Dilemma about 20 week scan and thousands dying in childbirth

[lulastic]

Hello,
bit of a funny one. I am in a dilemma about whether or not to go for 20 week scan. Did anyone else not go for one? Feel as if it is all a bit over medicalised.

And then in the midst of it all there are still thousands of women dying a day in poor countries because they can;t get enough care!

Mumsnet are backing a campaign to try and stop this:

And I have done a blog post about the first dilemma and the unfairness of things...
lulastic.blogspot.com/

Hi,

I chose not to go for my 20 week scan on the basis that I would continue to carry my baby regardless. I know some people say that it gives you time to prepare but for me the 80% false positive rate for something being wrong would have caused too much worry.

I wasn't interested in finding out about the sex either.

I'm trying to think of a way to word how I feel about the second part of your post (Friday afternoon brain is not working) but I will come back to this.

I did go for the 20 week scan - a couple of friends of mine found out their baby had problems that would need immediate attention after birth, so had to give birth in hospital with specialists on standby.

If they hadn't known about the problems the baby would have died. The 20 week scan isn't just about the gender (or aborting), it could save your baby's life - I think if you're going to skip one then the 12 week scan is less important.

I also chose not to have a 20 week scan, and was told many times that I should consider myself privileged to live in a country where we have such good antenatal care and that to refuse the scan was madness.

But I did a lot of research and found ^noevidence that routine ultrasound improved outcomes for healthy low-risk women or their babies. I am healthy and low-risk, had no wish to know of any abnormalities, no intention of terminating if my baby was not perfect, no desire to see the baby on screen, and no need to be told of the gender - so failed to see any good reason thatI* should go for the scan.

I feel strongly that women should be able make the informed choice to only have care and interventions that are relevant to us as individuals, instead of accepting everything offered as 'routine' whether or not it is likely to improve outcomes.

Sorry, dont know why all that got bolded there

Did you not want to know of any potential problems that could be treated in utero or immediately after birth though?

I think Missus sums it up really.

Hi Queen of Flaming Everything and Smallgingerone- that is pretty much all my reasons, plus the fact that I feel that every hospital visit results in a powershift- taken away from me and my natural ability to give birth and handed over to "those in the know"

I spoke to my mid wife about it yesterday who was surspiringly really encouraging. She said if your 12 week scan, and the follow up midwife visits show everything is going to plan (normal heart beat etc) then there is really no reason to go to the scan. There are very few circumstances where it can make a difference (i.e they have to operate on the baby in the womb to stop it dying) and most things (i.e low lying placenta) right themselves by 36 weeks anyway- but in the meantime you have been on this journey of worry and hospital checks.

My husband and I are fairly sure we aren't going to go to it, but only know one person who felt the same way! Thanks for posting, it is encouraging to hear others are on the same wave length.

Also- just noticed I didn't actually put the link to the Mum's Matter information! Here it is: www.oxfam.org.uk/get_involved/campaign/health_and_education/mumsmatter?ito=3764&itc=0

1000 women a day dying in childbirth, horrendous.

Loads of intense info about the lack of care in poor nations, but also a way for us to help the situation by emailing the Prime Minister.

It is an Oxfam, WI and Mumsnet thing...

I didn't have the blood tests for abnormalities for those reasons.

I did have the 20wk scan because as others say if there was anything wrong that needed treating then, to me, it seemed wrong not to take the opportunity.

I would also say that the scan does not always pick up abnormalities that do need treating. Which is what happened with us. Not life threatening abnormalities fortunately.

Not picking up those abnormalities saved me four months of worry and heartache however.

Its clear as mud now isn't it. But if I were to be pregnant again I would still have the scan.

So your not having the scan helps these women how?

While it's up to you what tests you have, saying that every visit takes power away from you all sounds a bit me me me and it's not really about you anymore. I'm with Missus84. Having known a few people who did have people on standby to take action when their babies were born it's a chance I wouldn't take.

I think the two parts of your post contradict as it's precisely because their births are not attended by people 'in the know' that these thousands of women die. (See also this week's news about homebirths being more risky for the baby). Forewarned is forewarned from the medical team's point of view, so it will make their job harder. And are you in danger of limiting your birth options if the team don't feel they have full info? e.g. if you wanted to try a water birth or midwife-led centre.

If this your first baby, you should also be prepared that your priorities might change hugely during the birth itself, from desire to have it as natural as possible, to 100% concern for the baby's health, to get it delivered safely at all costs. If there were any complications and no 20 week scan report, the medical team will not be able to say 'well we can rule out X so it could be Y...'

I had a 20-week scan, and haven't been on a journey of worry or hospital checks... Quite the opposite, in fact.

Agree with Missus84 and also Rockbird - it's not just about me and my peace of mind any more.

But, ultimately, you have to do what is right for you.

Echoing Rockbird and 5Dollarshake, you have a duty of care to your baby now. If having a ten minute scan ensures that nothing that could have been picked up goes unnoticed then why wouldn't you want that for your baby? How would you feel if something was wrong and resulted in birth or other complications simply because you didn't like the idea of a scan...

I think TBH it's almost insulting to not take up on medical care because others don't have access. It doesn't help them, and in turn many don't have access to drinking water - should we all therefore drink unclean rain water? I take most tests going if they are low risk/risk free (I had 20 week scan, high chance of downs but refused amnio) . I don't think we should go round whipping ourselves over the worlds problems, I think there are far more positive ways to help. I am sure most pregnant woman who do not have access to scans, or our standards of care would jump at the chance of it.

Great post from porcupine11.

My hospital used to have a relatively high rate of maternal and infant deaths. One of the main reasons for this is that there is a high number of immigrant women giving birth there, many of whom had had very little or no antenatal care.

They came in to give birth and the medical team would be faced with an emergency situation they had in no way prepared for.

I think if you are feeling sympathetic towards women in developing countries and the lack of care they receive, then it makes more sense to take advantage of the sort of care they are deprived of and would probably give anything for. Standing in solidarity with them by rejecting the care helps no-one, IMHO.

Antenatal care saves lives - both women's and babies'. That's the difference between developing and developed countries.

I went for my 20 week scan, and have to go back for another at 32 as there is an issue with his kidney. So I am glad I went as if the problem has worsened or still the same the baby will be treated after birth and monitored.
In saying that I can understand why people choose not to it is personal choice, and I had no intention of terminating if anything was found.

I didn't hesitate to have the 20 week scan as I wanted to know if there was anything wrong that could be treated in utero or would need immediate treatment after birth. The scan also tells you the position of the placenta, which is vital as a low lying placenta may indicate the need for an elective c-section. Yes, sometimes the placenta rights itself. But sometimes it doesn't. If I had not had this scan I would have viewed myself as being irresponsible both in terms of my baby's care and health and my own. OK, they can't pick up everything. But the fact that they can pick up SOME things was a good enough reasons to go ahead. A friend's baby's heart defect was picked up at the 20-week scan, so they knew to monitor carefully throughout the pregnancy, knew that she needed a c-section, and had the paediatric cardiac surgeon ready and waiting when the baby was born. He is now a wonderful 10 month old who is full of energy. If she had not had the scan, the outcome could have been very different. The information the scan provides is not just about gender and to help you decide whether you want to terminate. There was never any question of us terminating this pregnancy and for that reason we decided not to have the Down's screening. But that test provides you with a different type of knowledge.
As for the "power shift" - frankly bring on those who are "in the know" as far as I am concerned! I am not a sonographer, an obstetrician, a midwife, a GP, or any of the other healthcare practitioners I have come into contact with. I WANT and EXPECT them to have specialist knowledge and experience that I don't have. I want and expect them to use their years of education and professional expertise to provide me and my baby with the best care available and give all 3 of us (including DH here) the best chance to have the birth that we want to try to achieve.
And as for the argument that if you are low risk the information the scan provides doesn't make that much difference to the end result. Well, I haven't looked at the current research, so can't comment. But, it strikes me that one of the ways in which it is determined that you are low risk, is via tests such as the 20 week scan.

With all due respect to your earth-mothery wishes, refusing a diagnostic procedure that can end up saving your baby's life is a fairly moronic thing to do.

i would have the 20 weeks scan, it is the anomlay scan and issues that would not be apparent at the 12 weeks scan could be highlighted

i presume you are going for a home birth?

if so, you need to know htere are no issues such as placenta previa that could cause problems

not having the scan won't save someone else

one of the reasons that perinatal mortality is vastly reduced in teh first world is due to competent and consistent antenatal care

If your baby is sick when it is born will you be happy to hand over some power then? Ridiculous OP

And you know, the power shift only happens if you allow it to.

Part of my care is routine appointments with an Obstetrician and routine appointments with the midwife.

I am 35 weeks now, and my last appoint with the Ob was in March, when I was just entering the 2nd trimester.

The Obstetrician was so confident that I knew what was going on with my own body (admittedly this is DC2), that she discharged me from their care. Going forward I was just to be under the midwife. Of course, if anything had come to light at the 20-week scan I'd be back under the Ob, but assuming all was fine, I was trusted with a great deal of my own care.

I agree though, with cardamomginger - if it were my first, I'd be wanting all the professional care and advice going - but I still wouldn't just hand over the reigns to them and divulge all control. Nobody forces you to do that, and if you do, it says more about you.

I knew, long before I had the 20 week scan, that nothing I could discover would ever make me abort the baby.

I still had the 20 week scan though because I wanted to know if something was wrong and could be fixed (in utero or at the birth etc). I also just wanted to see the baby and have the reassurance (that i got) of the sonographer saying that all looked well wth the baby etc.

Also, the scan was able to say that my placenta is anterior but not low. If my placenta had been low and, after another later scan, had been shown not to have moved out of the way of the birth canal, natural birth would be v dangerous (huge risk of haemmorage(sop?!) etc).

Perhaps I am benig naive, but I didn't feel any choices or power was taken from me. The positive 20 wek scan gave me the reassurance to know that I should be able to have a healthy, natural birth and will insisit on minimum intervention.

Oh, and I chose not to find out the sex!

I sort of see your points (e.g. I know I would not have an amnio etc becasue I would not abort a baby with downs), but I am afraid I still don't really get why you wouldn't have the 20 week scan......

Wow, okay, really wasn't quite expecting such derision.

Sorry for raising some of my thoughts, will know that this isn't the place next time ;)

Would you prefer "Of course, by all means, live in ignorance of possible severer conditions, as long as your pregnancy does not feel over-medicalized"

I think the anomaly scan is an important one, regardless of how you feel about abortion. It's a chance to find out if there are any conditions affecting your unborn baby, any problems he/she might have etc that may require treatment. Skipping it is a bit like skipping any regular healthcheck - a bit silly in my opinion.