Would I BU to not have early antenatal care if I get pregnant again? (Miscarriage related)

[Lampoftheday]

I have had three pregnancies. One baby, two missed miscarriages. We are currently planning to TTC again now the grief of the last miscarriage is getting easier.

For the next pregnancy (fingers crossed) I know my mental health is going to be pretty fragile, and the best way to manage it would be to not to get my hopes up too much. And the easiest way to do that is to not be in the NHS system to start with. I would prefer to wait until either I miscarry myself or I feel a baby moving, and if I feel movement then I'd arrange a booking appointment after that. So effectively I'd be out of the system until about 16+ weeks pregnant.

I know this won’t make miscarriage itself less likely. But I really don't want to go through another early booking appointment when I'm trying not to get my hopes up. Being booked in for a 12-week scan would be horrible, especially being in the same clinic I know so well from the last bad news. And if I do miscarry I don’t want to go through EPU again if I can help it, I don’t want to be told that I'm measuring 2 weeks behind dates but we’ll still have to wait and see because you never know. Just, no, none of it.

Also after both miscarriages I’ve had to deal with NHS admin systems not keeping up well with the fact I’ve miscarried, so I’ve had letters and leaflets and phone calls about pregnancies that no longer exist.

So I’m thinking, sod it, next time I’ll just avoid all of that.

Would I be missing out on anything massively important this way? What I can think of is:

• dating at 12-week scan: I track ovulation so I’d know my dates
• NT screening at 12-week scan: would have refused this anyway
• early bloods, blood pressure, urinalysis etc from booking appointment: I’m generally fit and healthy and I doubt it’s changed much since last booking appointment
• getting told about folic acid, not drinking or shooting up heroin and so on: I know all this
• miscarriage complications or possible ectopic: I would give in and phone EPU in that case.

I know there are people who don’t find out they’re pregnant until 4 months anyway and the maternity system manages that fine. So presumably they could slot me in too if I said “oh I did know, I just didn’t say anything until now”? Is it unusual enough that they would be worried about me? Would dates be a hassle if I don't have an 'official' dating scan?

It's up to you. I did similar and had my booking in at 17 weeks. I did have private scans at 8week, 10weeks and 13 weeks though.

Hi OP. I had a very similar situation to you. I DC followed by 2 mmc. When I did get pregnant again I had massive anxieties around the hospital and attending clinics and scans which was one of the main reasons for booking a home birth at 30 weeks. So I do understand your concerns.

However, bear in mind you may not start feeling movements till much later. I was actually 20 weeks with my last pregnancy, which could lead to you missing your anamoly scan. Also, if you miss your dating scan this could mask future problems such as if baby is growing small for any reason.

Personally I needed the scans to reassure me, even though I remained anxious throughout. Good luck with whatever you decide

Yanbu, of course. It's an offer of care only.

However, if you leave it to 16 weeks, they may class you as a "late booker" , which can be a safeguarding concern. (I know!)

I'd consider having my booking appointment, and then telling the midwife I wanted no interventions, scans etc, and didn't consent to all the chat, that this is merely informative that you are pregnant.

But if you want to keep it to yourself, do. As you've had the bloods etc recently, the risks are likely low of doing this. But be aware you may get some intrusion via visits and maybe a social work call. They'll quickly NFA it, but late booking is a flag.

I was in exactly your situation op. I totally get it.

In the end I waited until I got to 12 weeks and then insisted on a scan to be done before I saw the midwife to avoid getting my hopes up. If you see a hb at this point the likelihood of miscarriage becomes much lower (1 or 2pc I think) so from that point on I felt comfortable being ‘in the system’ although my anxiety didn’t go away throughout my pregnancy really

Good luck. Pregnancy after miscarriages is tough

YANBU -It really is your decision. The only things Id add to your list of considerations are the possibility of having to have a later termination if the foetus is found to have a condition like anacephaly that is incompatible with life (not that you have to terminate in these circumstances obviously) and possible complications from late(r) diagnosis of a molar pregnancy.

Wishing you all the best with whatever decision you make.

Sorry for your losses OP.. I had an ectopic pregnancy at 9 weeks and emergency surgery where the tube ruptured as they were doing it.. if you do stay out of the system please get checked out at any sign of anything out of the ordinary (I didn’t have all of the usual symptoms either of an ectopic -no bleeding, no shoulder pain etc -just a few sharp pains) my successful pregnancy afterwards was fraught with anxiety and I coped by getting early scans but to each their own.. I am also healthy but in pregnancy have to have blood pressure medication from second trimester but you could monitor your pressure with a home machine if that was a concern.. I’m not trying to make you anxious and hopefully your next pregnancy progresses beautifully but please get seen at the first opportunity if you feel anything even slightly amiss.. wishing you luck 💐

I can understand your perspective.
However I think that anyone who opts our of the free and excellent care we receive is a bit daft. Pregancy is a natural and normal process but things can go wrong. I have friends who have lost Fallopian tubes due to late diagnosis of ectopic pregnancies. This is a horrible thing to think about, but if it was a pregnancy that was not compatible with life (would result in still birth) would you not rather have the chance to terminate at 12 weeks rather than carrying to full term or having a late (post 20 week) termination?

I think it’s fine, though I wouldn’t miss the 20 week anomaly scan as babies lives are saved through interventions planned following these scans. The main risk seems to be an undiagnosed ectopic pregnancy - but I’m not sure routine midwife care would pick this up?

Pregancy is a natural and normal process but things can go wrong.

Yes, that's not exactly news to me!

For the others: thank you, this is helpful. I might be okay with getting a scan after 12 weeks before seeing a midwife & having booking appointment stuff as you did @Purpleraindeer. I'm not sure how well the system here would handle that but it might be worth a try.

I don't know if there's a way to have a booking appointment without all the tests, bloods, chat about future antenatal care etc. I did try and avoid some of the discussion last time but the midwife said she had to tick off everything on her list that she needed to inform me about.

Earlier scans sadly not reassuring for me - last m/c was after a heartbeat and all looking fine at previous scan, sigh.

I’m sorry for your loss
I had a Mc at 12 weeks and then accidentally got pg 1 week later.
I did go to see my GP for reassurance but then I refused to have my bloods etc done again until I was around 14 weeks.
She’s 13 now so it worked out ok!
Best of luck x

At my booking appointment I said I wasn't ready yet to talk about future (pregnancy after 3 miscarriages) and the midwife completely respected that. I did have the blood tests, so perhaps she would have questioned that - but then you always have the right to refuse any testing, so they can't insist.

To be honest, I can't see any disadvantage to waiting to book in until, say, 14 weeks and getting a scan then. People get really excited/fixated on booking in, but for me it also felt mad to have an appointment where they'd talk about me having a baby but not actually do anything to check if I was.

I do think the movement plan might be problematic, though - what if you don't feel any until 20+ weeks? I know people commonly feel earlier in subsequent pregnancies, but if you had an anterior placenta it wouldn't be at all unusual to be a long way past 20 weeks. BUT I also don't think that's a decision you have to make now - you can wait and see how you feel in the situation, rather than as a hypothetical. You might find it's actually much harder to go that long without a scan, or you may find it's working well for you. I told myself I wouldn't get attached to my third pregnancy and failed miserably.

That's true I suppose. I had an anterior placenta with my full-term pregnancy and still felt movement fairly early (14 weeks I think). So was assuming it would be around then subsequently, but of course it might not work out like that. Wouldn't want to go as far as 20 weeks and risk missing out on anomaly scan.

It's completely up to you but although I understand where you coming if posters are correct about you being considered a "late booker" if you wait until 16 weeks, perhaps wait until you are 14 weeks? I know how you feel though as I had three miscarriages after my first child. With my final (successful) pregnancy I booked into a different hospital so that I didn't have to visit the same antenatal clinic. I also didn't tell anyone until I was about 19 weeks and although people noticed (they later told me), it meant I didn't have to have any pregnancy discussions which made things easier.

Forgot to say, as well as booking at a different hospital, I also had consultant-led care which meant I didn't have the same "booking in" experience with a midwife. A nurse did the bloods etc but I don't remember anyone chatting to me about antenatal care etc at that point.

Sorry for your losses OP .

I understand how you feel. I had two MMC last year, the last one was only discovered at the 12 week scan. I was absolutely terrified during this pregnancy the same would happen again, in fact i was convinced by the time I had the scan that it already had gone wrong. However I was happily surprised and saw a thumping heartbeat. I’m almost 15 weeks now and so far, so good. I also wanted to hold off on the scan and booking in appointment for as long as possible, tbh I felt like I was wasting everyone’s time going but I also knew given my history of MMC and almost dying during the first one, it was important for my health that I got checked out. My body doesn’t miscarry naturally for whatever reason so all that would have happened is I eventually would have had some spotting which would have required me going for a scan and needing surgery anyway. It made more sense to attend the 12 week scan.

It’s completely up to you but I wouldn’t risk it personally. Good luck.

YANBU, my friend didn't get booked in until around 21 weeks. I'd be tempted to do it your way next time and I didn't even have any problems in pregnancy.

Of course it's entirely your choice. But urine infections are a cause of miscarriage, and if you opt out of all antenatal care, you may have an asymptomatic one which gets missed. I am only saying this because it wasn't in your list, and if you wanted to, maybe you could ask your GP to send off a urine sample for you instead.

At our trust we have many women who are late bookers for all sorts of reasons, it isn't an automatic safeguarding concern. You might be asked why but if you explained what you have here that wouldn't be a problem.

Forgot to say, hope everything goes well for you

Just to add another perspective - one of the reasons for the 12 week scan is to determine the number of feutuses. The antenatal care for a multiple birth pregnancy can be very different to that of a singleton (and in some cases life saving). Good luck with whatever you decide x

With my last pregnancy I told the GP around 6 weeks who booked me in for the 20 week scan. I was contacted by the hospital and offered a 12 week scan but I wasn't interested in either dating the pregnancy or the nuchal tests. I did have an IM who I saw from 8 weeks or so, but no bloods. Obviously had there been any indication that I needed more care or scans then I would have gone for them but at every point we discussed what the outcome would be, what information would affect what I did, and went from there. I'd had a shit time within the NHS due to lack of informed consent and this was my way of dealing with that.