To wonder why pregnant women don't get more routine scans

[Sarahh2014]

I had a difficult pregnancy with scans at 8w 10 12 20 24 28 32.All was fine in the end but I often think that 2 scans might be enough to measure growth but a lot of people get anxious before their first and even second scans as a lot can happen in that time.Does anyone know why this doesn't happen? Is it because of cost? Genuinely wondering

Because the evidence is that for normal pregnancies, there is no reason to - ie. more scans doesn't save more babies, so why waste the money.

This is obviously different where indicated (eg. I had an extra scan because I was VBAC, and an older mother)

Because it isn't cost effective and the costs/risks outweigh the benefits in a healthy, low risk pregnancy. Basically, there's no advantage in a healthy, low risk pregnancy to routine scans. Babies don't get heart problems or kidney problems, etc. randomly one week and not another. If there is an anomaly, it is picked up at the 12 or 20 week scan. It doesn't usually just magically appear some other random time and when problems do crop up at other times, they have other symptoms - heart rate abnormalities, changes in movement patterns, manifest in symptoms for mum, etc. There's no reason to have a scan to check baby's heart rate, growth, movement or positioning in most cases. These can be checked perfectly well in a normal midwife exam. If they are monitoring something specific, it can be helpful. But there's no added benefit to just checking for the sake of checking.

But there can be costs and risks. For instance, costs to mum to have to take off work to attend hospital scans. Not everyone gets paid time off for appts. I'm self-employed, so I don't. It's lost income and I have to work extra hours in the evening. I'm with a midwife team where all appts are done at home, so midwife comes to my house and does everything. It's only 20 minutes out of my work day, which isn't a big deal. But driving to the hospital is 30 minutes each way, plus probably an hour waiting for scan/having it. I wouldn't want to do that and would be declining them. But then there's also costs to the NHS. There's no reason to be spending money when it doesn't improve health outcomes. That money is better spent on other things than people just wanting to have a look at their babies. Like better continuity of care in midwifery, or improvements to SCBU services for babies who are born poorly and need extra care, etc.

But then there is also the risk of unnecessary intervention. If scans happen at every appt, then there is a greater chance of seeing 'something' that isn't really anything (and wasn't picked up at 12 or 20 week scan), but then intervening on it nonetheless. Some of these unnecessary interventions can produce more harm than good on healthy mums and babies. You see this in the U.S. where routine scans are more the norm (as are other interventions we don't do routinely in the UK). It's part of the reason the U.S. has the worst outcomes in maternal and infant death and illness in the developed world (lack of universal health care and poverty being factors as well, of course). More care isn't always better and the NHS has really strict processes for determining based on the available evidence base what care to offer broadly and what care to reserve only when risk necessitates it.

It isn’t just the medical cost of the scans to take into account either - the law states reasonable time off for pregnancy related appointments, but it would cost the economy a bit insignificant amount in lost working hours if all pregnant women suddenly started having loads more appointments.

Given that the UK's rate of stillbirth is one of the highest in the developed world, I wish they would offer another routine scan around 36 weeks (to check things like placenta, fluid etc). I do appreciate that the NHS is being run into the ground though and there just aren't the resources. It's a shame you can't pay the NHS directly for an extra scan, as it's annoying having to pay so much to private companies who will just take your money then send you back to the NHS if there's a problem.

There have been research/reports that adding Doppler scans to the current routine scanning schedule with perhaps one additional scan in later pregnancy (around 32 weeks I believe) could reduce the rate of stillbirth significantly.

I was scanned every 4 weeks with DS due to concerns regarding the placenta and Doppler scans were carried out. If I have another baby I will definitely pay for Doppler scans to be done privately.

Rates of stillbirth in the UK are high compared to comparable countries, there must be a reason why? What do we do differently?

www.bbc.co.uk/news/health-29367001

@LisaSimpsonsbff Your conclusions are not consistent with the research in the Midwifery Today article I posted. It is not about scaring people, it is about understanding if real safety testing has been done and the research quoted in that article does not support multiple scans in pregnancies that are not high risk. The tone of the article is very much that there is no evidence that outside of clinically high risk pregnancies that the scans affect outcomes. Coupled with the fact that is also an absence of evidence that the scans do not pose a risk, whatever level that risk might be. There is an assumption that the scans are safe but medical interventions should be based on continually reviewed evidence, not assumptions.

weepingangel12 not everyone can afford private unfortunately

Had my babies in the 80s, 6 years apart and in 2 different areas of the country. I had no scans as neither hospital offered them unless there could be an issue with the pregnancy.

i only had a 12 week scan though the nhs, my family chipped in and paid for me to get a gender scan. i was told by my widwife the nhs only offer the 12 week scan although people i know had a few scans and no problems with pregnancy.

I’ve had an insane amount of scans already this pregnancy at 6, 7, 8, 12, 13, 16 weeks, due to bleeding. While it is very reassuring to see the baby is ok in there it is a very fleeting relief - a scan is no guarantee that things won’t go wrong in the future, even the almost immediate future. Like an exam result, it’s only an indication of how things are going at one precise moment in time.

Anomaly scans are obviously absolutely necessary, I’m not disputing that. I’m just saying that reassurance scans aren’t necessarily all that reassuring. For me, feeling my baby move (she’s nearly 18 weeks, I can feel her now!) is much more reassuring.

Cost and convenience primarily also for most people it just isn’t medically necessary to have multiple scans.
If you are anxious then no amount of scans is really going to make you less so. I know I could have had one a week and still worried myself sick in between!
There is extra surveillance when it’s medically appropriate but in the same way you don’t keep doing bloods all the way through a pregnancy you don’t need to keep doing scans.
It would be interesting to look at the stillbirth rates and see how many of those were for ‘complex’ vs ‘simple’ pregnancies. If there is evidence that the still birth rate could be reduced by adding a scan for all pregnancies at 36 weeks then of course if should be explored but I’m not sure if that evidence is there?

I live abroad and we get 8 free scans per pregnancy. Your pregnancy is also overseen by a gynocologist rather than a midwife.

My first 2 were born in the UK with midwife led care and to be honest I much preferred the relationship i had with midwives to having to schlep to the gynocologist to wait for ages to get in just to get another scan and internal exam which I never had in the Uk. I don't feel more reassured by the care here than by what i had in the Uk.

Child benefit is also dependent on attending these appointments so you can't opt out.

inamum21 that’s not true all Trusts offer the 12 week dating scan and 20 week abnormally scan. Of the two the 20 week one is vital which ever HCP told you otherwise is misinformed.

In a typically "normal" pregnancy, loads of scans just aren't necessary. I'm having extra this time around because my last baby was very big and very stuck and no one knew until I was whisked off for an emergency cesearen and they still had to use forceps to try and wiggle him out. An extra scan or two might have prevented that, who knows. I think a growth scan or something between 20 weeks scan and due date at least once would be great, but I guess it's not cost effective and isnt required in most circumstances.

Rainbows - that article highlighted one of the reason's my first child was stillborn. The fetal monitoring unit didn't take my concerns seriously enough. eg 'You are low risk, you are being too anxious because you had fertility treatment.' That was 13 years ago so hopefully things are getting better now.

Gamerwidow, most unexpected stillbirths occur in what appear to be low risk pregnancies. The most common reason for an unexpected stillbirth is placental problems that were not known about.

Whilst I'd be the first to agree that the Tories are screwing the NHS into oblivion, I had my first dc in 2006 and you got 2 routine scans then too.
I understood that a lot of countries do a third scan and there's some evidence that this can pick up problems that aren't apparent at 20 weeks or have developed after that so that could be worth making routine. Most 20 week scans aren't going to pick up an anomoly but we still have them so the 'not necessary in a healthy pregnancy' argument doesn't hold up well.

Money.

Women should be offered a scan later in pregnancy to confirm placental co diction, baby position and fluid volume.

Doing this as many other countries do would slash our awful still birth rate.

Forgive Given that that article argues against a routine 20 week anomaly scan, it isn't 'my conclusion' that it's wrong, it's the conclusion of the NHS and almost all developed nations. I also immediately distrusted this article when it said this:

By following up on children at age eight or nine born of mothers who had taken part in two controlled trials of routine ultrasound in pregnancy, they were able to show that routine ultrasonography was associated with a symptom of possible neurological problems.

I happen to know that in the study they're referring to the 'symptom of possible neurological problems' was that the scanned babies were more likely to be left-handed (which is such an odd finding that most doctors consider it coincidence). Most people reading it won't, and will imagine something much more worrying. That's scaremongering, and doesn't instill much confidence in the author.

It costs around £50 to get a private scan.. if no clinical need, suggest people just pay for this if they really need it.

If there is a clinical need, the NHS will provide.. I had a difficult pregnancy so had an NHS scan at 7 weeks, 12 weeks, 20 weeks, 28 weeks and then a couple towards the end I think.

According to the article above just adding a Doppler scan to the current 12 and 20 week scans could reduce rates of stillbirth by as much as 50%.

I think there should be a further scan at 32-36 weeks personally but I'm not sure why Doppler scans aren't routine as part of the current routine schedule?

I'm so sorry that happened to you, and for the loss of your baby, spikey

I've been consultant led for my last two pregnancies and both consultants have made mention that there should be a scan at around 36wks as standard to check position, size, placenta, etc. I don't know if it's something that is currently being researched?

DC2 was a missed breech, was also wrapped up in her cord and had barely any amniotic fluid so I had an EMCS. DC3 was meant to be a VBAC so I was given a positioning and growth scan at 36wks which found he was also breech even though on palpitation they thought he was head down. DC4 was a high transverse, not picked up until a scan at 36wks. Prior to that the MW swore blind she was head down even though I was reporting rib pain and lack of kicks.

I don't see a great deal of benefit in early scans for everyone but do in a universal scan at 36wks.

sunshine I have a vague notion that the doppler scan requires a different machine to the normal ultrasound. So I imagine that's a cost thing.

Shouldaknownbetter - around here you can't get the private scans for less than £89 .