Should I see the midwife before 12 week scan?

[lucielooo]

I'm a bit confused about my antenatal appointments at the moment! I had an appt with my GBP at 8 weeks where she took height/weight/bp and sent me for bloodtests for stds/blood type/rhesus and gave me the contact numbers for my named midwife.

Looking at the leaflets she gave me the midwife is supposed to contact me to make an appointment but I haven't heard anything and neither of the contact numbers the GP gave me for her work

I've had my date through for 12 week scan so not sure if this means my midwife is aware of me and has arranged it or if my gp did it.

Anyway, I phoned the surgery today to get an alternative contact number for the midwife and they said they could book me an appointment with her as she did them all at the surgery on wednesday afternoons. Anyway, according to the surgery it doesn't need to be before my 12 week scan - but I thought it did? I haven't done the medical history bit with the midwife or anything yet - and aren't there some tests that I need to decide if I want doing? I won't see her till 13 weeks if I go with the appointment the surgery offered me?

I know it varies in different areas.. I'm in Chelmsford (Mid Essex trust)

If it doesn't matter, I'm really not bothered but none of it seems to match up with what their info leaflet says!!

Generally you have a 'booking appointment' with your MW prior to your first scan. I had one at about 8 or 9 weeks (had to wait about 3 weeks till she was free!). It took roughly and hour and we went over everything from my health to whether I had had any previous pregnancies etc.

However, there doesn't seem to be one standard way of doing things throughout the country. I see my midwife at my local surgery rather than at a hospital. She, too, does Wednesdays and so far the only reason I have had to go to the hospital has been for scans and one blood test.

They obviously do things slightly differently at your surgery. If you are concerned, they should be able to provide you with a number for a midwife so you can at least have a chat on the phone.

You do need to decide about certain tests, you are right. If I was in your shoes, I would call the surgery again and ask for a midwife to call me back. Or failing that, call the hospital and ask to be put through to the maternity ward to speak to one of teh members of staff there.

Thanks daisystone - They seem to do half what is covered in the booking appt with the GP (I did go through all the stuff about previous pregnancies etc) and then half with the midwife (family history etc)

Think I will speak to the surgery again and see if I can actually get a number that works for the midwife and see what she says..! It's only really in terms of these extra tests that I think it matters, but I'm not sure what they are anyway.. Probably because I haven't seent the midwife!!

Thank you!

No problem.

The first scan is the dating scan just to check how far along you are and to see if you are expecting twins (or more!).

However, I think it is standard to have the nuchal scan at the same time which assesses your baby's risk of Down's Syndrome along with any other chromosomal abnormalities.

Again, you may not be having your nuchal scan at this point, but I would want to know before I went! I agree, it is best to call your surgery again.

Thanks Daisy I think you have to have the nuchal scan quite early to be accurate (if it's the one I'm thinking of)

Unless they're just not bothering with that bit because they think I'm low risk? GP did say I was low risk because I'm 29??

you should still get the nuchal scan though. Most places only do two scans and the first scan includes the nuchal scan. Maybe you get three scans and your nuchal scan is a couple of weeks later???

These are things they should tell you really. Crazy that they expect you to guess!
Give them a call.

Will do!

Thanks again daisystone :)

I had my booking in appointment after my scan. I don't think it's a problem.

Ive got my booking in scan on wednesday at 12 weeks then first scan at 12+6 next tues. I too thought this was late, all changed since my first pregnancy.

Seems quite common then!

So am I right in thinking that you have to request the nuchal fold test from your midwife if you want it? And that this is usually carried out at the 12 week scan? or have I got the wrong end of the stick?!

no! yes the nuchal scan is usually carried out at the 12 week scan but they are supposed to cover this off with you first and ask if you want all the tests - you have blood tests done at the same time (at least I did).

Not everyone wants the test to check for Down's etc because there is a very slight risk of miscarriage and some people don't want to know as it will not affect their decision as to whether to terminate or not.

The Midwife is supposed to discuss with you prior to the nuchal test so that you can make an informed decision

Aha, that's what I thought..

So how on earth does that happen if you haven't seen the midwife!

Tell you what it's very confusing this pregnancy lark!!

off to phone surgery again as originally planned
:)

Spoke to surgery again, and got the midwifes number - Yes I do need to see them for booking appointment before my scan so need to go to antenatal dept at hospital this Saturday (all the community midwives are on holiday/booked otherwise they'd come to the house.)

All sorted now!

Thanks for your help :)

Glad you're sorted - I had my scan at the hospital at 13+4, that was at 9.30am and booking in appointment was at 10am

haha Flisspaps - I suppose ultimately whatever order they do it in it doesn't change anything! Just bizarre that it's so different from one place to another.

Can anyone tell it's my first pregnancy.. by the time I'm on number ten I shan't give a monkeys!

you are very lucky if you get a nuchal scan on NHS !! I've just had to fork out £200 for mine mind you North Somerset PCT is in dire straits so have to save money somewhere along the line!!

Wow £200!
Pretty sure I get it at the same time as the 12 week as checked my paperwork when I got home and it refers to both.

Amazing how much it differs in different areas..

I turned up for my scan having not been booked in with midwife and they tried to send me away as they couldn't give me nuchal without someone explaining implications of the results first! Thankfully they found a midwife to run through it with me so I got the scan. They booked me in at the hospital too and were lovely, then the midwife was pissy with me for having some notes done when I met her as she had stuck some stickers on some already to give me!

Daisystone you are wrong if you are saying the nuchal scan has a slight risk of miscarriage - I think that's what you said? There is no risk attached to the nuchal scan at all, it's just a measurement / observations taking during the scan and combined with blood test results.
Amnios and cvs tests do carry a risk.

Thanks PrivetDancer... good to know that all seems to right now. Would be a nightmare getting there for long awaited scan only to be turned away!

Not so good about pissy midwife though! I am really hoping that when I finally meet my midwife she is nice!

Privet - yes that is right, what I should have written was that they are supposed to explain to you about the nuchal test and what it is for and that if they find that you are at increased risk they can do further test and it is these tests that carry a slight risk of miscarriage.

Really my point was that a midwife is supposed to cover this off with you before sending you for a scan as not everyone wants to know if they are at risk. Personally I did, but I have spoken to women who have turned down the option of having it.

My nuchal scan was covered by the NHS, can't belive you had to pay!

Pah, imagine a nuchal scan being covered by the NHS? Lucky you, daisystone. It's not covered in Scotland, not in my area at least.

Or, just a thought - is there a chance the sonographer just takes the nuchal fold measurement as part of the 'normal' 12-week scan and not mention anything if it all seems okay?

Or would you know if you were getting a nuchal scan? Sorry, probably a 'duh' question!

So what does the nuchal scan involve? Is it just measuring the nuchal fold? If it is I'm surprised it isn't done at the 12 week scan (if requested) as how does that incur any extra costs?

Here is some info on nuchal scan:

This is a collection of fluid under the skin at the back of a baby's neck. It can be measured using ultrasound when your baby is between 11 weeks and 13 weeks plus six days old. All babies have some fluid, but many babies with Down's syndrome have an increased amount (Snijders et al 1998: 351, 343-6).

A nuchal translucency (NT) scan is a screening test which assesses whether your baby is likely to have Down's syndrome. A screening test can only estimate the risk of your baby having Down's, whereas a diagnostic test, such as CVS or amniocentesis will give you a definite diagnosis (but also carries a small risk of miscarriage).

The NT scan can't tell for certain whether your baby is affected. However, it can help you decide whether or not to have a diagnostic test.

Different parts of the country do different tests. Some do blood tests at the same time, some just do the scan. My understanding is that it depends which hospital you go to as to the exact combination of tests that you get.

Just so you know, the nuchal fold test is a lot more complicated than the usual 12 week dating scan. The dating scan (the actual scanning part - as opposed to showing parents) takes about 5 mins usually. The nuchal can take up to an hour or so although this time includes getting Mum to walk around/drink/eat/jump up and down etc etc. It is because the position baby needs to be in is so precise that you cant just measure the nuchal fold wherever the baby is lying. The ability to get an accurate measurement is hugely effected by BMI/position of baby/how full your bladder is etc etc. Anyway, the nuchal therefore incurs a massive increase in cost, not including the extra bloods, pathology, calculating the risk and mw counselling time. Lots of NHS hospitals do not yet have this service in place although it is getting more and more wide spread.

And don't forget that although more accurate than bloods alone the nuchal still only gives you a risk for Down's. Hence why the mw counselling prior is so important - you have to decide what you'd do if your risk cme back as 'high' - what is 'high'risk to you? and would you have an invasive test to get a definate answer.

Sorry for all the waffle, hope the info helps? I hope your scan goes well

Thanks MrsS that's interesting to know and certainly makes sense. I'm not 100% sure whether I think it's necessary, so I guess it's a good thing I am seeing the midwife.