Dear Henci,

I’m 30 weeks pregnant.  I have really enjoyed receiving the weekly Lamaze email.  It has helped me stay confident and relaxed during a stressful time.  I always thought that when I had kids it would be in the most natural way possible.  My mother had 4 children in a birthing center in Seattle and always said it was the most amazing experience.

My problem is this:  At about 20 weeks the doctors said they found only one artery in the umbilical cord.  Since then it had been non-stop monitoring.  I have been getting an ultrasound every three weeks all in the name of “better safe than sorry”.  Every time I go in they tell me about the eventual problems that may occur, but scans have always shown the baby having a normal growth rate and further ultrasounds ruled out any birth defects. At my last visit they said that the umbilical flow is “borderline normal” and now they want to monitor me with ultrasounds once a week.

My questions are these:  How do I stay confident?  All this testing and constant hospital visits make me feel incapable, what can I do?  Sometimes I would like to quit all this testing and just carry out the pregnancy normally, would that be a irresponsible decision?  Do you know what could happen to me or my baby if I refused further monitoring?

Have you ever heard of such a situation or know to whom I could refer that has had experience with something similar? If you could offer me any kind of advice, it would be greatly appreciated.  If not could you refer me to anyone (or anything online) that could help answer my questions?   

Thank you for your time,

I searched on "single umbilical artery" on Medline Plus, the U.S. National Library of Medicine's consumer health site and came up with this. It doesn't say anything more than what you already know, that is, that babies are more likely to have other abnormalities, which has been ruled out in your case.

From what I can judge from your post, it isn't so much that your baby has a problem that is causing you distress but that you are feeling in the dark about what the problem means and what might need to be done about it. Here are some questions you may wish to ask:

• Now that we have ruled out other abnormalities, what are the potential problems, if any, with having a single uterine artery? If there are problems, how likely are they to occur?
• What are you looking for when you perform (insert name of test)? How accurate is this test at predicting a problem?
• What treatment will you recommend if (insert name of problem) occurs? If that doesn't resolve the problem, what would be the next step?
• Can you please direct me to where I can get more information on this issue?

Barring an emergency, you will want to make informed decisions about your care. This is not only what will best take care of you and your baby, it is also your legal right. This acronymn will help.

Benefits: Why is this drug/procedure/restriction being recommended?

Risks: What are its risks? How likely are they to occur? What other medical interventions might be needed as a result of this one?

Alternatives: What are my other options, including doing nothing? What are the benefits and risks of each of those?

Intuition/instinct: Once you have the information, allow yourself time to process it, and then listen to what your heart is telling you.

No or not now: You ask if it would be irresponsible to refuse further tests or treatments. Once you know the benefits and risks of the proposed test or treatment, you will know the answer to this question. If you decide to say "no" or "not now," discuss the circumstances that would change that answer.

During the discussion, ask yourself whether you are getting information or feelings. Hopefully, you are getting facts neutrally presented, but unfortunately, it is not uncommon for care providers to attempt to scare or bully women into doing what the care provider wants to do. If you find this to be the case, I would seriously think about changing care providers. Whatever the situation, you want care providers who respect and trust you and consider you a full partner in the decisions made about your and your baby's care. If it comes to looking for a different doctor, get back to me. I can give you some ideas for how to go about that and what to look for.

~ Henci