High BMI and NHS Scans

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I had a BMI of 46 at my booking appointment.

I've had 3 scans so far:

1st private - went perfectly.
2nd early NHS due to cramping and bleeding @ 11 weeks - went perfectly.
3rd 12 week NHS...

My 12 week NHS scan went appallingly because baby was head forward and feet back. Nobody mentioned that even in this position it should have been possible to get readings. Nobody mentioned my BMI at all either.
The midwives just said that baby was in an awkward position and that's that.
I left with no pictures and no nuchal screening.
Later on, my badger notes were updated to say it was impossible to scan me due to BMI. I was surprised because it wasn't mentioned while I was there. I assume they don't like saying it to your face.

I don't typically carry much weight around my middle and so I thought my scans would be normal but now I'm really fretting.

It's my 20 week scan v soon and I'm now absolutely convinced that they won't be able to check for abnormalities or tell me the gender.

Should I just book privately instead?

Did larger ladies here find that they weren't actually able to be told about abnormalities and gender before birth?

Really confused because I've been told that I'll be getting extra scans due to my size but it equally seems that scanning doesn't work on bigger women. My trust do not offer transvaginal.

Any advice or reassurance is gratefully received. Thanks so much.

My bmi was higher than yours & carry alot of weight on my belly. I had alot of scans due to history & didn't have any problems with getting measurements etc. I didn't find out the sex so can't say if that would of been a problem. Good luck for your next scan

I was a similar size and all scans went well apart from one. I can't remember the reason given, but I went back the following day and all was fine again. I didn't lose weight overnight, it was all the baby's fault. He's still an unco-operative pain in the arse now (15).

I’m a bmi of 37 and 35 weeks pregnant. They didn’t mention my bmi to me in any scans, I’m guessing because a lot of women would take offence. They only checked the nuchal measurements for Down syndrome at 12 weeks. They did a much more in-depth one at 20 weeks and on my scan report where it asked about view they had mentioned ‘slightly obscured due to body habitus.’ Eg- not the best view because I am larger. That’s fair enough and you have to remember that proportionally you might not carry as much fat on stomach as say your bottom. It’s still fat though and more than a woman with a bmi of 25 would have there.
I haven’t had any difficulties with scans or views or doctors treating me differently. No one has been rude or blamed me for being overweight. I hope that helps!

Wait, so at your 12 week scan did you not get given an estimated due date (based on measurements)? And what about screening tests - did they not discuss alternatives or even just that it wouldn't be possible with you?

Presumably during your 16 week appointment with midwife your BMI would have been mentioned for other reasons, did they not broach the scan issues then?

I know it can be a sensitive subject but I'm sure you'd rather they had this discussion with you rather than leave you in the dark! Sorry you're going through this!

Thanks for all your replies, ladies!

@DottieDam at my 12 week scan, they left my EDD as per my LMP because they said they couldn't measure properly. It was a student nurse doing the scan and she was getting quite flustered. So the trained midwife accompanying her said not to worry and we'd just leave it as my LMP.

I had a private scan a bit before that and they gave me an EDD of 2 days sooner. So I think I'm in the right ball park.

At my 16 week appointment with midwife, they talked to me about getting all my vaccines (done), seeing a consultant at 22 weeks (booked) and they dopplered me (found a heartbeat in no time at all)

My BMI was of course discussed at my 10 week appointment but all my tests were great: blood sugar; blood pressure etc so other than the being fat, they aren't worried yet.

I had a quad test instead of the nuchal screening in the end. The hospital midwives were reluctant to allow me one at first because I'm not in any of the risk categories for Downs (and I guess they deemed it a waste of money) but I was so upset about having no nuchal readings so they eventually agreed to it.

Sucks about the scan but I'm glad your not missing out on anything because of this. Fingers crossed without a trainee you get a good look at 20 weeks!!

I think it's just quite common regardless of weight! My BMI is about 22 and my baby was always in awkward positions which meant the scan couldn't go ahead x

My bmi was 42 (had baby oct 2021). And I had to come back multiple times for the 20 week scan. Position of baby and my extra "tissue" made some of the measurements very hard. I could tell they did not want to scan me as they knew it would be difficult. I'd say don't get an appointment at the end of the day as they will send you home without really trying. Good luck

I have a bmi of 35 and this has been quoted on every single scan. It has never been an issue however, I think it’s just a statement of fact to cover themselves.

For what it’s worth my 20 week scan took 3 hours and several walks to manoeuvre baby into position. Nothing to do with my weight and this has never been mentioned whilst being scanned- why would it? They’re sonographers not dieticians.

They put it on the reports to cover themselves all my scans in both pregnancies had 'difficulty due to maternal BMI' written on it even when they went fine. I think only one radiographer actually brought it up

I think it’s really poor that they didn’t offer you another scan the following week, or at least offer you quad testing immediately. I would actually be considering moving trust.

Yes, your BMI might cause some issues but they ought to be looking at ways around that, not just using it as a reason to do nothing.

I am a sonographer. Private went fine because it’s for fun not to check details. Going private won’t make a difference. They will either be a sonographer or someone less qualified. They will not be checking anatomy.
The failure rate for nuchals is incredibly high, whether people have a high bmi or not. The criteria is to accept the NT images is so strict and we are continually assessed every three months and if we put bad images through we can fail and can be struck off the register. They offer the quadruple blood test instead on the nhs if it fails. It’s almost as good. If you are very worried I suggest paying for the nipty/harmony blood test which is more accurate than the nt scan.
If they struggle on the 20 week scan they will offer a repeat scan and if that fails they will either send to a consultant or leave it there as long as no significant concerns. Depends on the trust.
As for mentioning weight. It’s difficult. In the past when I have mentioned it I have had complaints. So I don’t tend to any more. Just make a note on the report. It isn’t just about BMI. There are multiple factors. They type of fat. The position of baby. The position of uterus. How full empty the bladder is Etc etc.

Sorry just seen you had the quad and are further along.

I think you should maybe contact your midwife? Personally I think you should have been brought back at 13 weeks to rescan?

I'm a higher bmi 42, I was under fetal medicine for scans early on due to 2 previous birth defect babies. My baby was being a pain in the arse for some of them but they persevered and got measurements they needed eventually. I needed to have a scan at 22 weeks as at 20 weeks baby was in awkward position once again to double check everything was OK! We only managed to find out babies sex at 30 weeks because baby was always in such a bad position or the cord was in between their legs so wasn't a weight issue just more of a shy naughty baby lol

It sucks you had a crappy scan and no pictures. I have fingers crossed for your next one to be a bit more easier and smoother x

Also to add I've had a scan at 30 weeks and I have one next week at 35 weeks! Because baby is bigger they shouldn't have a issue scanning you then! I got some lovely pictures of our little one x

I am not a sonographer nor midwife but I work clinically in the nhs. Some patients get incredibly offended if their weight is mentioned at all as a possible cause for their problems and other patients are absolutely fine & totally realistic about the challenges that their weight may bring.
Unfortunately being verbally abused a few times is enough to make me never want to mention weight ever again unless absolutely unavoidable.

@olivehater thanks for lending some of your experience as a sonographer.

I really don't mind health care workers pointing out my weight... I mean, I am fat so there's very little point in skirting around the issue. 💁🏻‍♀️

Unfortunately, if my 20 week scan doesn't go well due to maternal BMI, I will not be offered a rescan under my trust. It says so on my letter from the hospital.

Instead, they offer to take the baby away for a "full abnormalities check" immediately after birth. I am in two minds about whether to accept this as my midwife says at my hospital, the baby will be taken literally immediately and for about 30 minutes so I'll miss that skin to skin and initial feeding bit that I want so much. So hard to know what to do for the best. I suppose the best thing for baby is to let them go immediately but it's such a heartbreaking thought. Urgh.

Wish I wasn't fat. I know it's my own fault but it's so sad to know that my experience will be so far from the "norm".

It feels utterly pointless to go for this 20 week scan. Hospital is an hours drive and I'm absolutely certain I'll be sent straight home again with no pictures or information.

If it doesn't go well I'd book a private scan for around 28 weeks when you'll get some nice 3D shots too.
I'm not a fan of most private places as I do think they're only geared for happy gender scans etc. However some of them are run by current NHS consultants (my fetal medicine consultant had one) and they will be thorough in checking for health issues.

If it makes you feel slightly better I recently found out I was pregnant at 20 weeks so missed any chance for the screening tests.

I’m fatter and my baby more awkward. There are a couple of things they haven’t been able to check but sounds more like you have a trust problem as opposed to BMI problem. Mine have been great with rescans, quad testing etc.

Please do go for the 20 week scan. The baby is bigger, and like olivehater said it can be dependent on a lot of factors what they can see. They may not be able to examine all the elements but they may be able to, or at least do a partial anomaly scan, and they will be able to see where your placenta is which is also important. It isn't about getting pretty pictures, it's about checking for conditions for your baby.

Also - if baby is born well and has good Apgars there is NO reason for anyone to interrupt skin to skin. Obviously if the baby is unwell that's different; but you can decline for the baby to be 'immediately examined' not least because screening is not compulsory, it's an offer not a requirement and there are women who decline all screening completely.

All babies get a detailed anatomy check at or soon after birth, it's called the NIPE or Newborn and Infant Physical Examination and is carried out up to 72 hours post birth; it checks for all sorts of things and you can request that it is done by a neonatologist if they aren't able to get decent views at 20 week scan.

With a raised BMI you are likely to be offered growth scans through your pregnancy too so that they can monitor the growth trajectory of baby as it's not possible on abdominal palpation. Often this won't be mentioned unless you have a consultant appointment before 20 weeks but sometimes it's at the 20 week scan they will book you in for a 28 week scan or a 32 week scan.

Good luck x

It is absolutely not pointless. Please don’t let this experience stop you getting further scans. The 20 weeks scan is very important. At this stage the sonographer checks the position of the placenta, if it is covering the cervix or not and offers repeat scans to check that it moves out of the way. This is essential to ensure a safe delivery of baby. Even if they can’t get finer details they can still pick up any major abnormalities. You will most likely be offered growth scans later in your pregnancy as well due to your bmi. Am sure you will get nice picture of your baby at some point.

Ah. This has really annoyed me in previous pregnancies too!

In my first pregnancy by booking BMI was 30.1. So just over the threshold for it to be noted on my notes that I’m obese. But then I had a lot of morning sickness in my first trimester and lost 8kg, so I was a perfectly healthy weight by the time I had any scans. I also don’t, and have never carried weight on my stomach.

So imagine my surprise when every single scan report I had said on it that the scan was ‘technically difficult due to high maternal adiposity’. In my trust they don’t weigh you again after your booking appointment, so they only had my booking BMI to go off. It was absolutely used as an excuse in case anything was missed/ not picked up in my opinion. Which I even then wouldn’t have minded so much… except I wasn’t overweight and felt shit enough about my pregnancy body without having that written on my scans needlessly.

I’m sorry if it’s upset you or worried you, but I think my anecdote shows that often it’s written just because it can be, and not because there was actually any difficulty in performing the scan. X

February you have just rather proved my point about not discussing weight with the patient. You are not a sonographer. You don’t understand the complexities of scanning through different types of tissues. There are many factors at play. The type of fat ( you can be slim with wobbly fat, large but tight as a drum) scar tissue etc. position of the uterus in relation to distance from the probe. If the sonographer struggled, they struggled for one reason or another. Sometimes I scan people that are very overweight and have no issues at all. Sometimes I struggle with people with a technically low bmi.

But those things you have mentioned aren’t maternal adiposity, which is what the scan reports for that pregnancy have said. And they have never been mentioned in either of my other two pregnancies where my booking weight was not 0.1 over the BMI threshold.

Bmi means nothing. They are just saying the scan images were not the ideal images and they struggled more than usual due to the way you were built (whatever reason it may have been). They aren’t going to start go into detail saying well she was slim but she had a wobbly belly so it was still hard or something or other. It’s a straight automated phrase. If every report said it it obviously was something.
We are actually altering the terms we use work and calling it maternal factors to stop getting grief over this sort of thing.