“What to Expect from your Ultrasound” – with Sonographer Sara Tenenbaum RDMS, RDCS

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics of women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Sara welcome to the podcast, how you doing?

Sara: I’m great. Thank you.

Dr. Fox: Sara and I work together at Carnegie Imaging. You are one of our terrific sonographers. And this is your first podcast, is that correct?

Sara: Yes.

Dr. Fox: Wonderful. Do you listen to podcasts?

Sara: Yes, I do.

Dr. Fox: All right. So you’re familiar with how they go?

Sara: Yes.

Dr. Fox: What prompted you to volunteer to be on the podcast?

Sara: I had some ideas about things that came up while scanning patients that I thought would be nice to put out there and have a better understanding of it. So sort of to spread knowledge for sonographers, for patients, just kind of what to expect, what to know about in a few things that kept coming up.

Dr. Fox: Well, I think that’s a great idea. We had a few podcasts on ultrasound already, but they were principally with folks like me, the doctors who sort of read them and interpret them and talk about them. But as most people know who have had an ultrasound in pregnancy, or not in pregnancy, the boots on the ground, it’s you guys, it’s the sonographers, you’re the ones with the patients, the majority of the time getting the majority of the images if not all of them. So I think having your perspective is gonna be terrific. So thanks for doing this, welcome aboard.

Sara: Thank you.

Dr. Fox: Tell us a bit about yourself, sort of how’d you get into the world of ultrasounding?

Sara: So what got me into the field of ultrasound was actually through family helping me out kind of deciding what I wanted to do. What I liked about it was that it’s in the helping profession and in medicine, but I actually don’t like needles and blood. So I needed to choose something that was not so invasive, but still very interesting. And I enjoyed the aspect of it being a puzzle, I enjoyed that it was with moving parts. So that’s kind of what drew me into the world of ultrasound.

Dr. Fox: What is the training to become a sonographer?

Sara: So it’s kind of changed since I started because I graduated like 11 years ago.

Dr. Fox: Okay. So what was it when you did it?

Sara: So when I went to it, the program I went to at the time was a year of prerequisites and then…

Dr. Fox: What kind of prerequisites? Like science-type classes?

Sara: Like anatomy, physiology, physics because ultrasound is all based on the principles of physics, and different anatomy classes based on the organs that we look at. And then we had clinicals for two years along with classes. So it was like two years including summers.

Dr. Fox: Right. So it’s a two-year program. When you finish, what degree do you have when you finish ultrasound?

Sara: So the program I went to was an associate’s program in diagnostic medical sonography at the time, whereas now it’s changed to actually be a bachelor’s.

Dr. Fox: A bachelor’s? And then…

Sara: And there’s some certificate programs, but…

Dr. Fox: Right. And then there is licensing or a degree that you get to where you get letters after your names, the RDMS, right?

Sara: Yes.

Dr. Fox: So what is that?

Sara: So every school kind of has different specialties that you’re able to take, what they’re called is registries in after. So pretty much you graduate from your program, but you need to take these registries in whatever specialties, whether it’s OB-GYN, fetal echo, pediatric echo, vascular abdomen. You have to take all those exams and pass them and then search for a job ultimately.

Dr. Fox: Right. And now, when you’re doing the training, you said there’s some classwork and some clinicals. Clinicals means you’re there with an ultrasound probe being taught how to do, what to look for, where to move your hands, how to work the knobs, all that stuff.

Sara: So yes. So most programs will set you up at locations that they’re connected with, different hospitals, doctors’ offices in different specialties throughout the program. And the program I went to started out with more days of coursework and less days of ultrasound clinical days. And then it changes toward the end of the program to be instead of like one day of ultrasound and four days of coursework to four days in a hospital or clinical setting and then less coursework days.

Dr. Fox: And when you graduate and you start getting these registries, what are these tests like? So to do an exam in OB-GYN, is it like, you know, months of studying or is it just like, you know, a half hour? What are we talking about here?

Sara: So it definitely varies on the strengths of each person that’s taking the test. Like for me, I didn’t do as well in abdomen in my coursework. So I knew that that would take longer to study for than let’s say OB-GYN, which was more my favorite and was I guess, quicker. But I feel in these programs there’s knowledge of what kind of questions. So you’re kind of taught, geared toward the exams as well, a bit. And it varied, like let’s say fetal echo, you wanna at least allot three months to study for that test. Like that is a difficult one. The images on these exams are not so simple. So, definitely it takes time.

Dr. Fox: And is the exam something where you take a written test, you send in images, is someone watching you do an ultrasound? Like what happens for these exams?

Sara: So the exams are at testing centers, and you go in and it’s on a computer, it consists of multiple choice questions. And also there are moving video images as part of the test as well that you’re supposed to answer questions off of too.

Dr. Fox: Yeah. I don’t think a lot of people understand that the person doing your ultrasound, number one, they’re highly trained, so maybe they knew that. But number two, their training might be specific, which is why, if you go, let’s say, and get your, a scan of your gallbladder, for example, CF gallstones, that same person may or may not have high competency to do your OB-GYN scan and vice versa. And so it’s, you know, when you’re getting an ultrasound, it matters not only who is the doctor who’s reading it, what is the unit that’s doing it?

But what is the training of the sonographers? I know… So, for example, in our unit, we focus obviously just on OB-GYN ultrasound and fetal echoes. So it doesn’t really matter to me if our sonographers have a lot of experience in doing, you know, carotid artery imaging and, you know, whatever, because we don’t do that. But it matters a tremendous amount to me that our sonographers have a lot of experience and knowledge in OB-GYN and maternal field of medicine and fetal echoes. And so it’s like any job, right? You need someone who knows what they’re doing in that specific field. And, you know, a sonographer is not a sonographer, is not a sonographer, there’s a lot of differences. Just like doctors don’t have all the same skills, or nurses don’t have all the same skills, or like this basic training that everyone gets but then people do specialize. What made you think of OB-GYN as your specialty?

Sara: I always enjoyed babies and I thought that it would be interesting to see them developing. And so it was what I enjoyed most along with cardiac imaging, which is why I went for my fetal echo as well.

Dr. Fox: Right. Talk about that’s a moving part within a moving part within a moving part.

Sara: Exactly.

Dr. Fox: Got a lot of moving parts going on there.

Sara: Yeah. So that’s kind of what drew me to it and just, it’s a big responsibility and it’s a whole body that you look at inside a person. So I just found that all very fascinating.

Dr. Fox: Right. Other than the fascinating aspect, what do you love about your job?

Sara: I like the interaction with patients. I like the learning that comes along with it. We’re constantly learning and seeing new things, and I just enjoy the whole atmosphere. I like working with doctors, being on a team.

Dr. Fox: Being on podcasts?

Sara: Yes, podcasts a big perk at this job.

Dr. Fox: Big perk on this job. I agree. 100%. All right. So we were going back and forth sort of on email and talking about what we should be talking about. And as you said, I think that’s really nice to have the perspective of the sonographer, and I totally agree with that. And I think that probably we should talk about sort of, from your perspective, what are things that patients should know or they should think about when they’re coming into their ultrasound? Things that you’ve noticed over the years, sort of tricks or tips or whatever it might be for people?

And I wanted to start with that because, you know, as a general overview, it’s really interesting because for most people who are gonna see…get an ultrasound or go to a radiologist, get imaging, people don’t think about like the emotions involved in that. Like I’m going to get a chest x-ray, people aren’t like, “Woo, yo, I’m very excited about it.” But for when they’re pregnant, they’re having ultrasound, there is a wide range of emotions, which can be obviously very exciting, very happy, you know, tears of joy on the one end, but also it could be very scary, right? There’s a lot of things that can come up that are legitimately problematic or potentially problematic. And I don’t know if everyone’s always prepared for these sort of emotional undercurrent that goes along with these ultrasounds. I wonder if you could talk about that a little. Like what have you seen or, you know, in terms of people coming in with their emotions, walking into it and during it and coming out of it? And how do you interact with those emotions, because you’re sort of watching people in the moment?

Sara: So yeah. So it’s definitely sometimes a balancing act always rather. Pretty much I find that a lot of patients come in very anxious, and I think that as a sonographer, you kind of learn on the job to manage your room and those emotions a bit. Like, I like to set a very calming tone. It’s very calm when you come into the room I work in. And I found that knowing what to expect in their ultrasound really helps them to relax, and that definitely makes my job easier when someone’s a bit more less tense, I guess. In terms of finding, let’s say, something that’s not great on an ultrasound, that’s something to navigate as well as a sonographer. And I have found that even when things aren’t great that are found, I’ve had patients actually thank me at the end of a sonogram for finding it. Even though they’re in this place where they’re not feeling great, you know, they got this bad news, but at the same time they understand that it was found by someone and it’s important.

Dr. Fox: Right. I think one of the things that some people don’t realize logistically is when you’re going for an ultrasound, almost always what’s gonna happen is you’re gonna go into the room and you’re gonna spend a lot of time with a sonographer before you see any doctor.

Sara: Well, yeah. We’re the first set of eyes to kind of find anything. Yes.

Dr. Fox: Yeah. Occasionally, like if I’m in my office and I’m doing the scan myself, maybe there is no sonographer, and that happens too, but not typically. I mean, almost always the first person you’re gonna meet sort of on the medical side is gonna be the sonographer, they’re the ones who are gonna introduce you to what’s gonna happen, what the scan’s gonna be like, what are we gonna do? How long is it gonna take? What are you gonna feel? Where do you sit? You know, bladder empty, bladder full, you know, all these things, do all the images.

But one of the odd things about that relationship is, the sonographer is not the one who’s responsibility it is to make the diagnosis. Now obviously the sonographers can, right? Because you do this all day every day, and we’ll discuss why, but we sort of leave that to the doctor to make the ultimate call. Are we saying, this is, you know, normal, are we saying that there’s, you know, something going on? So I wanted to first of all talk about why that is. Like why is it that the sonographers not gonna tell you, well, that’s great, that’s great, that’s a problem here, here, you know, sort of go through it in real-time. And then secondly, sort of, how do you do that logistically? Like how do you do a 45-minute scan and sort of keep a poker face, so to speak?

And can you do that? So in terms of the why, from my perspective, and I’m gonna ask you yours next, we sort of do it because ultimately, right, when someone walks out of the ultrasound unit, the results are gonna come from the doctor, right? Was everything perfect, was everything perfect, but we didn’t see everything you need to come back? Was everything not perfect? And if so, what does that mean? What are we gonna do? And that’s on us. Like, we’re the ones who have to make that call. We’re the ones who have to talk to the patient about it. What’s our plan, this… And even if we’re in agreement with the sonographer 99% of the times, we don’t want that to be on your heads, because what if I disagree with you, right?

And I could be wrong and you could be right, or I could be right and you could be wrong. But if we disagree, the last thing I want is the patient hearing from you, everything looks normal, and I say, everything’s not so normal, because that’s a real big shock to the system. Or the flip side, you say, oh, there’s a problem, I say, “Nah, it’s fine.” And that’s like, what? And then now it’s very confusing for people. So we try to reduce confusion by leaving those ultimate conclusions to one person. And so we’ve chosen the doctor in our unit, and that’s how typically goes. I’m curious on your perspective, and I know we work together, so you can be open about this. Just everyone on earth is gonna hear it. How does that make you sort of feel as a sonographer that you’re doing this, but it’s not on you? Is that like a relief or is that kind of an annoyance?

Sara: No. I’m actually very aware that the scope of my knowledge is to an extent, and I believe that the doctors have a bigger scope of knowledge on a lot of the conditions I might find to be able to answer the questions that patients have better than I can, to an extent. Like I can probably answer some surface-level questions, and that’s actually what I tell patients when they ask me, you know, is everything normal? I know you know. And we get that question throughout the scan and kind of at the beginning, I even have in my script, you know, I’m not gonna be the one to tell you everything is normal, the doctor’s the one that goes over that with you at the end, once we have all the pictures and they review it and look at everything and talk to you.

So when it comes to my knowledge, I tell the patients that ultimately in me telling them about a specific thing, like let’s say, I did find something wrong. I even said this to a patient the other day, her mother was asking me, is everything normal? They were nervous. And I said even if I did find something that was wrong, and I was able to tell you, you’d be anxious the rest of the scan, I would have a hard time finishing, and you wouldn’t even get all the information until the end. So it’s much better if you wait til the end. Yes, you’re a little anxious throughout the scan, and then someone at the end will be able to answer all the questions that you might have at one time. And I think that’s just a better method. It just makes more sense.

Dr. Fox: Right. And have you had any situations where navigating that was really tough? Like when is it really challenging? Is it like when it’s obvious to the patient that something’s wrong, either from they see something, an ultrasound or they can read your face?

Sara: I think that the hardest time I had was recently where there was someone knowing that a baby might not have a heartbeat, and they were aware of it, and I had just started my scan. And in a way it was tough because I had to be like, okay, you can cry, you can handle this, but I need to still finish my scan and I’m really sorry. And that’s a really tough position to be in. Like when they notice and then there’s questions and you still have to go through, or you have to go through and kind of explain in a considerate way because they’re still going through all they go through that, you need to get the rest of the information for the doctor to really go over everything and get an idea of what went on.

Dr. Fox: Yeah. It’s hard. I mean, I’ve had situations, you know, horrible things like that, where everyone knows what’s going on. And sometimes I’ll just like walk in and say, you know, this is horrible. You know, we’re gonna talk about this at length in my office, but, you know, let me let Sara get a, you know, about 15 minutes of pictures so I can have more information to give you. You’ll also have some time to sort of absorb some of the shock of it if they didn’t know if they didn’t expect it coming into the scan. But yeah. I mean, obviously, there’s no way to navigate a situation like that where it’s good, right? I mean, because it’s a horrible situation. It’s gonna suck no matter what, it’s just a matter of trying to do it as least horrible as possible under the circumstances and get the information. But on a scan where everything is normal, how do you sort of do that without being sort of coy? You know, giving like a little wink, you know, like I can’t tell you, but wink, wink, everything looks good.

Sara: It’s like any other scan. When you’re doing this for a while and you have experience and you know how to navigate being around patients, you just kind of always have to make it like there isn’t something. It’s just, you know, you’re just doing your job and doing what you’re supposed to do, and there’s the understanding hopefully that you’ve set for the patient that, you know, everything is fine until it’s said otherwise.

Dr. Fox: Yeah. Now do you in your room, is it more of…is it conversational while you’re doing the scan, or are you more sort of the quiet concentrator while you’re doing the ultrasound?

Sara: I’m definitely a talker. Also you feed off the patient. Like if someone’s very nervous and they come in but they’re not a talker, like you can kind of get an idea. I’ll always narrate through what I’m looking at. But you get a feel from the patient. Some are more interested in chatting, some are more interested in just, you know what, you concentrate, I know you need to do your job. And they don’t know your expertise, they don’t know how many years you’ve been doing it or they’ll comment like, oh, you’re more chatty than my last sonographer, but I kind of let them know, we all have our different styles. As you do this, you kind of develop your own. And if, let’s say, I’m concentrating on a specific area and they’re like, oh, you got quiet, is something going on there? Like what’s wrong? And I’ll just answer them, you know, I’m concentrating a bit more on this area, the baby’s in a difficult position. It’s tougher to get this image at this moment, so I’m just looking at whatever it is, let’s say the heart, which a lot of the time is tougher and they kind of understand.

Dr. Fox: Yeah. I mean, I think that’s an important lesson though, that, you know, sonographers, like everybody, are people with different personalities and some of them are chatty and are just sort of very comfortable being chatty and doing their scans and either they’re chatty the whole time, or like you said, sometimes they come in and out of it based on, you know, how much they have to really concentrate on the screen or their hand position or whatever it might be. And others are just very quiet. And the reason they’re quiet is not because they’re just, you know, grumpy it’s because it’s hard and they have to really…some people need to focus very differently. And if they’re talking, they’re gonna feel unfocused and maybe like they’re not doing a good job. And so if you’re the patient and you come in and you’re more of a conversationalist and the sonographer is not, don’t take that as anything bad, A personality wise or B sort of as bad news. Some people just can’t do their job. If they’re doing it, you need to concentrate, right? And others, if they’re sort of more stoic and the sonographer is a little more chatty, that doesn’t mean that they’re sort of ignoring their responsibility.

People just work differently under those circumstances and, you know, what their personalities are and sort of levels of concentrate. It’s like anything, right? Some people, when they, you know, study math, they have to be like quiet room focused, you know. And if anything, any noise, they’re out. And others can do it while like a movie’s playing in the background and why one brain works one way and one works the other way, it’s not based on intelligence, it’s just based on like, I don’t know what it is, but how we’re wired, which is wired differently. And I have that a lot. I’ll be scanning someone, and if I’m coming in, usually it’s either social or maybe there’s something I have to look at. Or even if there is a problem and they’ll start asking a question, I’ll say, listen, I need to focus, right? Let me focus on this, give me five minutes, and then we’ll talk, because if I do both at the same time, I’m not gonna get the right pictures, I’m gonna make the wrong diagnosis, and people get it but it’s really nice to know coming into it that the personality sonographer is gonna differ based on who they are and, you know, what time of day it is or whatever it might be. There’s a lot of, you know, differences that go into that.

Sara: Yeah. And I have found that there are some patients that like whether or not they’ve had children before, they come in already either having experienced a sonogram or just knowing what they want. And they’ll tell you, can you please narrate through what you’re seeing because I like to know as you go along, which I think is great when they express it or, you know, if someone’s quiet, you know, just be like, oh, what are you looking at, to get an idea if they feel kind of left out in that moment.

Dr. Fox: Yeah. And I think communication’s something that’s also really important because, you know, this is a real-time imaging, right? It’s not like an MRI where you get put in a machine, and come out on the machine and then someone looks at the images afterwards. There is some of that with ultrasound that you look at the images afterwards, but you need sort of some maneuvering to get those images. And sometimes that involves the patient needing to be positioned differently, or sometimes you have to sort of press on the probe differently. But it’s important to give feedback to the sonographer like, does that hurt, right? Am I uncomfortable? Because you wouldn’t know that necessarily and you need to know that, right?

Sara: Yes. I definitely do. I mean, I’ve had people that haven’t expressed themselves, let’s say being on their back and not really breathing so well because they’re laying for a bit and it’s further along in the pregnancy. And I mean, the last thing we want is for them to faint, you know? I mean, that definitely isn’t ideal. So, definitely, it’s appreciated if someone’s feeling there’s too much pressure or even, you know, for us to give them a warning, you know, this is a little difficult to get, we’re gonna be pressing and I hope that’s okay. And if it’s too painful, a patient, you know, should say it’s painful and ultrasound isn’t supposed to be so painful, at least in pregnancy, unless something is very difficult to get. And that’s expressed to them, you know, I’m gonna be pressing a bit, bear with me. It’s not gonna be very long, I just need to get this one picture or something.

Dr. Fox: Right. And also sometimes the ultrasound changes, right? Someone thinks they’re coming in or their scheduled to come in for a 20-minute ultrasound looking at the baby’s weight to their belly. But based on what we find, we say, oh, you know, we have to do another test because, you know, the fluid’s borderline, I’m gonna do another test or something looked, you know, I’m not so sure what’s going on from below, I’m gonna do a vaginal ultrasound now. And so now you’re like, wait, I have to get undressed, I have to go into my bladder. Like they’re putting a probe in. But that happens, like that’s a normal occurrence, and it does not again mean there’s a problem. Sometimes we just need to do different things based on what we find to ensure that it is fine, or just to get the images we need to get because you can’t always do it one modality versus the other, particularly in OB-GYN, there’s a lot of trans abdominal, which is appropriate to your belly, versus trans vaginal, which is the vaginal probe. And we don’t always know when we start the ultrasound, are we gonna need one, both? Well, I guess I can’t say neither, we’re gonna need one of them. So it’s gonna do one or both.

Sara: And patients are usually cool with it. They don’t…they trust us.

Dr. Fox: Well, you know, if you’ve developed trust, they’re gonna trust you. So that’s good. Now, can people request their sonographer?

Sara: So every place I’ve worked has been slightly different, but I have had people mention that, let’s say, they want a certain sonographer again, there are places that accommodate it, but it’s definitely as the schedule allows.

Dr. Fox: Right. We try to accommodate it. I mean, we’re happy to accommodate it if it’s possible, sometimes it’s impossible because it’s a, I can only come at 2:00 and I want the sonographer. We’re like, well it’s one or the other, like, you know, she’s already booked it 2:00. So, you know, whatever. But it is something, it’s allowable, you’re allowed to request. The worst thing that happens is someone says no, but it’s not unusual to request a sonographer. And I think another thing we went over before is, it’s not always the case that the doctor’s gonna come in the room and do any scanning themselves, right? And every unit’s different. In some units, the doctors always come in and scan, and some units, the doctors never come in and scan. In our unit, the doctors sometimes come in and scan. We talk to everybody, but we don’t always need to get images. That sort of depends on the circumstances and the doctor and the patient.

Sara: And I just want people to know that when a doctor comes in, it doesn’t always mean something is wrong.

Dr. Fox: Not in our units.

Sara: That’s the fear.

Yep

Dr. Fox: Yeah. We come in with good news too. We come in just to say hello. Yeah, yeah.

Sara: When someone hears a doctor is coming in, all of a sudden their eyes are huge and they’re like, what happened?

Dr. Fox: Hey, why is the doctor coming in? That’s not good.

Sara: Yeah. It’s not always a bad thing. So I think that’s important for people to know also.

Dr. Fox: It’s interesting because it does depend on the unit because there are… Again, everyone runs differently, and how people do it is their business, that’s fine. And some places literally the sonographer does it and you go home, and you hear nothing from anybody until your doctor, like your gynecologist, your OB calls you back two days later, says I got the report, everything’s fine. So we don’t do that in our unit. We always tell people before they leave, everything is normal or I have these concerns, they’re minor, they’re major, whatever it is. And that’s done by one of the doctors, which means that even for the normal scans, which is the majority of them, someone’s gonna walk in the room, say hello, you know, hi, meet Fox, I’m the doctor. Everything looks great. How you doing? Any questions? Have a good day.

Occasionally, it’s over the phone if let’s say, you know, I’m in one location and they’re like a floor above or the unit they’re in is busy. The two doctors who are working there are like behind closed doors with patients and they wanna get out. So they call me at another unit that look remotely and call them. But there’s gonna be some interaction with the doctor. Sometimes patients like, listen, if it’s normal, just let me go home and call me if there’s a problem. That’s fine too. We’re really, you know, we try to do what’s best for the patients. But yes we do come in for good news as well. And it’s typically coming in for good news. So the doctor coming in, in our unit at least, is not the grim reaper. We’re coming in with smiles. It’s all good. That is an important thing to know. What’s your take on people bringing their other children to the ultrasound?

Sara: I guess it depends on age, because…I mean, if it’s a baby and there’s another person taking care of the child or if it’s a well-behaved child, it’s fine, it’s not a distraction, as long as the sonographer can do their work. Like if it’s a kid that you know will be able to sit through it. Like an anatomy scan or an early anatomy scan, is not ideal to bring a child. They’re not gonna know what they’re looking at, and they’re not gonna be interested. And I know it’s hard childcare and things like that for people. So I totally understand.

Dr. Fox: It’s also hard for people to believe the fact that their child doesn’t really give a crap about that kid inside.

Sara: Yes. That too.

Dr. Fox: They’re like, nope, I don’t care I care about me…

Sara: And a lot of times [crosstalk 00:26:36].

Dr. Fox: …I’m the focus.

Sara: Like I’m not interested in having another sibling, I’m fine with things as they are, thanks. You know, no one asks me.

Dr. Fox: Yeah. People that’s very distressing when you learn that your children really don’t want you to have anymore.

Sara: But I think that growth scans if you wanna warm a kid up to it are great. You know, scan to bring the kids, like it’s short, it’s to the point a lot of the time. So that’s ideal.

Dr. Fox: Yeah. I think that there’s two things that people really need to think about before they bring their child into the room. Number one, like you said, is this child capable of sitting still, quiet? Whatever it might be, or mostly quiet, obviously, kids don’t to be silent for the entire length of the scan. And if they’re not, probably don’t bring them or make sure there’s someone else with you who’s okay leaving the room with them. If the person who’s with you is like, “No, I’m not leaving the room,” then you’re in trouble. Because it’s not that we get like morally offended if someone brings in a crying baby, like whatever, you know, God bless have a crying baby, but you can’t do your job because again, you have to concentrate and it’s very hard to concentrate if someone is screaming and it’s also hard if, you know, the kid is climbing up on the mother during the scan. You’re like, ah.

Sara: Yeah. I’ve had that where…

Dr. Fox: It happens.

Sara: …I was like, you know, the kid’s not cooperating and I guess it does have to stay on your chest. Like the kid does have to stay on your chest for the scan, but it’s definitely not gonna help my job be any easier.

Dr. Fox: Yeah. So that’s number one. And the other consideration…and I think the majority of people like sort of get that conceptually. They like, you know, who’s my kid? Can they do this? What time of day is the scan? You know, like [crosstalk 00:28:13] not everybody but most. The other thing that I don’t think a lot of people think about is, what if you get bad news that day? Like in ultrasound, yes, whatever, nine outta 10, 19 outta 20, whatever percent, some high percentage, you come in, it’s all good news. You’re seeing cute pictures, you’re seeing the heartbeat, everything looks great, happy smiles. But what if it’s that day where you get news that’s scary or worrisome and now you have to have a serious conversation about it with the doctor and come up with a plan and maybe do more testing. Do you wanna have that with your three-year-old on your lap?

And if the answer is yeah, fine, okay. Like, that’s fine, it’s okay with me. Like I don’t mind counseling someone if they’re holding their child. But a lot of people are like, oh, this is not a good situation, right? Because now my partner’s gotta take the kid outside and now it’s only me or now I’m really freaking out and I don’t wanna have my child would be during all this. So it’s hard because most of the time it is happy and it’s fun, but think about that other end. Like, would you bring your child to your mammogram? Would you bring your child to, you know… Like it’s just, people woldn’t…

Sara: It’s definitely something to consider. Yeah.

Dr. Fox: …in that sense. A, just because like they wouldn’t, but B, you know, what if the news isn’t good? You have to sort of think about how you’re gonna navigate that. And like you said, sometimes logistics just that’s it, I don’t have childcare, these are our options and we’re doing it more. And we’re obviously fine with it, but I just sometimes feel bad when I’m trying to have a conversation with someone and they can’t ask the questions they want to ask or get the information they wanna get because they need to focus on their child who’s with them. And then they’re like, “Listen, we have to do this another time.” And then they don’t get everything they need. So that’s just something to keep in mind. So sometimes, you know, it depends on obviously your child, depends on the circumstances, it depends what scan you’re coming for. But that’s just something to think about, I always warn people about. One thing I wanted to ask you about is 3D imaging, right? So getting those pictures where we see the 3D picture of the, usually the face, that’s what people wanna see typically. So, are you always trying to do that for people? Is it just if they ask, like, is it just sort of like a cute thing to do or do you get any real information from there? What’s your take on the 3D imaging?

Sara: So I try at every scan, I would say, I tell people that it doesn’t really look the most attractive earlier than like third trimester personally.

Dr. Fox: Right. You need those cheeks to fill out.

Sara: There are some people…Yeah. I’m like your baby is skin and bones and kind of needs to get some fat on its face. But, you know, there are some people that do come in pressing at the 16-week sonogram, 20-weeks sonogram, I wanna see the baby. So I’m like, I’ll gladly show you, but ultimately if it’s not what you expected to see, I’m not gonna print it and we’re gonna go and pretend it didn’t happen.

Dr. Fox: Yeah. 16 to 20 weeks, probably the only things that look cute maybe on 3D or maybe like a good picture of a hand or a foot or something you could sometimes. The face, yeah.

Sara: Which there isn’t always so much time to get, because it’s a lengthy skin and we’re focusing on…

Dr. Fox: Face is tough then.

Sara: The face is tough. Yeah. So, I definitely try on every growth sonogram, and I find that people want the pictures that they see in the textbooks, in the advertisements. And they think that their baby is going to look like that. And ultimately, I think it’s so important for patients to know it’s really position-dependent, and sometimes when we’re not doing it, like it’s not because we don’t want to, it’s because your baby’s not in a good position. It’s not gonna give us the picture we wanna see. And sometimes there are some patients that seem like a nonbeliever, so I’m like, okay, I’ll show you what it can look like right now just so you know like I’m not just saying this because I don’t wanna do it. I want you to see that this is what it looks like when the placenta’s against it. Comes up like a window…like the face is up against a window pane. Like it’s not cute. So I don’t wanna send home, you know, God forbid, a photo that a patient is gonna look at and not be in love with their baby. Like that’s not our goal here. You want nice images, and I think that people should know that. It’s physician dependent, we’re not magicians. And that also ultrasounds, not just, you know, about this pretty face, it’s diagnostic and there are certain things that we need to see that are important that the 3D doesn’t always take precedent.

Dr. Fox: I mean, when we use 3D imaging, it’s interesting. We use it frequently, but rarely for the reasons that people think. Like people think we would use 3D to get sort of that like picture of the surface of the face, like a photograph to like see something on it. And sometimes we do that if we suspect like a clef lip or something. Like that’s an image we’ll get. But most of the time we’re using 3D imaging, it’s not to get a 3D picture. It’s like a technology where you can, instead of snapping a 2D picture, you snap what’s called like a volume and then you can manipulate and get any 2D picture you want. So we sort of use the technology of it to sort of get different two-dimensional images. But obviously, sometimes you can get that really beautiful surface of the face. But in order to do that, like the position you’re talking about, the stars have to be aligned. Like number one, the baby has to be looking up towards the sky.

Number two, the baby can’t have his or her arms in front of the face or the placenta there or the cord right in front of the face. And there has to be a nice pocket of fluid there. So if you get a situation where the baby’s looking up, there’s a beautiful pocket of fluid right over the face, yeah, we’ll do it, and yeah, they’ll usually look pretty good if they’re in the third trimester. And so occasionally, we’ll be able to get like a picture that looks like a photograph. You’re like, “Oh my God, this is what my baby looks like.” But frequently that’s just not an option. And again, not because your baby doesn’t have a beautiful face, but just, you know, it’s like if you’re trying to take a photograph of a two-year-old, and they’re like sticking their, you know, hand in their armpit and running away from you, you’re not gonna get a good picture. And that’s basically how it works here. You need someone to like literally pose for you and stay still and like do all these things and fetuses, like children don’t always behave, they’re wily creatures.

Sara: Yeah. I think it’s also important to acknowledge that not everyone scans the same either.

Dr. Fox: Yeah. Or they didn’t have the machine. Sometimes they don’t have a 3D machine.

Sara: Sometimes the machines are… Yeah. The machines are not able to scan to a certain extent, and I think that that’s important also, that everyone scans differently. It’s not always gonna come out, you know, like your friends’ picture is perfectly without anything on it. You know, that everyone scans a little differently and that sonographers are not magicians, we are working the best with what we have.

Dr. Fox: Oh, I think you’re magicians.

Sara: Thank you.

Dr. Fox: You work magic. Sara, thank you so much for coming on the podcast. I really appreciate, this was great. I think it’s really helpful for people having their ultrasounds either by us or anywhere. And obviously, we look forward to seeing you in our ultrasound unit, and thanks again for coming on.

Sara: Thank you so much.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L W-O-M-A-N.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only, does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan. Paid sponsors of the podcast are not involved in the creation of the podcast or any of the content. Support for our sponsors should not be interpreted as medical advice from the podcast, the host or the guest.