I want a scan ..... whats the best way of actually getting one?

[mosschops30]

I am midwife led so not under a consultant. As Ive mentioned on previous threads I am concerned about size of baby, but even more so now about the position of the baby, as the midwife never seems sure where he is!
I am getting lots of movement, and its everywhere, big lump up the top sometime, sometime on the side (no idea if its head or bum). Lots of kicks from every angle you can imagine, and the worst stabbing pains you can imagine very low down.

I have asked the midwife for a scan, but shes a bit 'la-la' about it all saying, 'well its a good size we'll keep an eye on it', and about position 'i think its head down, but there are limbs everywhere, it could be still moving round, unlikely but it could be'!!! So none of these things are really helpful.

I am seeing her again on Friday, so will ask yet again if I can have a scan. Other than that the only other thing I can think of is ringing the consultant I saw privately for nuchal (who also works at the NHS hosp I am booked into) to see if he would consider referring me, as I cant afford to have another private scan.
I think I find it more worrying because I work in anaesthetics at the hospital, and if my baby is too big, or breech then Id like to know early and plan it and choose my anaesthetic team, rather than having to have an ECS and being horrified at who is doing it IYKWIM.

WWYD? TIA

Main indications for scan [in the 3rd trimester] are

?small for dates [fundal height of between 3-5 cms smaller than weeks gestation [units differ on policy]
?small for dates [fundal height has faltered in growth velocity]
?large for dates [fundal height 5cms larger than weeks gestation - units will differ]
?breech - usually performed at 36-37 weeks as change is less likely at this gestation
Reduced fetal movements on several occasions - ime 3, but units will differ
PreEclampsia - looking for placental function
Diabetes - looking for evidence of effect on the baby in terms of size.
?Ruptured membranes
?reduced liqour
Maternal indication - illnesses and medication for example.

I'll have failed to mention plenty, but hope this helps.

Also rememeber, cs are done on 7lb babies at 4am who are royally stuck, 10lbs babies pop out in lifts. Its all about head size [not always reflected by measurable body size, and very tricky to measure in the 3rd trimester when it matters], pelvic inlet and outlet size and shape, and fetal position in labour.

In other words, a scan might not give any indication at all of how you baby would/will travel through your pelvis. As no dount many will be along to telll us! They are soooooooo often a total red herring.

How many weeks are you? If over 35 I would simply insist on a scan and make the MW book you one - kick and scream. Breech positions can be difficult to ascertain. I have a good friend who found herself having a home birth with a baby who was in a breech position akin to doing the splits and a terrifying ECS/ambulance experience. MW kept saying all along she was not certain of position. I think a good MW should send you at about 35-36 weeks if she is not sure - before that my understanding is that they can change position.

If no joy with the MW talk to your GP.

Oh forgot - your certainly could give the consultant a bell, or is there no consultant at work you know that might have a sympathetic ear for you?

news I have had two babies already so I know my pelvis can accommodate at least a 7.7lb baby I have to say that I am less worried about the size now as it seems to look more normal than it did, more about the position.

Sorry am 36 weeks, forgot to mention that.

I have asked MW at last 2 appointments, but she seems rather laid back about it all, I find her a bit drippy TBH.

news can any doctor refer you for a scan? I know lots of docs that would do a form for me, but not sure whether it needs to be an obs/gynae doc rather than just a random anaesthetist

If you want one, you should be able to get one, and the MW if she is at all unsure at this stage should give you one. Insist. If she says no, immediately call your GP and explain the situation and approach freak-out if necessary. You'll get one.

Incidentally, my MW in my first pregnancy was not sure and automatically sent me at 37 weeks. If there is any doubt, you are within your rights to make a big fuss.

Your GP should be able to do it quickly and easily (at least they can in our NHS trust)

Would prob need to be obs - as they will be interpreting the result. ALso the sonographers would probably at it. They usually know the referring Dr's.

Good news on the pelvis - your body is very very unlikely to grow a baby it can't accomodate at this stage. If you have a new partner than perhaps new genes might do it but even then, your multip status is working for you.

Ask her how many cms variation they scan at, and how many you are. That should give you the info you need to see if you fall within scanning guidelines.

You could always pitch up to hosptial an clinic and ask for a 2nd opinion from a [senior or very experienced] doctor or midwife. Midwives generally have more experience feeling bumps, especially not-in-labour bumps.

unfortunately there is only one GP who likes referring patients for anything and you have to wait weeks to see her But I suppose its worth a try if the MW wont budge.

I have just got the extension number of my private consultant at the NHS hosp, but embarrassed to ring and ask him though, have no idea what to say??

Say you would value a second opinion on your fundal height, as you have a niggling worry. Your regular midwife does not seem to have any cause for concern or criteria to refer, but nevertheless you have the niggle and would appreciate their opinion.

It's all good, no one minds being asked their opinion. Most people are very flattered in fact!

thanks news no same partner

they scan at 2cms variation, and at 34 weeks I was spot on. But I do think that you could get 10 midwives to measure and they could all give you different numbers, its so random!
Yeah I thought that about the doctor doing the referring. Sadly I dont know any obs/gynae docs as they have their own theatres so we dont cover it up in main theatres

news sorry - do you mean say that to the consultant or a different MW at the hospital?

Their second opinion may be they may not want a scan for you either - they may simply give you the info on cms and growth velocity amd measurements. Just so you are aware . Even hearing it again though can be reassuring can't it.

Am making you sound an irrational worrying loon now - I don't mean to. Sorry!

x -posts.

You could say that to anyone really. I think consultant, Dr at hospital, or another midwife [community or hospital].

Just saw your 2cm post.

That is very reassuring. If the midwife requested a scan with that as the indication alone it would be questioned/declined [ime]. You are very right about the variation amongst practitioners [although if they locate the pubic bone and fundal height the tape measure is much better than hands and eye alone according to research] so that's why the lack of concern from your own regular midwife is reassuring.

Still though, you are completely able and welcome to seek a second 'hands on'. No harm and cheap as chips . Then see how you feel re:scanning.

Lol @ irrational loon, you know me so well

like I said, its not just the size its the position and being able to plan my CS if it was needed (god I hope not, as have planned lovely MLU birth in the water)

I do get irritated that it seems policy is to ignore mothers who are convinced their babies are in a position that differst to the midwives opinions. My mw was totally insistant that ds was head down, I knew he wasn't even though he was my first. All the kicks were far too low and his heartbeat was much louder right under my ribcage. Never mind all that, the mw was convinced she could feel a head. I made such a fuss about finding out for sure, so they sent me grudgingly for a scan, lucky they did as he was footling. I hope you get your scan, make a total pain of yourself

I'd persue the 2nd opinion if you feel it will help you put demons to bed and [hopefully] find your clinical presentation to be reassuring, and then crack on with your water birth plan. If it is larger and needs repositioning in labour - where better to do it that mobilising in water!

But do remember a 2nd opinion is entirely fine and not uncommon and we should all be encouraged to follow our instincts. You know how to be pregnant and birth so your opinion is valuable and usefull!

be direct.

say, " I am feeling concerned about the size and position of the baby, I know you often have difficulty knowing if the head or bottom is down, and I would really appreciate a scan, for reassurance and so that if the baby is breech, I can book a c.s rather than delivering an undiagnosed breech in the MLU."

i doubt she could say no to a scan

And remember - you are not the pain, they are the pain if they see you as a pain.

The midwife might have trouble getting a scan without a clear clinical indication as per her guidelines, but ?breech is a basic reason to scan. Be aware though that it might not assess for size, just presentation.
So be sure of what it is you want and what yo are asking for. {smile]

Why don't you trust your midwife? If she was concerned she would refer you for one.

Sorry, but the NHS isn't there to scan worried well people every 5 minutes when there is no clinical indication for it. Then they would have no time to do the scans for anyone else. The NHS is not a bottomless pit of cash.

They wouldn't refer for a scan for ? breech at 34 weeks as there would still be a good chance that even if baby was breech it would turn. However at 36 weeks if m/w is still unsure of position then she should refer you for a scan. Good luck.

bubbles I work for the NHS I know all about timewasters believe me, and I am not one of them. I think having 2 previous pregnancies and being a qualified nurse gives me enough knowledge to be concerned about the presentation and size of the baby. I havent said I dont 'trust' my midwife, but I would value some reassurance so I can make decisions that are best for me and my baby. Any scan outside of the norm, I have paid for privately rather than pulling the 'staff' card.

thanks for all the suggestions and opinions, Im sure if I did get a scan for presentation then I could just ask if size looks ok whilst Im there.

If the hospital is like the one where I work then they probably wouldn't check size as well. A scan card has to be filled out for every scan and the sonographers refuse to do anything thats not on the scan card. So if you were booked for a (quick) presentation scan thats all they would do. A growth scan takes a lot longer as there are precise measurements to be done.

stripey yes I know that but a quick idea of size does not take as long as say an anomaly scan at 20 weeks. And as I am staff, they may give it a quick once over and say 'yeah looks fine' I dont want a size and weight as I know these too can be unreliable but as long as he/she can say 'its not a whopper' then I'll be reassured
TBH theyre pretty good at our hospital, when I had a small bleed with ds at 30 weeks they did a scan and even took the time to take photos and gave us some to take away which I thought was nice as wasnt 'routine' IYKWIM

Sounds like the sonographers aren't as strict as ours then. Hope you get some reassurance either from your m/w or a scan soon.

Well, I was measuring three cm too small on my fundal height at 34 weeks and I was whisked off for a scan immediately (baby is fine - I've not put on enough weight!) I think they're much more concerned about too small than too big as long as the baby is active. It took a long time and seemed quite fiddly to get all the measurements - pretty sure they wouldn't do all that if they were just checking for breach

Is it a possibility to get it done privately?