Need midwife's advice - re: 20 week ultrasound scan

[GeorginaA]

I'm hoping someone on mumsnet can help. I've just been told the radiology department have "withdrawn the service" of the 20 week ultrasound scans, presumably until further notice. Apparently due to illness they can no longer cope with demand and they can't get through all the cancer patients. So pregnant mums no longer have this scan in our area.

Eventually they will get themselves sorted out and have a protocol for which high risk pregnancies will still get scans (which I wouldn't be anyway). Their reasoning is that they wouldn't pick up much at that scan anyway so it isn't "important" (it's not?! It's the only damn diagnostic test I'm having ffs!)

The midwife has also tried to put me off going privately saying there's a danger for what they look for and that they might not be accredited and look too long and damage the foetus!

So I'm really upset now and don't know what to do. I was so looking forward to that scan and had planned to take ds along with us to see the new baby and find out whether it was a brother or sister, and I was looking forward to the reassurance. I just don't know whether to start looking into a private scan or not and now I'm really confused what questions I should be asking if I do look for a private scan.

So this is a plea for information really. Should I go for a private scan? How much are they likely to be? What sort of questions should I be asking and am I really putting my baby in more risk by going for an ultrasound privately?

I know this isn't much help, but I had a sexing scan privately as our health authority will not tell you. It was done at the local private hospital and it was my consultant who actually carried it out. I had it at 24 weeks and although I had had my 20week scan in the NHS hospital he spent quite some time checking everything was OK, as well as the sex.

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GeorginaA - I am sorry that this has happened to you. I think your unit should be able to refer you to another unit to receive this scan,however it is perhaps worth pointing out that the 20 week scan is to pick up fetal abnormality. I think that women forget the purpose of the scan and I don't think it is wise to take young children along. If something abnormal was to be detected, it is not easy to discuss it with a youngster in tow. I presume that you have had the screening blood tests done. If you are 'low risk' there is unlikely to be anything wrong with the baby. I personally feel that scanning often causes more uncertainty than reassurance. All sorts of 'minor' things are picked up which cause intense worry, only to have disappeared at delivery. I do not think you would be at risk having a private scan. You could discuss referral for one with your doctor.

That is so appalling! - I can't believe what they are saying - the 20/21 week anomaly scan is really important (particularly if its the only one you are getting)since it picks up anomalies for crissakes!

I'm no expert but your midwife sounds like she is talking out of her posterior (sounds more polite than 'ar*e'. I would definitely get a private scan if I was you. Perhaps a more knowledgeable mumsnetter can point you in the direction of a good private service.

I know that the Fetal Medicine Centre in London are exceptionally good. I had a nuchal fold scan there (and they are the frontrunners / at the forefront of research in that area). I know you don't want a nuchal fold, but I am sure they do 'regular' scans too

Good luck - I feel really peed off on your behalf!!

Now I've read Mears post I'll have to defer to her better judgement (i.e. that for low risk pregnancies few genuine abnormalities are picked up, and minor problems can be identified which amount to nothing when the baby arrives). However notwithstanding Mears point which is very valid, I personally would still want the scan since you at least want to see baby before he / she arrives! I don't think your local hospital appreciates how important this is to expectant mums

Georgina, as someone who's baby's anomaly WAS picked up at the 20 week scan, I would echo Mears in suggesting you think v clearly about what role the scan plays for you, and what your reaction would be to an anomaly, anyway. Would agree (without being too doom-y, and of course the hugest majority of scans show regular development) that it is a serious medical diagnostic procedure and not simply a sneak preview at a new baby. For me it was hugely valuable that I was able to do research into my babies limb difference, and to know what to expect when he was born, but there were some scary moments when they said that his leg and some echogenic focii COULD be a marker for very serious / non viable chromosomal disorders (not Downs).

I do agree that it seems very hard to simply withdraw a screening which has now become commonplace, and if you do want re-assurance, perhaps your GP could refer you to another hospital? If you live near London, I am pretty sure you can refer yourself to the Harris Birthright Centre in Kings by phoning up, and I don't think private scans there are OTT in expense. Good luck.

I've read a lot of terrible statistics about ultrasounds lately; they miss just as many problems as they pick up, and they can lead to a lot of necessary stress & investigations (that was my personal experience, and something I've observed a lot among friends). Not to say you shouldn't get one, GeorginaA, just that I think the value of the 20 week scan is definintely over-rated.

No, I do agree the scan is for a serious reason too - forewarned is forearmed and all that, and no matter how small the chance I would like to know if anything was seriousoy wrong - as Blu says so you can research yourself and not blindly go along with what they are telling me.

But also, there is a lot of emotional significance to seeing the baby for the first time, and maybe that isn't "important", but it feels important to me (sorry) and that's why I'm prepared to pay (dear god, I hope not too much) rather than take up valuable NHS time away from people with real need, so I don't "miss out". But at the same time I don't want to put the baby in unnecessary risk just so I can call it "he" or "she" 20 weeks before they arrive into the world.

I'm currently in midwife-led care and the midwife says she does not no of a specific private hospital near here (Worcester) that does it. Do I need to make an appointment with the GP to get referred somewhere or are they unlikely to know anywhere either? It almost feels a bit like going behind the midwife's back by going to the GP (and I don't know my GP at all, whereas I've started to build up a relationship with the midwife) Is a better bet just to phone somewhere like Bupa and find out where there nearest one is? Or will they need a referal anyway?

Also, I know this wasn't what was meant by the posts, but it is confusing when in one breath I'm being told there's highly unlikely to be anything wrong so it's not worth having anyway, and in the next being told not to take my ds "just in case".

I think it is important that he gets to see there's "something there" in mummy's tummy so he can get used to the idea too, and I would also want him to know (in vague terms at least) why mummy was upset if there was something wrong. He's part of the family too.

I think I would phone BuPA and tell the midwife afterwards. All your reasons for wanting the scan and wanting your DS there are valid ones, GeorginA, but when you asked about "risk" I guess I just wanted to back up Mears by saying that one real "risk" is that they will flag up a potential problem that isn't a problem at all!

I only just properly read your MWs comments about them damaging the baby by looking at it too long -- that is kind of a weird thing to say. I'm obviously not a big fan of Ultrasound, but given all the long term studies that have only managed to come up with the most tenuous evidence about possible dangers associated with it, I'm a bit puzzled how one detailed scan is supposed to harm the little blighter.

Sorry, yes I understand that. Just feeling a bit emotional (damn pregnancy hormones!) about it all. Thank you for all your advice, I think I am going to do at least some preliminary research into how much it's going to cost and what they check for at our nearest Bupa and decide from there.

I am more reassured though that if I find out it is beyond our means that I don't need to worry too much about them "missing" something bad about the pregnancy, and that this is really more a nice to have. Thank you so much.

GeorginaA - NICE have issued national guidelines for antenatal care (issues October). They state that all women should be offered a scan at 18-20 weeks for fetal anomalies. It might be useful to quote this guidance to your midwife and say that , since your local hospital can't do it, you are reffered elsewhere.
Here in the link, you will need to scroll down through the document which is in pdf format.
here

My friend who is into her 13th week of pregnancy told me this Georgina and I was really surprised too. Hopefully they'll have it back on track when mystical child no2 is on it's way.

Our nearest Bupa is Southbank hospital.

GeorginaA, here's the link for Southbank, they do ultrasound scans but you have to contact them for details and prices. Southbank

How frustrating for you! I know how you feel - no one in my health authority gets a twenty week scan unless they are high risk - which I think is pretty outrageous. With ds the consultant pushed for me to have one (infertility probs, family history of spina bifida) and I got it. But with dd it was a real battle. In the end I booked a private scan at Newcastle but when I mentioned this to my GP he kicked up a fuss and managed to get me one locally on the NHS. I was relieved but soooo angry for all those women who have less pro-active GPs! In the end dd was born with a really deep sacral dimple and the first thing the ped said when she saw it was 'was her spine okay in the 20 week scan?'. If I hadn't had one I would have gone nuts (with worry and with RAGE!!!!).

It also sounds like your midwife has a bit of an agenda with scans - maybe she was thinking of one of the more 'commerical' scanning enterprises (colour 3D etc etc) . I know that a lot of private scanning is done by the same people who do it on the NHS so they know exactly what they are looking for.

If you decide you want a private scan I would move pretty quickly to book one up as (at least in my area) there is a lot of pressure on the private scanning units. Good luck - do whatever your instinct tells you.

Thank you all for your advice.

I've been talking to a friend of mine who is 9 weeks pregnant (and has the same doctor) and we've worked out a plan of action. We're going to write to our GP and let her know we're unhappy, quoting the NICE report (thanks Mears!) and saying that we understand resources are tight and as we're low risk we don't want to take the place of a cancer patient that really needs it.

HOWEVER, we would like other options to be made available to us, such as an out of area hospital or at the very least advise which accredited private hospital they recommend (as I assume even with private we'd need a referral from the GP?).

I've also emailed the Southbank BUPA hospital for info/prices in case all else fails so thank you for posting those links!

I'm actually quite cross about it now, not for myself, but for those people who have high risk pregnancies who they haven't made any provision for yet - they must be going out of their minds with worry, and might not be in the lucky position of taking the private option.

That sounds brilliant, Georgina!

GeorginaA, what about the dating scan at 12 weeks, is this one continuing? If so that's rediculous, surely it should be the other way round! When I had my 20 week scan back in April the Sonographer was talking about packing it in. Moral isn't very high. Assuming we're both talking about the same hospital, WRH?

Yup the Royal Worcester... the dating scan is still there (mine is tomorrow - two weeks late!) because apparently it's a different department and not the sonographers doing it? (that's what I was told anyway) and that one is strictly NOT for any type of diagnosis - just dating.

You're right, it's completely insane.

GeorginaA- I think you are doing the right thing i would be pushing all the way. I am a bit confused at your mw saying a detailed long scan could damage the feotus, I had DD 7 years ago and had the 12 week can 20 week scan (as normal) once I got to 28 weeks I had atleast two scans per week each lasting for anything between 5 mins to 30 mins. This ment by the time I had DD I had had over 20 scans!!. DD was perfectly healthy when born just a bit small, (the problems where SPROM, and IUGR< and placenta insufficiency) so I cannot agree with her saying they can cause damage!!
Hope everything works out for you.

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Having had a misdiagnosis and 6 weeks of unneeded worry and tests after a detailed ultrasound at 18 weeks, I'm not a big fan. But I'd also switch midwives -- telling you the baby might be damaged by scanning for too long?? There's no evidence that one overlong scan will do anything. My wigglebaby would have been injured long since, because it took them 45 minutes + to do the one with the misdiagnosis and over an hour for the fetal echocardiogram! (She doesn't sit still well, which contributed to the diagnosis problem.) There are good reasons that you might not want to do this, but scaremongering like that is just mean.