Thoughts after first antenatal clinic appointment

[nomoreheels]

Hi all, I'm new to this board but have been reading up loads with great interest. I'm 9 +6, 35 yrs old and this is my first pregnancy.

I had my first antenatal appointment at the hospital I've chosen yesterday. I was already familiar with their EPU as I had some spotting/cramping in week 6 that I got checked out. I was offered a vaginal scan as my hormone levels were high, which showed a baby with a heartbeat and that for now, everything was as it should be. I was very happy with the staff and the way I was treated, so I was looking forward to coming back for my first antenatal clinic appt.

Yesterday ended up being very stressful for us though - just wondered how other people's experiences were, especially when you were very new to all of this.

My issues were:

I was given masses of forms and the standard green maternity booklet to fill out on arrival. I did what I could in 20 minutes but was interrupted by a midwife who wanted to sign me up for some research. When I went through, I was told off for not filling it out enough. !! Not a huge deal but it seemed like the research staff and the working team were not communicating.

I was greeted by a student midwife in the waiting area. When I asked if my DP should come along (he was next to me as well) she leaned over and whispered loudly "IF YOU WANT!" It made us feel a bit weird and I guessed that he wasn't meant to come in, so he stayed out with his book. But when I went through and met the midwife who would be supervising, she asked where is your DP - they all come in!

We started the consultation, which was led by the student and was ok until we got to the domestic violence question. The student midwife did not seem to believe me when I said I had a good relationship and that there was definitely no violence at home. She asked me twice "Are you sure?" in quite a pushy way. (I've noted from other threads that some people's midwives skimmed over this issue, this was the opposite! I even saw the midwife shaking her head a bit.) I think she had good intentions, but it wasn't handled very well and made me wonder if she had decided she didn't like the look of my partner for some reason. He was a bit grumpy looking I guess... But it was 8:30 AM!

We then discussed booking the dating scan, at which point the midwife asked if I would be testing for Downs. I had not been sent any info leaflets with my appointment letter so I thought I would be getting information at today's appointment and could make a decision later, but she said "We're too busy here, you must decide today whether to book it in at the same time as your dating scan, which we'll do in two weeks." She then went on to say I should really make my mind up about whether I would abort, keep the baby or give it up for adoption if it had Downs. The only 'reassuring' thing she said was that at least I was 35 and not quite in the higher risk age category yet (which is 37 there.) Thanks...

I must confess that DP and I hadn't had that conversation privately yet - what tests we would choose to have, and what we would do with any news. I thought that we would decide on that after getting more information at this appointment. And like most new first timers I would imagine, we were just enjoying that I was finally pregnant after a year + of trying, although I did a lot of reading up on pregnancy itself. But when I thought about it later, why didn't she just focus on the issue of whether we wanted to have the test - why cause extra worry by bringing in the debate about whether we would abort etc when there was nothing to worry about yet? It seemed insensitive.

Or - I understand the need to be efficient with appointments, but could they not have spotted that this was clearly a major issue that needed dealing with privately, and let me ring up later - say by the morning at the latest - to add it to my appointment? It was two weeks away, not 2 days.

At this point I told them we would have to get my DP back in as we hadn't discussed this yet. I felt very much on the spot, as did my DP. I had to ask them to leave the room for a minute as they were both staring at us, expecting us to make a decision there and then. I was crying and feeling quite wobbly. We rushed a decision to not have the Downs testing as I said my gut instinct was that I wouldn't abort for that reason alone, so why go through the tests? My DP was scared by the thought of anything being wrong with our baby but agreed to support my feelings on this. If other serious, life threatening issues came up in future scans etc then we would deal with that as need be.

We had to spend a good couple of hours discussing this at home - a very important conversation to have of course - but we both said how shaky and crap we felt after the hospital appointment. We decided to stick with our decision though - from what I've read my general odds are around 1/200 at my age and that's what I'm going to focus on.

ANYHOW. Rant over.

I do think it's a real issue that they expect you to make decisions at the booking in appointment without giving you warning of it - I know I was a bit at being asked where I wanted to have my baby when I knew nothing about the options!

Luckily we'd discussed screening tests anyway as I'd done extra research myself - but what we did was put down that we would decide on amnio and other course of action if the nuchal showed an issue. This was fine with my MWs and as it turned out, we never had to make those choices.

Yeah, my community midwife (who I saw for 5 minutes at my surgery) expected me to announce where I wanted to have my baby too. Luckily I had decided on this hospital, though only on minimal research. I was referred there, then got my appointment letter - that was it. Of course I had leaflets from the CM on tests, eating, iron etc but the timing of decisions on testing wasn't clear at all and it would have been really helpful if the hospital could have said that.

It's all very confusing for a first timer, definitely.

What do you mean by testing for Downs - do you mean the nuchal fold, bloods or amnio?

Sorry you were put on the spot, but one thing to bear in mind is that, whether or not you would abort, having the non-invasive tests to understand your risk profile can help the midwifery team plan your care for your pregnany - i.e. if there is a very high risk, you may be given certain advice about which unit you choose to deliver in, etc. They should have told you this at the appointment.

Mind you, sounds par for the course with the NHS. I think at least 50% of staff have the compassion gene surgically removed when they start work.

I'm a first timer too. I'm really sorry that you have been treated this way. It's not fair. I would suggest getting a sheila kitzsinger book because she is really good at making you feel confident enough to challenge and ask for the care and attention you need.

good luck!

I had my booking appt at 10 weeks, they did all the paperwork, didn't bring husband to booking appt, the domestic violence question was skimmed over. I too had to make decision where to have baby at that appt but I have since changed my choice twice with no trouble at all.

I had dating scan at 12 weeks, husband was with me and dr asked us very quickly about nuchal scans, amnios etc, I hummed (am 36), husband said no very quickly, dr said she thought I was very low risk (have had 2 previous children) and said "well if you want scans you would need to know quickly what you would do if anything showed up" She was of the opinion that unless we were sure we would abort there was no point in having the extra scans. I felt that bit of the appt was a bit rushed and not maybe dealt with as sensitivitely as possible. To be fair dr was competent, friendly and decent. I sometimes think that we think our pregnancy is the most important thing in the world to us (rightly so) but to the doctor it is just another part of their job

Good luck, I am now 26 weeks and being kicked constantly!!

Hi all

RibenaBerry - I had to decide whether to have the combined nuchal & blood screening that day, as they wanted to book it as the same time as my dating scan. Which I understand - but we needed some private time to work this out properly and unfortunately it wasn't clear that we'd need to decide this on the day. If I end up having another DC I'll know for future!

Hmmm, they didn't say anything about the benefits of having the non-invasive DS tests for other reasons. The only risk issues I was told about was that she considered me to be a low risk pregnancy at the moment as I was a healthy weight etc - they put big stickers saying so all over my file.

She also frowned when I said I thought I'd like an epidural.

Sigh...

hazchem I will check out that book - I am a fairly assertive person most of the time but even though I tried to educate myself on pregnancy, I felt out of my depth and it wasn't a nice feeling.

The midwife was clearly very experienced, and was nice in some ways, but perhaps a bit jaded.

wigglesrock - it's becoming clear to me that people have so many different experiences, it's crazy! It would be nice if things were standardised a bit - it would save so much confusion.

I agree that we all probably think our PG is the most important thing in the world (and god knows the hormones don't help, I'm a right blubberpuss) but on the other hand being asked to make snap decisions about major things that could lead to decisions about whether to continue with your PG is pretty loopy as well...

There's also a bit of a feeling you get that you are the slow one - they've seen it all a million times before, so how come you don't know about everything as well?

Anyhow, the EPU staff were really lovely (especially the woman who did my scan) so I'm hoping this was just a bit of a blip.

I'd definitely read a general pregnancy book too - the NHS one isn't actually that bad or try the NCt one or Miriam Stoppard - so that you're informed from now on. Websites like babycentre are also very useful for this too.

If you change your mind on the Nuchal, realistically it can probably still be booked in to be done as you haven't had the scan yet!

They might want to book it in at the same time, but you do realise that if you want to change your mind you can don't you? Just ring up, complain about the fact you were put on the spot, explain that the issues weren't properly explained and they are going to have to re-do it.

Of course, you have every right to stick by your decision too, I just don't want you to feel that you cannot vary it.

nomoreheels have you joined a group on the antenatal thread yet, they are brillant for sharing (horror stories) info!!

This is my 3rd and I always feel out of my depth re pregnancy, don't be so hard on yourself, you've a tiny baby in there, its fantastic but very scary. I loved Kaz Cookes "rough Guide to Pregnancy" it was funny, helpful and a good read.

The green pregnancy form - here the midwife fills it in with you in your own home at the 6 week booking in appt.
But the choosing your place of delivery, I was asked by the nurse at the doctors surgery while the pee on the stick was still wet!

Nomoreheels, Congratulations on your pregnancy! I am sorry you had a terrible experience with the NHS. I am also 35 and 1st time pregnant, and I had an awful experience with NHS and decided to go privately as I also have some health issues that NHS does not treat as high risk, but they could be pregnancy/life threatening if not monitored carefully.

In terms of the general education, Pregnancy Bible by Ann Deans and What to Expect When You Are Expecting were the books that helped me a lot, and I would highly recommend these.

In terms of the Down syndrome testing, I agree with Ribena is that you might want to read up on the topic and reconsider at least the Nuchal scan (if anything, it is wonderful to see the baby wiggling and so reassuring!) and bloods at the same time. I think you might find peace of mind once you know you are having a healthy baby. I was told after mine my risk was 1:5500 (despite the risk dictated by my age was of 1:200) and I felt sooooo much better!

In the unfortunate case, if the probability of Down is high, then you would receive a more extensive pre-natal care as well as have time to mentally prepare for the birth of this baby which I think is quite important. As you already know that you would not terminate, you can refuse any CVS or amnio test if these were offered to you then. I would say you should ring the midwife and have her book you for a nuchal scan because if you were to change your mind later, they might be fully booked... It took me 3 weeks to get an appointment.

Wishing you a good pregnancy!

I've got "What to expect when you're pregnant" which is quite good, and the NHS one in my massive bundle of papers. I had read quite a lot already, it was just that we didn't know that we should have made our minds up about the nuchal/blood tests already. I hadn't spotted anywhere that this would be the case, I may have missed something of course!

Thanks for the reassurance that we can change our mind. I will look into it some more, but yesterday we decided that if we had the screening and the results indicated a higher risk, we wouldn't want to do an amnio due to increased risk of MC. If the screening showed higher risk, and the amnio was negative - but I then went on to have a MC - I don't know how we would cope. We have waited too long for me to finally fall PG.

Also, even if we are prepared to accept the possibility of having a DC with DS, we knew it would be hard to live with the outcome of the screening (even though it's not a result) for the rest of the pregnancy. I was clear (and my DP agreed) that I do not want to over worry this PG - there's enough stress in our lives already! So as I would not abort for the reasons of DS, we felt it was not for us.

But now I'm wondering if I should have it for other reasons mentioned. I'm really wondering why she didn't explain that the screening would be useful for other reasons now! Is that not fairly important? It seems a bit odd to me.

back to my books to read some more...

I had a similar feeling regarding the abnormalities testing. I was asked about it at my first appt and I had really had no idea about them, hadn't discussed them with DH (who wasn't there), and generally felt silly. The midwife wrote down that I would need to discuss it with him first, which made me feel like a teenager who couldn't make decisions on her own. I was allowed to go away and discuss it, though, but I left the appointment totally confused, not only about that, but about the whole process of scans/tests and when I would get them or how many there would be. I asked the midwife last week (at 22 weeks) what the process was and how many appointments I would have with her, and she told me then, but before then I had very little idea. I thought you got another scan after the 20 week one, and she had to explain that I would only be scanned again if they thought it was warranted (ie, not unless something seems to be wrong).

I was also totally taken aback to be asked if I wanted a homebirth - I was only about 7 weeks pregnant and hadn't got that far! I said no as a knee-jerk reaction, because I knew very little about the process and I'm a first-timer. I had no idea the midwifes come and stay with you throughout labour or anything. I haven't changed my mind, but I would have liked to know more about the process before I was asked to decide. It was the same with deciding on hospitals - she asked if I wanted to go to Simpsons or St John's and I was like what? Where? It turned out that the maternity ward at Edinburgh Royal Infirmary is called Simpsons and the other is the hospital at Livingston, but she might as well have been talking Greek for all I understood at first. I still don't know anything about the relative merits of the two hospitals - I picked ERI because I'm a lot closer to there, but I don't know which is actually better for maternity care.

Thank you all very much for the nice responses, they are much appreciated and helpful.

Lilly13, xposted my last one before seeing yours. I am digesting what you say - though I still don't know how I would manage 6-7 months of pregnancy knowing the screening came back high risk, even though a) I wouldn't abort and b) I wouldn't put myself through amnio/CVS. I am quite an emotional person and I have to think carefully about how I can best manage.

On the other hand, I can see the benefits of being prepared, and of course there's every possibility the screening would come back with a reassuring result. I just don't want to over worry though, it can't be good for me or for the baby. Maybe I am still just feeling a bit edgy after yesterday's fiasco.

As my DP said yesterday - there are so many things that can't be picked up on a scan anyhow - you take a risk just by getting PG, that's just the way it is.

It's a difficult one...

P.S. Good luck to everyone with their respective pregnancies! And I will check out the antenatal groups for June 2011... {grin]

Congrats on your pregnancy nomoreheels and I'm sorry you didn't have a great experience at your booking appt.

I think you've had some great replies re the testing and I can completely see where you are coming from re the DS issue - I was of the same mind. However we did decide to go ahead with the testing mainly coz (in my area) they also look at risk of other chromosomal abnormalities (Edward's, Patau etc.) which can cause more serious problems including late pregnancy loss. Having already had an early mc this year I couldn't face the thought of a later one that may have been predictable and more easily (if that's not a callous way to put it) dealt with at an earlier stage.
It might be worth checking what your hospital look for? or again maybe not if you've decided its not for you - its such a personal decision I can't believe they wanted you to decide on the spot!

Anyway best of luck with the rest of your pg, hope all goes well

I wouldn't worry too much about the screening test. It can cause a lot of worry for no reason, especially if you decide not to have invasive testing. It can also give false reassurance. Almost everyone I know with a child who has Downs had the sacreening, came back low risk (my own result for DS3 was 1 in over 10,000) and so was expecting their baby not to have Downs.

Sorry your appointment was so awful. At our hospital they actually made my DH stay outside for my booking appointment.

First off, sorry nomoreheels that you had such a lousy experience! The people you dealt with really sounded like clods. It's not you, it's them.

I've done quite a bit of thinking about the DS testing myself (11 weeks, first scan in 2 weeks) and can't quite decide what to do. I can't help but feel a bit misled about the carefully manipulated statistics that call a 1:150 chance of DS "high" but a 1:100 chance of MC dues to ammio or CVS "low". The cynic in me wonders what that's about. They also seem to assume that if you are high risk, you'll automatically go with amnio or CVS, and I don't want to be pushed into a decision I wouldn't normally and logically make just because I'm having a moment of emotion.

Yet there's a part of me that thinks it makes total sense to get tested, because that's what it's there for, right? Then I go and read threads on this forum about untold worry and stress from people who've been told their risk is high from tests that seem to have a huge likelihood of false positives. In my case, I would not terminate anyway, so why put myself through that. Especially given my age (36) comes with an objective risk factor and might skew everything else. I'd rather have my risk factor calculated with age not included, as I can't do anything about my age anyway. Will they do that?

I'm not actually sure if the midwife took my nodding at her explanation of the tests as consent for having them, but you can bet if I decide between now and the scan that I don't want DS testing and I show up and they are expecting to do the tests, I will just say no.

Hi all,

Thought I'd add my views too...

nomoreheels I'm shocked at the lack of inormation you seem to have received. I have a nuchal scan booked for 23rd Nov and my first midwife appointment on Wednesday so will be able to feedback properly on the quality of care then. Although I have received a booklet called "screening tests for you and your baby" which has bee really informative.

My DH2B will be joining me throughout any and all appointments - he's as excited as I am!

Good luck for all other pregnant ladies too... Oh and mouffloncake has set up a secret facebook group for us ladies due in June - PM her for details! x

I am reading this and feel like I have to reply. At our hospital, it is almost taken for granted that you will have a nuchal screening- we did and didn't think anything of it as it is done at the same time as the dating scan. However both I and my husband were adamant that I wouldn't have any further tests if it was bad news. Unfortunately, it turned out that it was bad news and we have a 1 in 4 chance of chromosomal abnormalities. It was only when faced with this that we decided to have a cvs which I had on Thursday and am now waiting for the results. There are a couple of things that much worry and research make me feel I should point out. Yes, the screening results gave caused an unimaginable amount of stress and worry for us, you don't have to have them but are you sure that you know what you will do when really faced with this situation? Secondly, the risks of miscarriage through invasive testing ie cvs or amniotic testing can be much reduced depending on the practitioner (we have been very lucky to have been referred to kings college in London) and thirdly, a high nuchal can be indicative of other problems with the baby especially heart problems - we have and will continue to see a foetal cardiologist as part of this process. I am notvsaying that you should or shouldn't have testing, I am just letting you know my experience from someone who has been through it.

Btw I am 30 so no where near a high risk age group.

I just thought it might be worth mentioning that the true and best Nuchal test you can have is the one where they do the bloods on the same day. Some NHS areas will measure the nuchal fold but not do the blood tests which is not as accurate as a complete 'proper' nuchal screening test. Obviously neither can tell you for sure but I know a lot of people who have had what the NHS offer and been given high risk bt didn't realise they should have had the bloods taken at the same time.

Hi all, thought I'd do a little update.

My scan is next week (5 days away!) and we've decided not to have the nuchal/blood screening. For us this is the right choice - we feel a lot more relaxed. I appreciate it's not the same for everyone, and I know I could have changed my mind.

Interestingly, I spoke with a friend who said that she and her DP had decided against the screening too. At her 12 week scan, they offered it to her anyhow (on the spot) and she made a snap decision to have it done, although her DP was reluctant. She is a worrier and couldn't resist having it done when it was suddenly offered. It did add a lot of stress to her day though and in the end the results were low risk.

I have told this to my DP and we still think we'd say no if this was to happen to us. I do think it's a bit crap that my friend was offered it when they'd already said no though!