- All ultra-sounds in a non-complicated pregnancy are offered and not compulsory.
- Whether you accept that offer or not is your choice!
- If your partner is not able to accompany you in person to a scan or other clinic appointment, you can dial in with your partner or record the conversation.
- You can feedback your experiences of your care during your pregnancy, fertility and post-natal journey via the Central Cheshire Maternity Voices partnership. (MVP)
There is no doubt that being able to see that monochromatic fuzzy outline of your baby on a screen whilst its still inside you, is an emotional and significant event. The miracle of pregnancy, combined with the non-invasive* application of scientific development is remarkable and one can be forgiven for saying, undeniably magical. Pregnant people and their families often describe it as the first time they “believed” that they were pregnant; that it was the start of a bonding process for fathers or partners; that it was an event in their pregnancy that they were most looking forward to, and so on. These feelings are real, valid, and understandable given the ubiquitous nature of scans. Occasionally the scanning experience is less anticipated and for some families is downright distressing; if anomalies are discovered or if the pregnant person has severe anxiety or fear of hospitals, for example.
Over the last 12 months, for various reasons and to varying degrees, as the Covid-19 pandemic waxed and waned and infection control procedures remain, pregnant people have often been denied the support of a significant person, to share their scan experience. If that experience is at the negative end of the scale, this can, and is causing emotional harm. There is, of course a need to balance the emotional and physical needs of an expectant person or couple with reducing the chances of Covid-19 infection to them and indeed the sonographers and support staff. At a recent Central Cheshire MVP meeting (Jan 2021) we were told that at that time, the sonographers department was running at about 70% due to their own sickness, self isolation requirements, childcare/home schooling and so on. The sonographers who do your maternity scans at Leighton maternity unit, also support the rest of the hospital. I understand the pressures and I’m sure you do, but understanding that doesn’t mean that you can’t feel stressed, angry, sad, or annoyed about the change in what you were hoping was going to be a positive experience.
I am writing this blog as a response to all of this uncertainty and change. I did some digging around the internet and found the NICE guidelines CG62 – Antenatal Care for Uncomplicated pregnancies. (emphasis my own) and by presenting this information to you I hope that you will be more able to manage your expectations, potential disappointment and preparedness for outcomes that may not be altogether positive, within the restrictions imposed as a result of the Covid-19 pandemic and beyond. It’s March 9th 2021 and the “reopening” of the country has begun, but it is realistic to assume that some level of infection control and protection will be required in maternity departments for some months to come.
A note on choice
While these scans (and many other tests and appointments) are routinely offered, and are included in such tomes as the NICE guidelines, that does not make them the law! The key words to remember are offer and choice.
Everything that happens to you in your pregnancy, birth and post-natal period (that isn’t an automatic function of your body – like contractions say) is your choice. It might be an obvious decision (to you), but it is still your choice. This is true of scans as well. You are offered scans, you think about the many factors which might influence your individual decision, and decide whether you take them up on their offer or not.
Nice Guideline CG62 – Antenatal Care for uncomplicated pregnancies
In the UK, the NICE guideline CG62 – describes two occasions when an Ultra-sound scan is offered**
- Gestational age assessment (CG62; 1.2.6)- is offered between 10 weeks and 13 weeks & 6 days (as well as determining gestational age, this is also used to detect multiple pregnancies) If this scan happens before 14 weeks, an ultra-sound screening for Down’s Syndrome can also be offered. (Down’s Syndrome screening cannot be done by ultrasound after 14 weeks and should not be done at any time without consent)
- Screening for fetal abnormalities (CG62; 1.7.1) – should be offered between 18 weeks and 20 weeks and 6 days this is commonly referred to as the 20 week or anomaly scan. The majority of pregnant people who have scans see healthy babies, because fetal abnormalities are rare, which leads me to believe that this is probably the reason why these scans have become synonymous with “seeing your baby for the first time” However the NICE guidelines specifically state:
At the first contact with a healthcare professional, women should be given information about the purpose and implications of the anomaly scan to enable them to make an informed choice as to whether or not to have the scan.NCG62 – 22.214.171.124 – emphasis my own
The Gestational Age Assessment.
A pregnancy is considered to be “term” between 37 and 42 weeks. If a baby is not born at 40 weeks (the EDD) the pregnant person is not overdue, merely still pregnant. I have blogged about this before – here and AIMS has some excellent information on Due Dates and accuracy of the various prediction methods here. (TL;DR: they’re not very accurate).
If you haven’t been aware of your pregnancy or booked in with maternity support before 13 weeks, it is unlikely that a dating scan will be helpful. It becomes less accurate as more weeks go by after 13 weeks. In these late booking in cases it is extraordinarily rare that multiple pregnancies (another reason for the dating scan offer) are not picked up through the usual schedule of regular appointments and conversations and checks with midwives, without the use of a scan at all.
If a pregnant person is sure of the dates of their last period, they may decide to decline the offer of this scan. It might be of more use in cases of irregular periods, or when recollection of menstruation dates is more fuzzy. Worth remembering though that a due date arrived at by this “10 week scan” is still an estimated due date (EDD) but anecdotally is likely to trump any dates calculated from the menstrual cycle information, even when those dates are certain. In some countries, dating scans are not offered unless there is doubt about the validity of the menstrual dates.
Declining the offer of this scan, may raise some eyebrows, and even generate some “feedback” but if you are informed and confident in your decision then remember that they are not compulsory. Declining or accepting this offer does not mean that you will decline or accept all offers. Situations and information can change and so do decisions.
The fetal abnormality scan
Screening for fetal abnormalities, whether by ultrasound or other method, is a sensitive and highly personal subject, families have their own approaches as to whether to accept these offers or not. “Seeing your baby”, “bonding with baby” and/or finding out the gender, are often happy consequences of this scan, but do not feature in the medical reasoning behind the offer.
There is nothing in the NICE guidelines, for example, about identifying the biological sex of your unborn baby, this is entirely optional and dependant on your Health Trust and the skills of your sonographer and your request to know, may be declined.
The NICE guidelines do say that the purpose of the scan is “to identify anomalies and allow:
parents to prepare
managed birth in a specialist centre
Whilst equipment and technical abilities are improving all the time, and more refined observations of fetal abnormalities are possible, it is still not possible to detect all the possible abnormalities that might occur, whilst your baby is still in utero. Humans survive in an infinite variety of forms and abilities, that’s one of the things that makes us so amazing.*** We also exist with different tolerances for ambiguity or control, so whether you want to be able to make a choice, prepare or undergo intrauterine therapy is your decision and yours alone, whether you have the scan or not.
Do Not Do Recommendation
The evidence does not support the routine use of ultrasound scanning after 24 weeks of gestation and therefore it should not be offeredhttps://www.nice.org.uk/donotdo/the-evidence-does-not-support-the-routine-use-of-ultrasound-scanning-after-24-weeks-of-gestation-and-therefore-it-should-not-be-offered
It might surprise some women and pregnant people to learn that not offering routine scans after 24 weeks is a thing. This is definitely worth knowing, if you are offered scans after this time and you have no other risk factors or concerns for needing one.
Navigating scans if restrictions are in place
Firstly – find out what ‘s happening locally. At Leighton maternity unit – as I type (March 2021), the following is the situation regarding support and attendance at pregnancy ultra-sound scans. I would expect this to be updated shortly, so will amend this post when the news breaks.
This infographic obviously covers all maternity/covid restrictions locally, but in relation to scans, if you cannot or do not travel to the hospital by car, there are identified areas for partners and pregnant people to wait inside the hospital.
Secondly – know your rights. For example; if you do need to attend further for re-scans, or for any other purpose where a partner is not able to attend, you are able to video the scan and/or speak to your partner on the phone while you are in clinic.
Additionally, Birthrights, (a link that’s worth keeping in your pregnancy and birth resources) explain that maternity services should always consider exceptions, should review changes regularly, and provide reasonable adjustments for vulnerable communities such as those represented by disability, mental health, and Black and Ethnic minorities. Birthrights’ Covid-19 specific information where you can follow the link pictured above is here.
Thirdly – let the people who proved the services you have encountered know how they’re doing! If you have any feedback for local maternity services (Cheshire) in relation to the care you’ve received or been offered at any stage of your pregnancy or fertility journey, you can of course contact that service directly, but the Central Cheshire Maternity Voices Partnership (MVP)***** would also like to hear from you. They can take your feedback to the maternity care providers (anonymously if you wish) individually, via one of their monthly listening events, or at one of the quarterly meetings, to ensure that improvements are made or maintained.
*non-invasive but not necessarily completely harm less. https://www.aims.org.uk/journal/item/ultrasound-weighing-the-propaganda-against-the-facts
** offered not essential – up to the pregnant person to decide whether to have it or not.
*** Myself and Kate Blakemore the founder of Motherwell Cheshire, recorded an online discussion about our personal experiences of having babies with additional support needs. You can find this video here.
**** there are MVPs all across the country, if you are not using the services provided in or around Cheshire, you can find your local Partnership here.
***** I am the current vice chair of this group – so you could contact me as well if you wish.