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/

if you expect people not to get cross or raise serious objections to declining antenatal care, then perhaps this is not the place

we are so luck in the UK that the NHS provides every woman with this scan.

there are are serious life threatening complications that can be picked up by the 20 weeks scan

you don't have to roll over and let people do stuff to you if you don't want, but having hte information with which to make informed choices about your antenatal care which impacts on your baby's health is vital IMO

what is your partner's view ?

Here is my thread on the same subject. I was called 'cavalier', among other things. I escaped being called 'moronic' though.

I said then and I stand by it now, that when something becomes 'routine' and normalised it is interesting to see how the burden of proof falls on those who wish to decline it rather than on those who consider it necessary.

I failed to find any research that shows an improvement in outcomes with routine scanning. The small decrease in neonatal death is due to the fact that babies found to have abnormalities incompatible with life are more likely to be terminated than carried to term.

Good luck with whatever you decide

Among my local midwifery/home birthy community there is a contingent who strongly believe that ultrasound can harm or at least distress the baby.

They may have a point - especially given that they are now looking at ultrasound waves as a method of contraception for men.

I think this is a reaction to 3D scans which have become very popular and are done mostly for vanity reasons. Plenty of medical professionals suggest that these may pose an unacceptable risk because of the amount of exposure involved.

Personally, I have had scans and with no new evidence, would still continue to scan in pregnancy. But I do have my doubts, especially because as the op says, there is a lack of evidence showing any measurable improvement in outcomes after a 20 week scan.

Well you did ask our opinion!

Just had a look at your thread Queen. And if I may quote a section of one of your posts:

"I don't want to dismiss the stories posters tell of how problems were detected and treated in their babies. When I say 'low risk', I mean otherwise low risk. I appreciate that a scan could show something that would make us 'high risk', but when looking at studies and WHO statements, the message is that for women who are otherwise low risk, routine scanning is not associated with a statistically significant improvement in outcomes."

Two things to say in response to this:

1. My friend was "otherwise low risk", and then they found the heart defect in her baby.
2. Let's assume that she wasn't scanned, and that the worst happened (it was a very serious defect) and her baby died. Fine, maybe adding her baby's death to the sum total would not have tipped it into the realm of being statistically significant. But, if it's your baby that's just died, and died from something that could have been treatable, I don't think you are going to give a monkey's about the niceties of statistics.

I have no problem with people deciding not to have scans, it is personal choice. With DD all was good on my 20 week scan and I would have gotten away with not having one on that occassion. However on this occassion, there was a finding that if still there or worse at 32 weeks, can treated after birth, which is a relief for me and I am glad I had it.
I myself would not have terminated a child for any medical condition as I am sure many women wouldn't but I did find this time my 20 week scan was useful in my case.

"for women who are otherwise low risk, routine scanning is not associated with a statistically significant improvement in outcomes."

That statement is demonstrably false, considering for example, placenta previa which happens to otherwise low risk women all the time and whose outcome is very significantly improved through diagnosis via scans.

If that's your choice, then that is completely fair enough, people have a lot of different opinions on every other pregnancy related matter. I personally think, that if you are lucky enough to live in a country that is more medically advanced, then you should take advantage.

You can still raise awareness and help/donate etc. towards said cause, and I think it's great that you have something you feel so strongly about. But even on the basis that it's another chance to see your baby, and see how much he has grown, I personally think that it is worth it.

I have strong ties to animal cruelty charities, but I would never stop my pets getting any type of jab/medical treatment just because other animals aren't in the same position to have it.

Regardless of what you choose to do i wish you all the best in your pregnancy and good luck with the campaign

"we are so luck in the UK that the NHS provides every woman with this scan."

I don't know whether this is the case throughout the UK - certainly when I was pregnant in Glasgow in 2007, I was only entitled to a dating scan at 10-12 weeks.

Only people who live in a privileged first world country would have the luxury of considering not having a 20 week scan for the reason of a perceived 'power shift'....I mean what is the big deal...

It's not always a matter of life and death, but that doesn't mean knowing the problems before birth isn't important.

My cousin's baby was born with it's oesophagus not attached to it's stomach. It wasn't urgent surgery, in fact they had to wait a number of months in hospital for the oesophagus to grow enough to be joined. Knowing in advance meant however that they didn't go through the trauma of their outwardly perfect child having major problems/starving before it was diagnosed.

It also meant that they could research the condition and discover the special dummy they could use to keep their baby's suckling instinct intact for the months she was tube fed expressed breast milk so that eventually when she recovered from the operation my cousin successfully bf her.

and statistics mean nothing to individuals. whatever your percentage chance of having a healthy baby you either do or you don't in the end.

In the past year I have had one good friend whose baby was stillborn and another aquantance whose baby died at a week old from conditions that would have been picked up on scans. Helping my friend through the heartache of this loss just puts all statistics out the window. 'healthy and lowrisk' gets bandied about a bit. Its all well and good if you are one of those women but are you positive you are! Its a big risk to take. My friend was other wise in the lowrisk category but unfortunately what was going on in her womb was a different story.
Its not just about handicaps or abnormalities. Its also about condition of the placenta, condition and position of the cord, babies organs, and hundreds of other perfectly manageable situations if the medical staff are forewarned.
Regarding 'handing over power' knowledge is power. I would rather know in advance and have my research done rather than have to act or make decisions in a flash that would affect me or the baby.

Our mortality rate is so low because we have better antenatal care.

It won't help the women who haven't got access to this care if everyone with access refuses it.

We do have better antenatal care, thats undoubtedly true. We also have a far higher standard of living generally than many countries - better nutrition, education, sanitiation and so on. All of which also make a difference to our infant mortality rates. Its far from clear how routine scanning contributes to the overall level of care or outcomes though.

Of course choosing not to have a scan will make no difference to those women in parts of the world where there is insufficient antenatal care, any more than eating all your dinner up will make a difference to those without sufficient food. But having something that actually has no proven benefit, just on the basis that one should consider oneself lucky to have the opportunity, is not the answer either. Its down to the individual to make the decision beased on the information they can access - and in my case, that information did not make me feel the scan was necessary.

I haven't read all ove the posts, but I only wanted one scan because of misgivings over ultrasound having read some papers and studies which leave questions unanswered.

I innitially refused the 12 wk scan and got everyone very excited! In the end I agreed to a dating scan but only by a senior sonographer, who took probably 1 minute of total scanning time.

The 20 wk one I wanted becuase I read that if things like spina bifida are seen, the birth can be managed in a way to help promote a better outcome for baby (e.g. perhaps a C/S rather than natural to prevent further damage)

Again I requested a senior sonographer because I am not a fan of u/s (I'm not saying it is dangerous but no one is/can say it is risk free, it is known to 'shake up' the molecules at a cellular level and heat them up raising questions about the effect on developing tissues) however it was explained things like plotting the growth are beneficial as again it may affect the management of the pregnancy with the aim of a more positive outcome for baby e.g. if placenta is not giving baby what it needs and growth is impeded then baby may do better outside of the womb.

I think you are quite right to question everything and anything regarding your pregnancy and the management of it as you wish to, this to me is better than going on the normal production line completely guiless. The medical fraternity are not always right, they have been wrong before, you and your family are the one who has to live with the consequences not them.

So you are protesting about lack of medical care for mums in the 3rd world by turning down medical care in your nice clean 1st world. Right. Tbh moronic is being nice. If you are worried about being over-medicalised then just grow a backbone rather than put your babys life at risk.

Speaking as a senior sonographer who has written papers on safety of ultrasound I'd (briefly)say Sedgiebaby is describing a process called cavitation which has been produced in test conditions using different conditions for scanning than we currently use in the UK. Heat and cavitation and two main side effects and cannot be reproduced at the lavels we currently scan at.

There are two caveats to this:

1. Patient driven desire for 'social' scans have meant 4D scanning is now popular and uses higher 'power' and scans for far longer than routine obstetric scans. This will increase the risk
2. Doppler scanning used to be used for specific clinical situations where the information helped that pregnancy. Research into this area will make it more mainstream and the use will increase. (e.g.Middle cerebral artery useful in some but should not be routine )

oh and a 3rd
3) Experienced sonographers are being driven out of the profession for a number of reasons -salary is not commensurate with experience and skill and 'anyone' can scan. It's not a protected profession and anyone can pick up a probe. Thus you have inadequate inexperienced staff maybe working privately or within NHS (due to shortage of experienced staff) and their work is reflected as a general problem. Good staff will be smeared with the problems of all staff regardless of grade/skill etc

My third baby would have died if an issue had gone undetected.

Equally I think scans are a choice. Being informed about that choice is important

I spent several weeks on the ante-natal ward in both pregnancies and on both occasions I met and talked to women who had had no idea that they (or their babies) were not low risk until things started going wrong. One woman had had two stillbirths . Of course, statistically speaking, being low risk is going to make a difference to the outcome, but for the individual woman it can be a complete misnomer.

I've been working on the Oxfam Health and Education for all campaign as a volunteer for over three years, and i took my 20-week scan.

In my opinion, campaigning so that everyone gets equal access to healthcare doesn't mean you should get less, it means others should get more.

I couldn't ever see Oxfam or anyone else advising that you miss out on some crucial screening just to make a point.

"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."

Couldn't she have equally said there is really no reason not to go to the scan?

In response to Fanjo: she could have said either and both would have been incorrect taken out of context.

At 12 weeks I could exclude many obvious major structural defects and a low lying placenta. Therefore if these are your only concerns and they have been excluded.... there is no reason to go for another scan.

At 12 weeks I could miss a cardiac abnormality or a renal problem (amongst many others). Both might be treatable and since scans are considered 'safe' according to much research there is no reason to not have one if this is information that could halp your pregnancy.

A scan informs you of (ab)normal anatomy at a point in a pregnancy.

It's limited by quality of the image and skill of the operator.

It's limited by the devleopment of the fetus.

The results and what you do with them are very very personal and in my experience women claim they will do one thing with the information but often faced with reality....do something else.

I hadn't realised the 20 week scan was so scary! I was quite looking forward to it

Look forward to it Fanjo. A skilled operator will show you your baby in detail. Whilst they are checking the ventricular septum and mitral valve and skin covering the spine........ they should also be saying oooh look at that hand....foot.....face and when you see the baby move it's very special.

The problem I have with scans is that people negate the medical need. (OP)

There is not a requirement to have a scan. It IS a choice that YOU can make. Medical professionals would usually encourage you to have one in order that they don't have to deal with the consequence of a surprise finding at birth. Dealing with a serious medical situation when you have planned for it, is a far more comfortable experience for staff (and parents and baby)

Most scans are fun

Most scans are a lovely experience BUT it is a medical test and priority should be given to the test not the 'social' occasion. If you want a social occasion, book a 4D scan. Then, you can eat popcorn and interrupt the sonographer at will, directing them to look at this and that.

Your post makes no sense.

My DC1's 20 wk scan showed I had low lying placenta. I was planning a home birth and despite some indication that the placenta had moved I bled very heavily when I went into early labour and it is doubtful whether mysel or DC1 would have survived if we had been ignorant to the matters the 20 wk scan flagged up.

My DC3's 12 & 20 wk scan were fine. i had a "vanity" scan to find out the sex (which couldn't be clearly seen at the previous scan). I was told DC3 had a number of physical abnormalities and was suffering from IUGR. I was told that he would not survive the remainder of my pregnancy. I am so pleased that I had that time whilst he was still alive and moving and kicking to say goodbye and prepare myself for his loss.