holiday season!

Happy Holidays!

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Posted on October 27th, 2012 by wombwithaviewblog.com

When fetal gender determination turns into the likes of a Willie Wonka movie..

I love it.  Not really.  I’m scanning a patient for the anatomy screen, the exam performed between 18 – 20wks to evaluate fetal anatomy among other things or sometimes referred to as “the scan where we found out the sex”.  Every time I hear this I have to find some politically correct way of telling a patient that we could care less about gender determination and include it NOwhere in the report.  Nonetheless, most refer to it in this way.  God forbid if baby is not cooperating to determine gender.  Then I hear things like the following:

“I can’t wait a whole month to find out”  or

“Well, this is what we came here for today!”  or

“Come on, open those legs, open up!” (as mom or grandma or dad jiggles and pokes on mom’s belly like they’re trying to wake the dead) or

“Can I jump up and down in the hall a little and try again?”  or  “Should I go and get something to eat and come back?” Uh, no.  Like I have time for that because I have no other patients waiting for an exam.  And my favorite..

“I’m not getting off this table until you tell me what it is.”

I have to smile very nicely and try to refrain from hitting the eject button. Not really..I don’t actually have one of those but sometimes..I would like one.  We know patients are excited to find out what they are having.  It IS a very exciting time but in this Veruca Salt generation of “I need it now”, the idea that we cannot determine the gender when patients have waited SO long to find out is incomprehensible to them.

And then I get the “But can you guess?” question.  Not no, but heck no will I try to guess.  No good can come of guessing!  Do you want me to guess or do you want me to be right?  I never want to go back and tell a patient she is having the opposite gender of what they have previously been told!  So, I will not guess but I do promise each patient a thorough and excellent examination.

At the end of it, I hope I can write in all my little report boxes..normal, normal, normal..

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Posted on July 27th, 2012 by wombwithaviewblog.com

People, we as medical professionals KNOW you are excited about your sonogram.  Believe me!  We are moms, too, and we know you have counted down the days and lost sleep just waiting to find out the gender.  Visitors during your sonogram are allowed but PLEASE also realize your entourage of 20 friends and family are NOT welcome!!   This is not a family reunion or a party.  This is first and foremost a medical examination.  Ask anyone who has made a career of OB sonography; we are attempting to essentially rule out approximately 200 abnormalities and disease processes in one fell swoop.   It requires lots of concentration to make sure we are including all of the internal organs, limbs and structures requiring documentation.  Sure, we can make small talk and usually I do.  But when five family members or three kids or even one other person is providing non-stop and unwanted chatter buzzing about my head, it can make a bitch snap.  (Okay, I know that was unprofessional but it was also funny so I kept it.)

Nana playing gaga googoo with your 18month old whose pounding on a musical toy with the volume all the way up is a distraction.  The friend with both your mother and mother-in-law comparing and contrasting all of their labor and delivery experiences during the ENTIRE scan is a distraction.  Everybody’s fingers all over my monitor asking what is this and that while the toddler is getting into my cabinets of betadine and syringes and the five year old nephew is playing his DS and the 3 year old is taunting the baby in the stroller by stealing the pacifier thereby making it scream it’s little head off and little Ashley and Jack are chasing each other around the room and Jack then sees the “cool pictures” coming out of my machine so he has to pull them out…you get the picture.

Most places have limits on how many people you can take into the room.  So you are not disappointed on your big day, call your doctor’s office and ask about their policies.  It’s a good idea to let mom come back with one person for the initial scan.  It is because we like to make sure there is a heartbeat and nothing seriously wrong so you are not getting terrible news at the same time as Uncle Erwin.  This is a private matter we are sure you would not want to share with an audience.    After the initial medical exam is performed is a good time to let everyone else in.  At that point, I really don’t care how many are in there because it is play time, it will only take a couple of minutes and I’ve already done my real work.

So, all you moms with your first big sonograms coming up, I hope you enjoy your experience!  I hope you have a sonographer who is really nice and engaging who will point out all the little parts for you and give you some great pics!  And I hope your baby cooperates so you can find out what you’re having.  If you can give your sonographer a few minutes of pin-dropping silence, she will love you for it!  And if you bring another adult with you who actually takes the screaming baby outside, she’ll love you forever.

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