Midwife prediction 20 weeks off

[Robinbuildsbears]

This hasn't happened to me, but to my SIL instead.

SIL has been feeling like she might be pregnant for a little while, but didn't stop getting her periods and has been on the pill so didn't take a pregnancy test until she started to get bigger in the belly.

She got her initial midwife appointment 2 weeks after calling with a positive test, where the midwife felt her belly and decided that she couldn't feel her uterus, so wrote down an estimate of 7 weeks. SIL insisted on getting a scan earlier than 5 weeks away, so the midwife reluctantly agreed to give her an appointment a few days later (today).

The scan confirmed that she is approximately 27 weeks along, literally 20 weeks further than the first midwife had said. Obviously a big shock for everyone in the family, and also for the staff at the hospital, if the first midwife hadn't written down in her notes 7 weeks they wouldn't have believed it.

How does a trained professional midwife manage to get it so wrong? Is it really that difficult to tell, does this sort of thing happen often? Or was this midwife just completely incompetent? My feeling is that SIL should put in a complaint about her and that she clearly needs retraining or something, or am I being too harsh?

Apparently my expectations of midwife knowledge are much too high

I really dont understand what your issue is. So what she estimated how many weeks pregnant your SIL was. She still got a scan didnt she? Has she hurt her? Has the Midwife ESTIMATING wrong affected your SIL pregnancy at all? Is anyone in danger because of this wrong estimate?

No, no and no.

Your snarky comment was particularly rude. What an odd thing to get worked up about. I'm glad for the Midwife that your not her patient

Your SIL didn't know herself how pregnant she was, when it's her own body, yet expected someone else to be able to tell accurately.

This is why dating scans are a thing.

That happened to me - first baby IVF at 42 - never, ever expected a natural pregnancy - midwife said 20 weeks, scan said 32. It was like one of those 'I didn't know I was pregnant programmes' Didn't blame the midwife - he was tiny. Why do we have to blame and complain all the time?

I would agree with you even an untrained eye would know a visible bump is further along then 7 weeks.
Maybe there is some procedure when no knowledge of date put on 7 weeks for scan booking.
Not sure how complaints work, presume internal team review ( if they happen) would pick it up and manager would discuss with staff.

midwife here!

palpating the abdomen should be able to give us an idea of gestation. However, it’s not an exact science as maternal tissue, uterine position and fetal position/size can of course impact this palpation.

I don’t think there is anything to complain about in this situation, but do agree that usually a midwife should be able to determine a rough idea of gestation based on a palpation.

This.

There was no harm done in this instance, but the midwives job is literally this and she failed at the first hurdle.

As I pointed out in my earlier post, MW’s training is very lacking in this area according to a consultant friend.
My midwife at the Labour ward was using a pinard stethoscope instead of a Doppler machine. I thought I went into a time machine back to the 60s.

@VaccineSticker so the midwife 'failed' at a guess. What harm occurred?

Its like the hysterical, blood baying posts here who want to COMPLAIN!! at a scan because the sonographer said 'he'.

I don't know how you would expect anybody to give a close estimation of gestation on just feeling the belly.

Periods, no huge signs or symptoms, I'm assuming no definitive bump? How on Earth would she know just by touch. Your sister in law didn't bother to take a test despite suspicions so it's kind of her fault it went on so long although understandable because she had periods.

If it were me I would would focus on getting ready for the baby's arrival rather than causing shit for a midwife just because she isn't mystic Meg.

There was no harm done in this instance, but the midwives job is literally this and she failed at the first hurdle.

I don’t think a midwife’s sole job is to tell gestation by feeling alone? Surely most people know the date of their last period so having a midwife try to determine gestation when the mother herself doesn’t know is not usual.

Actually a pinnard is more accurate and reliable than a Doppler. You can only hear what your ears can hear with a pinnard so no room for error, a Doppler can double the heartrate occasionally or pick up sounds which isn’t a heartrate.

I am concerned about your consultant friend.

Recently I met a woman who had been assessed by a consultant and after a palpation was told she was approx 5 weeks pregnant.
A week later she had a scan and was 38 weeks pregnant.

You get bad midwives, you get bad consultants. There are many more good ones though!

So I’m assuming your sister wasn’t already overweight at all? i.e. the midwife wasn’t having to assess through any additional to normal layers of subcutaneous tissue?

I'm very very petite and as a result when I'm pregnant my uterus is high and feels way further along than I actually am.

For example apparently your uterus should be at your tummy button at 20 weeks - my torso is so small & short my uterus was directly under my ribs as early as 16 weeks (usually happens in the third trimester). None of the midwives believed me until they scanned me.

All that is to say there's wild variations on women's uterus size, position, their build/bones, height etc - and the size of their baby. You can't blame the midwife for this.

Your sister might be bigger framed with a small baby, or a uterus that tips back and makes it feel smaller. I wouldn't blame the midwife really for this - she still gave your sister the scan

I’m going to go against the grain and agree with you that midwife could be incompetent and I would raise this.
no, midwives don’t just take a guess, they are trained to do certain things that an average joe can’t including properly feeling the uterus and baby from outside.
there is no negative outcome NOW but there could be with another person.

I agree with others - if a woman doesn't know she's pregnant herself for over 20 weeks, then the likelihood is the baby is sitting in a way that isn't obvious to anyone else either.

I'm sure the midwife will be beating herself up enough without you making a complaint about her.

You’re being very unreasonable to consider complaining, yes. She did absolutely nothing wrong. There was no negative outcome. Your SIL would have had a scan anyway soon. It’s not even your body so I’m confused as to why you’re out for blood.

If your SIL couldn’t work out that she was pregnant until 27w then how would you expect the midwife to know she was further on than 7w. Did your SIL not feel baby moving at around 18-22w-ish and get a little bit suspicious??

If your SIL has a higher BMI it’s very difficult to palpate the uterus and accurately estimate size of the foetus. The foetus is low down in the pelvis until later pregnancy so it is also difficult to palpate until much later in pregnancy. Also in second pregnancies some women do look to be further on than they are quite quickly so the fact you say she looked pregnant isn’t particularly helpful. My friend looked to be about 6 months pregnant with her second when she was in fact only around 12 weeks, I think it’s something to do with weakening of the abdominal wall.

If she’s been having periods then the midwife would have had to consider that the last period date may be accurate for dating purposes.

Your SIL has no basis to complain, ie you won’t be able to get a payout for this 🙄

People love to complain at the drop of a hat. Modern Britain.

To be fair she missed half of her own pregnancy so it doesn't seem too mad that the midwife was off too!

This! I'm a midwife and it does seem unusual for a midwife to miss this, however as pp have said the midwife probably wasn't expecting her to anywhere near 27 weeks so wasn't even palpating above the umbilicus!

I had one client who stands out because her abs were so strong that I couldn't even palpate the top of the uterus!! I had to send her for repeated scans. All was fine but she barely looked pregnant even at term.

@VaccineSticker

It is still correct practice to locate the fetal heart by first using a pinards stethoscope. It isn't always done this way, but to criticise a midwife for doing so is wrong. Measuring the symphysis fundal height using a tape measure is also current, correct practice. It is how static/tailing growth can be detected for example.

Sonographers are trained purely in scanning. Some MWs also underake sonography, but have undergone extensive extra training to do so.

Yes, people can and do make mistakes. We always try and learn from this.

As for midwives needing to be overlooked by an obstetrician!? I am a mw with many years of experience, I can't even begin to tell you the number of obstetricians I have overseen over the years and helped them to learn and develop!

We practice as a team, I have respect for the skills & knowledge my obstetric colleagues have, just as they have respect for the skills & knowledge of the midwives. I want the best care and the best outcomes for the people I look after.