Posted on April 29th, 2017 by wombwithaviewblog.com
8 Week Twins

8 Week Twins!

Ultrasound Results – What’s the Big Deal?

Your ultrasound results must always come from your physician! But why can’t your sonographer just tell you if everything looks okay? It’s so irritating when she won’t talk, right? The most frequent question a patient asks is if everything looks okay, healthy, or normal. Hmm, if I had a dollar for every time I’ve heard this… Usually, to the patient’s dismay, this is something we just can’t discuss with you. Read on for details about why we have to be so doggone tight-lipped.

Ultrasound Results Have to Come from the Docs

My usual response when a patient asked this question is “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.” Only your physician has the legal right to give you this information. Yes, it is my job to know what I am seeing and to recognize it when something does not appear normal. However, sonographers are not physicians. We are trained to perform your examination; not to manage the health of you and your baby. Your doctor studied for many years, learning how to do just that. And he or she is the only person who can answer the multitude of questions you will positively have if a problem IS suspected. Our job is to share what we see with your doctor. Your doctor examines the information and concludes whether he or she agrees with our findings. The doc then shares his/her interpretation of the information with you along with what options he/she recommends next.

But, But…

Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something wrong or not.” I’ll admit that I do, but I always defer to the physician’s interpretation. Sometimes, the patient presses a third or even fourth time, and I just have to stick to my guns. I know it simply comes from a place of parental anxiety. We do understand. For the nervous patient, waiting for results can feel like a lifetime. I do empathize because most patients have a valid reason for being nervous. A previous pregnancy loss or abnormal scan is enough to scare serious fear into the hearts of anyone. I want expectant moms to understand that if your sonographer says something inappropriate, she could lose her job. Only your doctor can calm your fears and reassure you about your pregnancy issues in a way that no one else can. Your results are part of the sacred and private relationship between you and your doctor!

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All about ultrasound in the 1st Trimester – it’s coming soon!

~ And as always, THANKS for reading! ~

Your questions and comments are welcome at wombviewerblog@gmail.com!

wwavblogger, RDMS
wwavblogger, RDMS

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Posted on April 25th, 2017 by wombwithaviewblog.com

Becoming a sonographer/ultrasound technologist was one of THE biggest challenges of my entire life. The training was challenging, but finding myself in a new field and technology where I was painfully ignorant and unsure?  Healthcare is not a place for the timid.

If I was going to work with physicians, I better learn what I was doing fast or go home. It took a while for the puzzle pieces to fit..a good 6 months to 1 year. Thereafter, little light bulbs of realization would flicker every time I put two and two together. It was a marriage of all things unfamiliar. I was learning to read patient charts, learning about labs and correlative examinations, interaction with the physicians and with my patients. All of these things were a recipe for growing my new career as well as learning the technology. In the beginning, it was more about “How do I not screw up?” rather than “Wow, that was a great case!”

I promise you, it’s not for the squeamish. If another person’s urine, vomit, or blood bothers you, Ultrasound may not be for you. I cannot emphasize that enough! It was a hard year, and I felt like I was walking a tightrope for the vast majority of it. Brutal.

All new sonographers will miss pathology. It’s a fact of the modality. Initially, you are too concerned with getting all the right images. You’re too inexperienced to notice minor pathology. This is why it is so imperative that a newly-trained sonographer has direct supervision from someone very experienced. With lots of experience comes confidence. After a while, a newbie will start to get a feel for his/her scanning ability and stop second-guessing herself. Was I not seeing an organ because it can’t be seen or because I just couldn’t find it? It’s an awful feeling. However, it is one that can be overcome with time and, again, experience.

The more normal examinations a technologist performs, the sooner she will know when a case is not normal. Ten to fifteen scans per day over the course of a year equals a good bit of experience. After the first few months of constant supervision (if you don’t have it, ask for it!), you will start to become a little more comfortable with the examinations. You’ll then only need a supervisor’s help when something isn’t right. You may not be able to pinpoint a diagnosis, but you know it’s not what you normally see. This is very important in your early career. Eventually, you will be able to put together differentials to possibly explain what you are imaging. It’s a good feeling when you get to this point!

It was a slow learning process, at least for me, anyway. Over the years, it became easier to work with the docs. More importantly, I learned how to better communicate with my patients, which has been the most rewarding. It feels really good to correctly diagnose a case. But it feels even better to have a patient sincerely thank you for your help…or give you a hug in appreciation. It feels good to know I’ve made a small but, hopefully, significant difference. It’s been a good career for me. And for those who are going into it, hang in there because it gets better. For those who have practiced a long time and feel the flames of burnout, take a vacation! We all need to step back and take a breather once in a while.

Every case is someone’s health and life at stake, and not a week goes by still without learning something new. What a sonographer finds or doesn’t will either lead that patient to other tests or not. It is sometimes intimidating to think that a patient is on your table and yours alone. It’s up to you to find the problem in question.

I always say I would never want to re-live those earlier years, yet they have shaped who I am. They helped me become a better sonographer. So get out there! Become a sonographer, become good it, research and read, and ask questions of co-workers and docs alike. Make a difference in someone’s life. Make a difference in your own:)

facial profile

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Posted on October 11th, 2016 by wombwithaviewblog.com

Ever wonder what your sonographer might be thinking as she calls you back for your exam? While I cannot speak for all, let me give you some insight into some of the heavyweights at the forefront of my thoughts with each new patient.

What’s in a Job?

Firstly, we have a job to do. While the patient may be wondering why she wasn’t called back at her exact appointment time, your sonographer is already very busy with the business of having you as a patient. We are busy with a checklist of items that must be completed before we ever call your name! We are examining your chart and looking for your doctor’s order (we cannot begin without this!). We have to determine why you are coming to see us in the first place, so we have to know what type of exam needs to be performed. Oh, yeah! Your prior pertinent medical history and testing are pretty important, too. In other words, we have to be able to answer the 5 W’s…Who, What, When, Where and Why:

    • Who are we scanning? Who (what provider..doc, nurse practitioner) ordered this exam?
    • What type of ultrasound exam are we performing?
    • When was she scanned last and what was found? Do we have that report(s)?
    • Where are we targeting the examination?
    • Why are we scanning this patient?

Patients or Patience?

After spending so many years in the healthcare field and encountering a challenging personality type or two along the way, we sonographers wonder whether our next patient might be naughty or nice? The Rolodex of mental questions might look something like this:

  • Will my brain get picked for some interesting ultrasound facts or will I get the silent treatment? It is a bit awkward when a patient has nothing to say…I mean zero words.
  • Will she need to beat her dueling children because they won’t let her focus on Baby #3 (who may turn into Baby #1 if they don’t quit fighting)?
  • Siblings are sometimes the most comical addition to an exam, but will I have to listen to “Let It Go” on a tablet for thirty minutes – again?
  • Will her family sound like my Italian kin at Thanksgiving in that tiny. enclosed. room?
  • Will it be standing room only with Grandpa breathing down my neck for the whole exam? Gramps is really nice, but he’s gotta mosey on over to the other side of that table.
  • Will I have to ask Dad to take their screaming toddler back to the waiting room? We hate to kick anyone out. But our eardrums can’t take it, and admin typically frowns upon keeping rum in our exam rooms.
  • Will I get the evil eye if I say that I cannot determine what sex she’s having? And will she then rant on Facebook that I have no idea what I’m doing? I hate when this happens.
  • But seriously, and most importantly, will this baby look normal?

The Questions We Get Almost Every Time

Does everything look okay? Do you see anything wrong? Is my baby growing well?

These are all valid questions, to be sure! But as most patients know, they are ones that only your doc can answer. Legally, only your doctor can review the exam and determine its results. Only she/he can discuss these results with you even if they’re negative. Why is this? So that they can also provide you with the comfort and answers in the face of concerning findings.

My answer was always relatively the same. “So far so good, but your doctor has to review the images and give you the results.” Every blue moon, a patient express that I must know what I’m seeing. I would always agree but reiterate the rules.

There are times and extenuating circumstances where you may know what your doctor is following. In these cases, we have to be careful with our words. Every practice is a little different with respect to how much your sonographer can say. It’s a fine balance! Too little, and we cause you to worry. Too much, and we could be fired!

Of course, every sonographer on the planet is happy when they enjoy the time they have with their patients and families and kids. Some of my favorites have also been the loudest, most fun, and the funniest! One thing is for sure…I can definitely sing the “Frozen” theme song with your kid the next time you visit:)

Many blessings and happy, healthy babies to you all! Feel free to email me at wombviewerblog@gmail.com with any questions or comments!

wwavblogger, RDMS

wwavblogger, RDMS

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Posted on February 25th, 2015 by wombwithaviewblog.com

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

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

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

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

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

one doc's images one doc's images

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

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

Best wishes,
wwavblogger

***

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

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

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

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Posted on January 24th, 2015 by wombwithaviewblog.com

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

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

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

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

image

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

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

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

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

Good Luck!
wwavblogger

***

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

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

female gender

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Posted on January 21st, 2015 by wombwithaviewblog.com

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

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

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

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

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

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Posted on December 21st, 2014 by wombwithaviewblog.com

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

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

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

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

image

Merry Christmas and Happy Holidays until next post!

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Posted on August 15th, 2014 by wombwithaviewblog.com

On January 22, 2014 I wrote a post regarding a concern for many parents that is asked of me pretty frequently..the nuchal cord or the situation where the cord is around Baby’s neck one or more times.  I’ve included a link to that post below.

http://www.wombwithaviewblog.com/nuchal-cord/

Here is a comment to this post I received from a reader who is a fellow sonographer and mom who also gets this question quite often from her patients:

reader:  When I was pregnant with my 2nd daughter, I’d scan myself (hey who doesn’t, perk of the job! Lol), she had nuchal cord the entire 3rd trimester. It never caused a problem and when I pushed her out my doc simply took it off her neck. I get asked that question a lot and I’m glad I can tell my patients my story to help calm their worries. Because oh do some people worry!

wwavblogger:  Yes, people will always worry because it’s only bad outcomes that they hear about. They never hear of all the babies born who are unaffected! I tell patients it’s like flying in an airplane..yes, you know it can crash but that doesn’t mean it will and the likelihood is very remote..much like a nuchal cord.

***

I will also add here that my first daughter, too, was born with either a double or triple nuchal cord that we weren’t aware of; I wasn’t yet a sonographer and also didn’t have a sonogram prior to delivery.  She never displayed any signs of distress in labor and delivery was uneventful, which is always a good thing when speaking of the whole pregnancy experience!

It’s hard as moms to not worry about all the things we hear about and especially the bad outcomes that seem to draw the most attention.  It’s even harder in this age of technology to not consult Dr. Google which is a terrible mistake and something about which I’ve also posted!  I will say it again for the millionth time in my career..consult your doctor regarding your fears and needed information. No one wants to be one of the stats but that is out of our hands, chalked up to fate and the gods or otherwise left up to the universe and its mysterious ways.  In other words, it’s something we have to put to the back of our minds because we have no control of it.  We all know as moms there are so many other things to focus our attention on in a day that we can control..providing the love and attention to our other children and spouses, decorating a nursery or simply just enjoying your pregnancy by reading only positive,  uplifting and lighthearted print…like my blog!!! 😉

Please keep coming back for more!

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Posted on August 6th, 2014 by wombwithaviewblog.com

Young kids are always accompanying their parents to the ultrasound to see their new sibling on the monitor.  Honestly, unless they are over the age of four, interest steadily declines and sometimes rather quickly as soon as the lights shut off.  Mom and Dad want them to be more interested than they truly are.  At 2 and 3 they simply are in the age of “me” and actually could care less about whether their new baby sister or brother, the one they’ll torment for years to come, can be seen on the “TV”.   Furthermore, if they do comprehend what a baby really is, the one on the monitor sure doesn’t look like any baby they’ve ever seen!

Parents try to come as prepared as possible with iPads in hand, games and snacks.  Sometimes none of it matters and they scream and carry on until it’s over or grandma hauls him out.  Every once in a while I’ll have a little visitor who is so cute, I just want to keep him with me all day.  Today I had one such little guy.  He was 3, barely understandable and so stinking cute.  The kids who are quiet are usually intimidated by the surroundings and are fearful Mom is going to be hurt.  I usually break the ice by offering them to feel the gel.  I hold out a gloved finger with a big glob on it.  I’ll make a game out of it and even if they are grossed out initially, very soon they are asking for a squirt.

Little man did just the same today.  After a bit he got comfortable with me and asked what his baby sister was doing in there. I replied she was swimming.  I didn’t understand most of anything he said…except that his baby sister was a fish.  He said it over and over and over again.  And the more we laughed, the more he said it.  Of course, he knew he had a baby sister in there before anyone else did.  I swear I just think they have a connection with one another!  We confirmed it was a sister and he kept reiterating “Baby sister a fish.”

I gave him his very own picture of Baby Sister to keep for himself.  Kids just love that and I made a new little friend.  He walked out of my room and looking up at me with a big smile kept repeating all the way down the hall that his baby sister was still indeed a fish.  Too darned cute!

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Posted on July 19th, 2014 by wombwithaviewblog.com

New sonographer advice is a topic that needs addressing for anyone new to the field. It’s a tough place out there for you. I know, I lived it, too.

A Fine Example of Negligence

I felt a bit distressed to learn something recently. It is an important lesson for any new sonographer, especially. A recent graduate of a sonography program landed her very first job out of school with a temp agency. With essentially no work experience, her recruiter advised her to “Fake it ’til you make it.” I thought I’d faint. She lied saying her recruit had one year of experience and placed her in an OB practice to work alone. The lack of responsibility of this recruiter left me surprised and horrified. The quality of exam a patient receives was obviously of no importance. This is unfortunate.

Moreover, the horror this new sonographer experienced is another story. Even though she had a brief period of training by the sonographer going on leave, she was uncomfortable with scanning or reporting anything on her own. With no experience to call on, she did not possess the confidence to call a case normal or abnormal. Where does someone even begin to construct a report when she is unsure of what she sees on the monitor? This is unfortunate and a precarious circumstance for all involved.

Don’t get me wrong. Everyone has to learn, and all new sonographers need the opportunity to become better. But, like so many things in life, there’s a right way and a wrong way to accomplish this task. It has to be fair to both the sonographer in training as well as the patient. Therefore, the following is a message to all sonographers who have just stepped out of the classroom and into the real world of practice.

Turn the Table…

From a slightly different perspective, please consider the following. If it were you, your daughter, your mother, or your sister on the examination table, wouldn’t you want to know if it was the first exam performed by your provider? We all like to feel as though we are in good hands, competent hands when we seek medical attention or advice. Wouldn’t it be disconcerting to know the person scanning you is new, overwhelmed, and lacks the knowledge in all ways to perform your exam properly? Every patient deserves to have their examination performed by someone who is knowledgeable and properly trained. After all your hard work in school, you deserve to be properly trained!

Just in Case Your Instructors Didn’t Tell You…

You are not qualified to work alone. You need direct supervision from someone with qualified experience. You need direct supervision for all of your exams performed for at least three solid months. After that, you need to ensure you work in an environment with at least one other experienced go-to sonographer for questions..because you will have them. You will have a lot of them. We all did.

You should never lie about your experience, even if a recruiter tells you to do so. Potential employers need to ensure how much they can rely on your skill and experience outside the classroom. Your class time and clinical rotations count as experience toward taking your registry examinations, but it doesn’t go far toward real-world experience. You were in school and learning. You will still be learning volumes over the next few years. No one ever knows it all, and this is a field where you will continue to learn your entire career.

Students and new technologists, once you have scanned about twenty-five normal cases (give or take), you will be able to scan a normal exam on your own pretty easily. Tackling pathology is a whole other ball game. You will feel more comfortable you taking on the challenge of an unfamiliar process when you develop more confidence in your skill and ability. Everyone’s learning curve is different. If you learn new things quickly, you may feel more confident in your skills in less time. If you have a no-fear personality, you’ll have less problem jumping in with questions or presenting cases to physicians when you are unsure of a diagnosis.

What About a Private OB Practice?

Sonographers in a private practice need a great deal of experience. They need to be able to work independently and have enough confidence in their skills to tackle a challenging case without breaking a sweat. They should feel very comfortable scanning patients in every week of pregnancy with no question regarding the protocol of any exam. Do we still turn to our co-workers for a second eye from time to time? Of course, we do. It’s all part of continuing education and proactively learning where we have the opportunity to grow. It’s imperative. Remember, we never know it all!

In our office, we do not hire anyone who is not registered in OB/GYN with less than three years of full-time OB/GYN experience. How can a physician trust your work if you don’t trust it yourself? A physician relies heavily on the experience of his/her sonographers to provide competent and thorough examinations. How can they properly treat their patients otherwise?

Your job as a sonographer is to find pathology. You can’t diagnose what you don’t recognize, and you won’t recognize what you’ve never seen. This is just the nature of the beast.

Be Your Own Advocate!

I’m sorry if your educators failed you. They have a responsibility to not only teach you in the classroom, but what to expect outside of it. This is not your fault. It reminds me of an old adage which says that you can’t know what you don’t know. So, before you take your first job or any job thereafter, ask yourself if you are experienced enough to commit to it. Then ask if you will have supervision. Start out in a teaching hospital. Sonographers are thrilled to share their knowledge with you in such facilities! Learn what you need before you think about branching out on your own. You owe it to yourself in order to become a better sonographer. You owe it to your patient to provide a quality examination.

Patients: if this is overly concerning to you, it should be. You can always inquire as to the experience of your healthcare providers!

Comments: 2 Comments »

Posted on July 17th, 2014 by wombwithaviewblog.com

..to blast everyone in your OB doc’s office.  The old adage that one can attract more bees with honey seems to be something we learn as we become more mature in this life.  Certainly, most of us can reflect on a time when we wish we had taken the higher road.  I guess when you’re unhappy with an uncooperative fetus, everything else in life just sucks, too.  Read below for what NOT to do in this circumstance..

Most expectant moms understand by now that the only way to obtain the totally precious 3D images they’re paying for is for Baby to be facing up toward Mom’s belly with nothing else in Baby’s face except a nice pocket of fluid.  If you didn’t know this, now you do!  I love to impart a plethora of informative tidbits to my beloved readers and future moms.  However, if Baby is facing down?  Forget it.  We can’t scan through your back (too many bones) and pretty much nothing usually changes Baby’s position.  But hell hath no fury like a mom jacked-up with pregnancy hormones.

My co-worker (who was her sonographer and a sweetie-pie, at that) did what I would have done..rolled mom to each side and jiggled the belly until the cows came home but this resulted in nothing.  She explained what we views we needed, what we didn’t have and why and offered for her to come back.  The patient seemed reasonable enough and agreed to come back another day (free of a second charge, mind you)…or so we thought.

The patient reaches the appointment desk on the way out and, I suppose, had just enough time for her blood to boil.  She unleashed a rash of f-bombs on the poor receptionist.  She made the appointment, left and called back unleashing a second wave by  bitching about my co-worker (who tried to make her pretty pictures), the receptionist, a phone nurse, the office manager and, by the time she was done, cursed out her physician.  Whoa, Nelly!  Too bad we couldn’t take her down with an injection of sedatives while she was still on the property.  Just kidding!  We’re legally not allowed to do this even though some patients need it when they start foaming at the mouth.

And what did it get her in the end?  The search for a new OB doc!

Note to self:  If I behave this way in a private practice, I WILL be fired as a patient..preggers or not!

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Posted on July 15th, 2014 by wombwithaviewblog.com

If you think kids say the darndest things, some of their mothers aren’t much better.  I feel my job here in this blog is to inform you but to also make you laugh.  Anyone who works with the general public knows that some people are just not taught the etiquette of speaking or behaving in public.  Therefore, we end up with stories like this.  I hope you get as much a kick out of this story as I did!

My co-worker completes an exam, steps out of the room to allow her patient to get dressed and awaits her exit.  As the young mother, her FOB (father of baby) and toddler walk out she says “I’m really sorry..my boyfriend farted in there and he stunk up your whole room.”

For as funny as this was (my co-worker didn’t laugh as much as I did, by the way), couldn’t she have just blamed it on the baby?!

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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 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!

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Posted on June 26th, 2014 by wombwithaviewblog.com

I don’t get it.  Most every American girl has her ears pierced but this age of head to toe studs and bar thingy piercings has me begging the question “Why in the world there??!”  And for as attached as women are to their dangling belly stars and rhinestones, they absolutely HAVE to be removed prior to your ultrasound exam!  Sorry, ladies, they can damage the footprint of the probe which is made from rubber.  We request people take them out before they come in for their scans, but alas, some don’t and end up fighting to get them out for 10 minutes..10 minutes of precious scanning time, I might add.

I have all kinds of people and all walks of life lie on my table for a scan.  I’ve seen the eyebrow, lip and dimple piercings.  I’ve seen gages and bars and multiple hoops and rings in the ears and nose and, oh but yes, I’ve seen clitoral piercings.  Holy cow, and I’m holding my breath typing this just thinking about it, but why in the mother of pearl..???  Ooh.  or Ew.  That’s all I can say about it.  I’m sorry if I offend anyone with such metal in her nether regions and I’ve heard stories about WHY they are obtained.  Just know that I shudder only because it’s something I could never and would never do in a million and five years.  No way.  No how.  To each his own and you are more woman than I.  That being said, today was a first…

So, as I am draping my patient and tucking the green paper into her undies, two barbell piercings with a ball on each end are revealed on her pelvis just inside her pelvic bones.  Huh?  Just looped through the skin.  Why in the world would anyone put them there?  (or anywhere, I’m thinking) But on your pelvis?  What’s next, the elbow?  I’ve seen some crazy tattoos down there (enough for another post all by itself, believe me) but never a pierced pelvis.

You know, it’s funny to think about but it will precisely be those people who so adamantly require their metal in odd places that will give birth to a child who will grow up repulsed by them!

Remember, all you pierced mamas out there..belly rings OUT prior to your ultrasound!  It’s just more time you’ll have to look at your little pumpkin 🙂

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Posted on June 18th, 2014 by wombwithaviewblog.com

So because I totally lost my marbles and didn’t post some great story about fathers on Father’s Day, I guess I’ll do it today instead!  So I would love to share this really funny experience with one very overprotective Dad.

A couple of years ago I had a patient who was coming in every week for BPPs or Biophysical Profiles as they are called.  I’ve explained this one before but it is simply a way to determine the well-being of a fetus by scoring the baby on his/her movements.  We also measure Baby’s fluid and monitor Baby’s weight, as well.  During these scans, babies sometimes are napping or lazy.  Sometimes we have to “force” a little movement by nudging baby which we accomplish by poking at mom’s tummy.  If Baby is REALLY asleep, we sometimes have to poke quite a bit.  I, of course, always ask Mom if I am hurting her and I’m surely not hurting Baby.  But Dad, on this particular day while accompanying Mom for the visit, didn’t think so…and he let it be known.

I start poking around on Baby and Dad pipes up saying “You need to stop that..  You’re pushing too hard.”  I assured him that I wasn’t and asked Mom again if she was hurting.  She actually laughed a bit and stated she was fine and that she wanted me to just do what I needed.  She also tried to calm Dad but he wasn’t having it.  After a little more vigorous poking, Dad said “You’re gonna cause Shaken Baby Syndrome!”  I laughed to myself and did all I could to keep from bursting out with laughter at his reaction.  I reassured Dad that Baby is well protected in there and we certainly wouldn’t do anything that could cause harm to the little one.

He eased up but wasn’t happy about it.  I just couldn’t be upset with him.  He was starting his job early..being protective of his baby girl very early in life.

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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!

***

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

 

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Posted on May 24th, 2014 by wombwithaviewblog.com

Who doesn’t love ribs on Memorial Day weekend??!  Today’s post is all about ribs but not the kind we love to bathe in barbecue sauce.

Bone on ultrasound shows up white because it is very dense.  Water, on the other hand, is the opposite and shows up black.  Ultrasound cannot travel through bone so as your baby’s bones become more dense, they become more of an obstacle to see certain things like the heart.

Next time you have a scan, notice the appearance of  baby’s bones.  Because sound cannot penetrate through bone, what you’ll see instead is a perfect shadow behind the bone.  We cannot see anything in that shadow.  Therefore, anything that lies behind bone cannot be well-visualized.

Take a look at the image of this baby’s ribcage below.  Notice the arrows pointing to the white dots (ribs) and the black shadow that follows each one!

SONY DSC

 

Thank you to all the moms and dads who serve our country in the armed forces!  It’s a hard job and we appreciate you!  Have a great Memorial weekend!!

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Posted on May 22nd, 2014 by wombwithaviewblog.com

Here’s an email I received from a UK reader asking about determining Baby’s size/weight.  Read on for my response!

reader:  Hi, I was just wondering how accurate scans are at estimating weight ? I’m 36 weeks +1 and I had a growth and reassurance ultrasound today.  Baby was perfect 🙂 and they estimated 7lbs.  This is my 4th child and the only full-term baby I have had was my last and he was 7lb 10.  I am a little worried this baby is going to be a 9 pounder and that I’m going to have a difficult labour.  This is my last baby so I really don’t want to spend these last weeks worrying over nothing so any info would be gratefully appreciated.  Thanks in advance.  I love reading your blog!

wwavb:  I love my UK readers!  First, let me say I am happy you found my blog and are enjoying it. Thank you so much for saying so!  I truly hope you’ll spread the word and please subscribe for future automatic posts!

Now on to your question. I’m unsure what the discrepancy is in the UK for fetal weight. Our machines may be calibrated slightly differently here in the states. That being said, 1lb +/- is not unheard of and sometimes can be greater depending on the level of skill of your sonographer and fetal position which can make measuring baby more difficult and less accurate, which is precisely why it’s called “estimated”.

If your baby is at 50% or thereabouts, it means he is average in size and will gain on average 1/2lb /wk from here on out. If your baby is measuring bigger then average (which I wouldn’t know without seeing the individual % for each measurement), it’s feasible chunky monkey could gain a little more each week.

Just know that if this baby ends up being larger doesn’t mean you’ll have problems delivering!

Cheerio!

wwavblogger

***

I’ve definitely posted on weight before as it is a very often received question!  Everyone wants to mentally prepare for what they are going to have to push out of there.  Check out one of my prior posts on EFW!

http://www.wombwithaviewblog.com/how-much-will-my-baby-weigh/

Comments: 2 Comments »

Posted on May 21st, 2014 by wombwithaviewblog.com

I must have dyslexia.  I originally wrote one artery and two veins..sheez..definitely two arteries and one vein.  So glad I caught that..it’s late!  Already changed!

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Posted on May 21st, 2014 by wombwithaviewblog.com

Very simply, the cord is made up of two arteries and and one vein.  This is one of the important bits of information we obtain during your anatomy screen or the scan most get at 18 – 20wks.

Sometimes only one artery develops and babies can grow just fine in those cases.  Usually, if your baby has a two-vessel cord or SUA, single umbilical artery, as they are commonly referred to, your doctor may request more ultrasounds to follow Baby’s growth over the course of your pregnancy.

You may sometimes see your sonographer add “color” to Baby’s cord.  Typically, we apply blue to the vein and red to the arteries.  This color flow just allows us to see them better so as to evaluate the flow within the cord in the 3rd trimester.

We can never see all the cord from placental to fetal insertion later in the pregnancy.  Baby gets to be too big and we see segments of the cord here and there.  One question I always get is if the cord can be seen around the baby’s neck.  Ya know, sometimes we do see a nuchal cord but it just isn’t something your doctors want or even need to know about.  The cord moves all the time and they just will not even give it a second thought unless it’s wrapped twice and you are near your delivery date.  Otherwise, there’s nothing anyone can do about it and cord accidents are actually quite rare.  It’s one of those things in life you simply cannot worry about like getting on a plane for a 10 hour ride.  You’re not going to ruin your trip to Europe by stressing about it, right?!  Of course, you shouldn’t!

Wow, you guys are gonna be a plethora of ultrasound knowledge after reading my blog;)

‘Til next time!

SONY DSC

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Posted on May 17th, 2014 by wombwithaviewblog.com

I love receiving uplifting emails from readers!  It inspires me to continue blogging and to look for more ways to inform you about your fetus and you.  It also gives me great content to share with other readers!  I encourage all my readers, subscribers or not, to share with me your ultrasound stories, comments, images and photos of your baby!  I hope you’ll read, enjoy and subscribe to my blog to find answers for all your ultrasound questions!

Read this great email from a fellow healthcare worker:

nurse and mom-to-be:  Hello!! I must say I love your blog & wit!! Patients are so lucky to have such a skilled sonographer like you. I must say I’ve experienced both. My last one we met  (18 week ultrasound) with was great, 20+ years experience & worked with higher acuity patients, too. She respected our wishes and wrote down the sex with a picture for us to open later. She asked us to leave the room so she could analyze the image. We also asked her track record and she says she does not reveal if not sure. She labeled every body part for us and thoroughly educated us, as I’m sure you do too!!  I’ve been a nurse for 10 years so I can only imagine the questions you get!  Love the idea of your site – you really utilize your talent and help us crazy pregnant ladies!!

 Best wishes & I’m now a subscriber (&huge fan), yay!
wwavb:  Hi and thank you so much for reading and your kind words!  AWESOME!!  I’ve worked two years on content and I would love to make my site into a book one day!!  I think it would be an entertaining read for anyone and a great shower gift for new moms:)

Your great feedback was a great Mother’s Day gift, by the way!

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Posted on May 11th, 2014 by wombwithaviewblog.com

Even though the work of a Mom is the most difficult, most important and most challenging job you’ll ever have, it is also the most rewarding. The time and effort you put into your children will reflect when you see them become productive, loving and passionate adults.

Whether you are fortunate enough to be a stay-at-home Mom, one who has chosen to work hard to educate herself and built a career or one who has to work to support her family, know that what you do for your children is important on an every-single-day basis even though it is only really validated once a year.

I can say as a working Mom my children’s entire lives, as much as I would have loved to stay at home with them while they were small or even work part-time as they grew up, it just wasn’t an option for me.  I had to support myself and my children.  No one else was going to do it.  Balancing it all and maintaining my sanity was a daily chore.  Thank God for the help and support of some great care-givers along the way.  Not only could I leave my babies knowing they were being taken care of, but my children learned that someone else could care for them, too, in my absence.  We loved her and she loved us.  Even though I couldn’t be with my children the way I wanted, out of it grew a love none of us would have otherwise experienced.  Your children will have many teachers in life; you are the first.  Teach them what love looks like so they know the difference between the good teachers and the bad ones.  

I’ve enjoyed a long career and I’ve learned so much that has helped me become a better care-giver to my patients over the years because I’m also a mother.  We wear many hats and sometimes you don’t realize how all those hats help you help others.

My kids think I’m superwoman.  They put me on a pedestal and it feels amazing.  So all of you moms out there working to bring home the bacon while raising your children, it pays off.  No matter how crazy you feel, if you always make quality time for your children, love and encourage them, it just pays off tenfold in the love they give back to you.  You also realize that what you’ve taught them can be defined as the importance of education, responsibility, resilience and accountability. To watch your children flourish as talented impassioned adults is the greatest Mother’s Day present of all 🙂

And it all starts here:

Baby A 8wks

Thanks for reading my blog and being a part of my life.

HAPPY MOTHER’S DAY!!!!

wwavblogger

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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!
unnamed
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 😉

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Posted on May 7th, 2014 by wombwithaviewblog.com

You just cannot compare your pregnant belly to anyone else’s!  Though some so-called friends and family may try and though you may receive tons of unsolicited opinions, pregnant bellies are as different as people are different.

If you are fortunate enough to be tall and lanky with a long torso, your uterus will have more room to grow up instead of out.  This sounds like a blessing and it is physically.  But it usually results in women who don’t show very much and end up getting hit with a barrage of questions like “Are you sure you are eating enough?” or “Is your baby too small?” to comments like “You need to feed your child.”  Patients come in for their ultrasounds worried about the growth of their baby because of comments from idiots like these.

Conversely, if you are one who is height-challenged or in possession of a short torso, your poor little uterus has no choice but to grow out.  It only has so much “up” room.  These patients are usually miserable by the end of their pregancy because they tend to have bigger bellies and can appear farther along.  Sometimes, having too much amniotic fluid in the third trimester (quite common) can make your belly look bigger, too.  And, yes, of course, they get hounded with such questions all the time, not to mention the old “Are you sure there are not two in there?”.

So, if you fit either one of the above categories, you should first discuss any concerns you have with your doctor.  If your doctor says you and your baby are just fine, you have the right to blacken the eye of the next person who dares to say such to your face.  Tell security hormones made you do it (I can’t condone violence but the thought is nice, right?).  If you’re not into smackdowns then think of some clever comeback to make them think twice about what a stupid comment it was they just made.  (Hmm..how about something like “Hey, how about that..my baby is almost as big as your beer gut.”)  Hopefully, they feel terrible enough that the mere presence of another beautifully expectant mom makes them turn and run for cover 😉

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Posted on May 1st, 2014 by wombwithaviewblog.com

I am always absolutely astounded..flabbergasted..when people ask me my opinion about gender and then don’t believe it.  They keep asking. And asking. And asking. They continue to ask the same question over and over but in a different way.  It. makes. me. CRAZY!

This is especially true when it’s just too darned early!  Consider this..does a fetus at 8wks look like a baby?  No.  Does a baby chick embryo curled up in an eggshell look like a chicken?  No.  The same applies to external genitalia on a fetus!  It’s not completely developed yet so one just cannot discern boy or girl very early in the pregnancy.  In fact, TOO early in the pregnancy they both have itty bitty parts that stick out and can all look the same.

Read the emails from the grandma-to-be below who just didn’t want to take “It’s too early” for an answer.

g-ma:  Hi, I subscribed to your blog. I love it. These are my grand baby at 12 weeks 2 days. Any guesses?  The baby’s legs were crossed at the 16 week ultrasound.

12 Week Fetus

12 Week Fetus

Too early for sex guess!

12 Week Fetus

 

wwavb:  Hi! And thanks for reading and subscribing! So glad you are enjoying the info!

Okay, so if you’ve read any of my posts on the subject, you know that guessing at 12wks is like flipping a coin. Just too early. An accurate guess can be made at 18 wks IF baby is cooperating!
Any guess any earlier is simply a guess and I just wouldn’t invest in paint.

Best wishes for a healthy grandbaby!

g-ma:  Thank you for your response!  It’s just driving me crazy wondering what those two white ovals are in between the legs.  Doesn’t look girl or boy. Could it be fingers or an umbilical cord?

wwavb:  No, haha. It’s definitely external genitalia but boys and girls look the same at that age! Over the next several weeks, girl stuff shrinks to form labia and all her girly parts; boy parts get bigger to form the scrotal sac and penis. It’s all still developing on the outside even though chromosomally it’s already determined on the inside.

g-ma:  Thanks for being so helpful. I would think it’s a boy for sure if it’s genitalia!  But, not if they look alike at 12 weeks.

 wwavb:  Sounds like you’re not too far off from finding out. Happy shopping!
g-ma:  Really… No guesses? I know it would be a guess. I thought the pics looked pretty clear. Everyone thought boy.

wwavb:  Wow.  You’ve earned a spot in a post for your persistence.  But it doesn’t change the facts.  You can either believe what you and your fam think you see in the images OR you can believe someone who has seen tens of THOUSANDS of fetuses at this age.  Up to you!

The professional verdict is that it’s simply TOO EARLY to determine gender on any baby at that age.  It’s just not all formed yet!!!
Let me know what you end up having!
***

People have a tendency to believe only what they can see or understand.  As long as sonographers guess too early and continue to be wrong, I will have to persistently defend my determination until the cows come home.  My advice when it comes to gender is that you have to entrust the word of an experienced sonographer..or just buy neutral!

Comments: 3 Comments »

Posted on April 29th, 2014 by wombwithaviewblog.com

Sometimes it’s just effortless, well with the exception of trying to get this baby girl to just turn over!  We asked, she listened.  What a good little baby!  The result was just great imaging.  She was 27w3d here which is an optimal time for a 3D scan.  Babies have begun to develop some fat in their skin so cheeks look a little more plump now.

What you’ll see here is a great 2D facial profile, which is ideal for great 3D images and then two really sweet 3D images.  Mom was happy to share:)  She’s a keeper!

2D facial profile

 

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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!

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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 17th, 2014 by wombwithaviewblog.com

Oh, what our poor patients experience at the hands of our inexperience and in the name of education.

Ya know, one of the things students learn is not only how to use the buttons on the machine, not only how many images to take and what kind, not only how to detect pathology but also how to (or how not to) insert a transvaginal probe.  It can be a little tricky!  We are not gynecologists, sitting there with our head between our patient’s legs, however, there is a right way and a very wrong way to place this probe.  The vagina can be an elusive little boogar depending on a patient’s body shape and, especially if you are at all very new to vaginal probe placement.  One suggestion to a new sonographer is not to try this with your eyes closed.  The gel on the end of that thing can make it feel like a slip-n-slide down there if you’re not careful!  Just like you have to look at the road to know you are in the correct lane, you also have to look at your patient, briefly, to ensure the probe doesn’t migrate..well, south.

Read part of an email from a pregnant patient:

reader:  I had a (pretty harrowing) ultrasound at 7 weeks due to pain and spotting, in which the student tech tried to insert the probe into my anus, twice (really). She didn’t so much as wipe it before shoving it very hard into the correct orifice :-/  Actually there was another lady in the room, but she was tapping away on a computer. When I yelped due to the wandering wand, she looked up and asked if the student needed help, but she said no and continued. I suspected she was a student because of this episode, and sure enough my little report confirmed it.

wwavblogger:  Let me just say that your email and the case of mistaken orifice identity is unfortunate but you totally made me laugh (really).  One of the things a new sonographer has to learn about using a probe is how to insert it.  So sorry this was your experience.  I’m interested in knowing, though, if there was an experienced sonographer supervising her?  Did she say she was a student?  Just curious..  Students and new sonographers should always be supervised.  It’s a peeve of mine when this doesn’t happen!

***

Patients, speak up if this happens to you!  If you have questions about the competence of your sonographer, you have every right to discuss the concern with your doctor.  Sonographers, pay attention to what you are doing.  If you are unsure, you have to learn to ask the patient if the probe feels like it is in the vaginal canal.  Believe me, she’ll let you know if you are flying south.

Comments: 2 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.

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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.

 

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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.

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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 7th, 2014 by wombwithaviewblog.com

Ok, people, I’ve done virtually nothing with my Twitter account so help me change that!

You can find me @wombwaviewblog

I’ll try to keep up with tweeting about my latest posts and whatever else is going on in the world of ultrasound so please follow me on Twitter @wombwaviewblog!

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Posted on April 6th, 2014 by wombwithaviewblog.com

Studying ultrasound is no easy task.  Actually, it was the most difficult and challenging thing I’ve ever done.  Check the email I received from my ambitious Aussie reader below:

reader:  Hi there, I just wanted to start off by saying I love reading your blog!

I especially wanted to message you because, whether I’m the first person to say so or not, mothers aren’t the only readers you have!
I am not pregnant, (or even anywhere near the ballpark of having children!), rather, I am extremely eager to pursue sonography as a career, specialising in Obstetrics and Gynecology so I can do what you do. Showing parents their children for the very first time is such a special moment that it would make all of the hard work and waiting worthwhile.
You truly inspire me and keep me motivated, as currently I’m only starting my path towards becoming a sonographer. That’s because sonography is a post-graduate course, and I am new to university this year. (Thus, about 3 years before I can even begin studying ultrasound)
I hope that you take pride in knowing that your blog is bringing comfort and joy to parents as well as inspiration and motivation to people like me. I really do see you as a role model for the type of professional that I would like to be in the future. Please keep up the amazing work!
You are blessed to have such a rewarding career, even with the ups and downs of pregnancy. I am not so blind as to think that pregnancy is always complication free, especially as a reader of your blog, but I know that the smiles on the faces of just one happy couple could make any day a great day.
I’ll be silently cheering for you to continue blogging!
***
I wish her and every other aspiring sonographer the best in their ultrasound endeavors.  Best advice?  Don’t be afraid to ask questions for as long as it takes to reach clarity.
I was interviewed a while back and I’ll add a small segment from that..basically, general advice for all sonographers.  Enjoy!
I’d love to add a message for sonographers, especially those who are new to the field. A quality exam is important. Your thoroughness, accuracy and attention to detail can determine whether your patient goes to surgery or goes home, only for a Stage 4 process to be found six months later because you only did a quasi-sweep of the RT adnexa. Ultrasound, being the most operator-dependent modality, requires great experience. I recommend all newly-certified sonographers work in a busy hospital where education and supervision are emphasized. You should NOT try to work in a clinical setting alone right out of training! It will take time for you to recognize pathology on your own. You WILL miss things and it will be a disservice to your patients. I cannot emphasize this enough. Ask questions of your supervisors and physicians. Ask for supervision while scanning. Look up answers. Become informed. Details matter. Talk to your patients and listen. It’s important they feel you care about why they are seeing you. Don’t just be a good sonographer, be a great one. Your patients deserve it. Good luck in your ultrasound career where education and the opportunities to learn are endless.  We never know it all so keep challenging yourself!

Comments: 1 Comment »

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!

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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..

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Posted on March 31st, 2014 by wombwithaviewblog.com

I commonly get questions about the report as I pull up this page on the monitor when I am revealing Baby’s weight after taking a biometry (that is, the measurements of Baby’s head, belly and femur).  Patients usually want to know why the measurements I took differ from the current gestational age.  The fact is they can..this is not an exact science so even a difference of a week can be totally normal.  Sometimes, a large difference can simply reflect a dating issue, meaning you are either farther or less along than you thought.  Your doctor knows how to differentiate between the two.

Check out part of the report below.  This is an old exam on a Baby B who was growing just fine!

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First, notice GA.  This is the Gestational Age of Mom currently.  EDD of 8/15/2007 is the Estimated Due Date determined earlier in the pregnancy which corresponds with the GA.

Below that, you’ll see AUA or Actual Ultrasound Age.    It says 19w3d, a couple of days farther along.  This is merely an average of all four measurements taken and is considered consistent with GA, meaning her due date will stay the same.

The biometry consists of the BPD (width of the fetal head), HC (head circumference), AC (abdominal circumference) and FL (femur length).  The names in parentheses refer to the physicians whose charts for these measurements are programmed into the software.  The values are taken in centimeters and each one represents a GA based on that measurement.  You can see that the BPD measured 8d larger.  This is totally normal.  All the other measurements were pretty close to GA within a couple of days.  Again, these all demonstrate normal growth.

Below the dimensions you’ll see EFW or Estimated Fetal Weight calculated in grams with a small standard deviation and also displayed in ounces.  This is determined by the four above measurements entered into the system by the sonographer.

Below that are ratios of these measurements.  If baby isn’t growing properly, it will reflect here but we will also see that in the individual measurements.

Below that is an M-Mode or Motion Mode which demonstrates the fetal heart rate (HR) taken.  120 – 160bpm or beats/minute is totally normal.

This is only a small portion of a report on twins but enough to explain Biometry.  This concludes Ultrasound 101.

Have a great day, people!

Comments: 1 Comment »

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 March 28th, 2014 by wombwithaviewblog.com

Is three company or is it a crowd?  I think when we are talking a uterus, crowded..definitely crowded.  Granted, they may start out with lots of wiggle room but space is a hot commodity by the end.

I scanned first trimester triplets the other day and couldn’t help feeling this woman has no idea what she is in for.  I know twins can be a quite difficult pregnancy so imagining three in the third trimester and as newborns is completely unfathomable.  They were IVF babies; two were implanted.  Go figure one of them would morph into two!  They were thrilled..and scared.

We really only scan anything beyond twins in the first trimester and then refer them out to the perinatologist for management of the rest of the pregnancy.  An ultrasound exam is quite easy early on.  My job is to determine how many babies are seen, how many main sacs (chorions) exist and how many amnions.  If two babies share a space, then it is important to try to discern a separating membrane between them.  We also measure each one for size and document normal heart rates and yolk sacs.

You can google images of triplets by ultrasound. I don’t personally have any to share!

I’m sure this couple I met is wondering how in the world they are going to get through the next several months, much less provide for three babies at the same time.  It’s like I always say, our babies come to us when they are ready..not necessarily when we are.  Sometimes they need a little company coming into this great big world.  Many families have done this before them; all of you with three buns in the oven will find a way, too.  There always seems to be enough love to go around.

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Posted on March 23rd, 2014 by wombwithaviewblog.com

Patients typically find out about this the hard way.  They seek medical attention and end up with a terrible reaction to latex that they didn’t even know they had.  Whether the unwanted outcome is hives, swelling or itching..none of it is fun!

Of course, we exercise universal precautions when performing ultrasound examinations..we wear gloves with every patient and wash hands when removed.  We have signs throughout the office, as most places do, reminding patients to let us know when latex is a problem.  As one less thing I have to remember, I simply use vinyl gloves instead.  They do not have as much “give” as latex gloves but get the job done, nonetheless.

Most of you ladies are familiar with transvaginal ultrasound exams.  Pregnant or not, if you’ve ever needed a pelvic evaluation with ultrasound, it’s probably been performed with this approach.  One of my very first posts was about ladies who have had this done for the first time and their subsequent reaction.  I usually get the big saucer-like eyes and hilarious commentary!   Here is a link to that one along with a picture of the “said” probe…(you may need to drag this link to your browser)

www.wombwithaviewblog.com/youre-gonna-put-what-where/

So, even for these exams I use a glove instead of a condom.  Again, it gets the job done but it looks pretty funny.  I usually insert the middle finger of the glove over the probe, leaving vinyl fingers flapping around.  Patients typically do make comments about this or laugh.  Hey, we have to make comedy in medicine wherever we can find it, right?

Next time you find yourself about to come in close personal contact with a transvaginal probe, ask your sonographer about the cover if you have a latex allergy.  Down South is not a place you want to discover you have one!!

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Posted on March 21st, 2014 by wombwithaviewblog.com

It always cracks me up when grandmothers-to-be come in for a sonogram visit.  They tell you how excited they are, that this is the first time they are seeing their grandbaby and they just can’t wait.  I start my examination and the funniest part of this whole experience begins..they talk to their grandchild as if he or she is already here.  And it’s hilarious.

It’s the “coochey coo” in the baby voice and “Nana’s here!”

Also, it’s “Come on, turn for Grandma.  Let’s see your precious little face..come on, come on!”, as she pokes on mom’s belly.

I think at some point she forgets that there are only adults in the room and she continues her entire conversation for the duration of the scan with the baby voice.  “Nana came just to see you today.  She had such a long flight and mommy has that room all ready and we all just can’t wait for this baby to get here.  It’s so cute, yes it is, yes it is.  Let Granny see that baby.  Oh, look at that little ear.  Oh, those toes are just so precious.  Can we tell what baby weighs, today?  It’s Granny’s precious baby…” and on and on.

Keep in mind I’m still trying to do my job and undeniably distracted but you gotta love Grams.  She’ll teach your child all kinds of great things, spoil her a little and provide unsolicited advice for child-rearing for the rest of her life but she’ll be there in a pinch.  I hope I can be that kind of pain in the ass one day when I’m a Nonna, too.

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Posted on March 20th, 2014 by wombwithaviewblog.com

..is not something I always hear.  Don’t get me wrong!  Plenty of my patients are thoughtful enough to spout these words of gratitude (which I SO appreciate!) and it’s not like I HAVE to hear it from every patient!  ..but some people need manners…and a bath.

There are some patients about whose upbringing I have to wonder.  I think anyone who deals with the general public on a daily basis feels the same.  When someone helps you, you thank them.  When you go out in public, especially to your doctor’s office, you put on decent clothing.  Most people don’t wear attire in which they are more out than in.  You typically bathe daily, make an effort to brush your hair and, especially, your teeth.  Some people missed out on these very pertinent lessons somewhere along the way. For example, I am in the middle of scanning a young patient today.  I get a knock at the door.  Honey Boo Boo’s family walks in.  Joy.  Well, it was only two people but I am assuming it was the sister and the BF/FOB.  He says nothing…the entire time.  The sister yammers on (barely recognizable as English) about some family garbage.  They barely acknowledge the ultrasound and moving fetus at all.

I just wanted to ask if their mother never taught them any manners..or personal hygiene.

People can have kids left and right but raising them properly takes time, effort, lots of love and discipline.  If our children are going to grow up to be responsible and respectful young adults, teaching them manners should also be at the top of that list.  My kids knew how to say “thank you” before 2 and, thankfully, grew out of the stinky “I don’t want to use soap” phase a couple of years later.

Rude and smelly people are not my cup of tea.  Thank heavens for Febreze Air Effects (linen & sky – it’s my fave).

 

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Posted on March 16th, 2014 by wombwithaviewblog.com

So, any of you ladies out there who are old enough to have visited the Gynecologist at some point in your lives are familiar with the fanciful attire we have you wear.  “Okay now, undress from the waist down and cover up with this!”, as we point to the green paper drape on the table.  We’re women, too..we get it.  This is not a visit to the spa and no woman enjoys scooting to the edge and setting her feet in stirrups.  Alas, it has to be done if we are to properly take care of our person.  And we do understand that people who are pregnant look WAY more forward to doing this than those of us who are not.

Funny story about those paper drapes:

So a little old Asian woman is on my schedule for an ultrasound.  She barely understands English and speaks it very brokenly.  She nods as if she understands the instructions for getting undressed so, very unsure of this, I step out and give her a minute.  When I re-enter..relief!  Ah, yes, she understood and did just as I asked.  She must comprehend way more than she can speak.  I proceed with her examination and when all was done, I give her instructions again on how to clean up, get dressed and come outside into the hallway so I can show her where to wait and be checked in for her doctor.  She nods (many times) in understanding.

Let me pause here to explain that as I am waiting for the patient to dress, I am just outside my door furiously making notes on my images to ensure a complete and accurate report and circling diagnosis and procedure codes for my billing slip.  The patient opens my door to leave, I look her in the eyes and smile to say “thank you” and she says it back. I direct her to the waiting room and hurriedly look back at my notes.  I proceed to my room for clean-up and to begin writing my report of the exam.

A few minutes later, one of the MAs (Medical Assistants) comes to my room and asks why my patient is sitting in the waiting room covered with her drape!!!  H O L Y  C O W!!  Yes, she did.  She exited my room without getting dressed, with the drape still around her waist and I didn’t even notice!  Poor thing obviously did not quite comprehend ALL her exit instructions.  You know, Mandarin translator I am not but you never really EXPECT for a patient to walk out of an exam room with no pants.

Half naked for your test is one thing.  Half naked in the waiting room?  Probably not a good trend to start…

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Posted on March 14th, 2014 by wombwithaviewblog.com

Or maybe not..especially if your physician’s office has a “no video recording” policy in his/her practice.  Let me just say I catch lots of flack for this!  It’s me who has to enforce it and me who has to hear it when I do.  In this day and age of technological advances where you can pretty much do all things in life, necessary and not, with a smartphone, patients and family automatically whip out that phone and start setting those video options about the time they step foot into my room.

Then I have to be the bad guy.  “I’m sorry, you can’t record.”  Holy cow.  The world stops spinning.  Mouths drop.  Chests puff up.  Attitudes ensue.  I immediately get hit with the following:

“Why not?”

“It’s MY baby!”

“Whose rule is this?”

“Well, the doctor is not in here right now.”

” I want to talk to your manager.”

“They just want you to pay for pictures.”

“This sucks!”

Suck, though it may, if it’s office policy, you don’t really have  a choice but to oblige or step out.  My co-worker has a problem enforcing this law of the land.  She hates confrontation and is always afraid a patient is going to come flying over the table and hold a knife to her throat.  I, on the other hand, don’t really care.  It’s not my rule!  That usually is my first reply.

Then I go into my spiel.  “First and foremost, this is a medical diagnostic exam.  They legally own it.  Yes, it’s YOUR baby but it’s THEIR practice, their machine, I am their employee and this is a service THEY are providing for you.  You can ask your doctor in the room if you can record the heartbeat but I can’t let you in here.”

If someone refuses to put the phone away, I can stop scanning and ask him to leave the room.  I can call for back-up if he refuses…the office manager (you don’t want me to do this).  Finally, I can Tarzan-call the Video Mafia who will drop out of the ceiling and capture the trouble-maker with a fish net.  I haven’t had to resort to such theatrics yet.  It’s simply a matter of time 🙂

 

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Posted on March 13th, 2014 by wombwithaviewblog.com

Some patients do not have a filter.  Seriously.  Sometimes the information they divulge is hilarious.  Sometimes it’s unbelievable.  Most often, it’s just too much information.  Regardless, we have to master the poker face  (pa pa pa pa poker face.  I’m sorry, I couldn’t resist.  Love her, hate her, meat dress or not, you have to admit she is an amazing talent).  Ok, so enough pop culture and back to TMI..

No, we can’t determine to the day when it was exactly that you conceived, much less pm vs am.  Your sonographer doesn’t need to know you slept with two guys in the same day so you’re just going to wait and see what color the baby is when you deliver to determine paternity…good job.  (Yes, this happened.)  She also doesn’t need to know you had to call the cops on your crazy mother or that your FOB (father of baby) used to date your sister.  TMI.

We don’t need to know what things you put in your vagina, unless of course, they get stuck up there and that is the reason for your visit.  Even still, this information may be necessary for your doc but it’s not something you have to share with me.  Really.  TMI.

There are many other things the entire office, including staff and other patients, also don’t need to know..like what’s going on in your custody battle, that you’re two months late with your car payment or what’s on the grocery list for your post-PAP Smear errands.  And nobody cares who posted what on Facebook.  Some things can just wait until you leave your doctor’s office and nobody wants to hear it.  This is simply one of those places in which cell phones should be banned.

There is such a thing as Doctor Office etiquette; let’s keep it on a need-to-know basis, people.

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Posted on March 9th, 2014 by wombwithaviewblog.com

It’s positively amazing to me the power of the fetus.  Our children can melt our hearts in a way no one else can.

So, as a follow-up to my last post, the very same couple who left our office like fire-breathing dragons melted like a hot knife in butter the very second they saw their baby on that monitor.  Total transformation.  It was ooh’s and ah’s and oh-my-gosh-did-you-see-that’s.  It’s hard to stay mad when you watch your unborn child bouncing around in there like she is on a trampoline.  It’s pretty cute.  And incredible.  And surreal, especially if it’s your first.  The awe you feel is an understatement.  Considering what happened the day before (I, fortunately, was not there or witness to the wrath), I decided to play up the moment and took a little extra time to point out flailing arms, hands waving hi and 10mm feet.  Seeing a little nose and lips pretty much sealed the deal.  They were totally in love and forgot all about the circumstances surrounding getting their appointment made in the first place.

In this business, you have to learn how to diffuse a situation with calm words, a smile and professionalism.  When that doesn’t work, Baby will take care of the rest 🙂

Jena's Sweet Pea

 

SONY DSC

 

SONY DSC

 

SONY DSC

 

These are pics that not just a mom can love!

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Posted on March 7th, 2014 by wombwithaviewblog.com

So, what do you do when a patient freaks out?  I don’t get it, really.  Who in their right minds yell, scream, stomp feet and curse their OB staff?  Really?  These are the people who are taking care of you in your pregnancy.  These people work with your doc to bring a healthy baby into this world for you.  Moreover, these are the people you have to put your feet in stirrups for..they stick you with needles and shove all kinds of instruments into your nether regions and you are going to tick them off?  Our staff is the utmost in professional to everyone, bitch or not, but  you win more bees with honey.  I’m just sayin’.

Practices, like many other offices, rely on computers to manage all their scheduling.  But humans operate computers.  So you are bound to encounter computer-generated human error somewhere at some point in your lifetime.  Does this mean you should go off the deep end?  When this happens, we truly bend over backwards to try to accommodate a patient’s needs.  Truly.  That means we’ll do whatever we have to do to make it right..stay late, work during lunch or squeeze her between two other appointments.  Alas, we work on a schedule (even though we all know how that schedule can go awry in a doctor’s office) and most of us have a life outside of the office that demands our presence, especially when we have kids and families and pets of our own.  So, sometimes we’re limited…our schedules are booked, her doc isn’t here, the sonographer can’t stay.  It’s life.

There is a saying in management among doctors’ office administration..patients are the lifeblood of the practice.  So, of course, without patients, there is no practice.  However, anyone who works with the general public KNOWS that you just can’t please all people.  That is to say, some people are not EVER pleased, ALL of which who also have absolutely no personal accountability.  These are the ones that I’d like to boot right out the front door..pregnant or not.  Good thing it isn’t my practice, I guess!

So what happens when patients are late?  And I don’t mean two minutes late; I’m talking the more than 15 minutes, or 25 or 40 or 1 1/2hrs late.  Their appointments get cancelled or rescheduled to a different time or day.  This is the only option.  Is it fair to boot the person on the table or the one who showed up on time?  Not gonna happen.  Late, late, late with no phone call, explanation or apology just late..and horrendously bitchy.  Often times, these patients present with a mouth white with foam and a spinning head that spews forth obscenities like pea soup from Linda Blair.  It’s not a pretty site.

All I can say to any patient with a mouth like Nicki Minaj and a how-dare-you attitude is don’t expect any favors..I won’t have any openings, no cutting into my lunch and I sure won’t be staying late.   You won’t be making any friends here.  If you’re not careful, you may get dismissed from the practice so they never have to deal with you again.  It’s happened.

Remember, it’s good to have friends in GYN places…bees, honey…it may be cliche’ but there’s a reason that saying has been around longer than ultrasound.

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Posted on March 4th, 2014 by wombwithaviewblog.com

Don’t you remember the first time you ever saw your child’s heartbeat by ultrasound?  It was so surreal and pretty amazing, wasn’t it?!  It’s one of the first things a parent asks to see.

Home pregnancy tests these days are so advanced and boast being able to tell you your pregnant from your first missed day.  This may be a great advance in pee tests but all it does is make the mom-to-be want to rush out to her doctor’s office for confirmation.  The problem is most OB docs won’t try to confirm a pregnancy until 6 or sometimes even 8wks.  So, mom has to wait..and wait..and wait.

We’ve talked about heartbeat so many times in previous posts.  I will reiterate here that  too early in the pregnancy, we just can’t see it.  The earliest we can see a heartbeat is about 5w6d from LMP or Last Menstrual Period and then only with the most current and modern technology like the mac daddy I use at work.  The only machine better would be used at MFM, Maternal Fetal Medicine, the high-risk OB office.  If your dates vary even by a day earlier, we will likely not see the flicker of cardiac activity.  Even then, it is discernable but sometimes very difficult to measure for a rate.  Waiting a week makes a world of difference in how well we can see, even better after two.  It’s also much easier to measure the embryo for dating the pregnancy.  For these reasons, you must wait to see your doctor and have your first ultrasound.

A fetal heart rate ranges between 120 – 160 beats per minute or BPM.  As an embryo, it starts out slower, really increases over the next couple of weeks and then levels out to the 120-160 range.  I won’t discuss how slow is too slow or how fast is too fast because it depends on GA (gestational age) and how other things look early on as to whether your doctor is concerned about the rate.  Like I have stated numerous times before, some things sometimes have to be deferred to your physician’s interpretation!

Regardless of when it happens in the pregnancy, seeing Baby’s heartbeat for the first time is still an amazing thing to share with parents, especially when it’s a wanted pregnancy and the waterworks ensue.  It’s hard for ME to choke them back, specifically on occasion when you know it’s IVF or this patient has long struggled with infertility.  It’s a really special event to witness..sniff, sniff.  (Note to other sonographers..keep a box of tissues handy!)

 

 

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Posted on March 1st, 2014 by wombwithaviewblog.com

What exactly do I do? Let’s break it down. This information will definitely be helpful to anyone interested in training for a career as a sonographer. Many are fascinated by ultrasound! So, this may also be an interesting read for those who are merely curious about what we do. This may also be a little long, so hunker down with a good cup o’ joe.

Ultrasound is very technical, so attention to detail is of great importance. We work in the millimeters, so spacial concepts and 3-dimensional thinking are necessary. We can visualize mentally what we are only partially seeing on the monitor. For new sonographers, this gets easier with improved scanning ability over time. None of us were great sonographers right out the gate!

So, what am I? I have many names…sonographer, ultrasound technologist, ultrasound tech or technician. A certified sonographer is someone with a couple of years of experience who has passed a Physics exam and one specialty examination (like OB/GYN). You then earn the credentials of RDMS, Registered Diagnostic Medical Sonographer. There are many other examinations for which one can earn more credentials.

We start off with some book knowledge. We learn medical terminology, A&P, pathology (disease) and how it presents, ultrasound physics, biology, and examination protocol, for example. In my particular training, we started clinical rotations where we visited different clinical settings for a period of time. We would follow other more experienced sonographers to observe examinations. I learned a little about the technologist/patient relationship like what to say and (most importantly!) what not to say.

We also learned how to present our examinations to the Radiologist, the reading physician. You better have all your ducks in a row here, people! They are tough. They can and will ask you a hundred questions, and you better have the right answer waiting. Like any other profession, some are easier to work with and offer more guidance. Some, well..don’t. After you are more experienced and have proven yourself time after time, the tough ones let up a little:) They know when a sonographer knows her stuff, and they know when they can trust your skill and ability. It just takes time.

We learned how to handle patients in hospital beds, how to transport them, and how to handle their catheters. Learning to keep urine, vomit, or blood off your person was a good time, too! We also learned what to do if it happened anyway and how to not get sick yourself. It doesn’t help your patient! If you have a good teacher, you also learn how to handle patients with dignity and respect. It’s hard for someone to feel that when they lie in a hospital bed. In an outpatient setting, you learn that patients are the lifeblood of a practice. When dealing with the general public, you can’t always say what you want, and you have to learn to filter.  This is sometimes VERY HARD to do!

A sonographer learns scanning ability with hands-on training with a machine and an experienced sonographer at the helm. Ultrasound machines are very much like most computers. They all have the same basic functions, but some have a few more bells and whistles than others. We learn what something looks like by watching someone else.  S…l…o…w…l…y over time we begin to be able to recognize parts ourselves. Then we take over the probe. We have to learn how to hold it and find the parts ourselves. We learn how to properly measure organs and how to adjust 40 knobs so that the image looks the way it should. Additionally, we have to learn image protocol which includes what images to take and how many.

Eventually, after a few months of scanning, these technical details become second nature. As soon as the probe touches the skin, we set about making our image look as needed without much thought. It is only then that we start to recognize pathology. Sometimes, disease processes present exactly as one learned from the book, sometimes not. Oftentimes, we see something we know is NOT normal, but we can’t exactly put a name to the process. What students need to know is that one of the most important things they’ll learn about ultrasound is to first learn what “normal” is.  Once one scans many normal exams, it is much easier to recognize when something is wrong.

We learn all the above for many different parts of the body! Some aspects of ultrasound include Intracranial and Peripheral Vascular (vessels of the arms and legs), Echo (the heart), Small Parts (breast, testicle and thyroid), Abdominal (all abdominal organs and vessels), OB or Obstetric (maternal and fetal), GYN or Gynecology (pelvic organs in a non-pregnant female), and many others. Ultrasound is also performed on the eyes and in more recent years, muscles and nerves. We also spent a bit of time learning about biohazard waste management and HIPAA regulations that keep patient information private.

Over time and with more experience, we learn how to better manage our patients and case loads. I say it’s a process with a long learning curve, especially for anyone starting out with no medical background. At times, I cursed my choice of career, place of employment, and certain unpleasant physicians. I sometimes cried before and after a particularly hellish workday or weekend of call. It was the hardest thing I’ve ever done. BUT I did it. And slowly but surely, the puzzle pieces came together. They began to fit in a way that brought light and clarity to every exam I performed. Suddenly, it just started to make sense.

When I began to ask more questions about something I didn’t understand, I received better response from docs I admired for their extensive education, intelligence, and knowledge. You can’t be afraid to ask questions! It’s important to your docs, their practice, and patients. It’s also important to you, the sonographer, for your own developing skill and ability. This confidence grows over time! It’s a great feeling when you finally get to this point.

To this day, I still get a rush when I recognize pathology and all the puzzle pieces come together. It makes me happy when I can explain something to a patient that gives clarity to her understanding. There’s nothing like a “thank you” (or even a hug!) by a patient. And who doesn’t love positive feedback by a physician who says you did a great job? As difficult as my career was in the beginning, I’m still at it after 23 years. And year after year, post all the blood, sweat, tears and pain, I feel I’ve come a long way:)

 

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Posted on February 27th, 2014 by wombwithaviewblog.com

So, I wrote this post about two years ago as one of my firsts.  It’s worth addressing again.  Now that I have a few regular readers and since most of you are pregnant, it’s definitely worth repeating!

Basically, you have questions..some we (sonographers) can answer and some we just can’t!

***

Probably, the most frequent question I get asked is if everything looks okay, healthy, normal, etc.  Wow, if I had a dollar for every time I’ve heard this I could retire by now!!  Usually to the patient’s dismay, this is something NO SONOGRAPHER can ever tell you.  Firstly, not everything that is abnormal can be seen by ultrasound (some chromosomal abnormalities, for example).  No sonographer can ever say that a fetus has Down Syndrome simply by an ultrasound examination alone.  Yes, we look for red flags; occasionally, we see them; sometimes we don’t.  However, other tests have to be done to confirm such.  If you’ve ever been pregnant, you know there are a multitude of tests that your doctor will request at certain times in your pregnancy depending on what the two of you have discussed.

Secondly, only your physician, his/her nurse or doc on call in his/her absence has the legal right to give you these results.  Yes, it is my job to know what I am seeing and to know if something does not appear structurally normal.  That is the scope of my job..to find abnormalities and report them to your doctor.  I have to be able to answer his/her questions about what I am seeing, questioning or diagnosing and how other parts of your baby are functioning in light of the finding.  It’s a big piece of your pregnancy puzzle that helps your doctor determine how your pregnancy needs to be managed.

Regardless of whether it is something relatively insignificant that we see or seriously abnormal, it is NEVER our place to inform you of these findings.  Our job is to share this information or any suspicions with your doctor, your doctor examines the information and concludes whether he or she agrees with our findings and your doctor then shares his/her interpretation of the information with you along with what options he/she recommends next.

The reason it is done this way is because

a) sonographers are not physicians; your doctor went to school for many years to learn how to manage your pregnancy and care and

b) your doctor is the only person who is truly qualified to answer the plethora of ensuing questions when a problem IS suspected.

Finally, you have to remember that it is your physician with whom you have the personal relationship.  Your doctor cares for you and your unborn child and your doctor wants to be the person to break any news to you, console you and inform you.  Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something really wrong or not.”  I’ll admit that I do but I always defer to the physician’s interpretation.  I know it is simply parent anxiety and a lack of understanding of proper medical protocol that drives the questions.  For the nervous patient, it does sometimes feel like an eternity waiting for results.  My usual response when a patient has asked this question is “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.”

Only your doctor can advise you, calm your fears and reassure you about your pregnancy in a way that no one else can!

***

As always, feel free to ask me your questions!  If it pertains to the scope of my job, I’ll be happy to answer.  If it’s a question your doc needs to answer, you can be sure I’ll defer to your physician!

Happy pregnancies to you all 🙂

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Posted on February 20th, 2014 by wombwithaviewblog.com

This is a first trimester screening test for chromosomal abnormalities which I have performed for a couple of years now.  We have to have special certification in order to perform this examination.  I will not get into any serious depth regarding the subject because I am not a doctor, I am not YOUR doctor, this testing is quite complicated and only your doctor can give you the most pertinent, accurate and up-to-date information, as well as, answer all your questions on the subject!  I CANNOT STRESS THIS LAST STATEMENT ENOUGH!!!  I literally am only scratching the surface here from an ultrasound standpoint.

Read on for this question from a reader regarding NT scans:

reader:  I just read about NT scans and how they can be a way to detect Down syndrome. My doctor never mentioned anything about this to me. Do you think it was done during my 12 week dating ultrasound? Or is this something that you need to specifically request? I’m 29 and have no family history so I’m not sure if that’s why it wasn’t offered. After my 12 week ultrasound she did offer other tests but she said I wasn’t high risk and we opted not to do them.  Thank you for your time!

wwavb:  I can chime in on this because I do the NT scan so I know a bit about them.  You answered your own question.  The tests that your doctor talked to you about may have included the NT scan but you opted not to do them, so that’s why you didn’t have it.

The NT scan is an attempt at a measurement of the nuchal area along with a finger stick.  The measurement cannot always be obtained.  It is probably one of the most tedious examinations I do and this measurement can only be taken one way.  Period.  There are a number of variables which depend mostly on fetal position that dictate this.  If we can’t get the measurement, the test cannot be performed.  The lab takes the measurement from the scan and some numerical values from your blood and personal history and puts that all into a formula.  The result determines your RISK or CHANCES for having a baby with four different chromosomal abnormalities, of which Down Syndrome is one.  This result does NOT tell you whether your baby has these abnormalities or not, only your risk for having a baby with this problem.  If it comes back elevated, you have to decide whether you want to proceed with other tests like amniocentesis which WILL determine if your baby has a particular one of these abnormalities.
For your greatest clarity, you should ask your doctor at your next visit if the NT is something she would have offered.  If you have a concern and would like to look into genetic testing, certainly discuss with your doctor what options she would recommend for you.  She is your best educator!!  
Hope that helped!
Here’s to your happy and healthy pregnancies!

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Posted on February 7th, 2014 by wombwithaviewblog.com

No kidding..  A patient requested her anatomy screen examination be cancelled because she went to a facility where students practiced on her and they already did the scan so she didn’t need to have it done a second time.  Huh?

Um, no.  When you have an ultrasound done, it’s because the examination was ordered by your physician and whomever is doing your exam must have in possession a written order or, if in the same facility, see the order in writing in the patient’s chart.  No order, no exam.  Yes, students practice and that’s ok.  Actually, they shouldn’t practice unless they have written permission by your physician but that isn’t carved in stone..just my opinion.  If I was running an ultrasound education program, it’s something I would require.  If I was a pregnant patient and students were going to practice on me and my baby for an hour or two, I’d want to make sure my doctor was ok with that.  I’ve never heard of them NOT being ok with that, but as your care provider, your doctor probably would like to know about it.

A student or many students practicing on your belly does not a formal and official scan make..by any stretch of the imagination.  And why in the world would someone think such?  I have no clue.  I decided to quit trying to figure out what patients are thinking a long time ago.  Students are still struggling to make heads or tails of your fetus, don’t know the function of half of the buttons on the machine and have no idea how to measure something..anything on their own.  One would think that would be obvious to the person being scanned..maybe not.

Anyhow, I’m sure most of my readers will know that your doctor will want a report of your ultrasound from the qualified and experienced facility from where or person from whom he/she ordered it to be performed.  I’m just guessing, but he /she PROBABLY wouldn’t want it signed by so-and-so, sonographer-to-be in several short months if my grades are good.  Just saying.

P.S.  Sarcasm has been a family trait passed down from many generations so, though I try to stifle it, it still manages to come seeping through even my written word;)

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Posted on February 4th, 2014 by wombwithaviewblog.com

Calling all readers!

Everyone, especially me, can really appreciate a great ultrasound image.  So, send me some!!

If you are in possession of really great ultrasound images, please email them to me and I will share with the world.  If you have a great profile or 3D image of your baby’s face, great 2D images of hands, feet or funny things your baby did during your ultrasound, please share!  By the way, you know they’re great when your sonographer tells you so!

Most people love an opportunity to ham it up and, sometimes, so does your fetus!  Show us what you’ve got.

If you don’t have pics but burning questions instead, just click the “Ask Me” page.  Remember!  I’m not your doc and cannot give medical advice but I’ll do my best to fill your brain with ultrasound knowledge.

This was a great profile of Megan.  She’s now about 6 with long curly locks and beautiful:)

SONY DSC

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Posted on February 1st, 2014 by wombwithaviewblog.com

I simply HAVE to give a shout out to my VERY FIRST subscriber overseas!!  You know who you are:)  I’m so happy to know my message of quality sonography is as far-reaching as the UK, a beautiful land with some of the most amazing vistas for the photographer in me (I don’t just enjoy getting a great shot of Baby) and totally on my bucket list!

I will continue to do my best to post informative as well as fun and humorous facts and pics from the world of OB/GYN sonography as I know it.

A fun little fact from overseas:  I once received a report from a patient who transferred her OB care from London.  Did any of you know they call amniotic fluid “liquor”?  Interesting!

“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”
― Dr. SeussI Can Read With My Eyes Shut!

Until next time..

wwavblogger

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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..

unnamed

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

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Posted on January 12th, 2014 by wombwithaviewblog.com

As promised, a more light-hearted (and even comical, if I do say so myself) post!  I’m going to give you a little test.  What do you see below??

 

unnamed

 

Did you say a smiley face??  If so, you are entirely wrong!  BUT you are among hundreds who have guessed the same.  I cannot tell you how many people have asked, young and old alike, if we were looking at baby’s face or if baby was smiling.  Do our faces really look like this??  I always ask this of myself, to myself when anyone asks this question but then I remember that they can’t read ultrasound and to the lay person it really is like looking at clouds.  You can make all sorts of crazy things out of the images passing by on the monitor.  That’s why you have me, the narrator, to point out what you are REALLY seeing.

This is a cross-section of the fetal abdomen.  Imagine chopping down a tree and looking down at the trunk..it’s a circle, right?  Same thing here.  On the left is baby’s spine, on the right is the front of baby’s belly.  See my image below for an annotation of all these structures!

unnamed_2

ivc = inferior vena cava or main vein in the torso

ao = aorta or main artery in the torso

gb = gallbladder

uv = umbilical vein – we are only seeing a tiny segment of that vessel in the image.

stomach – self-explanatory!  When baby swallows amniotic fluid, the stomach becomes more distended and shows as black like the amniotic fluid is black.  Sometimes, patients will ask, “What is that hole?”  It’s funny how we associate black spots as holes and they are always surprised when I say that it’s not a hole and it’s actually a stomach that is full!

Anything fluid on ultrasound is black, so the blood vessels appear black, as well.  In the gallbladder, you have bile (a fluid) so it presents as black, too.  The other organ that is present in the image is the liver.  It is difficult to outline the liver but it is the gray stuff above and below the gallbladder and above the stomach.

 

Unbelievable question of the century??  “What is an abdomen?”  No, I’m sure in the heck not kidding.  I’ve gotten this question only a few times but each time it came from some teen or young adult (who should have known better) and each time I’m totally flabbergasted.  Slept through biology, maybe?  There’s your good laugh for the day.

So, next time you go for a diagnostic ultrasound, providing you are in your second trimester and beyond, look for the “smiley face” when your sonographer measures your baby’s abdominal circumference (AC)!

Hope you enjoyed Ultrasound 101 today!

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Posted on January 11th, 2014 by wombwithaviewblog.com

So, a question I get asked frequently is “You have such a fun job, don’t you?”  They’re always surprised when I say, “No, not always”..until I explain why.

A really very unfortunate circumstance of pregnancy is the sometimes displaced or ectopic one.  This just means that the pregnancy is located somewhere other than where it is supposed to be which is within the uterine lining near the top of the uterus.  If a patient has pain early on in a pregnancy, and we can’t see evidence of a pregnancy (at least a gestational sac) inside the uterus and we think we should by calculating LMP (last menstrual period) along with blood values, we start to look for an ectopic.  This is a gray zone because too early, we just can’t see it.  These patients are watched very carefully with blood work and extra ultrasounds until we’ve proven one is there.  Physicians want these patients treated as soon as possible because they can pose a health risk for mom.

Most of the time these pregnancies present as a mass somewhere outside of uterus, usually in the tube between the uterus and ovary.  I have also had the misfortune, only a couple of times in my whole career, of finding an ectopic pregnancy with an embryo and a heartbeat.  Unfortunately, these pregnancies cannot be saved.  They have to implant on their own and can’t just be “placed” inside of the uterus.

These are challenging scans that definitely put one’s ultrasound ability and expertise to the test and helps to know that your sonographer is a seasoned veteran!  It’s okay for a newly certified sonographer to scan you, this is how one learns pathology and how to scan well.  We all started somewhere.  BUT she NEEDS direct supervision while doing so..by another seasoned vet!!!!  (This comment is made in the hopes that any new sonographer will read this and heed the information!!)

So, some of the time, great fun. Other times, very much not.  About once a week or so, sad.  Every day, educational in some way, shape or form.

Today, you get an informative post, though a bummer it is.  Tomorrow, something fun.  I promise!

 

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Posted on January 9th, 2014 by wombwithaviewblog.com

So, I know that what results in a total disappointment for patients and the whole entourage is a very uncooperative baby.  Fetus, Jr. has a mind of his own and, believe me, you can poke until the cows come home but he will still likely not turn.  Yes, sometimes they’ll kind of fake you out..wiggle a bit and turn the face a quarter of the way..and then back down.  Mom, Grandmas and dads-to-be are all rooting him on, pushing on the belly and talking to him with English he doesn’t yet understand, as if any of this will make him magically move into the position of choice.  Most of the time, they’re not having ANY of it.

I’m talking about 3D scans.  They are a total blast when baby is in a great position and the best time to do them is about 27-28wks.  But it’s sort of all or nothing.  A great position is baby facing upward toward mom’s belly with a great pocket of fluid in front of the face and no placenta, limbs or cord in the way.  Any of the above-mentioned parts will obscure baby’s face in a 3D rendering so that it just cannot be seen, therefore, making a 3D image not possible.  Also, trying to attempt a 3D too far into the third trimester is a mistake.  Baby usually gets that head engaged quite low, obscuring part of the forehead and eyes, and fluid slightly diminishes as you get farther along so that will also make the probability quite low that a good 3D scan can be obtained later in pregnancy.  Now, let me disclose that I certainly have gotten some great images later in the 3rd trimester but it was totally by chance, not the norm and I just don’t recommend scheduling them that late!  And, I can’t really say for sure…  I’m assuming you are now asking, “Well, when is too late??”  I think after 30-31wks, you may be SOL.

If baby is cooperating, it’s tons of fun (as I have a love of photography outside of the daily fetus, uterus and ovaries) and I just click, click away.  Some of the best 3D scans will yield a good 50+ images.   And fun is had by all.  If baby is camera-shy or just plain obstinate, we blame dad and end up turning mom every way but on her head to no avail.  I usually just let her come back the next week to try again..

Try eating a good meal (not m&ms and a Coke -although both are delish, I can’t encourage that!) about 30minutes before your scan.  Schedule it right after breakfast or lunch.  Babies usually get more active after a meal and this may help your 3D be a success.  You don’t want your baby doing cartwheels after a sugar high..this can make getting images more difficult.

Good luck and email me your great 3D images if you have them!  I’d love to share them with everyone in a post and other moms will love to see them!

SONY DSC

What a cutie!

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Posted on January 4th, 2014 by wombwithaviewblog.com

..my patient’s precocious 4 year old son said to me one day.  I wrote a post about it back then.  He was so cute and must have asked about five times to hear his little brother’s heartbeep!

So let’s talk about heart rate today, or “beeps” per minute (bpm).  People want to always believe the old wives’ tale about baby being a girl if the heart rate is high and low if it’s a boy.  I think L&D nurses could probably lend an opionion on this as they monitor the rate for long periods of time and may certainly know something I don’t.  As far as ultrasound goes, it doesn’t mean a thing.  We are only sampling a few seconds of heart motion at a time to obtain a rate and really only need three cardiac cycles to measure it.  The fetal heart rate is like our own in that when a fetus is very active it speeds up and when they rest it slows.

We can first see a heart beat at about 6wks (gestational age – that’s counting from the first day of your last period).  It can start out quite slow..about 100bpm and looks like a little flutter.  If it’s a lot slower on the initial scan, in the low 80s or less or if it’s very irregular, we get a little worried.  It can be an indication that maybe the pregnancy may not progress.  There’s no way to ever know for sure and my docs will usually have their patient come back in a week or two in these cases.  After about 6wks, the heart rate should only get stronger and more easily visible by ultrasound.  In the next couple of weeks after that, it gets really high..as much as 180bpm or so.  After that, it starts to hang out around 120 – 160bpm which is what we call within a normal range.  It can be a tad higher or lower but we wouldn’t expect it to remain there.  Either way, we can’t link it to gender.

Regardless, it’s usually the first thing a patient wants to see or hear.  Siblings get a kick out of it if they’re older.  The younger ones (maybe <2?) get scared by it.  Otherwise, the heartbeep is a pretty cool thing to watch!

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Posted on January 4th, 2014 by wombwithaviewblog.com

I ran into a patient of mine today who recently delivered her first baby.  She couldn’t wait to show her off.  “She’s finally here!” She was so sweet and told me how much she loved having me as her sonographer every week.  I love it! And, of course, her baby was absolutely beautiful.

She took a minute to vent about her L&D experience, of which she was NOT a fan. She said, “Nobody told me what it was REALLY going to be like.” I laughed and expressed I was not a fan of mine, either, but that it’s different for everyone and that some people actually call it easy or loved it..which is why some beloved souls feel the urge to do the pregnancy thing over..and over..and over!  I don’t know about you but I find it a bit too expensive in this day and age to pop out more than 2. Combine diapers and formula with education, extra-curricular activities and 24 years per kid and viola!! ..it adds up to a really nice house.  But I digress..I love motherhood, love my kids and wouldn’t change a thing (well, maybe one or two little things).

We go through pregnancy for ourselves, our spouses and to make our families feel complete.  It’s the love we put in and the love we get back that makes it worthwhile.  And when they’re bad, we stick them in a corner because we sure can’t shove them back where they came from.  I sometimes say I’ve made my contribution to Mother Earth with my twice-inhabited womb. For my patient today and many like her, it’s one and done!

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Posted on January 1st, 2014 by wombwithaviewblog.com

Happy 2014 to all my readers and moms-to-be everywhere in this new year!

May your pregnancies be joyful and healthy and lives full with bouncing babies.

Thank you for reading, subscribing and contributing to my blog.

Here’s hoping for a fruitful year ahead with resolutions to all your ultrasound queries!

SONY DSC

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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 31st, 2013 by wombwithaviewblog.com

As promised..I’ll explain Biophysical Profiles today (as known about the OB office, BPPs for short).  So, pretty frequently we’ll get hit up by one of the nurses with “Can you squeeze in a BPP?”  Our answer is always “Of course, we can..” ..because BPPs are the kind of exam that our docs need that day.  If we can’t do it, the patient has to go to the hospital to have it done.  And why in the world would anybody want to go to the hospital when they can have it done more conveniently (and better, if I do say so myself) in our office.

If a patient comes in complaining of decreased fetal movement in the third trimester, you’re almost guaranteed to have one of these ordered.  We also schedule them weekly after about 32wks for patients who have gestational diabetes, hypertension or a myriad of other maternal or fetal conditions that need to be monitored.  It’s basically an assessment of fetal well-being.  So, if baby is moving and growing and fluid is good, all is well with the uterine world for another week.

So, let’s get technical.  We give baby a score on his/her movements and amniotic fluid.  The maximum score I can give is an 8/8, a 2 for each of the 4 things we look for.  Baby has to demonstrate the following:

  • 3 movements of the torso
  • 1 episode of flexion/extension of the hands or limbs
  • diaphragm movements (or what we call fetal breathing movements) lasting 30 seconds.  The breathing movements only mimic real breathing and it’s something they do every once in a while…it’s only practice!  Ask your sonographer to show you..it’s really cool to watch:)
  • AFI, which I talked about yesterday.  If baby has enough fluid, we give a 2 for that.

 

It’s not uncommon for baby to not perform the breathing movements.  We see it all the time and it doesn’t mean baby isn’t doing well.  If all else is good, it just means we have to give baby a 6/8 instead and sometimes your doctor will do an NST or Non-Stress Test in addition to the BPP.  The NST means you have to sit with a monitor around your belly and press a button every time baby moves.  A strip will print out a tracing of baby’s heart rate and your doctor will evaluate it.  If good, baby gets an 8/10.  If the tracing is not to your doctor’s liking, it usually means a trip to L&D for extra monitoring.

That’s BPPs in a nutshell.  Now if you need one, you kinda know what’s going on!

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Posted on December 15th, 2013 by wombwithaviewblog.com

Patients are confused by the need (or not) of a full bladder for ultrasound.  As a general rule, having a little fluid in the bladder for your mid-pregnancy scan aids a little in evaluation of the cervix; a length of the cervix is what we measure. However, later in the pregnancy, especially after we have determined that your placenta is in a good place, having a full bladder is not necessary and only makes you miserable.  Early in pregnancy or if the patient is not pregnant, an empty bladder is necessary for the transvaginal ultrasound.

For a non-pregnant and non-sexually active patient, a full-bladder prep is required in order to see the organs.  The uterus lies behind the bladder and since sound waves penetrate easily through water, having the full bladder sort of acts as a window to the uterus and ovaries.  It’s still somewhat limited because abdominally the organs are much farther from the probe.  We usually get a much better resolution with TV (transvaginal imaging) because the probe is much closer to the organs with an internal scan, providing a more magnified view.  Having a full bladder with this approach only gets in the way.

Every office or hospital has a different protocol.  Some will have you fill your bladder, scan that way first, then empty for a TV scan, also.  Usually, pregnant or not, your doctor may want a urine sample if you are seeing him/her that day.

Best advice?  Ask about a bladder prep when you are making your ultrasound appointment and ask when you arrive if a sample is needed or if you can empty.  Every once in a while someone gets it wrong and then you’ve peed when you needed to hold it or you drank 400 ounces of water and you didn’t have to or you didn’t get a prep at all and now you have to be rescheduled.  It’s a bummer.  We’re all human and we hate when it happens!

When in doubt, ask if you are free to pee!

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Posted on December 3rd, 2013 by wombwithaviewblog.com

Don’t you hate it, pregnant readers (I don’t really know what other readers I’ve got), when random people of family or friends ask you if you are feeling baby yet?  ..and you say ‘No, not really’ ..and they scare the living daylights out of you with a reaction of total terror and a panic-stricken look on their faces? ..oh, and I forgot to mention, you’re only like 16wks.  Now, I can’t condone violence or anything but you can politely remind them to mind their own business with whatever expletive you’d like to add.  It’s your right as a pregnant person (in my opinion)!

I’m frequently asked that question, “When should I start to feel baby move?”  There is no definite start time as we are all shaped differently so that time varies as much as people do.  It’s a question better posed for your doctor because he/she can give you more specifics on fetal activity and kick counts later on in gestation.  As far as ultrasound is concerned, we see baby jerk and kick and wave around arms and legs but not every second of the scan.  They’ll become very active for a couple of minutes and then become very still and take a little siesta.  The very beginning of fetal movement I can usually see at about 8wks when they look like a little gummy bear and they just start to do the tiniest little wiggle.  It’s the cutest thing!  They get more and more active from there and even just a few weeks later one can see baby doing feats of all kinds of athleticism!

So, you 18 – 20 weekers, if you’re still not sure you are feeling baby, it may be totally normal for you.  As always, if you have any questions WHATSOEVER, always always always (can I stress it enough?) always call your doctor!

And, please refrain from smacking Aunt Jude right between the eyes.

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Posted on November 23rd, 2013 by wombwithaviewblog.com

This one is for sonographers.  I thought initially the patient could read it, also, to understand what it is she should expect from her sonographer.  However, I quickly realized this isn’t something the patient needs to read to understand..it’s something she already expects.  Every patient that walks into your room, regardless of how she reacts to you, EXPECTS to be greeted kindly and with a smile; EXPECTS to be explained in a fully understandable way what kind of examination she can expect to have performed and how it will be performed and whether it will be painful.  She expects conversation..and she deserves it.

Sonographers, you have GOT to get out of the mindset that your only job is to look at that monitor and say nothing else to your patient.  She is human, she has feelings.  Sometimes, she is even scared and anxious about the examination she is going to undergo.  Sometimes, she’s not afraid of the examination but fearful of results.  Sometimes, she’ll even tell you so.  YOU are a provider.  YOU are the master and conductor of the environment in your room at that moment.  You have to remember that the exam you are performing requires “invading” the personal space of another individual and actual contact with that person.  It IS a very personal experience for that patient and, often, a very uncomfortable one.  Your patients are trusting that you will do a good job for them because you are there representing, an extension of, her physician.

You can ask her how she’s feeling today.  If she says ‘Terrible’, you can lend apologies and say you hope her day will be better as soon as this test is over!  Patients often laugh as I’m gelling up the middle finger of a vinyl glove as I slide it down over the vaginal probe.  I always say ‘Gotta have a little comedy in medicine somewhere, right??!’  They’ll ask about your family, pictures, your kids, your experience in your career.  Talking to them during the exam helps most people to just get through it a little more easily.

Don’t be afraid to open a conversation for fear of being asked the question we all cannot answer regarding results.  The best way to respond to this is to simply state ‘Well, my job is to take these measurements and images.  Your doctor will want to examine them along with your other clinical information and then decide how your ultrasound fits into that picture.  Only your doctor has all the pieces of that puzzle!”

For OBs, you just about can’t get through an exam without mom or dad asking ‘Does everything look ok?’  I’ll usually say ‘So far, so good but, you know, your doctor will go over this entire exam with you and you can ask her any questions you have.’  Point out their baby’s parts as you take your images.  Thank the heavens for postprocessing!  You can always go back and focus on things that need special attention after your patient leaves.

On occasion, they’ll say ‘Yeah, but you know what you’re looking at.’  I’ll say ‘Yes, I have to know what I’m seeing to know which measurements to take but it’s your doctor who has to decide what it all means for you.’  Or otherwise explain that her doctor will get a report from the radiologist.  And be knowledgeable regarding how long they’ll have to wait to receive results.  You can bet the farm you’ll get THIS question.

One thing I’ve realized over the years, and anyone who works with the general public would agree, that you can’t make everyone happy all the time.  It’s just impossible.  Some people can’t be made happy.  But when you go out of your way to make conversation with your patient, make her feel comfortable, answer her questions and show her how cute and fat her baby’s cheeks are, it (most of the time) makes for a happier patient.

It feels good to get a warm ‘Thank you’ as you walk your patient out.  If you can send her out with a good chuckle, even better:)

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Posted on November 19th, 2013 by wombwithaviewblog.com

All patients ~  your ultrasound, sonogram (same thing) should not be painful!  Regardless of whether you are having a transvaginal scan or an abdominal one, it should never really hurt.  Now sometimes a patient may come in with some pelvic pain already.  That may even be the reason for the ultrasound to begin with (mostly in non-pregnant patients).  In this case, it may be uncomfortable but should never be painful.  I always tell my patients to be sure and let me know if something is.  Patients tend to NOT want to say anything.  They want to tough it out.  They fear they will not get an adequate exam if they say something.  Your sonographer wants to know and NEEDS to know if something is hurting you too much.

I will say that we tend to get quite focused on the task at hand which is to find that oftentimes ever-elusive ovary or to obtain that perfect measurement.  I’m very technical so I often strive for perfection personally..yes, that’s good but it sometimes causes me to take a bit more time than I really should, fighting to obtain that just-right view, when really in the whole scheme of things it doesn’t really contribute significantly pertinent information.  It’s true to some degree that the harder we push, the better image we obtain..for some things.  The novice tends to forget there’s a human under that probe!  She is so concentrated on the monitor and overwhelmed by all the lighted buttons and sticking to exam protocol that she forgets to ease up on the pressure.  Most of us have experienced this at one time or another.  There is a loooonnng learning curve to peforming ultrasound properly.  It takes time, a lot of experience and a lot of supervision.  A sonographer cannot learn to scan well if he/she is not TAUGHT to scan well.

So, next time you have a vaginal scan performed and you feel like your sonographer has perforated your uterus, SAY SOMETHING!  Tell her she’s pushing too hard and to please ease off.  Ultrasound people, if you can’t obtain your images without killing your patient in the process, you’re not doing your job properly.  Like I always say, we don’t have to scan your tonsils!

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Posted on November 16th, 2013 by wombwithaviewblog.com

Aw, shucks.. It warms my heart when a patient specifically asks for me and wants me to perform her scan.  Especially, when that patient is a physician..and her husband is a physician who are both super intelligent and I scanned them throughout their last pregnancy and they want me again for this one.  They greet me with hugs.  We talk.  They ask me questions about ultrasound, I answer them.  They thank me profusely and say, ‘Sorry! You are stuck with us forever!’ It’s a great feeling.

I was there for her miscarriages; I was there when she was anxious at the start of her next pregnancy; I was there again when she needed weekly scans in her third trimester.  It’s not just another patient, it’s a relationship.  It’s NOT just another patient, it’s a relationship.  That was worth typing twice.  It’s patients like these that reaffirm I’m good at what I do (we all need this affirmation, don’t we?) and justify that I’m still where I need to be..for the time being.

When someone says ‘I can’t imagine anyone else doing my scans’, it’s the highest compliment a sonographer can receive.

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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 
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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
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(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 September 25th, 2013 by wombwithaviewblog.com

One of the greatest things about my job in OB sonography is the fact that I get to scan patients who have been my patients before.  That is, patients who I had the privilege to scan and know through a prior pregnancy and she shows up again with another pregnancy and first child in tow!  I love to see them in color!

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Posted on June 21st, 2013 by wombwithaviewblog.com

Who knows???  We don’t have a crystal ball, right?

Even so, that is a question I get most every week.  If I could determine THAT with any accuracy, I’m sure I could have retired a long time ago!  The only thing ultrasound can really do is a biometry to estimate an approximate weight at present, called an EFW or Estimated Fetal Weight.  We do this by measuring your baby’s head in two dimensions, a circumference of the abdomen and a femur length.  These measurements are converted by the software into grams/pounds and the result has a standard deviation of about +/- 1+lbs in the 3rd trimester..or +/- 1/2 lb if you’re really good;)  All measurements, as all of ultrasound imaging, are extremely technically dependent and can vary quite a bit.  As sonographers, we are trained to know which views provide the most accurate measurements which are universally standard; however, sometimes baby’s position makes it difficult to obtain them adequately.  The EFW really provides just an educated guess since we can’t actually put baby on a scale.

These individual measurements tell your doctor whether baby is growing adequately, not enough or too much.  Either far side of average and you may find yourself getting scheduled for more ultrasounds to follow baby’s growth.  After all, nobody wants to push out a 12-pounder!!

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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 March 4th, 2013 by wombwithaviewblog.com

They made it!  Beginning the second trimester is a big deal and it started yesterday.  Everyone has just worked so hard to get to this point..so much growing and developing!  Babies are 12w1d now, fully formed and just have to keep growing from this point.  They really look like babies now and not so much the alien they used to resemble.  Tiny hands and feet are distinctly recognizable now as you can see in the photos below.  Awww!

Some organs can be seen at this point like the stomach as it fills due to baby’s swallowing of the amniotic fluid and the urinary bladder as it becomes more distended due to functioning kidneys.  The stomach and bladder appear as black because fluid shows up black on ultrasound.  The brain can be seen but is still developing at this point and the heart is a beating machine but still too small to see much detail.  All of these things and more will be evaluated around the 18-20wk timeframe or as your doctor orders.

Notice, in the image of the itsy-bitsy bottom of the foot, the scale in centimeters on the right-hand side. The foot measures about 1cm or less than 1/2 an inch right now!

Baby A is showing off today and waving to Mom.  Bye-bye ’til next visit!

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Posted on March 3rd, 2013 by wombwithaviewblog.com

We all know this is the age of technology.  And, no, I’m not talking about ultrasound software, though this technology is ever-amazing and always improving almost as fast as your iPhone.  What in the world, pray tell, can I be referring to but the dreaded cell phone??  I realize almost every person above the age of 6 has a smartphone but do you really have to be on it during an ultrasound exam??  Do you really have to iron out a billing issue with your internet provider right now?  I know people use it to pacify the kids but I’ll be quite frank..THEY don’t need to be in there, either!  If they are at an age or of the mindframe that they need to be kept busy with something else during the exam, they should not have come with you in the first place.  The music and games are loud and provide a terrible distraction for those of us who are trying to work!  We have a job to do..to make sure your baby is normal and this requires concentration.  Little Einsteins squawking in the background makes that a little more difficult to do.  I hate to ask people to mute games or leave with screaming kids but sometimes I just have to do it.

For the love of Pete, please do your sonographer and doc a favor and turn off all electronics during your exam and let grandma take the kids to the waiting room.  Better yet, let grandma babysit them at home.  I love when patients show up with no help, no carrier and baby in arms or with a toddler and no stroller or additional person to take out the screaming toddler because he is pissed to be strapped in and can’t see Mom.  It’s really great when someone shows up with two or more kids and no help.  Really?  Ladies, you’re moms..you juggle and manage a lot of things so please use your common sense when it comes to your medical exams.  We can’t examine your next kid very well while you are trying to discipline your others.

We will not be upset if you reschedule for a time that you have a sitter.  I promise!  We’re moms, too.  My kids didn’t grow up around family, either, so I know what it’s like to need a reliable sitter.  However, at the end of the day, it’s a medical exam and very young children need to stay home.  Please, please, please..just reschedule.

 

 

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Posted on February 23rd, 2013 by wombwithaviewblog.com

first trimester ultrasound 11wks

first trimester ultrasound 11wks

So a little more time has passed and we are now about 11wks!  Babies are slightly bigger = about 4.3cm now or almost two inches!  The second trimester starts at 12wks so the first trimester, thought of as the most crucial one for growth and development, is almost over.  Babies can be seen doing a lot of quick jerky movements at this point.  They can be quite active and actually mimic little jumping beans in there!  In the second image, you can see little legs quite distinctly.

Until next time!

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Posted on February 22nd, 2013 by wombwithaviewblog.com

I have a question..  What in the world makes anyone presume he or she can narrate an ultrasound examination??  I have to laugh but I do try so hard to keep it smothered.  No, that’s not the eye blinking or an ear when I’m looking at the brain.  How can I tell that’s a penis?  Well, it looks like a penis..and scrotal sac.. and little girls don’t usually have those things.  You know you’ve heard it a thousand times, my fellow OB sonographers!!  LOL  It takes us months of training to be able to decipher this stuff but some patients and/or their family continually point out things on the screen like they know what they are seeing but, alas, are entirely wrong.

I’ve talked about this before but I just HAD to say after a recent experience that an amniotic sac does not contain bubbles (it’s cross-sections of the umbilical cord that look circular) and a fetus cannot burp or “fart” because Peanut cannot ingest the air that is required to create such bodily functions since a fetus lives in fluid and does not actually use the lungs in utero.

Also, it’s called a placenta.  What is it??  It’s a temporary organ that feeds the baby until delivery…what’s that?..no..the cord is not attached to mom’s belly button.  Sheez.

REALLY?? Is this REALLY something I HAVE to explain?  To all those who did not know the above information, it’s called Biology 101.  Take a class!

One more for the road…”What are labia?”  Yeah.  You know this came from a man.

 

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Posted on February 21st, 2013 by wombwithaviewblog.com

This is again a 9wk image.  I just wanted to point out that the amnion can be seen early in pregnancy.  This is the thin membrane that kinda looks like a little bubble around the baby.  It can be seen around each fetus and it’s what most people know as the amniotic sac, amniotic fluid, sac of fluid or “liquor” if you have a sonogram done in the UK!  (I read a report one time from a transferring patient who had an exam done in England and I just thought that was comical.)

Anyhow, the babies can be seen doing some little wiggling now.  So cute..  More soon!

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Posted on February 1st, 2013 by wombwithaviewblog.com

About a week has passed and my friend, the pregnant mom, has decided to become a little less neurotic and not asked to be scanned every other day!  I must add here that this waiting has, indeed, almost killed her but she did it and I am so proud:)  The babies are doing great!  They are now each 8wks and referred to as a fetus.  You can see in the first image that Baby A is a whopping 15mm.  Wow, a future linebacker, maybe?  Just kidding.  All babies grow about the same rate right now.  They are just beginning to sprout little arm and leg buds and look just like a little gummy bear.  So cute!  

In the second image, you can see both babies together and each in their own gestational sac.  Again, this means they can be different sexes and likely not identical.

In this last image, you can see what is more of a side view of Baby B.  Stay tuned in..they’re changing every day!

 

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Posted on December 16th, 2012 by wombwithaviewblog.com

Since December is celebrated in part by the birth of Christ, let’s focus on another new beginning…the very beginnings of a pregnancy and what we see as sonographers.  It’s quite an amazing transformation from week to week!  We will start at about 5weeks, 5days (5w5d)ere.  We can only estimate because we cannot yet see an embryo.  However, we can see a gestational sac (GS), where the baby grows, and a yolk sac (YS), which provides nutrients for the embryo/fetus until the placenta develops.  The black inside the GS represents fluid.  Until an embryo can be seen and measured, measuring the gestational sac is the only way to estimate gestational age by sonography.

Keep visiting this site for an update on this baby’s growth and development through the first trimester!

Merry Christmas!

 

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Posted on August 17th, 2012 by wombwithaviewblog.com

Sometimes, the answer to that question is a big fat no.  It’s actually a little condescending to us sonographers who always try to give a patient great ultrasound pictures and will usually give MANY images if baby is cooperating so it implies that we are not TRYING to give you great pics.  I know that some sonographers are just downright unfriendly and unhappy in their hospital jobs (prey tell, why?) so I cannot say this is not sometimes the case, unfortunately.  In ultrasound, fetal cooperation IS the name of the game.  If baby doesn’t cooperate, cute pictures simply are not gonna happen.  Especially when baby is facing mom’s back, it then becomes very difficult for me to see the specific organs and structures that I need to document much less to be able to get cute pics of the face.  Because of the way ultrasound works, baby needs to be facing upward toward mom’s belly in order to see the face well.  Usually, if baby is in this position without limbs or the cord in the way, we can typically get some really great shots of the fetal facial profile.  The feet and hands are cute but it is seeing that face that identifies us with another person.  Without this shot, the patient usually leaves feeling a little empty-handed.  Poo.  I hate when this happens.  I usually apologize profusely and just say that their baby simply did not want to cooperate that day.

Also, the one major thing that can hamper images..weight.  I will never say this to a patient when she asks the above question but it is truth.  The more tissue the sound waves have to penetrate, the worse the image will be on the monitor…Ultrasound Physics 101.  So, unfortunately, the more a patient weighs, the less likely it will be that I can get good pictures no matter what position baby is in.  Same for 3D.  We cannot tell a patient who weighs 300lbs that she cannot have a 3D scan, but we know it will simply not be a good one and we just try to get her the best images we can.

So, at the end of the day, we can jiggle all we want, we can poke at the belly and we can stand mom on her head but sometimes those babies just won’t budge.  “Can’t you get me better pictures?”  For the 20th time this week, I’ll just smile , apologize and hand her an image of a penis and a foot.

Please leave a reply or comment below by clicking “No Comments”!

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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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