Why aren't ultrasounds used when women start labouring in hospital?(8 Posts)
We all hear stories of babies in the wrong position, head too large for mothers pelvis, cord around neck, etc etc - mostly not discovered till the poor mother has been trying to no avail and then everything ends up panicked and/or in an emergency c section.
So, why oh why, doesn't the NHS just scan all women that come into hospital in labour? All the information would be right there on the screen!
It wouldn't be helpful for most
Cord around neck very common and doesn't cause an issue for most babies
'wonky pelvis' can't be diagnosed ahead because the joints in the pelvis move a bit during birth.
It would pick up a breech, yes.
What do you been by 'bad position'? Most babies come out in the end - knowing the position is less than ideal would cause more anxiety for the mum and possible increase in unnecessary interventions.
The only thing that would be picked up is breech, which should be picked up by palpating anyway. Though Ido know a hospital which does do admission scans with a portable scanner on the labour ward to check for breech.
But they don't look for anything else, for one thing the quality of the portable scanners is fairly crap, not sure you'd be able to see a cord round the neck. As already said cord round the neck aren't usually a problem. You wouldn't be able to tell if a head was too big for a pelvis at all. Normally whether the head will fit or not depends on how much the baby flexes its head as it descends and this will change throughout labour.
They used one on me, after ARM and just before CS
well mine was in a crappy position but if I'd stayed positive (and avoided pethedine and been in better positions) he could have moved. He didn't but he could have
If I had had the added worry of knowing that he was in that position I would have had more adrenaline and less good labour hormones and been less able to handle the contractions etc etc.. cascade of interventions blah blah blah
I'm going to try to stay happier and clamer this time so would NOT need to be told if the baby wasn't in the right posiiton yet as that negativity could lead to another cascade of interventions which could result in the baby not turning again IYKWIM
As previous posters have said: scan would show breech or transverse baby but little else to rely on. Baby size at term by uss is notoriously innaccurate.
Whether a baby will come out the way it went in is determined by many factors which can all change during the process of labour.
:As said before, the pregnant pelvis is mobile and has the capacity to shift to allow the baby out. This is enhanced by mother's mobility allowing subtle pelvic adjustments and and not sitting or lying in one position which prevents the bones moving.this is where the birth ball, walking, stairs, squatting, lunging etc comes in.
:The pelvic floor has a role in guiding the baby's head into an OA position for exit. It works best aided by gravity and not paralysed by an epidural.
The contractions need to be well co-ordinated and powerful for best effect.
:Good contractions work wonders in an unpromising situation. Spontaneous labour is most likely to deliver this. You can promote this by not allowing yourself to get exhausted, dehydrated or overwrought in the latent phase. Oxytocin release is enhanced by privacy, feeling loved and cared for, darkness. Keeping your bladder and bowel empty also helps, so regular toilet trips.
:The baby also plays a role. Their heads have a degree of bendiness to help them fit through the pelvis (moulding). And a well, mature baby with good muscle tone makes little movements to help itself adapt to its path.
The longer i am a midwife, the less I make predictions about who will have a straightforward vaginal birth and who will need help. I try to supply the conditions for best outcome but I'm humble about my limitations. Thankfully in this country I am encouraged to promote normal birth but I have rapid access to obstetricians where the path is not straightforward.
A midwife was able to tell me by va after I got to hospital (I'd been contracting at 5 to 3 minutes for 12 hours and in was only 2cm) that dd1 was op. She was born op by ventouse after 37 hours of labour.
Scan wouldnt have told me anything didn't know. And I didn't have a baby who was breech or transverse - surely any experienced midwife could tell?
You're putting an awful lot of faith in the accuracy of an ultrasound there, OP!
Cords around neck - rarely an issue. And the times when it might be a problem wouldn't be obvious until well into the labour anyway.
Malposition - plenty of babies come out quite happily even in the 'wrong' position, and position changes massively throughout labour anyway.
Head 'too big' - a head that's genuinely too large to fit through a pelvis (quite rare tbh) would be unlikely to engage in the first place - you can feel that easily on abdominal palpation.
Scanning every woman as they come into hospital = just a hell of a lot more unnecessary c-sections!
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