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A call for a change to be made to the 'no-doppler policy' at 16 week midwife check(127 Posts)
I've just had the most pointless 16 week midwife check ever (this is 3rd pg so I know from experience that this was completely pointless).
Other than dipstick my pee and prod me in the tummy, she did nothing, asked nothing other than "keeping well?" and wrote nothing down other than "keeping well" (seriously). It took me 25 mins to drive to the appt and 25 mins back, a total including appt time (and pre-appt waiting time) of about 1 hour, 10 mins.
She was quite defensive (obviously gets it in the ear a lot from upset pg mums), and said "but what would I do if I couldn't hear a heartbeat?" I replied, "Well, I'd hope you'd send me for a scan so they could see if I was carrying a live or dead baby". She replied "no, I'd get in trouble for that" and I said "well, I'd rather know at 16 weeks that the child had died rather than carry it around for another 4 weeks and find out at the scan".
My suggestion, if the NHS / Royal College of Midwives is so worried about not hearing heartbeats at 16 weeks, that they just send us dipstick packs, so we can dip our own pee (3 minutes), write our own notes (3 minutes) and not spend 45 minutes sitting in the car.
Anyone feel the same?
I heard my baby's hb at my 16 w check up. The midwife took 5 mins to find it, but she persevered until she did.
I think it varies from area to area. I'm happy with my ante natal care at my surgery.
But she's not just checking your urine. She's having a chat with you which will tell her a fair amount and she's giving you a chance to talk to her.
At my 16w app I heard the heartbeat, I got my blood results from the booking appointment, I got my pee dipped and my BP taken, appointments arranged for seeing some other people I needed to see, and any questions answered. I don't see it as a pointless exercise.
The HB was listened to with the proviso that it might not be heard due to positioning of baby and to not panic and assume the worst if they couldn't find it, and I was happy to go ahead with that agreement.
Apps don't really get any much more than that over the weeks, sorry to disappoint.
Sorry, I don't understand - did you ask her to listen to the heartbeat and did she refuse?
I can understand her reluctance, even if she was untactful. It can be hard to hear the heartbeat, and it might cause additional stress.
I can't remember the exact timing, but when I was twenty-something weeks pregnant, the midwife got the doppler out and couldn't find a heartbeat. It took her 20 minutes to find it. Luckily by that stage we could see DD moving around in my tummy so we knew she was okay, but if she had been asleep it would have been terrifying for me and the stress would have been horrendous.
Yes - I asked if she would listen and she folded her arms and said no, it's not the policy any more (as sometimes they can't find it).
As for a chance to chat, it really wasn't. To give an example, I mentioned that I had a really dizzy spell last night (to the point that the room started spinning) but that it felt very different to a fainting episode (which I've experienced too, not in pg though). She kept going on about fainting in pregnancy, so I felt she wasn't listening at all. Or perhaps, just not understanding. I didn't warm to her at all and felt hurried and that I was being a pest asking if she'd listen to the heartbeat.
The appts are different across the country I know, and I'm glad the majority get the time taken properly with them, but my point is, in areas where it's not allowed to listen to the heartbeat, let's scrap the 16 week check and dipstick our pees at home.
I had my GP check for a heartbeat at each visit. Had a four hour wait at hospital today (35 weeks) for a quick measurement with a tape, urine check and 'are you ok?' chat.
Figure it is part and parcel of it all.
I have my own Doppler though- so glad of it.
Oh mrspaddy I know - there's such a lot of time wasting that goes on, but at least you came away knowing all is ok. I have come away not knowing anything at all.
I like going to my midwife appoints.
My 16 week one included listening to babys heartbeat which took a matter of minutes, results from previous blood test, BP taken and a general chat about how I was.
It is placed nicely in the middle from the 12 and 20 week scan for a good check up
It must depend on trust (or MW) as I heard HB at 16 weeks.
I also heard the heartbeat at my 16 week appointment. I wouldn't have minded if my midwife hadn't tried though, I am a first time mum however and I have enjoyed the regular contact with my midwife, she is lovely and I feel well looked after.
Yes - obviously it varies across Trusts. Why is there even a variation?
Are you certain it's your trust, do you know others in your area? I sometimes wonder about these 'policies' quoted by some HCPs...
I don't get why there is variation either...everyone should be entitled to exactly the same care. I think I would be a bit pissed off after your experience today too.
My midwife listened to the heartbeat at my 16 week check. And my friends said they had the same xx
I got to hear baby's heart beat at my 16week appt. I can see why most midwifes don't though!! As she STRUGGLED to find it, took her many attempts, but she; in the end, found it, I was on the verge of crying as it only gave DP and I worry!
I now see why they don't, baby is still very small and harder to find heart beat.
Just relax OP! I know it's what you look forward to, but it won't be long until your scan or until the baby is here!
It definitely varies from area to area as with all 3 of my pregnancies the MW has listened to the HB at 16w. They have always mentioned in passing that they are told that they don't have to do it though because it can be hard to find that early and if they don't find it it creates unnecessary stress but they've done it because they like doing it! Having said that, I think personally that so many people buy their own dopplers these days that the MWs might prefer to find the HB at the 16w scan on the basis that they know what they are doing rather than pregnant women doing their nut at home because they can't find it themselves. Or 'reassuring' themselves by hearing it when actually they are listening to their own heartbeat!
I heard heartbeat at 17 week appt with my regular midwife. However I had to see a different midwife at 26 weeks and she said "we don't listen for heartbeat this early any more, as long as you are feeling movements we don't worry"
I was a bit tbh. 4th pregnancy.
Sorry you were disappointed with your appointment
Unfortunately (although it shouldn't) I think it can depend on the trust policy and even the individual mw.
Personally I have had a really good experience so far (24 weeks with dc1). Had to see my mw at 14 weeks as had early pgp - she was really helpful and great at referring me on and giving advice. To my suprise she listened for the heartbeat and found it straight away!
However, she is a very experienced mw and I'm very tiny in build which possibly makes it easier.
Heard it again at 16 weeks and will hear it Thur when I see her. She's always on the other end of the phone as well if I have concerns and I feel really well looked after.
I do however agree with you that all women should get the standard of care I'm getting as it's unfair that some get a raw deal
Hopefully your 20 week scan is soon? And you will get to hear hb at 25 weeks. Good luck! X
Isn't the variation across trusts the whole thing about returning the NHS to local control etc? I mean, you can have policies set centrally (and therefore everyone has exactly the same care) or you can have policies set at the trust level (in which case it's a postcode lottery), but it's pretty unlikely that if you leave it up to the trusts to take decisions at a local level that every single one will make exactly the same decision.
I'm sorry you didn't hear the heartbeat at 16 weeks and it does sound to me like she was rushed and wasn't listening to you properly which must be super frustrating after a long drive and wait.
I agree that the decision to use or not to use seems to depend on the experience / time / will of the individual midwife. This one felt hurried and I wondered whether she didn't have time to do it. I asked whether it was a cost cutting exercise (time is money and all that) and she said no. They also don't tell you the gender of the baby at the anomaly scan in my area (although on this occasion I'm happy not knowing), which is a cost cutting exercise.
I'm slim, still in normal non-mat clothes and probably a perfect candidate to get a good heartbeat instantly from...and yet she was unmoving. And I totally agree with rocky that surely it's better for a professional to have a go at listening to the HB rather than me running off now to get a doppler and having a panic attack when I can't do it myself.
Nice guidelines say that midwives should not listen in to the baby's heartbeat any more. I know women find it reassuring but it tells you nothing apart from the baby is alive at that moment. Research has shown that this can sometimes be a false reassurance.
Ie; women hears the heartbeat at an appointment. Later on that day or the next day she thinks that baby isn't moving much. But rather than ring the hospital to arrange to go in for a monitoring she doesn't bother as she thinks that she's just very recently heard the heartbeat and it was ok. Honestly there is research which backs this up.
And yes where I work midwives aren't supposed to listen in. If one did at a 16 week appointment there is no way if she was unable to find the heartbeat that you'd get a scan. Scan appointments are precious due to availabilty sonographers and machines. The sonographers would refuse to scan for such a reason and the clinic manager would back them up.
So where would that leave you? Upset and worried with no reassurance and a 4 week wait for the anomaly scan.
My3 I posted on our antenatal thread too before I saw this.
My 16 w check up (I was 15w3) midwife checked blood pressure (v low), went over bloods, checked notes, talked about delayed cord clamping, she listened for heartbeat (little one swam away after a couple of seconds so she spent time refinding Zom), chatted about how I've been, discussed movements and arranged next appt for 24 weeks where she'll review anomoly scan.
Good point viva and interesting that it's the same where you work (perhaps we are neighbours), and you back up what she said ref the scan. But I'm still in a position where I'm not getting movement anyhow so the HB would be the first sign that everything is ok until the 20 week scan when presumably I'll be feeling movement regularly. So, as it stands I'm upset, worried, with no reassurance and a 4 week wait for an anomaly scan.
Just for informational purposes, I live in Canada and we have a check at 18 weeks, where they listen for the heartbeat as a matter of course. With DC3, they couldn't find it and I had to wait an agonizing weekend for an ultrasound to make sure he was OK (he was).
Just to say, I can understand why they have the 16 week no-Doppler policy and yes, perhaps arrangements could be made for those who have to travel/miss work for an appointment at this stage.
Did you not have a 12 week/dating scan?
I can understand been worried, but you'd be more worried if the midwife hadn't been able to find the heartbeat and then hadn't been able to offer you a scan.
Where are you having these appointments that is a 45min drive away?
Mine are at my gp which is a two minute walk from my house. If you're with a gp far from home then I think you have to accept the journey might not always seem worth it.
Viva yes, of course I had a 12 week dating scan, what has that got to do with the price of tea in China?
Bad you must live in a town, I live in the country - the GP clinic happens to be 25 mins away by car. I accept that, but I'd rather not make a journey if it's going to be completely pointless.
And as far as I can tell the appts are mainly bp and pee which are the two pre-eclampsia indicators.
You don't mention bp. If she didn't take your bp I'd really question that!
(And I doubt they'd trust us to self-monitor bp even though you can)
My MWs do the Doppler at 16 weeks. i think it's important.
She did do BP (although the electronic monitor broke - apparently 'only happens to her') and that is normal, so that is helpful I guess!
It's just that you said if you'd heard the hb today it would have been the first sign that everything was ok.
Therefore I thought maybe you hadn't had a 12 week scan. But you have, surely that was a sign that everything was ok.
viva that was 4 weeks ago for the OP though. i wouldn't feel very reassured if there was no checking to see if baby was live from 12 weeks to 20 weeks. alot can happen from 12 weeks to 16 week.s
Absolutely extreme, that's my position - at 12 weeks I had a wonderful scan, saw the baby, brilliant. But my next opportunity is at 20 weeks to get any professional confirmation that all is ok. I feel that's a bit shitty and I am inclined to borrow a doppler, then risk freaking out when I can't find the HB. It seems silly not to do the HB in some areas when they will in most others.
Which kind of proves the point that a Doppler or even a scan is only reassuring on the day (or even at the time) that its done. So if you hear the hb today, why would you still be reassured next week or even tomorrow?
Saying that seeing the hb on scan is reassuring. Having seen that and coupled with no bleeding/pain it's very unlikely that anything has gone wrong between that scan and 16 weeks.
Thanks viva I know the chances are that ALL is well, I just feel robbed that on a day when 99% of women hear the HB and have that instant feeling of reassurance, I haven't.
I hope the next few weeks whizz by and you're having your scan and feeling movements soon.
My main concern at all my appts, having had PE in a previous pregnancy, has been to have my BP and urine checked. My great-grandmother died of PE, purely because ante-natal care was so crap back then. It's such an important thing to monitor.
I am not sure a dipstick and home monitor would be suitable for everyone, so I can definitely see the point of a standard 16 week check. Plus women have other concerns during this time; SPD, HG etc. At the 12 and 20 week scans, you see the baby, but you don't get a health check yourself, and so to go from the booking appt to the post-20 week scan appt with no midwife appt would be too long imo.
Sorry you didn't get to hear the heartbeat tho (I did, but fwiw was told she might not find it), and 45 minutes does sound a long way to go for five mins. Unfortunately that prob won't change - I'm 39 weeks and my appt this week was still very brief. And your midwife does sound a bit dismissive about your fainting etc. Maybe your GP would be more helpful? Just a thought but you can buy dopplers for home-use, and you could always pay for a private scan?
Anyway, your 20 week scan will be here before you know it - I also hope the time whizzes for you! xx
Vic is right.
You don't need to check for the heartbeat at 16 weeks. I am a sonographer and as long as the scan was normal at 12 weeks the chances of babies heart stopping before 20 week scan are extremely low. I fact in my 6 years of scanning I have never once scanned someone at a routine 20 weeks scan and not found a heart beat.
So it is pretty pointless checking the heartbeat at 16 weeks to be honest. All it does is panic expectant mothers if the midwife struggles to find it - as it can be pretty difficult especially if they have a large bmi. Then sonographers scan slots would wasted on unnessesary scans for reassurance.
Sorry buts that's just how it is. There aren't that many sonographers and we are constantly being asked to do extras on top of our working lists. We have to prioritise the urgent things first.
As Viva says, NICE guidelines are not to listen to the heartbeat at all at any routine appointments, regardless of gestation.
Many MWs and Drs do check, but this is against NICE guidelines.
I have only had the Doppler at my very first MW apt and that was only because we didn't have clue how pregnant I was - both MW's had a feel around my tummy and deduced that I must have been "about 24 weeks" (this was where I almost fell off the bed)- They then got the Doppler as they felt that any heartbeat under 20 weeks would be hard to find.
I had it once more at 32 weeks (two weeks ago) and that was only for the student midwifes benefit - the main midwife said that they don't tend to do it anymore and will only use it if specifically requested my mum-to-be.
I have had a midwife try and listen in at 16 weeks and that was in a pregnancy where there was already a problem. Despite me being pregnant with twins, she couldn't find either heartbeat and went off to find a midwife to scan me. (my antenatal appointments then were at a midwife led unit and midwives did the 12 week scan and consultants had portable scanners in each room too and scanned at all appointments) Her colleagues were very clearly unimpressed with her and had I not been able to have the scan I would have been very worried, whereas I would have been disappointed if she didn't try and find the heartbeat, but not so worried.
I'm not really sure what it is you want OP? As you say you could have just dipped your urine and filled out your notes at home, but then you wouldn't have heard the heartbeat either. Plus, it's unlikely you'd be able to take your own blood pressure at home, which is important.
I'm sorry that you're worried but as someone who is scanned regularly and seen weekly by a consultant, I can assure you, it really does only reassure you for that day sadly. Hopefully the time between now and your 20 week scan will go quickly. Alternative, you could always pay for a private scan to reassure yourself?
I insisted on hearing heartbeat and midwife said most likely she won't be able to find one. But I insisted anyway, she went ahead and did it....found the heartbeat in a few seconds! I think for some it might be difficult and some easier...so midwives prefer not to scare if she can't find it. If you insist however, they usually try. Just explain you will not freak if she can't find. I like going to my midwife appointments, even if it's just to chat, check blood pressure and pee on stick. It's important to keep getting monitored and if you have any concerns or questions be able to ask.
My midwife did a doppler test at the 16 week appointment, I didn't realise that this wasn't standard practice.
Having said that, she also did a doppler test at my last appointment - at 30 weeks - and it took her a good 5 minutes to find the babies heartbeat (Baby wasn't where she thought it was - anterior placenta was making it hard to figure baby's position out). So I can sort of see why they might be reluctant to do them at routine earlier appointments.
But there's not that much needs doing with a normal, healthy pregnancy.
I only had the heartbeat listened to at 17 weeks with DS1 because I'd had yet another heavy bleed (3rd that pregnancy) and rather than a doppler, the midwife listened with her trumpet thingy.
Much as you would have found a doppler reassuring, some mums to be would find it invasive - no idea how well founded it is, but there's some people who are concerned that dopplers and even ultrasound scans are potentially harmful to baby and should only be used if of benefit to baby, rather than mother.
On my third pregnancy my midwife couldn't find my baby's heartbeat at the 16 week checkup. She immediately sent me to EPU for a scan with a wonderful and compassionate woman who had to tell me that my baby had died at 11 weeks 6 days - one day after I'd had my dating scan.
My very lovely midwife said in all her years, only once had she failed to find a heartbeat at 16 weeks. She knew pretty much straight away.
I'm very much in favour of the midwife checking for a heartbeat at 16 weeks.
(Nb two wonderful sons later, I will never forget how supportive those two women were during those three pregnancies. Well done Glangwili hospital )
My 16wk appt was the first time I actually got to meet my midwife (high risk pgs are booked in at hospital) so it was important from my point of view.
I heard the heartbeat at 14 weeks but I was lucky they couldn't find it at 17 weeks so I had a scan, the trip to hospital was awful, then they couldn't hear it at 19 weeks so another scan but was at hospital anyway so consultant did it himself. If they did this all the time it would cost a fortune!
You already said if she couldn't find the heartbeat that you would expect a scan. My local EPU was double booked all week this week already. Where do they fit the extra people in?
It isn't an exact science. The baby is still small at 16 weeks. There's a good chance the heartbeat might be hard to find.
Believe me, I understand PG anxiety. Im 9 weeks PG after a previous MC and my sister lost her DD at term.
But as others have said, its very rare for things to go wrong at this stage. You just need to try not to worry.
You could always buy your own Doppler and drive yourself mad with worry in the comfort of your own home....
Perversely, my MW listened for the heartbeat at my 12 week appointment, gleefully telling me that she may not hear anything (knowing full well that I had had two previous miscarriages ). I didn't have the emotional strentgh to ask her not to, and hate to think what state I would have been in iof she hadn't found anything.
Buuuut, personally, I think that an experienced MW should be able to find a HB using a doppler at 16 weeks.
And another thing; most of my MW appointments were of the "wait around for not much time spent" category, but all my <term> pregnancies were very straightforward. My SIL, on the other hand, had terrible problems that were only picked up via a routine MW appointment. She was more than happy for all the travelling back and forth as it meant her baby's genetic problem was anticipated well in advance of the birth thanks to an on the ball midwife who picked it up at a routine appointment.
Aaaaaand, the MW service, like all aspects of the NHS, is at breaking point. MW's really do do their best.
I had a similar experience as you OP.
MW refused to listen for hb, it was my second pregnancy and I hadnt felt baby move, I felt DD move at 13 weeks so I was anxious about it yet she still refused. The doppler was lying on the table between us the whole time.
a colleague had her 16 week check @ 2 weeks before me and got to hear the hb. she lives about 2 miles from me different LA, gave birth at the same hospital.
I left the appt and ordered a doppler and heard hb myself 5 days later.
I think everyone should be entitled to the same care.
I know they have rules to abide by and if they bend the rules once etc etc but I just do not understand the logic in allowing a pregnant woman to leave an appt with anxieties which could be alleviated.
I had already had an early scan at 8 weeks due to HG and was having a thoroughly shitty pregnancy.
It was a very stressful time.
oh and congrats OP I hope the rest of your pregnancy goes well and you get to hear hb soon.
DS is now 10mo and a bundle of energy
Maybe you should be glad that it was a nice simple appointment for you but there are lots of women this won't of been the case - referrals need to be made, BP monitored, blood test results discussed, scan results discussed and discussion re: further testing. Medication checked & started.
YABU thinking that every woman is the same as you and that there is no point in anyone having the 16 week check. Just be glad you had no issues and be grateful for the healthcare you receive free on the NHS
When I went for my appt at 10 weeks with ds1 mw whipped the Doppler out and could hear hb. Defo before my scan. This time round I realise that she is a bit of a maverick!. My mw said the policy is not before 16 weeks bc of reasons u describe. So may differ regionally but also individually .
In Scotland we don't even get a 16 week appt. it's 12 week scan, 20 week scan then midwife appt at 22 weeks.
10 weeks is really early to try and even locate a HB- how can the MW be sure it wasn't your heartbeat that you heard?
I'm glad they don't listen to the hb at 16 weeks any more. My 16 week appointment was a terrifying 20 minute search for a heartbeat, followed by an emergency scan referral. Turned out my LO was incredibly high up for 16 weeks but honestly, I would have much preferred they didn't look for the hb.
Straightfoward mw appointments can sometimes feel a bit disappointing, but as other posters have said, it means you're having a straightforward pregnancy. There are plenty of people who don't and the 16 week appointment is a vital step in identifying those for whom there may be complications emerging.
The other thing I would say is that it's up to you to make sure you get the most out of these appointments. Go armed with questions (written down if necessary), ask for clarification if you're not happy with the answers, and don't leave until you've discussed everything you want to.
Congratulations, Saggy! That's excellent news
I think the major issue for you is the travelling time. That's your 'fault' for living in the country, surely? (I mean that in terms of your personal responsibility/choice rather than the NHS or any individual HCP.)
With DD1 at 28 weeks I had to go for a half hour trace at the local Antenatal unit because the midwife had heard a couple of decelerations. She said it was probably just the baby pulling on the cord. All was fine but that was the worst hour or so of that pregnancy as I cried at my sister's and all the way to the hospital. DH and I resolved never to buy a personal heartbeat monitor as we'd be checking all the time and worrying that we couldn't interpret the sounds properly.
As pp have said, remember that it won't be such a straightforward appointment for many women. Try to relax and enjoy your pregnancy rather than stressing over everything. You'll be feeling movements within a few weeks. If pregnancy taught me one thing it was patience!
books - that's not true for first time mums in Lothian. We all had an appt between 16 and 18 weeks where our booking blood results are given and 12wk scan results discussed.
Because of my age I went to the hospital for my 16 week check and the doctor there listened to the heart beat - took a moment or two but she got it and it was strong.
As this is my first pregnancy and I am totally clueless I had no idea I would be able to hear the baby's heartbeat. I am so glad I did though - that was the point where I finally felt like I had a baby inside of me. I had had the 12 week scan (and one at 8 weeks as I had bleeding) but they didn't seem real - the heartbeat did.
I don't care what the NICE guidelines are I think if many women are given the opportunity to hear the heartbeat at 16 weeks then that should be available for all women. I understand the OP's disappointment and upset at being denied this.
I had my 16 week appt with my MW last Thursday.
I wasn't very ok.
i had suffered a threatened MC 9 days earlier, (blood everywhere) and had spent a night on a drip in hospital. I had tried to ring the MW on the way to A&E but she wasn't answering her phone. I had left a text message, but got no reply.
I had had a scan the morning i left the hospital, and baby was ok. Oblivious even, thank God.
MW: Oh - you must have so worried. But if the gynea couldn't explain it then i can't be expected to. No, no listening in to HB today. (this muttered with her back to me - i didn't even twig what she was on about till i was handed my notes back to leave) Urine's ok, BP's ok. 20 week scan was booked ages ago. That's it. questions?
Me should i be feeling baby move?
She - hmmm, some people do .... See you at 28 weeks - bye.
She won't see me now for 12 weeks.
sigh. i dunno - i just hoped for more from her.
I had a scan at every antenatal appt, whether it was with midwife, gp, or consultant. Just a quick scan, so they could see heart beating, baby moving etc, not lke the big scan at 12 and 20 weeks.
Was really shocked when I read on mumsnet how unusual that is. I was very pleased with my antenatal care, it was very attentive, and all forms of physical and mental health issues were covered.
treacle are you in the UK? It's extremely rare for GPs and MWs to be trained and experienced in antenatal scanning.
It's also rare for GP surgeries to even own an ultrasound scanner!
Fascinating reading that 'do not' guidance. It is obviously very widely ignored, because in my area everyone did a gd glucose challenge, soft markers checked for Downs AND had Fetal HB checked in every appointment.
As someone who has mc I think the benefit was peace of mind. Didn't stop me anxiously checking for movements!
I've just come back from an emergency appointment with my midwife at 14 weeks due to a small, old bleed yesterday. They said there was no way they would check for the heartbeat and they don't offer it until 26 weeks! My older children are 13 and 10 and I distinctly remember hearing their heartbeats at the same GP practise at 14-16 weeks.
Saying that, the doctor and MW have been fantastic over the last two days and I know I would have gone into a panic if they hadn't found a heartbeat.
It's a tricky one. It depends whether you see listening for hb as a clinical test or as something nice for mum.
If its a clinical test then the very basics of any test is that a) you should have a clear idea if what it is you want to find out and b) you are going to do something with the results and c) it's predictive or useful. Listening for a hb in that basis means that I must be able to refer for a scan or something else if I can't find it. Otherwise it's a useless clinical test and shouldn't have been performed. Listening for a hb isn't predictive or useful as explained above so it should be discounted on that basis anyway.
Where I work I can refer for a scan at 16 weeks if I can't find a heartbeat. So I do listen. I do not listen before then, not even at 15w6d, as I can't do anything if I can't find it.
If listening for a hb is just something nice for mum then we can't expect to spend NHS money on scans etc if we can't find it. I feel this leaves mums in a really scary position. S I always treat it is a clinical test, only listen when I would expect to find it I.e. after 16 weeks and have recourse if I don't. Really obese women are seen by the consultant at 16 weeks anyway so I don't have that to contend with which makes it even trickier.
Some hospitals will be strict on nice guidelines (where it suits them) and I've heard of listening in been a disciplinary issue for midwives. So if I worked at such a trust I wouldn't do it in a million years, knowing there was a good chance that it would be spotted in an audit and I'd get a bollocking/file note.
my mw checked for heartbeat at 14 weeks and found it straight away
Some of it must be cost cutting though? I had my 4th, 2yrs ago. I was booked in at 8wks and as I said we were having our nuchal scan privately, they then refused to give me an nhs scan at 12wks. I saw her again at 16wk and then not until 32wks! I did have my 20wk scan in the middle but that is not with a MW so no opportunity to discuss pg related stuff.
How can they think its reasonable to see you at 4mths then not again until 8mths? It wasn't like that with the other 3 when we lived elsewhere so I can only assume its local policy.
You should have seen someone at 28 weeks. Also most hospitals at 20weeks after the scan you see a midwife who checks bp, etc.
Not listening in to the hb doesn't save money at all. Appointments are still the same length of time.
I think you're right it's cost cutting, because trusts who enforce this wont scan for unheard hbs. That's where the cost saving is, in the scan. They have to rationalise it - how many babies lives are saved by the routine listening in of heartbeats during an antenatal appt? That number must be approaching nil. I've never heard of that routine listening in ending up being so critical it saves a life. So it, and the follow up scans associated with it, aren't worth the money. Listening in routinely is not predictive, it doesn't change outcomes, and it costs money. So it's GOOD that its no longer recommended. It's the type of good cost cutting we need.
Where I live we have booking in appt then 12 week scan then 20 week scan then midwife appt at 24 weeks, so I didn't see my midwife for 19 weeks, haven't even got a direct contact number for my midwife just the local midwife led unit, haven't seen the same midwife either I'm now 33 weeks this is my second pregnancy so pritty much knew what to expect. Still when I went to appointment yesterday an seen yet another different midwife and was told I had a high platelet count I had to go through medical history all over again and she still didn't know what to do about platlets had to go find out from someone else. Have never discussed previous scans or bloods with any of them did hear baby's heart beat tho, guess it all depends on whereby live an how often u get to see midwife hear hub etc, sorry for long post
Obviously patchy, disjointed care isn't acceptable and I'm not saying that is a good cost cutting measure! Just talking about the heartbeat issue.
Btw there is research which shows that the more medical appointments a woman has in her pg the less likely she is to mc. This is from Prof Lesley Reagan's book on mc. So reassurance to women is not pointless and in fact may even save money as iirc the MIST mc study of over 1,000 mc showed 1/3 natural mc involves a hospital stay and of course treating with medical or surgical management involves in patient time.
I agree Harder.
I don't think it's cost cutting so much as more useful direction of funds.
As I said up thread, my local EPU was double booked solid all week. A MNer friend who sadly MC, had problems over the weekend and couldn't get a scan until Wednesday. Those double booking will have been people who were bleeding, cramping, suffering abdo pain or have had previous MC and ectopic PG and were seeking much needed confirmation that their PGs were safe of viable. As others have said, there is very little risk after a healthy 12 week scan. Repeated referral for scans after not being able to find a HB because the baby is high, low or hiding behind its placenta is going to put undue pressure on already overloaded EPUs who do an amazing job helping those people who really need their support.
Not a midwife, but I don't write much of my notes when the patient is there. Usually done after.
More often than not in my lunchtime.
Viva, I was told that it was because it was my 4th. She said they have a schedule for 1st then 2nd then 3rd+.
I was also 42 at the time yet I wasn't asked if I was interested in having an amino at all. She also kept telling me that guidelines referred to me as a geriatric mother. Nice.
I also didn't get to hear hb at my 16 week appt. I FULLY understand where mythree is coming from.
The thing that isn't being considered is:
Yes, if you can't find the hb, that would be stressful, of course it would.
However, I've been stressing every day since the 16 week appointment that something is wrong. Every day. In tears. How is that any better than a potential risk that I might have been stressed by not being able to find it?
I'm not saying one is less stressful than the other, just that if it's not done on the basis of 'potential distress', then it needs to be recognised that simply not doing it is a cause of distress in its own right.
Also, I felt my mw was dismissive and uninterested at my 16wk appt too - when I raised things with her (like ongoing, intermittent diarrhoea, which I had understood could be risky), she said 'yes, pregnancy will cause changes in your body, you know', as if I was 16, stupid, and had no fucking clue about pregnancy. I've read a lot, I want to be actively involved in my care and to take good care of myself (thereby reducing the burden on the NHS, as some of the difficulties encountered in pregnancy could be mitigated if women were better able, and knew enough to take good care of themselves), and I was asking for these reasons. It was rude and unnecessary to treat me the way she did. The variation in standards of care is unacceptable - why was this midwife so patronising and unhelpful? Her colleague, who I saw the previous time, was brilliant? Is there a problem in the training programme? Is there insufficient screening of who practices midwifery?
I do understand that MW services are overstretched, but that doesn't mean pregnant women should simply 'put up and shut up' - we have a right to have adequate healthcare. That includes being treated in a way that reduces stress and takes care of our mental health as well as testing our wee for proteins. Pregnancy, especially for the first time, is a very new, overwhelming, potentially frightening, experience. I didn't go to the GP saying 'ouch, I stubbed my toe'. All pregnancy books I've read acknowledge that pregnant women will have concerns, worries and fears and dismissing these is hardly a healthy way to treat us.
Btw, I'd had excellent MW care with my other 3. And I've always had one to one care in labour. Just my 4th, poor antenatal care (I believe) then poor care in labour.
All it has shown me is how patchy care is across the country.
Holidays, pregnant women carry their own notes, so they must completed during the appt.
Sunny I would agree with that but it must mean fewer later miscarriages and that will be because more appts pick up the IUGR babies, the preeclamptics, the UTIs etc which cause miscarriage. It's not because of more listening in to babies.
Marykatherine, I've never heard that before. There's a national schedule for first babies and one for subsequent babies. Shouldn't be a difference if its second or fourth.
I think there is an interesting feminist argument as to why women may need to feel reassurance from the technological gaze of medical paraphernalia. It's the whole "women's bodies are a bit crap and pregnancy is a weird alien state and you can only be reassured that you are ok if the patriarchy use their machines on you". It's only recently that we've had dopplers at all and yet now women feel they literally cannot be safe in their pregnancy unless they are regularly used. As if pregnancy can't progress without these machines. This is just a general point I find interesting by the way, not directed at any one in particular or to denigrate anyone's experience.
I've lost two babies between the 12 and 20 week scans. Doesn't seem so rare to me. I would say an appointment at 16 weeks is pretty essential for my peace of mind.
Thanks, Viva, that's interesting. Not sure if she was mistaken or if it's local policy then.
What about the amnio? Is there national age guidelines on when or if it should be offered? Should it have been offered to me at 42?
Oh and I've had 4 babies in 3 different areas and have never seen a MW after my 20wk scan.
NICE just say everyone should be offered screening, Mary. No mention made of routine diagnostic tests for Downs.
vinegar, yes, I am in the UK, in N Ireland. It was a sonographer who did the 20 week scan but all others were by midwife, consultant or GP. GPs equipment wasn't up to the standard of that used in the hospital, it wasn't such a clear picture, and he wasn't looking for abnormalities obviously, it was really just a 30 sec thing to see the heartbeat. Midwives were a bit more thorough, took measurements etc, but nothing on the scale of the 'big' 20 week scan.
Hi OP, me too, told they don't listen to the heartbeat anymore at 16w as it is harder to pick up and would upset women if they couldn't find it. I didn't even get a prod in the tummy. Just tested my wee, BP taken, how you feeling etc. I can feel some movements so I feel ok, but it wasn't really worth the 45 min wait in the wating room let along the time to get there and back.
interesting discussions on this v fast moving thread! tiredem i was m beginning to wonder if my pregnancy brain is making this up bit no defo 10 weeks and defo baby .you can tell bc of their increased heart rate and it was bloody fast! Recorded on phone too.
I herd the heartbeat at 16weeks it was a student midwife that found it and she was very excited. I think ur being a little unfair, she may have asked u less questions as its not ur first pregancy and I know that as I was still being sick at this point it was nice to just go and chat about how crap I felt.
Thanks, hardertokidnap. For some reason I thought my age meant it should have been discussed with me. My friend was offered one at 38 so I thought being 42 it would at least have been mentioned.
I was also denied an epidural as it was my 4th and I'd had the previous 2 without any painkillers at all. I believe this was for cost reasons too.
get your own Doppler if you are that anxious. I got mine off eBay for 30 quid or you can rent for 9.95 a month. the best thing ever for combatting anxiety.
YABU about the appointment. it was only pointless because your bp and urine were ok and you are Generally well. me too. we're lucky, not hard done by.
the chance that anything has gone wrong since 12weeks is very very vry low.
Thanks for all your input...clearly this is a hot topic. I agree with humpty that the anxiety caused by not getting a standard of care which is expected across the rest of the country (eg Doppler at 16 weeks) causes greater anxiety than potentially not finding a hb at 16 weeks with a fraction of the pregnant population. So long as the mw says 'I may not be able to find the hb, are you still happy for me to try' then its up to the individual woman to put herself in the position that apparently isn't that common, where the hb cannot be detected. Babies do die between 12 and 20 weeks. It is fairly commons, there are a few posters on this thread who have experienced this and i know a fair few who have had that dreadful experience as well. I wouldn't mind so much if it was policy across the whole of the uk not to use a Doppler at 16 weeks. what I do mind is feeling I'm missing out because of the area where I live (central Scotland). Ad as for the driving, I am really not worried about driving, I am we'll used to it, what I do mind is driving when I'm pretty busy anyhow, for what felt like a waste of my time. (I know I know, it wasn't a real waste of time)
it is not 'fairly common' for babies to die between 12 and 20 weeks. the overall risk of miscarriage in second trimester is 0.5% so lower if you have no risk factors e.g. previous mc, etc.
I'm currently 19w and get terrible pregnancy anxiety which is why I recommend getting your own Doppler. if they hadn't found the heartbeat you wouldn't have accepted it, you would have demanded a scan as you said in your op.
You are right eccentria but dh worries we won't be able to use it properly so I have to convince him too! Would have been so much simpler if the mw had done it, I would have been relaxed up to my twenty week scan.
tell your DP it's a piece of cake :-) I've been finding it since 16weeks and, while I'm not massive, I'm not super slim either so i do have some excess weight on my belly.
I'm on my phone but when I get on laptop I'll post you a link to the one I got. I use it twice a day and it's really changed things for me, wish I'd had it in previous pregnancy!
j find scans/hb checks only stay reassuring for about a week and then I start worrying again, or something happens like my daughter jumping on my belly! its great to be able to check at home
DH got a doppler when I was pregnant with DS, and he got a huge lecture from the midwife when he mentioned this to her.
Apparently it's fairly common for untrained people to have problems finding baby on their home doppler, and then panic and call the midwives at the hospital.
Midwife said that they recommended keeping an eye on baby movements instead, although I know 16 weeks would be very early to be able to feel anything - I've had anterior placentas for both pregnancies, and never felt any baby kicks before 20 weeks with DC2 (took longer than 20 weeks in first pregnancy) because of that.
I wouldn't tell the midwife!
incidentally I've had anterior placenta both times, first pregnancy felt almost nothing til about 23 weeks, but this time have felt from 17 weeks, don't know why
I also have a home Doppler and along with the newborn breathing alarm is the best peace of mind equipment ever.
We have never had a problem picking up the heartbeat. Also your heartbeat is unlikely to be 158bpm. I think baby's heartbeat is very distinctive from mum's.
I heard the heartbeat at my 16 week scan. My midwife said she wasn't supposed to but as I had been suffering from hyperemesis and had to have blood taken to check my iron and she knew I hated needles she did it as a treat. Said she had been a midwife long enough that she could ignore the rules a bit.
Just to add I am in central london and heartbeat wasn't checked at my 16 week appointment, was told policy not to anymore as cant always be picked up and causes mum's more stress etc why it isn't, similar to other people's experiences. Yes I was a bit disappointed but somehow managed to wait until 20 week scan and then hb has been checked at every appointment since, even at GP.
I know you're feeling let down but if she palpated your uterus she would have been making sure it is the right size for your dates, if it wasn't then she would have sent you for a scan.
As your uterus is the right size for your dates then that in itself is a very good sign that things are going well.
It's not an absolute but as Viva says, even a heard heartbeat isn't a promise that all will be well at 20 weeks, there's a lot we can't have control of.
My MW listened for the h&b at 16 weeks with all my first three babies. Babies 1 and 2 - found it with no problem. When it came to baby 3, she couldn't find it; she did reassure me that this was not unusual at 16 weeks but it was worrying.
Luckily, I was referred for a scan the following morning, squeezed into a probably overstretched EPU clinic as the first patient. The baby had died at around 14 weeks.
With baby 4 (a year later) it was hideously stressful going for that 16 week appointment. When I finally got there, the MW told me that the new policy was not to listen for the hb. I am sorry to say I cried until she gave in .
I accept it can be tricky at 16 weeks but really for the small number of us for whom something has gone wrong after 12 weeks, is it really acceptable to leave it until 20 weeks? Would it really have been better for me to have gone for the anomaly scan to be told it had been over for weeks, that it was now too late for an ERPC and that I would have to go through giving birth to a baby that had died six weeks earlier? I don't get it.
letmefly I'm really sorry to hear that I do agree that they should listen at 16 weeks.
OP this is the Doppler I got - there are lots of them going second hand on Ebay too
I was 16 weeks when I bought it and it sometimes took a few mins to find it. Am now 19 weeks and it's much easier and quicker. However, I've never not been able to find it with the Doppler. Just takes a bit of practice and a bit of hunting at first.
I got it because I thought I might not feel movements til after 20 weeks, as with my daughter, and I couldn't bear to wait that long. It has made pregnancy a much less anxious experience for me.
The main warning I've read is not to use it in later pregnancy instead of counting movements, as that can be falsely reassuring. So once I start feeling proper regular movements, I'm going to sell mine on.
"I wouldn't mind so much if it was policy across the whole of the uk not to use a Doppler at 16 weeks."
The link posted by someone else though said NICE actually don't recommend dopplers at any appointment though. So I don't think you are missing out because of your area, just midwife preference?
I really would get a doppler (does your DH have to agree?!) if you need that much reassurance. It didn't cross my mind I wasn't pregnant between my 12 and 20 week scan (as eccentrica is right, it isn't fairly common for babies to die after 12 weeks, as the sonographer who posted earlier also confirmed) but I can understand why some people need more certainty.
Are the home Dopplers any good? which would peeps recommend?
But it is policy pretty much across the whole of the UK isn't it, if the NICE guidelines say it?
Nothing to do with being in Scotland at all.
The fact that many of us have heard the HB at our 16 week appointments would say otherwise.
With dd I was oblivious to anything bad happening. I didn't even know what a miscarriage was because I'd never thought about one. With DS, after 4 mc's I was very anxious and bought a Doppler and heard his hb everyday from week 11 to 40. Every single day.
This time I've only listened in twice and luckily, her movements are very regular so I'm not anxious at all.
If you really need the reassurance, then I'd buy a Doppler and use it at home. But be warned, you need to fiddle around a lot until you hear a hb and sometimes you may need "reassurance" at 2 or 3am when you can't feel baby move and you'll find the battery dead or something. This causes more grief than good. (Personal experience).
Or rather it's supposed to be policy I meant... I heard mine too, and am in Scotland.
Well I am getting v confused but the poster who posted with the NICE guidelines suggests it is not policy but that most midwives do it anyway. Which suggests that the OP is just unlucky having a midwife who said no.
I had a midwife appointment at 17+2. She tested my urine and listened to mini-me's heartbeat (150 bpm). All seemed normal so I was very happy with that. I'm assuming it varies between areas.
Scotland doesn't use NICE or not always - certainly not for drug decisions anyway..
In Scotland the following organisations perform a similar function to NICE:
The NHS Quality Improvement for Scotland carries out technology appraisals
The Scottish Intercollegiate Guidelines Network (SIGN) provides clinical guidelines
The Scottish Medicines Consortium (SMC) gives immediate advice on new medicines when they become available
letmefly what a horrid situation, I am so sorry you lost a baby and I am so pleased that you went on to have a successful fourth pregnancy (and that the 16 week midwife had a heart).
I have since spoken to a gp friend and a midwife friend, both of whom know the midwife in question with my situation. It was interesting what they said, basically that I'm not the first person to find her manner appalling and that its very much 'her way or no way'. People have moved to other tactics to avoid seeing her. But, apparently she is experienced and her professional judgement is great, so it's a toss up between sacrificing the human approach and the ball ache of going for check ups even further away. As for my astonishment that she wouldn't listen in, they both agreed that 'it causes more stress than manageable when they can't hear a heartbeat', that 'sonographers are already over stretched and do not appreciate having to scan healthy mothers who have been worked into a false state of stress'. But still, I think it's crazy that some mws are happy to do it and some are not, and come on, if so many people can find a baby hb on their own with no experience using a Doppler as early as 11 weeks I find it impossible to understand how an experienced mw cannot. I am still for bringing back the doppler at 16 weeks nationwide.
They couldn't find the HB at my 16 week scan.
They booked me in for another appointment in a week so that they could try again.
I got told if they couldn't find it at the next appointment I would be sent for an emergency scan
It was without doubt one of the worst weeks of my life.
They found the HB at my next appointment, but I honestly wish they hadn't bothered looking for it because what is the point if you then do nothing about it for another week anyway
Well quite. The resources should be made available instantly in situations like yours.
But isn't that the point that your GP friends made though...?That as there is a chance that it won't be found at 16 weeks because it is too early (as in poor jacquelines's case), so unnecessarily stresses out mothers, but sending someone for a reassurance scan would be over-stretching already pressed sonographers.
When I went for a mini-scan (one of those mobile scanners) at the day unit for poss breech, I did think, why don't midwives have those in their offices - money is the reason of course, but if they were able to whip those out for a quick check in the event of uncertainty...
It does sound though like you have got a midwife who maybe doesn't suit you (or other women by the sound of it!). It's such a shame you have so far to drive to find any midwife and that the one you have you don't 'click' with.
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