36 week scans bring cancelled

[UnilakTea]

Morning! Just thought I'd let you know that atleast in my area of Kent they are cancelling 36 week scans unless your high risk!

Hi all, many women are commenting they haven't had urine tests or BP monitoring because of cancelled appointments. Just wanted to point out you can buy the urine sticks online and a good BP monitor also so I have been doing it myself, its really helped with the anxiety.

I don’t have the urine sticks or blood pressure monitor yet

Can anyone recommend where to buy from and how much I should be looking to pay for the monitor?

Also how do I know if my result is ok or not.
I’ve never paid attention to the numbers before and just rely on the HCP’s when they say it’s ok or it’s not ok

Hi, I bought them on Amazon, urine sticks were about £8 and BP monitor was about £20. On the box of the urine sticks it tells you what colours mean / what you are looking for I.e the lightest colour means no protein etc.

On the blood pressure monitor it also tells you if its okay. Then I suppose tell your HCP what your BPs have been. Your maternity notes will also tell you what they have been previously so you could compare.

Don't panic if its high though just do it again!

Its not ideal but at least its something.

Last 2 midwife appointments were on the phone but supposed to be having a face to face one after Easter but who knows? Also seeing the consultant the following week but been warned that might be cancelled. I'm really scared of something going wrong and no one picking up on it because everything is being cut.
Last time I went to hospital for reduced movements I was told my bump was measuring about 3 weeks larger than should be but no idea if that's a concern or not as at the time I was more concerned about the heartbeat.

What a tough job hopefulhalf, you must be very stressed and I hope you get some decent rest today.

I hope your lowest bar for pregnant women doesn’t come to “is this as bad as Shamina Begum experienced?”

I agree with @Luckyme30, women and babies are being thrown under the bus because almost all of the resources are being allocated to coronavirus.
This is going to be an unpopular opinion, but I'm not even sure this is justified because we still don't know what the real mortality rate for this virus is. Of course, any death from Covid is tragic, and we should try and prevent these where possible, but there should be a consideration of the long-term health and needs of mothers and babies too. I feel like by prioritizing Covid over all other conditions, we are putting a lot of lives in danger in the long term. This also goes for cancer patients etc.
I can't see why they couldn't keep maternity services, which are already stretched and underfunded, separate from covid wards. Midwives should not be expected to care for any patients other than babies and pregnant women. And funnily enough, some of those wards set aside for covid will currently be empty and staff will be sitting around waiting for patients. Makes no sense.

BP checks and urinalyis can be done outside hospital. Scans can't, perinatal mortality is not dependant on frequent scans. They have only become routine in the last 25 years or so. I don't think anyone is suggesting no checks at all. But bringing low risk women in for "routine" 36 week scans is not sensible at the moment.

I'm aware of a woman who has been told she will have no face to face appointments from 28 weeks to 40 weeks. That is not acceptable under any circumstances.

I agree the 36 week scan is something that could go for a lot of women given it's not standard in a lot of places anyway. But urine, BP and heart rate should be monitored.

@Rebelwithallthecause I bought the Omron Basic M2 on Amazon for £23.99. I took it along when I was last at MAU to compare and it gives almost identical readings to the hospital equipment so I trust mine. I record my readings on a free app (BloodPressure on my Android) and it tells you whether it is a normal reading. Because it logs the results you can keep an eye on whether it is trending up over time and call your midwife to discuss that or any other concerns.

In a high prevalence corona area (London) with a low risk ( perhaps 2nd ) pregnancy that might be necessary and also safest. As others say BP monitors can be bought. It's not ideal, but it might be the safest for that women.

Actually hopeful, she's high risk and it isn't at all. But that wouldn't be acceptable for any woman, because as several of us have pointed out, there is no way to tell a pregnancy is healthy and low risk without the basic checks.

Well you can look at risk factors and that does predict the liklihood of complications.

But bringing low risk women in for "routine" 36 week scans is not sensible at the moment.

I was considered a low risk pregnancy and went into hospital last week for a routine 36 week scan. They found increased amniotic fluid around the baby (polyhydramnios) which they suspect has been caused by late onset of gestational diabetes.

These findings mean that I will now need to be closely monitored for the rest of my pregnancy and birth, and could have to be induced early if my blood sugars aren't kept under control.

If I hadn't gone into hospital for that routine 36 week scan I would never have known this.

I'm only 22 weeks but am also 42 with rapidly worsening gestational diabetes. All my growth scans bar 36 weeks have been cancelled, most of my consultant appointments will be remote, and my community midwife has cancelled everything except 28 week bloods.

I'm also missing any birth choices meetings which were put in place after a bad experience 18 months ago. Not essential to stop me dying, but a pretty big deal for mental health I can promise.

I spoke to my diabetic midwife this morning. I know her pretty well now and she is distraught by the new guidelines. GD is risky, ongoing scans ARE very important, and women with high risk levels are being neglected, like it or not. Yes there has to be balance, but as someone who has seen how badly this can go, it's no wonder she's horrified.

It's not just low risk women who are having their care compromised.

Personally I'm fairly laid back but it is scary, women who haven't done this before are going to be understandably terrified for their babies and there will be losses. That's not scaremongering, it's fact. Poo pooing those fears doesn't help at what is already a vulnerable time for mental health. I don't have an easy answer, but comparing me to Shamima Begum is unhelpful in the extreme.

Gestational diabetes can be diagnosed by urinalysis or blood spot testing. You don't need a scan.

“ I can't see why they couldn't keep maternity services, which are already stretched and underfunded, separate from covid wards. Midwives should not be expected to care for any patients other than babies and pregnant women”

Well except that the anticipation is that there will be an overlap between the two, so women giving birth with Covid19. And they have to be cared for separately to minimise the risks to other women and to make sure their care is tailored to their needs. I hate that MLUs are being turned into Covid19 isolation areas in the sense that I then might not have access to that environment, but it is appropriate that there is a separate space for women who have caught the virus. I imagine that the reason it’s the MLUs that have been earmarked for this is to do with the amount of space, ability to convert to isolation areas, the fact that there will always be women without the virus who need access to the labour ward but, in theory, “low risk” women can give birth in either location.

It is completely shit that the options are being ever restricted, and I hate it at the same time as I can understand it.

I don’t understand some of the comments on here, pre eclampsia, a VERY serious and deadly problem is no longer being checked for. I will not see a midwife until I give birth, so from 28 weeks until birth no one will monitor baby size or position, mothers urine, blood pressure or anything like that. At my last appointment I got measured by my midwife, my blood pressure was elevated but not enough for concern and my baby was breech.

I can’t work out what direction my baby is facing, I have a blood pressure monitor but it was only cheap and I’m worried it’s not accurate, and if I measure my own bump using the same paper tape measure and the best of my ability (but admittedly my ability is learned from YouTube) it means my bump hasn’t grown in 4 weeks. Has it actually not grown or am I just measuring differently to my midwife? I don’t know and I won’t know because even if I DO discover something, who do I contact? Do I ring triage and say ‘I’m home testing myself and I think somethings wrong’ what if they scoff and say don’t be silly and I don’t get seen but something is actually wrong? They did the same when I was in labour with my daughter. ‘You couldn’t possibly be needing to come in after an hour of contractions, it’s your first baby and you’re still able to breath through the contractions, you’ll be ages yet’ I’m lucky that I ignored her and did the 40 minute drive to the hospital because I don’t think I’d have made it if I hadn’t of ignored her, and my baby had shoulder dystocia, I had retained placenta and haemorrhaging. We both could have died!

hopefulhalf You are conflating diagnosis and monitoring. Urinalysis and blood spot testing are one of the ways that management of GDM is undertaken. Diagnosis is usually via GTT which requires hanging around the hospital for approximately 3 hours. Another element of monitoring is scans which check whether the GDM is adversely affecting the baby. It has a much higher risk of problems with the placenta (as it is in fact “caused” by the placenta). This is important stuff for the well-being of the mother and baby.

Pre- eclampsia is important. It's not diagnosed by ultra-sound or blood tests.

Gestational diabetes can be diagnosed by urinalysis or blood spot testing. You don't need a scan.

But polyhydramnios can't be detected without a scan.

Gestational diabetes is not diagnosed via urinalysis or blood spot testing. High sugar results can be triggers for sending a woman to be tested for suspected GDM.

Sorry should have said screening for GDM is through urinalysis or blood spot testing. GTT is gold standard, but may not be possible at the current tine.

@hopefulhalf

But it is caught by midwives using urine tests and blood pressure monitoring, which can only be done in person not over the phone. And if you read my reply slightly above your last comment, maybe you can answer the very valid point of even if we do detect these things happening who the hell do we call and would they even believe us/take us seriously?

GD can develop at any time. The guidelines now recommend a HB1AC which actually isn't a great diagnostic in GD as it looks at 3 months sugars levels and can miss late onset GD. Regular urine and a GTT is much better.

Either way, the point is, the diagnosis is there, but not the correct monitoring after diagnosis. What good is diagnosis if the recommended monitoring and treatment aren't possible?!

There are other conditions which are much more likely to be picked up by HCPs too, none of which will if there are no face to face appointments.