Scanning For Trouble

I was working as a midwife when I found out I was pregnant with my first child. I had no idea how far along my pregnancy was and allowed myself the excuse that, as a midwife, I needed to know when I was due so that I didn't book anyone whose due date was too close to mine. So, off I went to my 'dating scan', excited at the prospect of seeing my little baby on a screen.

The scanning process turned out to be a rather invasive one. Being so early on in my pregnancy the ultrasonographer told me I'd need a trans-vaginal scan - immediately my romantic notions of 'seeing' my unborn child were diminished (this, by the way, was the only 'internal examination' of any sort that I had throughout all three of my pregnancies and births). But the worse was yet to come... My tiny unborn child had no heartbeat. "The size of your baby suggests an age of 5 1/2 weeks, by which time we would usually be seeing a beating heart," the ultrasonographer plainly informed me. "Come back for another scan in 7 -10 days and we'll check for a heartbeat again."

The week that followed was torture. I didn't know whether a was carrying a live or a dead child in my womb. Each day, until that next scan, felt like an eternity. Thankfully, the following scan showed a vigorously beating heart within my child's chest. I resolved, there and then, not to have another pregnancy scan unless there was a damn good reason to do so.

Over the 17 years that have passed since the beginning of my midwifery training I have come across many women whose pregnancy ultrasound scans have caused a lot of needless stress. The WHO does not recommend the use of routine ultrasound scans during pregnancy. This is because outcomes for the baby do not improve as a result of such scanning. Yet many pregnant women view their routine 20 week scan as a 'rite of passage' and an accurate means of determining whether or not their unborn baby is healthy. Frequently they are not told of the limitations and possible adverse outcomes of routine scanning (click here for a comprehensive article on the concerns related to ultrasound scanning).

In discussing the 'to scan or not to scan' debate with others, I have often heard it argued that having a routine 20 week scan is chosen as a means of decreasing stress levels during pregnancy because these women believe they will be reassured that 'everything is okay' with their baby. Interestingly, this has even been said to me by women who have 'had to' have multiple scans because there was a concern about some thing or another... they couldn't see the heart properly; there was too little fluid around the baby; they were worried about the position of the placenta; the baby was too small; the baby was too big... things that ultimately did not turn out to be of any concern, yet for a period of time they caused some degree of anxiety for the mothers.

I, for one, choose not to have routine pregnancy scans in large part because I am scared of the anxiety that having a scan might create for me. In the absence of worrying signals in pregnancy, I prefer to assume that I am growing a healthy baby in my healthy body. Admittedly I have had the misfortune of coming across a disproportionately large number of women who had 'false positive' and 'false negative' scan 'findings' (the numbers of false positive and false negative findings are, according to all the research I have come across, very small) which has also helped to secure my conviction that routine scanning does more harm than good. Some of the more extreme examples have included:

• a routine scan (and many subsequent follow-up scans) 'showing' fluid on the baby's brain that the doctors warned the mother would cause her baby to be brain damaged and very unlikely to live for long (this baby was found to be completely healthy at birth)
• a routine scan 'showing' a major heart abnormality (this baby's heart was completely normal at birth)
• a routine scan failed to detect a diaphragmatic hernia which had resulted in the baby's organs growing into his chest cavity leaving little space for his lungs to develop (this baby died shortly after birth)

And I have also seen the devastating results of discovering difficult truths during a routine mid-pregnancy scan...

A friend of mine was joyously pregnant with her first child. At 20 weeks she and her husband went along for their scan, excited about seeing their baby on a screen and anxious to hear that 'all was well' with their baby. Sadly, the scan detected a major heart abnormality, one that would be incompatible with life outside the womb. My friend was given the choice to either be given an injection of something that would quickly end her baby's life, then being delivered of her dead baby; or to carry on her pregnancy until it's end and give birth to her baby, knowing that her baby would die shortly after birth. She was devastated. She couldn't bear to carry on her pregnancy and chose the first option.

Another friend was given the same tragic news at her routine 20 week scan... your baby's heart has an abnormality which is inoperable and will result in your baby dying shortly after birth. She chose to continue her pregnancy, suffering through the comments of well-meaning people who didn't know her reality: how's your pregnancy going?; when's your baby due?; have you got the nursery ready?; are you looking forward to the birth?; would you like some hand-me-downs for your baby?, and desperately trying not to feel too attached to her unborn baby. Her baby died in her arms within a couple of hours of being born.

I can't help but feel that if it was me, I'd rather have discovered this sort of tragedy after the birth. At least, that way, a positive pregnancy and birth could be experienced beforehand, which is far more preferable, to my way of thinking, than being faced with either of the situations that my friends had to live through. Of course there is never a good time to find out such devastating news. But finding out via a mid-pregnancy routine scan is not going to change the outcome, not in any sort of a positive way anyway.

A routine ultrasound scan in pregnancy is an unnecessary intervention, often the first 'trigger point' for a number of consequential interventions... interventions that research has shown do not improve the pregnancy outcome! Like other unnecessary medical interventions in pregnancy and birth, routine scanning can erode a woman's belief in her body's ability to naturally grow and birth a healthy baby - something which we all know should be the reality for the vast majority of birthing women. Choosing to have a routine scan in pregnancy needs to be an informed and considered decision, not a flippant choice... Just because you can, doesn't mean you should.