Scan during labour or rather lack of

[waxingsatirical]

I don't understand why an ultrasound is not standard procedure during labour. Wouldn't this be able to spot possible complications such as cord around neck or bad positioning?

Our first was born with his cord around his neck and shoulder, luckily not just neck and there were no complications. I can't help but suspect that this slowed down the labour though.

Wouldn't this has shown up on an altrasound performed after engagement? Then we could have elected for c section.

I've also heard about cases with limbs coming out first which could be avoided.

We have another one on the way so please put my mind at ease.

By no means an expert but I believe the cord being around the neck is quite common and easily sorted in most cases? (I.E midwife unwraps the cord).

I remember my midwife checking the presentation on the baby at all appointments towards the end by feeling the bump. At my 40 week appointment she wasn't sure of presentation so sent me for a scan to double check definitely head down.

Therefore if there is no confusion a scan wouldn't be necessary? That's why I assume they don't do one as standard anyway.

A scan during labour would be pointless as the situation can change rapidly so what you think you know from the scan and what is actually happening are two very different things.
I've never had a full term natural delivery but my dm has had four and we were all born with the cord around our necks and it wasn't an issue. She's had labour's that lasted a few hours and others that have been much longer so it just depends as to how long labour will last. I cant imagine the cord being around the neck is really going to extend labour by very much - maybe a few minutes while the midwife moves it out of the way

I did actually have a scan during labour. Our daughter was back to back and they wanted to check if she had rotated - the scan showed she had, but only sideways, so half a rotation so to speak. So just to reassure you that they will do one if they think it’s needed.

Roughly 1/3 of babies are born with the chord around their neck, it’s normal and in the vast majority or cases isn’t a problem.

I don’t think we should turn birth into any more of a medical procedure than it already is.

The ultrasound would also be another instance where the labouring woman would need to be still and on her back, something that doesn’t really aid natural birth.

A nuchal cord is rarely an issue, it’s very common and 99 times out of a 100 the midwife just unwraps it at birth. It really isn’t the kind of emergency a lot of people think it is. I think because something around the neck has such strong consequences extra utero the same kind of logic is applied when it happens in utero and it isn’t the same. Your section rates would skyrocket for no benefit if that became a reason for operative birth. That’s a big op for a woman who doesn’t need it (and I include physical/emotional reasons as a need).

Same with positions, often USS will be used to check breech/cephalic positioning prior to induction - good practice to identify if it’s a head or a bum prior to forcing Labour to start. Breech birth is associated with better outcomes if Labour starts naturally. So IOL would not be recommending if baby was breech.

OP positioning, babies are born in op (back to back) position all the time, it’s not a problem, yea labours can take longer and epidural is more likely to be required due to the associated back ache but it’s not a positioning that precludes vaginal birth if that’s your aim.

Dc1 was born with the cord round his neck and dc2 was back to back. Neither had any problems during birth. I had an ultrasound during labour with dc5. I think they thought he might be breech (he wasn't) but I'm not sure as I was fairly out of it by that point.

I’m a midwife...a cord around the neck is very, very rarely an issue. The ones that are an issue would be picked up by detecting a drop in the fetal heart following contractions and would probably end up sections due to concerns over the heart rate.

Mobile scanners aren’t good enough to pick up cords....the picture quality isn’t good enough compared to the big, static scanners. We can’t when every labouring woman down to the sonography dept.

Any limb presentation would be picked up by the midwife on vaginal examination. Ditto with most malpositions ...though most babies will rotate to a better one during labour. An OP baby will often rotate to OA. A baby who starts off with a bit of a face presentation will flex better as labour progresses.

So no, it’s not needed. The best thing is what already happens, keeping an eye on progress and if progress slows working out why and if anything needs to be done or can wait and see.

I had a scan in labour with my dd3 when they noticed it was her bum crowning rather than her head.

I wish I’d had a scan so we’d known DS was OP- I’d have availed myself of an epidural instead of getting to the point where by the time I asked for one it was too late, and going through all that agony with just gas & air.

ok thanks for your input. I thought that cord around neck was a serious issue. My son did not breath straight away when he came out and I assumed this was because of the cord, but I guess unrelated.

My baby's heartbeat went just as he was born, because the cord was 3 times around the neck. Thankfully he was fine, started breathing as soon as he was born and cord removed. Of course, I was traumatised and asked the midwife this question- why don't we scan all women in labour?

so she said it would actually be misleading- ie. the cord can sometimes slip down in the last minute, so it wouldn't have been seen on a scan earlier. Babies move a lot in labour so unless you are constantly being scanned, there is no real way of knowing what is going on in there...