putting what, where? and literal navel-gazing

deadringers

I don’t want a transvaginal ultrasound. I’ve had one before, and it wasn’t great. A speculum doesn’t bother me that much, I mean, who wants a pap smear, but still. And I’ve even had an IUD before and the insertion of that was no picnic (don’t google ‘tenaculum’ unless you like the stuff of nightmares.) So it’s not the discomfort, it’s the whole procedure.

*warning – frank discussion of sexual assault below*

 

 

 

 

I was coerced into sexual activity, (and some weird sexual activities) quite young. I was barely 13. I sometimes hesitate to call it rape, mostly because there was only implied physical force involved, but the man involved was over twice my age and very aggressively pushy. So it was rape, and continues to affect me even now. Someone holding a device and moving it around my vagina is making me nauseated to contemplate. The last time I had one, seventeen years ago, I was bleeding and we needed to check to see if I was miscarrying again. (I wasn’t! Yay!) I was willing to put up with the personal awfulness of the procedure because it would provide information we couldn’t get otherwise.

But that’s not the case now. I have a chart showing ovulation, and know within 24-48 hours when the baby was conceived. The ultrasound gives a gestational age within 3-5 days. So not only do I have the information already, the ultrasound will provide less accurate information!

Now I have two options. One is easy, one is harder. The first, easy way, is to delay the scheduling of the scan until I know the tech won’t use a vaginal probe, but will instead view the baby from my abdomen, like most pregnancy ultrasounds. That means waiting a week or so to call to set it up. I may do that.

But then I question the need for it at all. I plan to get an anatomy scan midway through, as I’ve said. So I may call the doctor herself, and explain why I’m not getting one now unless she can give me a compelling reason to do so. That’s the harder option, because I don’t like arguing with people.

So I’ll think it over this weekend. I’m leaning toward option 2.

8 thoughts on “putting what, where? and literal navel-gazing

  1. Are you wanting support and/or buy-in from the doc, especially if you end up staying with her for care? If so, discussing with her seems obvious as it gets your needs out on the table from the start and allows her the opportunity to address them and show her style of care.

    If you aren’t looking for that and know a week’s delay will eliminate the issue, which wouldn’t even register as unusual in a doc’s office, then I don’t personally see a need for bringing it up.

    Option 3 is that almost all techs will allow you to be the one who inserts the wand and some have good experience with other modifications like staying draped, putting up a hand to stop at any time, etc, etc. Techs are actually ranked/graded and you can see if it is possible to get in with a higher ranked tech (whatever that’s called) with trauma experience. And Option 4 (depending on finances) is that you can agree to the abdominal first and if it isn’t sufficient then leave and come back in a couple weeks when it will be.

    Aside from the WHO’s questioning the usefulness of early pregnancy ultrasound if it can’t provide additional assistance, care guidelines for sexual abuse victims are to delay unnecessary interventions for this reason as well. You’re definitely on solid ground. “As guidelines suggests, postponing or modifying the breast or pelvic examination may be important interventions for reducing stress triggers”
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046271/

    She’s likely to offer a mental health referral in order to help heal from the trauma. She might also want to include a small team of people like a social worker, nurse practitioner, etc because of the insurance billing of who is allowed to do what, so don’t be surprised or read a personal concern into that. Doulas, of course, would be included in that small list. Many women share this trauma so you will find a network of support whatever you choose (and we’re happily on team Glee). I’m sorry you have to make these choices.

    • I’m looking for “Yeah, that’s fine if you don’t want the ultrasound until the anatomy scan. We wouldn’t be getting any new information anyway. I schedule them because they’re part of the ‘standard of care’ so I feel like I need to offer them to everyone.”

      If I get much deviation from that I’ll need to reconsider whether she should be my OB. Who I hope not to even need, because if everything is cool we’ll be at home with the midwife instead of the hospital.

      At this point I’m set against a vaginal ultrasound, and do not want therapy or further medical bustle about this issue. So telling her about my trauma history is unlikely. I will either dodge it all or just decline on WHO grounds.

  2. I have found that they first try to scan with the abdominal wand. Only if they can’t get it with that (and even as fat as I am, they usually can) they will try the vaginal scan. I would bet you can call to schedule and ask if they are willing to get the measurements using only an abdominal scan, I would bet they would be fine with it. How far along are you again? I mean, I was 8 weeks with one kiddo and the abdominal scan was fine (it could have a lot to do with baby position etc as well, but still…) Telling the tech that you are not comfortable (use however strong a wording as you want, even mention sexual assault) with a vaginal scan but totally willing to do the abdominal one might be your best bet.

    • But that’s the thing, I’m not totally willing to do the abdominal scan. I mean, it’s unnecessary, since I know the date of conception, and it’s not an ectopic pregnancy. Any other information will be discovered at the anatomy scan at 20 weeks or before (twins) so like I said, unless there is a compelling reason for one right now as well, I’m going to wait for the 20.

      I’ll be easygoing about it but they’re going to have to be quite convincing.

  3. I’m not really sure I understand why your doctor says an internal ultrasound is part of the standard of care? Is there a concern about the baby’s development? It’s been a couple of years, but all my doctor ever wanted was a 12ish week to check placental placement and that all the organs were where they’re supposed to be and a 20 week for skull closure and measurements. My doctor’s not super crunchy-granola or anything, but if I didn’t want anything I just told her and that was that. In fact, I’ve asked her in the past about an earlier ultrasound and she said it would have to be transvaginal and that she didn’t do those unless it was absolutely necessary.
    Your doctor is essentially your, I hesitate to call her “employee”, but maybe “contractor” is a good term. YOU are paying HER to perform a service that you need someone with expertise to do. That doesn’t mean that you have signed your will over to her, and it DOES mean that she needs to work with you to provide the best standard of care for YOU.
    I agree that you should not need to do anything unnecessary that causes you trauma. Communicating that this is a problem for you because of past experiences should be all your doctor needs to adjust her level of care.

    • I know I’m in charge. And I don’t know if a transvaginal ultrasound would even be on the table. I don’t want a 12 week one either.

      I have already been told, by this doctor, that she will drop me from care if I am not very careful with what I say. I asked her originally to provide shadow care, meaning I would definitely be planning a home birth and only deliver in the hospital if there was a problem – having gone to her for all prenatals. She was absolutely against that and, as I said, told me she could not be my doctor. So I’m a little tentative about being pushy until I get what I want, which is a 20 week scan.

  4. Drop her and run. You don’t need your care team making threats like that and leaving you hesitant to voice your preferences and concerns. There are other docs and other hospitals. That’s my .02

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