Feticide at 40 Weeks?

Elk baby boyPlease welcome Amanda Elkohen for this guest post about her third birth. She writes at Rabbi’s Wife.

This was my third pregnancy. I felt like I had a good handle on things. We traveled to the US in my 6th month with no problems, and I had low blood pressure in my 3rd trimester, which made me dizzy a lot, but was otherwise manageable. With my previous pregnancies I gave birth long before my due date, so going all the way to 40 weeks seemed like such a LONG pregnancy!

Once I was “past due” I was referred to the hospital clinic for checkups three times a week. At the second checkup, my world was rocked. They sent me for an ultrasound because I had been measuring big. I don’t think excessive ultrasounds are a good idea, so I hadn’t had one since my detailed scan at 23 weeks.

You can always tell when they think something isn’t right, and I got that sense from the tech who ran my ultrasound.  She sent me right back to the OB with a hastily scribbled note I couldn’t decipher.  When I walked into the office, I was pleased to see the doc was a religious woman, wearing a scarf over her hair.  She explained to my husband and I that I had “too much” water and that she was certain it was an indicator that the baby was damaged in some way, because I had refused some of the testing (advanced glucose and genetic screening) and missed the window for others (because of our travels) .  She recommended feticide.  We were both totally floored.

Whatever a person’s beliefs about abortion may be, I couldn’t fathom why you would kill a child that was PAST DUE, a fully formed individual just waiting for delivery.  A child fully capable of surviving outside the womb.  We refused to even consider what she was offering, and told her that if the child had problems, we would deal with them.  She made some phone calls and declared the need to induce me immediately, preferably by c-section.  I also refused this, as I really desired to give birth normally, as I had the previous 2 times.  She tried offering late-term abortion AGAIN, using the Israeli doctor’s best friend, guilt.  We refused again, but I was starting to feel very shaken by the whole experience.  She insisted that I return for another ultrasound the following day.

On our way home from the hospital, we called everyone we could think of to pray that things would come out favorably.  When I returned the next day, it was a different doc, who read my new ultrasound and couldn’t figure out what all the fuss was about.  My water had reduced by 1/3 and she absolutely refused to induce me.  She agreed to strip my membranes and let nature take it’s course over Shabbat.  I went in again on Sunday, and when they were stripping my membranes again, my water broke.  Since the clinic was right in the hospital, I just walked over to L&D and checked myself in.  I figured the worst was over, I would have my baby in 12 hours or fewer.  Silly me.  You can go over to my blog to read about the c-section, which was also a nightmare.
I’m still very angry at this doctor for offering, insisting even that feticide was the right choice based just on an ultrasound.

My beautiful boy is a testament to the fact that doctors are not the Almighty, they make mistakes.

My thoughts:

  • Do these frequent checkups after 40 weeks do more harm than good? I was always pressured to induce even though there was no indication of any problem.
  • I’ve also been made to feel guilty when I refused certain prenatal tests. Israel has the highest level of prenatal testing in the world.
  • It’s important to file a complaint when something happens in the hospital, with a copy to the health ministry. That is the only way to effect change.

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Comments

  1. I’m in shock! I’m so sorry for your dreadful experience.

  2. Very upsetting to hear, but the longer I listen to the stories of people here in Israel, the more I hear these stories.

  3. I have no words to describe how I feel about this. Deeply disturbing. Too much medical intervention. Too much testing.

  4. Sounds like a very harrowing ordeal. But i just don’t understand the feticide recommendation. It’s not even legal in Israel. Under Israeli law, all abortions, and most definitely late term ones, have to be approved by a committee. A doctor can’t just recommend or prescribe it, like a medication or other treatment.

    When a friend of mine tragically was forced to terminate a 12 week pregnancy because her uterus perforated, endangering both her own life and the fetus’, through a rav she was able to convene a massive committee at Shaarei Tzedek to discuss her issue and try to figure out some way to save the baby (unfortunately, they couldn’t, it was such a rare case and it was determined that because of the perforation, the baby would indeed kill her if it wasn’t terminated)

    What was the Hebrew word that she used? Is there some possibility you misunderstood?

    Also, I’ve just never heard of that kind of recommendation for too much water. A much more detailed u/s would be required to even consider such a thing and would certainly be possible. I would somewhat understand if they did a u/s and saw there was no brain or a severe deformity of the heart of other vital organs. But too much water?

    I’ve always believed in taking a Hebrew speaking, knowledgeable and experienced doula for first births in Israel because the system is complicated and you really need someone who understands the terms and can speedily translate and advocate for you.

    • The doctor was a native english speaker, so the conversation took place entirely in English.
      Her diagnosis was that the baby was Down’s and thus should be terminated. Our paperwork, which was in Hebrew, and I would have to find it to see exactly what terms she used, essentially stated that she determined the baby to be down’s and strongly recomended that we immediately terminate the pregnancy which we refused against medical advice.
      Whether what she was doing was legal or not I cannot say. However, I know that when I took the paperwork that evening to speak with my Rosh Yeshiva about the issue, he was apoplectic and immediately faxed copies to Rav Ovadiah and a number of other Rabbanim, insisting to me and those Rabbanim over the phone that the doctor had crossed a line.

      • Ok, so your dr. wanted to “terminate” pregnancy at 40 weeks because she thought the baby had Down’s Syndrome??? How is that not murder? As far as I know, “terminating pregnancy” at 40 weeks is called, giving birth, and if need be *induction* or worst case *emergency c-section*. I don’t think I could psychologically even deal with knowing the details of what a “40 week termination” entails. Horrifying. I’m not sorry to say I think your doc should be held accountable for such reckless “medicine”. Did you lodge a complaint against her?

      • She sounds like a crazy doctor and it’s unfortunate that you ran into her. I hope you lodged a complaint.

  5. As the husband, it was definitely a difficult experience. I blogged about it as it happened, simply because I was in shock then, as I am now.
    Most of us are conditioned, to a greater or lesser extent, to trust health care workers, and to do what they say. So it is a bit of a head trip when suddenly one is telling you that you have to have an abortion, and pressuring you to do so.
    The religious element didn’t help either. You see someone dressed religious and your assumption is that they have the same commitment to halakha as you do. So when they are suddenly telling you that should do something that is very clearly against halakha… it is more of a mind trip.

  6. This is a shocking story… beyond disturbing! All I can say is thank G’d Amanda Elkohen had the strength and faith to prevail. Bless your beautiful sweet baby Amanda! May he live a long and happy life!

  7. That is so bizarre and disturbing. I also had extra water during my last pregnancy. Of course, the the doctors ordered tests to rule out gestational diabetes, but during one of my many ultrasounds, I asked one of the doctors about the water. He said that the baby looked fine and that sometimes there’s extra water and that’s ok. Extra water is just extra water. btw, my baby was born healthy.

  8. “Israel has the highest level of prenatal testing in the world.”

    I met with 4 OB’s within the kupah before I stuck with one. All religious.

    The first two (who worked in an OB capacity in my local clinic) kept pushing amnio, to which I said but why we won’t do anything anyway and we don’t want the miscarriage risk. One even phoned me at home after some test (which I didn’t authorize but she tricked me into) came back with the “low” stat of 1/130 chance. Also they were both young female Israelis.

    The third was only in the expert U/S capacity at our kupah, so he wasn’t an option to switch to. He mentioned that Israel has a crazy-high abortion rate because the “preservation of the species” urge among Jews has taken an extreme turn in the chiloni community so that they seek to have children so perfect that even irrelevant defects are considered justification for abortion. This at least helped me understand where the craziness from the other 2 OB’s was coming from.

    I finally followed some recommendations to travel to another city for an OB there, where she wasn’t as spooked by a 1/260 chance of downs (the test I did agree to) and finally treated me for some normal ills of pregnancy I had been complaining about but the others were just too focused on my age (40) to deal with anything mundane other than say “yeah that can be normal during pregnancy” and ignore it.

    • I travel 40 minutes to see my lovable, old fashioned OB in Kfar Sava, on my kuppa (maccabi). I’m over 35 and the kuppah u/s techs all have gently reminded me at all the u/s’s that I can get an amnio whenever I want and I “gently” remind them that I’m not interested. I did all the other tests and they came back fine and my Dr. is totally on my side. No amnio all the way.

      I think the key with Israeli prenatal is going to docs with good recommendations. I didn’t get any raring recs for OB’s here in Modiin, so I stuck with my old one, even though it means a bit of a commute to get there. I also think it’s VERY important to know top doctors at the major hospitals in case you need a second op, which I definitely would have done in the poster’s case. There are crazy incompetent doctors everywhere. The best defense against them is an expert second opinion.

      I can recommend Dr. Nili Yanai Hadassah Ein Kerem and Dr. Ron Rabinowitz at Shaarei Tzedek. It’s not hard to get an emergency appointment, especially in a crazy case like this. Dr. Yanai is head of u/s at EK and takes cases like this all the time (a friend of mine got a diagnosis of Down’s at an earlier appt, went to Yanai and she said it was hogwash. Which it was). At the end of the day, u/s is about reading shadows. Obviously, some are a lot better at it than others.

      • I think which OB in Kfar Saba you mean. My friend told me it is someone who does not get frightened if you are over 35 or 40 and pregnant.

        Plenty of people have babies at that age today

        • It’s Dr. Hillel Factor. (I’m not shy about recommending him). Wonderful man and dr. Respectful, helpful, informative, and caring.

  9. I am in complete shock. Someone — a doctor—told you to terminate a full-term 40 week baby b/c he *might* have down’s. This is beyond the scope of normal in any way. It is so beyond the scope of normal–whether you are religiuos or not—that something is very wrong with that dr (and their must be other stories or complaints about her) or you misunderstood. Since you have already stated that you didn’t misunderstand….i really think you need to spend the time and energy (not easy, i know) reporting her to the highest levels.

    I had a friend who terminatd at 12 weeks as well b/c of severe deformities…she also had to convene an entire committee of ravs and drs to be allowd to do so.

    I can also HIGHLY recommend Dr. yanai. She is the best out there and really has very laid back view of the world (for the record, my tests for downs came back high and she recommended against the amnio stating that chance of miscarriage was higher—and I went on to give birth to a complete nomral boy K’H.)

  10. The first two paragraphs got cut off accidentally. Apologies to Amanda and Michael. I replaced them in the post but here they are for those following comments:
    This was my third pregnancy. I felt like I had a good handle on things. We traveled to the US in my 6th month with no problems, and I had low blood pressure in my 3rd trimester, which made me dizzy a lot, but was otherwise manageable. With my previous pregnancies I gave birth long before my due date, so going all the way to 40 weeks seemed like such a LONG pregnancy!

    Once I was “past due” I was referred to the hospital clinic for checkups three times a week. At the second checkup, my world was rocked. They sent me for an ultrasound because I had been measuring big. I don’t think excessive ultrasounds are a good idea, so I hadn’t had one since my detailed scan at 23 weeks.

  11. My next door neighbor had CMV in her second pregnancy in the third trimester and the baby was infected. A dr. at Hadassah Hospital offered her an abortion at 39 weeks and explained in great detail how they would do it.
    The did not go through with it and the child is a lovely energetic and completely normal 10 year old boy.
    I am not surprised by the story.
    I do find it strange to identify yourself by your husband’s profession though.

    • Ariela-
      I’m so thankful things worked out for your neighbor. It’s strange to me if they wanted her to actually have the abortion that they detailed the process. it’s so brutal, it would turn most people’s stomachs.
      As for Identifying myself as the Rabbi’s wife, it’s the moniker others have chosen for me, I simply embraced it. In his work field (not as a rabbi, he simply has semicha) he is the only Orthodox guy around, so when his associates meet me, they call me “the rabbi’s wife”. I think it’s funny and I mean it as kind of tongue in cheek.
      My husband will tell you (or anyone who is around us much) that I am not the kind of woman who put her brain in a jar for a man to keep. People often underestimate me, but I’m the tough one in the family!

      • –My husband will tell you (or anyone who is around us much) that I am not the kind of woman who put her brain in a jar for a man to keep–

        LOL (for real) I love that line! Can I use it?

      • Thank you for explaining that. I just see the “woman who put her brain in a jar for a man to keep” so much in the Orthodox Jewish world that I am super sensitive to it.
        What a horrible experience you had!

  12. What a horrifying experience! I assume you will be filing a complaint about this doctor. Do you think it will be acted upon? If not, do you think it might be a good idea for you to publicize her name so people can avoid her?

  13. There aren’t words to describe the experience you encountered in that single meeting with this MD. I’m actually really quite concerned by the prognosis and deeply impressed that as parents you were able to move on from this horrible treatment to go on to another MD.

    As for Chana’s observation that a mother is made to feel guilty for refusing a prenatal testing, I feel like many OBs will make that snap judgment. They see a religious couple, they convince themselves that a decision is out of naive superstition. If they want to change the couples’ minds they had better make them feel very bad about their backwardness and how they are endangering their unborn child.

    BUT, it is possible (even in Israel)for an MD who has serious concerns to speak to you like a reasonable person citing age, family medical history etc other heightened risk factors. This type of physician is a gem of the socialized system where MDs are over-worked, over-stressed and seemingly often in disdain for the very people they treat (in my experience).

    • But isn’t diabetes testing very usefull, especially if you are a bit chubby?

      • unless you are hypoglycemic, or get a false positive, or something else, which puts the “high risk” tab on your file and can lead to increased unnecessary medical intervention.

  14. Your experience is truly disturbing. That doctor should not be practicing medicine. Congraulations on your beautiful baby boy!

  15. What a beautiful blessing your baby is! So sorry his delivery was difficult (in just about every way) but how much more precious is he to you now! I pray that doc will have a change of heart.

  16. I read your story with great sadness. We have a 19-year-old daughter with Down syndrome. She is delightful. The shocking statistic is that when the mother knows (or thinks, given that testing is not 100 percent accurate) that she will have a child with Downs, 90 percent will choose abortion. Perhaps because medical professionals pressure them, as you were pressured. When our daughter was born, our doctors were supportive, but I have met others who are not. They think she is a tragedy; we think she is a gift.

  17. Ms. Krieger says:

    Oh, what a terrible experience. I absolutely relate to how upset the author is, over both the doctor’s bizarre recommendation and then the C-section.

    The C-section story you relate is one of my nightmares, too. (i.e. a normal and healthy pregnancy/baby is ended with a traumatic C-section because of over-monitoring and intervention-prone doctors.)

    This article discusses whether we are too monitored during pregnancy:
    http://thehealthcareblog.com/blog/2011/02/01/a-normal-pregnancy-is-a-retrospective-diagnosis/

    In it, JD Kleinke(who recently wrote a book about the economics and pressures faced by working OBs in the US) details a similar (but not as traumatic) series of events that happened to his niece. Very interesting meditation on whether we are over-monitored during pregnancy.

    • Fascinating article. So glad all was ok with that baby!

      Makes me wonder also with the HMO system (in that article Kaiser, in Israel in general) where the OB’s aren’t even connected with the final outcome – their role is reduced to testing and monitoring prior to birth, and the big moment is left to another staff entirely.

      • I think that’s a valid point. you don’t have a relationship with the people who deliver you, and the OB who does all the pre-natal doesn’t get to see the outcome of their care.
        I hope that if the doc who had seen me at the clinic had realized that I was an educated consumer, not just lazy or careless, her response would have been different.

      • I think because the Israeli system separates pregnancy from labor and delivery. Since I have a close relationship with my OB (and I had a close one with caregivers for all of my births) I’ve never seen our relationship “reduced” to anything. My first OB did delivered my firstborn privately, and I didn’t see it made a huge difference to my outcome, but that’s because I’ve, thank Gd, always had normal straightforward births. My doctors always met my babies at the 6 week checkup. But, again, I didn’t feel it made a difference to my care or outcome one way or the other.

        For my second pregnancy, I saw my family doctor for my whole pregnancy. She monitored my condition, ordered tests and the u/s was done by the main kuppah. Then, after the birth, she was my child’s ped. But there was no way she could have delivered me anyway, because she wasn’t an ob.

        I think the system is generally fine for the majority of normal births. I think it’s very difficult when problems come up suddenly or with high risk pregnancies. Unfortunately, a lot of Israeli medicine (even non-obstetrical) comes down to knowing the right people and being able to contact them quickly. Research and networking are essential, especially if you are high risk or complications arise.

  18. Ms. Krieger says:

    …and just for what it’s worth, I have declined all genetic and ultrasound testing during my current pregnancy. My husband and I discussed it and decided we would be unwilling to terminate the pregnancy under any circumstances (save an obvious life-threatening complication that would be obvious without such tests.) And so we decided to live without the anxiety.

    • Ms Krieger:
      Some women have more anxiety when they don’t do the tests.

    • Ms Kreiger,
      Ultrasound testing today can also be life saving, it is not only to decide the baby’s “fate”. For example, I know someone who saw a heart problem in the US, as soon as the baby was born they had appropriate doctors waiting, and within a short time an operation was done to fix this. This child who was obvioulsy highly monitored when she was young is a perfectly healthy 13 year old girl today. Without Ultrasound, she could have been counted an another “cot death”.

      My cousin saw in US that their baby had a blocked intestine, after the birth, this was fixed easily. Someone we know, only discovered this at the age of 2 with a baby who did not gain weight and had all sorts of problems.

      So it is worth learning a lot about the tests, to work out the full significance, as today Ultrasound is a diagnostic tool that can help babies to be healthy after birth. (even if somone is told their child has a specific genetic problem, it means that they can prepare for it, and the hospital can provide an appropriate medical team to be there in the delivery room, or do a ceaserean if this will give the baby a better chance)

  19. Everyone’s already commented enough on your story so I won’t add. Just wanted to say that my 2 children were born in Israel, one at 41.5 weeks and the other just under 41 weeks. Nobody ever mentioned inducing to me (though if I’d have got to 42 I know they would have done). My neighbour also was induced at 42, but they didn’t mention it before.

    • Julie, I’ve had three here in Israel, also all past 40 weeks and the only time they wanted to induce me, for my last at 41 weeks, it was because I had some bleeding (not just bloody show). I declined pitocin and they were fine with it. I said I wanted to get it started on my own and they said walk around as much as you like. No pressure, nothing.

    • This might have had to do with your age and any other health factor throughout the pregnancy (even as simple as how much added stress the prolonged pregnancy was putting on your body). I carried to 42 weeks with my first child. There was not ever a discussion of when they would want to induce me, didn’t come up once. But I was young, was still mobile and active, not in distress and neither was my baby. Again, might have been the good MD/patient relationship that kept any of that talk off the table for that long.

      • Well, the doctor who saw me at Meir at 41 weeks had never met me in her life. After 40 weeks, you don’t see your regular OB anymore, you got to the main clinic for monitoring or the hospital if you have contractions.

        I agree though, age, general health before and during pregnancy are certainly factors for inducing or not.

        I guess I’ve been supremely lucky that I’ve had only positive birth experiences here in Israel. Nobody has ever pushed any interventions on me, I was always allowed to labor how I wanted and for how long I wanted. When I didn’t want to do AFP testing or anything for the last two babies, my doctors were fine with it. The only time I was denied anything was when I asked for a pacifier from the nursery with my last baby and they said “Of course not, it interferes with nursing!”.

  20. As for ultrasounds, a small-built friend was told her baby was nearly 3 kg. After she’d been in labour for quite a few painful hours they decided to do a C-section – turns out they underestimated by a whole kg! If that had been known in the beginning, everyone (including/especially my friend) would have said to do a C-section

  21. I could write the book on bad pregnancy experiences in Israel. I made aliyah while pregnant with my first daughter and a routine ultrasound indicated a problem. After one inconclusive amnio, in my 8th month the doctors tried to convince me to do another one. I naively asked what was the point (since I was so far along) and was told by the doctor: well, we think there’s a genetic problem that’s not compatible with life and we know small babies (she was very small) tend to go into distress and then we have to do a c-section. you’re young and it’s your first pregnancy and if that happened then we wouldn’t do a c-section. i was aghast – basically he told me that they would just let my baby die during delivery! when i was pregnant with my second daughter, i refused to do amnio (since i had a history of miscarriages). due to other issues i was hospitalized for 2 1/2 months in sheba and i was having u/s every other day to measure growth and every time i encountered a new doctor and told them i hadn’t done amnio (or chelbon ubari) they looked at me like i was an idiot. 10 years ago when pregnant with a baby boy who ultimately was born very prematurely and died at 6 days, i was hospitalized in my 7th month in belinson and at almost every doctor visit the doctors made sure to tell me how chances were the baby wouldn’t make it and even if he did he would probably have massive problems. after i delivered i went to speak to the head of high risk and i said to him, what was the point of telling me every day – i understood the first time, and i was in my 7th month – what did you expect me to do? and he told me that they had a woman in a similar experience who wanted to above and the committee wouldn’t approve it. i left with the feeling that it was basically a CYA thing. i learned a long time ago that israeli doctors believe that only perfect babies should find their way into the world.

  22. What an awful experience… and I am so sorry you had to experience that. We have also refused all testing and scans on our pregnancies and have had to fight with the medical world all the way. I wish you all strength with your little guy!!!

  23. I have no words. And I thought things were crazy on this side of the Atlantic. I’m so happy your son is here and so sorry you had to go through all that ridiculousness before his arrival.

    I had the typical North American first birth – cascade of interventions ending in a c-section that wasn’t really warranted at the time. Then I fought to find a midwife so I could VBAC at home – far from the machines that go ping and a new doctor walking into my room every few hours to tell me that my baby was too big to be born vaginally. Right. My second’s head was bigger, though #1 was chubbier, but fat squishes 🙂

  24. While this is a terrible example of medical malpractice and no one should have to go through such a trauma, this woman’s sweeping generalization about doctors and Israeli doctors are out of place.
    Yes, Israelis do more prenatal testing than anyone else, but in my opinion that’s as much to do with the patient as the doctor. My OB/Gyn has always discouraged unnecessary amnios or invasive tests and I know for a fact he’s not such an exception.
    Clearly that doctor was incompetent. There are lots of incompetent doctors and if it is the responsibility of every adult to understand that doctors are trained technicians and obviously not the Almighty and we have to be a little critical when we decide who we hire to take care of our health. I do hope that the ministry was notified of this example of grotesque negligence. But this does not justify bashing Israeli doctors (accusing them of using guilt to to get you to do something??). We should be thankful we have access to the level of healthcare we have.

    • The fact is that I have been made to feel guilty for refusing tests, and been offered unnecessary interventions and prenatal tests. But you are correct, we enjoy a high level of care and many caring, knowledgeable, professional doctors.

    • Lauren, I agree completely and have had similar experiences.

    • Listen, I know there are good doctors out there in Israel. But all to often for us, it is a roll of the dice as to which kind we get, as we can only afford basic medical care. Some were trained at Johns Hopkins and others at Krasnadar polytechnic.
      We have had some very good luck with specialists here. Our Son had to see a neurologist (his soft spots closed early) and that doctor was wonderful, not panicky at all, very helpful, got us an earlier screening, etc. I have seen a good nutritionist. Our Pediatrician, while brusque, is very helpful. I’ve just had a hard time (in 3 pregnancies) finding a nice OB that I don’t have to pay $$$ for.

      • Yes, its a roll of the dice as to what your doctor is like, and also depends on your personal circumstances.
        I was really unimnpressed with the OB I used for my first Israel pregnancy. I felt prety much ignored and irrelevant, to the extent that I went to him at 39.5 weeks and he finished with “come back in 4 weeks”. When I pointed out that in 4 weeks I shouldn’t be pregnant any more, he shrugged adn said that when I was overdue I should go tot he hospital for a checkup.

        I was discussing this with friend, who used the same OB. She had had a traumatic pregnancy which ended in miscarriage. He was there for her every strp, even came to the hospital with her when she miscarried, in teh middle of the night (and no, she hadn’t taken him privately). If there’s nothing to worry about, he doesn’t worry. But when the ned for a good doctor arose, he was there.

        • It’s typical of many professionals, hospitals, etc.–you will hear wonderful stories and horror stories. Birth and pregnancy, though, are especially stressful and emotions are more likely to color our experiences.

      • I wonder if the soft-spots closing early is related to c/s babies? My c/s baby’s soft spots were gone by 6 mo and we saw a ped who dx’d it “a variation on normal”. I’ve heard of other babies with early-closing soft-spots and it seems they all were delivered by c/s…

        • My first’s closed early also, but since we weren’t going to tipat chalav until 12 months, there was nobody to freak out about it.
          Now that the girls are getting immunizations, the nurse checks David also, and was concerned about his head.

  25. Pregnant... says:

    I’ve had bad experiences with Israeli OBs in the past too. Now I have one that I like much better, but I still don’t think I want the stress of constant ultrasounds… I just discovered that I’m about 4 weeks pregnant (YAY!) and I’m wondering at what point I should call my doctor to set up an appointment. Part of me wants to wait it out for a few weeks so that I don’t have an inconclusive 5 wk ultrasound or have to convince the doctor that I don’t want one. Any thoughts or advice? (The pregnancy seems totally normal so far, no question in my mind about it being ectopic or anything that would justify seeing a doctor immediately.)

    • Firstly, B’sha’ah Tova!

      Re. seeing a doctor in early pregnancy: well, 2 of my 3 kids were conceived when I was both on the pill (2 different ones) and breastfeeding. I hadn’t had a period since falling pregnant with #1, so I discovered I was pregnant when I felt the babies move. With DD#2, I first saw a doctor when I was 4 or 5 months, and with DD#3, I was in denial (can’t happen twice, can it?) and didn’t go and see a doctor until about 7 months. Was it a good idea not to see a doctor for so long? B”H pregnancies and births were uneventful, no complications, but I was told off in the hospital for not having all my tests and paperwork in order when I came in to give birth. Had there been complications, it might have been more of an issue.

      Hindsight is 20:20, but until then, there’s no knowing.

    • I’m not sure why you think the 5 week u/s is inconclusive. Meaning, you might have miscounted and it might be too early to see anything? My understanding is that it most accurately dates the pregnancy and it’s really there to make sure you don’t have an ectopic or molar pregnancy (burst ovaries are really no fun). As the baby grows, u/s is actually less accurate in dating the pregnancy. (Baby measurements get are really approximate. That’s why late term u/s weight estimates are the least accurate.)

      In any case, I’ve always started at my family doctor who sent me for a blood test to confirm the pregnancy. You could do that and then wait a few weeks to have a first u/s. Or simply tell your dr. you’re not interested.

      • At 5 weeks, they often do not see the heartbeat, it is more likely to be seen at 6 weeks, so better to do a US then.

        As for ectopic. The symptoms are so varied and inconclusive, that as someone who has had one, it is better to confirm that the pregancy is in the correct place.

    • Ms. Krieger says:

      it is common (in US) for women to not have their first obstetrical/midwife appointment until 9 or 10 weeks.

      If you’re thinking of avoiding ultrasounds, go for it! There are very few problems that can be found solely by ultrasound. Ectopic pregnancies quickly become apparent from other symptoms, as do molar pregnancies, etc.

      Mostly it seems ultrasounds in the US pick up on vague, inconclusive problems (short cervix, potentially malformed kidneys, etc.) that serve no purpose except to get you to worry and come back for another ultrasound. Your Israeli mileage may vary.

      If you want an ultrasound for certain reasons but don’t want too many of them, have just one, at 20 weeks. That’s when they can usually confirm all body parts present, sex, etc.

      • I have a friend who suffered a burst ovary. I’m not sure what you mean by “quickly” becoming apparent by other symptoms. She suffered horrible abdominal pain and the doctors at the hospital were sure it was either appendix or “psychological” until they finally did an ultrasound and saw the ectopic pregnancy. Since she didn’t even suspect pregnancy, she didn’t go to get checked earlier. I’d much rather find out about this type of thing sooner rather than when I’m about to/already have lost an ovary.

        Another friend discovered kidney abnormalities in her son that did need surgery, which was performed I think when he was 6 months old. He’s a perfectly healthy boy now, but without the u/s they would have had to wait for kidney deterioration or for the child to get sick to discover it. Another friend found a severe heart abnormality that’s required years of surgeries to fix. (the child is going for his fourth this summer).

        U/S checks heart function, brain function. I don’t know why anyone wouldn’t want to know these things. Wouldn’t you want to chance to research the best medical care for your child if s/he has a problem that requires it?

        Again, Israel is rampant with bad u/s technicians, but good ones, of which I’ve encountered quite a few, are very helpful. I don’t understand this dismissive attitude towards them.

        • Abbi, there are always stories about people who found unusual conditions because of routine screening.
          With any kind of screening, you need to weigh the possible benefits with the risks of false positives, as well as cost to the medical system. Some types of screening cause additional risks (amnio and mammography come to mind)

          • MII, the point of the routine screening is not only to say “B”H eveything is OK, but also to find these unusual conditions (or make sure there are not any)
            Problem is that there are 2 types of screening, some are statistical tests, which only give you a statistic, so then they pressure you to do amniotic testing to get something specific.

            In ultrasounds themselves, you can chose to have detailed ultrasounds performed by an expert Doctor (in the framework of the expanded health care insurance) or the regular ultrasounds in the clinic.
            The detailed ultrasounds can find such things as heart or kidney anomalies, which is either something they see or do not see. However, even here they can see markers for genetic conditions and give pregnant mothers a fright again. Again, in Israel the best thing is to be educated, either by joining one of the pregnancy forums, or reading on the internet.

          • I just want to point out that you can choose to have expert u/s screenings privately and often your insurance will reimburse you for all or part of these appts. I know with maccabi zahav (their expanded insurance) you can have up to 3-4 expert consultations a year and you can be reimbursed for these types of screenings as consultations.

            OTOH, I had a heart ultrasound for the baby at my regular maccaabi clinic, covered under my regular insurance. And the doctor who did the u/s’s for me at 16 and 20 weeks in Modiin was excellent: very thorough, explained exactly what she was looking for the whole time. I thought she was very competent.

            I don’t think anybody debates the clear risks of amnio. U/s there are all different kinds of things flying around the internet, but nothing conclusive that i’ve seen. And i’ve seen many examples of how it’s saved lives.

  26. For those interested, I originally blogged this here:
    http://mekubal.wordpress.com/2010/08/18/choose-life-the-value-of-a-baby/
    It contains a bit more raw emotion, as well as a vid explaining what the procedure would have looked like.

  27. I am floored by this….

  28. If I understand the gist of this post right, the mother neglected her health exams during pregnancy.

    I don’t know if this is a wise thing to do. Especially when you are a bit overweight, I think it is good idea to monitor for diabetes.

    Because excessive amniotic fluid might also come form pregnancy diabetes. So I think the lesson we can learn from this story is: Don’t neglect the heath checks during pregnancy…

    • Because I am hypoglycemic, I will always test positive on a glucose tolerance test. False positives like that will mark you file as “high risk” and most certainly lead to a higher level of medical intervention during birth. I choose not to go through that.
      As we’ve both been pre-screened for genetic problems, and will never choose to abort a “handicapped” child I forgo the genetic testing for each pregnancy as well. As I get older and my risk increases, I may think about getting the testing to be emotionally prepared for whatever, but as it stands, I am very low risk right now.
      I’m not convinced of the need for or safety of multiple ultrasounds. So I also don’t get the “Normal” amount, just one detailed scan.
      To reiterate, it wasn’t neglect, it was a choice.

      • I’m not understanding how you came to the decision that your hypoglycemia doesn’t require mointoring. There is a difference between prenatal genetic testing, ultrasounds, and regular prenatal checkups. I can understand rejecting the first two. I’m not clear where you stand on the last. The fact that you have hypoglycemia probably contributed to the fact that you had too much water at the end. Was this on your pregnancy record? Was your doctor aware of it? If not, how were the doctors at the clinic supposed to be aware of your condition and take it into account when assessing your pregnancy? This in no way mitigates the crazy doctor you encountered. However, if you’re not going to do your part by disclosing all of your health issues and have them properly monitored, how can the doctors examining you help you?

        It’s important to be an informed advocate for your own health. It’s also important to recognize when you’re sabotaging your own health and safety by taking matters into your own hands and deciding against medical supervision and treatment because “you know what’s best”.

        The Israeli health system can be frustrating to deal with. Don’t make it harder on yourself and you baby by making unilateral decisions that complicate the process.

      • But did you rule out that the hyperhydramnion was caused by diabetes?

        Isn’t hypoglycemia in itself an indicator of diabetes?

        I don’t think it is such a good idea to say “I fall into a risk category, so I prefer not to do the testing”. This sounds quite irresponsible in my ears…

        • –Isn’t hypoglycemia in itself an indicator of diabetes?–

          Absolutely not. While the two tend to run in the same family, they are two different condition.

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  1. […] Late-Term Abortions in Israel: Too Many? Posted on Mar 6, 2011 in Featured Articles, Pregnancy | 0 comments My daughter was looking through old newspapers for a project when she called one to my attention. When I say the subtitle “Dozens of Israeli women undergo unnecessary late-term abortions,” I thought it would be about cases where the fetus turned out to be healthy. […]

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