A call for a change to be made to the 'no-doppler policy' at 16 week midwife check

[Mythreeknights]

I've just had the most pointless 16 week midwife check ever (this is 3rd pg so I know from experience that this was completely pointless).
Other than dipstick my pee and prod me in the tummy, she did nothing, asked nothing other than "keeping well?" and wrote nothing down other than "keeping well" (seriously). It took me 25 mins to drive to the appt and 25 mins back, a total including appt time (and pre-appt waiting time) of about 1 hour, 10 mins.

She was quite defensive (obviously gets it in the ear a lot from upset pg mums), and said "but what would I do if I couldn't hear a heartbeat?" I replied, "Well, I'd hope you'd send me for a scan so they could see if I was carrying a live or dead baby". She replied "no, I'd get in trouble for that" and I said "well, I'd rather know at 16 weeks that the child had died rather than carry it around for another 4 weeks and find out at the scan".

My suggestion, if the NHS / Royal College of Midwives is so worried about not hearing heartbeats at 16 weeks, that they just send us dipstick packs, so we can dip our own pee (3 minutes), write our own notes (3 minutes) and not spend 45 minutes sitting in the car.

Anyone feel the same?

[Ra88]

my mw checked for heartbeat at 14 weeks and found it straight away

[MaryKatharine]

Some of it must be cost cutting though? I had my 4th, 2yrs ago. I was booked in at 8wks and as I said we were having our nuchal scan privately, they then refused to give me an nhs scan at 12wks. I saw her again at 16wk and then not until 32wks! I did have my 20wk scan in the middle but that is not with a MW so no opportunity to discuss pg related stuff.

How can they think its reasonable to see you at 4mths then not again until 8mths? It wasn't like that with the other 3 when we lived elsewhere so I can only assume its local policy.

[VivaLeBeaver]

appt schedule

You should have seen someone at 28 weeks. Also most hospitals at 20weeks after the scan you see a midwife who checks bp, etc.

Not listening in to the hb doesn't save money at all. Appointments are still the same length of time.

[HarderToKidnap]

I think you're right it's cost cutting, because trusts who enforce this wont scan for unheard hbs. That's where the cost saving is, in the scan. They have to rationalise it - how many babies lives are saved by the routine listening in of heartbeats during an antenatal appt? That number must be approaching nil. I've never heard of that routine listening in ending up being so critical it saves a life. So it, and the follow up scans associated with it, aren't worth the money. Listening in routinely is not predictive, it doesn't change outcomes, and it costs money. So it's GOOD that its no longer recommended. It's the type of good cost cutting we need.

[Mamtodsddonway13]

Where I live we have booking in appt then 12 week scan then 20 week scan then midwife appt at 24 weeks, so I didn't see my midwife for 19 weeks, haven't even got a direct contact number for my midwife just the local midwife led unit, haven't seen the same midwife either I'm now 33 weeks this is my second pregnancy so pritty much knew what to expect. Still when I went to appointment yesterday an seen yet another different midwife and was told I had a high platelet count I had to go through medical history all over again and she still didn't know what to do about platlets had to go find out from someone else. Have never discussed previous scans or bloods with any of them did hear baby's heart beat tho, guess it all depends on whereby live an how often u get to see midwife hear hub etc, sorry for long post

[HarderToKidnap]

Obviously patchy, disjointed care isn't acceptable and I'm not saying that is a good cost cutting measure! Just talking about the heartbeat issue.

[SaggyOldClothCatPuss]

I agree Harder.
I don't think it's cost cutting so much as more useful direction of funds.
As I said up thread, my local EPU was double booked solid all week. A MNer friend who sadly MC, had problems over the weekend and couldn't get a scan until Wednesday. Those double booking will have been people who were bleeding, cramping, suffering abdo pain or have had previous MC and ectopic PG and were seeking much needed confirmation that their PGs were safe of viable. As others have said, there is very little risk after a healthy 12 week scan. Repeated referral for scans after not being able to find a HB because the baby is high, low or hiding behind its placenta is going to put undue pressure on already overloaded EPUs who do an amazing job helping those people who really need their support.

[holidaysarenice]

Not a midwife, but I don't write much of my notes when the patient is there. Usually done after.

More often than not in my lunchtime.

[MaryKatharine]

Viva, I was told that it was because it was my 4th. She said they have a schedule for 1st then 2nd then 3rd+.

I was also 42 at the time yet I wasn't asked if I was interested in having an amino at all. She also kept telling me that guidelines referred to me as a geriatric mother. Nice.

[HumptyDumptyBumpty]

I also didn't get to hear hb at my 16 week appt. I FULLY understand where mythree is coming from.

The thing that isn't being considered is:
Yes, if you can't find the hb, that would be stressful, of course it would.
However, I've been stressing every day since the 16 week appointment that something is wrong. Every day. In tears. How is that any better than a potential risk that I might have been stressed by not being able to find it?
I'm not saying one is less stressful than the other, just that if it's not done on the basis of 'potential distress', then it needs to be recognised that simply not doing it is a cause of distress in its own right.

Also, I felt my mw was dismissive and uninterested at my 16wk appt too - when I raised things with her (like ongoing, intermittent diarrhoea, which I had understood could be risky), she said 'yes, pregnancy will cause changes in your body, you know', as if I was 16, stupid, and had no fucking clue about pregnancy. I've read a lot, I want to be actively involved in my care and to take good care of myself (thereby reducing the burden on the NHS, as some of the difficulties encountered in pregnancy could be mitigated if women were better able, and knew enough to take good care of themselves), and I was asking for these reasons. It was rude and unnecessary to treat me the way she did. The variation in standards of care is unacceptable - why was this midwife so patronising and unhelpful? Her colleague, who I saw the previous time, was brilliant? Is there a problem in the training programme? Is there insufficient screening of who practices midwifery?

I do understand that MW services are overstretched, but that doesn't mean pregnant women should simply 'put up and shut up' - we have a right to have adequate healthcare. That includes being treated in a way that reduces stress and takes care of our mental health as well as testing our wee for proteins. Pregnancy, especially for the first time, is a very new, overwhelming, potentially frightening, experience. I didn't go to the GP saying 'ouch, I stubbed my toe'. All pregnancy books I've read acknowledge that pregnant women will have concerns, worries and fears and dismissing these is hardly a healthy way to treat us.

[MaryKatharine]

Btw, I'd had excellent MW care with my other 3. And I've always had one to one care in labour. Just my 4th, poor antenatal care (I believe) then poor care in labour.

All it has shown me is how patchy care is across the country.

[HarderToKidnap]

Holidays, pregnant women carry their own notes, so they must completed during the appt.

Sunny I would agree with that but it must mean fewer later miscarriages and that will be because more appts pick up the IUGR babies, the preeclamptics, the UTIs etc which cause miscarriage. It's not because of more listening in to babies.

[VivaLeBeaver]

Marykatherine, I've never heard that before. There's a national schedule for first babies and one for subsequent babies. Shouldn't be a difference if its second or fourth.

[HarderToKidnap]

I think there is an interesting feminist argument as to why women may need to feel reassurance from the technological gaze of medical paraphernalia. It's the whole "women's bodies are a bit crap and pregnancy is a weird alien state and you can only be reassured that you are ok if the patriarchy use their machines on you". It's only recently that we've had dopplers at all and yet now women feel they literally cannot be safe in their pregnancy unless they are regularly used. As if pregnancy can't progress without these machines. This is just a general point I find interesting by the way, not directed at any one in particular or to denigrate anyone's experience.

[IdaClair]

I've lost two babies between the 12 and 20 week scans. Doesn't seem so rare to me. I would say an appointment at 16 weeks is pretty essential for my peace of mind.

[MaryKatharine]

Thanks, Viva, that's interesting. Not sure if she was mistaken or if it's local policy then.

What about the amnio? Is there national age guidelines on when or if it should be offered? Should it have been offered to me at 42?

[MaryKatharine]

Oh and I've had 4 babies in 3 different areas and have never seen a MW after my 20wk scan.

[HarderToKidnap]

NICE just say everyone should be offered screening, Mary. No mention made of routine diagnostic tests for Downs.

[treaclesoda]

vinegar, yes, I am in the UK, in N Ireland. It was a sonographer who did the 20 week scan but all others were by midwife, consultant or GP. GPs equipment wasn't up to the standard of that used in the hospital, it wasn't such a clear picture, and he wasn't looking for abnormalities obviously, it was really just a 30 sec thing to see the heartbeat. Midwives were a bit more thorough, took measurements etc, but nothing on the scale of the 'big' 20 week scan.

[AppleYumYum]

Hi OP, me too, told they don't listen to the heartbeat anymore at 16w as it is harder to pick up and would upset women if they couldn't find it. I didn't even get a prod in the tummy. Just tested my wee, BP taken, how you feeling etc. I can feel some movements so I feel ok, but it wasn't really worth the 45 min wait in the wating room let along the time to get there and back.

[apprenticemamma]

interesting discussions on this v fast moving thread! tiredem i was m beginning to wonder if my pregnancy brain is making this up bit no defo 10 weeks and defo baby .you can tell bc of their increased heart rate and it was bloody fast! Recorded on phone too.

[Dollybird86]

I herd the heartbeat at 16weeks it was a student midwife that found it and she was very excited. I think ur being a little unfair, she may have asked u less questions as its not ur first pregancy and I know that as I was still being sick at this point it was nice to just go and chat about how crap I felt.

[MaryKatharine]

Thanks, hardertokidnap. For some reason I thought my age meant it should have been discussed with me. My friend was offered one at 38 so I thought being 42 it would at least have been mentioned.

I was also denied an epidural as it was my 4th and I'd had the previous 2 without any painkillers at all. I believe this was for cost reasons too.

[eccentrica]

get your own Doppler if you are that anxious. I got mine off eBay for 30 quid or you can rent for 9.95 a month. the best thing ever for combatting anxiety.

YABU about the appointment. it was only pointless because your bp and urine were ok and you are Generally well. me too. we're lucky, not hard done by.

the chance that anything has gone wrong since 12weeks is very very vry low.