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Ultrasound scans or pregnancy scans have become a rite of passage when you are pregnant! From that 12-week scan where you see your baby for the first time and finally, get to breathe a sigh of relief to the 20-week anatomy and gender scan where you suddenly realize you are halfway through your pregnancy and better start planning for them to come out! You might even pay for extra private scans or have additional scans at the end of your pregnancy!
But navigating scans can be filled with anxiety for some, and they aren't always that special memory that you look back on and treasure, the person doing the scan can make a huge difference.
As with anything during pregnancy, you have many choices regarding scans! They are a great opportunity to practice your decision-making and advocacy skills.
How many ultrasound scans will I have in the Leeds General Infirmary?
In the UK the NICE guidelines recommend a minimum of two scans.
A 12-week and a 20-week scan, depending on your risk factors you may be offered growth scans in addition to this.
Before your 12-week scan, you may have an early scan with the NHS or privately to confirm your pregnancy or investigate bleeding. Or you may have had a scan in the rainbow clinic if you have lost a baby before.
If your midwives have concerns about the position of your baby close to your due date you may be offered a positional ultrasound scan, and if you go in for reduced fetal movements and concerns are identified on the CTG you may be given an extra scan.
You may also choose to have a private ultrasound at any point which is available at private clinics which you will need to pay for! You can even get 3d scan and 4d scans in most private clinics.
It's important to know that more scans do not equal improved outcomes, a study done in Denmark found that routine scanning vs abdominal palpation does not improve the rate of severe adverse outcomes and it also increases the rate of induction of labor. (Henrichs J, Verfaille V, Jellema P et al 2019)
In fact the World Health Organisation recommends one scan before 24 weeks gestation as part of antenatal care.
12 Week Ultrasound Scan at the LGI
This is most often the most nerve-wracking scan, it can be the first time someone other than the pee-on-a-stick pregnancy test confirms you are pregnant! It carries a lot of emotional weight and you may be feeling anxious, scared, excited, or a mixture of all three!
The 12-week scan, which should take place at 11+2 weeks and 14+1 weeks, is to check if you are having a single pregnancy (or if it's twins or more!). This was one of the first things the ultrasound technician said to me at my first scan! I hadn't even considered the possibility of twins before then! She said 'There is just one in there!'
During the 12-week scan, they also determine gestational age, until then your due date is calculated from the first day of your last period and your average period length. The date that is created from the measurements in this scan often replaces your 'original' date, which can feel frustrating if it turns out you are five days less pregnant than you thought, or a shock if you are further along.
Evidence shows that ultrasound-guided due dates are accurate with a range of plus or minus 5-7 days (ACOG Guidance), which is quite a big range! If you add to that the fact that only 4% of babies are born (BBC article) on their due date and the average time a first-time mum gives birth is actually 40+5 days (Smith 2001a).
During the 12-week scan if you consent to it they screen for Down's syndrome, Edwards' syndrome and Patau's syndrome (see the NHS fetal anomaly screening programme). They will take additional measurements (nuchal translucency) during the scan and you will have a blood test afterward. So if you don't like blood tests it is good to be prepared for this!.
They also check the blood flow into and around baby and your uterus.
Do I need a full bladder for my 12-week scan?
The 12-week scan is often done with a full bladder, you should receive instructions before the scan to drink 500ml of water or squash half an hour before the appointment!
This seems like unnecessary torture for a pregnant woman whose bladder is in overdrive, and with NHS waiting times for appointments, this can mean that you are sat in the waiting room dying for the toilet for what seems like forever!
There is a reason for this though, a full bladder pushes the uterus up and out of the pelvis, pushes your bowels out of the way and all that fluid helps those ultrasound waves travel and the image to be clearer.
Ways to advocate for yourself in the 12-week scan
If your full bladder becomes too uncomfortable and you have waited longer than expected inform the staff that you have used the toilet and continue to drink plenty of fluids.
If you are uncomfortable sitting in a waiting room with other pregnant women due to past trauma or you find the lights/noises hard to cope with ask to be seated somewhere else.
You should be able to bring at least one person with you to the scan to support you.
You will be asked to roll down your trousers or take off your skirt or remove them, you should be able to keep your pants on unless they ask to do an internal ultrasound. You are entitled to privacy so you can ask anyone to leave the room whilst you undress and should be given paper towels (or take a light blanket) to cover yourself with.
If you are feeling anxious you should tell the technician and ask to be told as soon as they see the baby's heartbeat.
If you have sensory processing differences you can ask to place the ultrasound gel on your belly yourself.
You can ask for as little or as much information about what they are doing as you want.
If you feel any pain or too much pressure ask the Sonographer to stop.
How do I book my 12-week scan?
Your midwife will book this scan during your booking appointment when they take your medical history, this should be around 8 weeks! You shouldn't have to do anything else!
When do I get my 12-week scan letter?
You will get a letter in the post one or two weeks ahead of the appointment date, but it could be sooner than this!
What will happen when I go to my 12-week scan at Leeds Teaching Hospitals?
Depending on which hospital you are under in Leed Teaching Hospitals NHS Trust (LTHT) the scan will either be in Clarendon Wing at Leeds General Infirmary or Gledhow wing in St James Hospital.
You will head to reception for the radiology appointment and will be asked to wait in a room with lots of pregnant women at different stages of their pregnancy (don't compare bumps!).
There may be a wait (possibly a long one!) before you are called in to see the ultrasound Sonographer.
Once in the room, the Sonographer will let you know how they would like you to sit on the bench and which clothes you should remove, they should leave the room to let you do this and provide you with paper towels to cover yourself (or you can take a light blanket).
They will (or you will) place ultrasound gel on your belly, quite close to your kicker line, and use a handheld device to scan your tummy.
They should tell you quite quickly that they can see a heartbeat and how many babies are in there, if they don't, feel free to ask!
There may be a screen in the room for you and your partner to see the image of your baby, or if this isn't the case the Sonographer may turn their screen to show you any images they think you will find interesting, again don't be afraid to ask!
Sometimes if the image isn't clear or you are a little less far along than you thought they may ask to switch to an internal ultrasound, which is a handheld probe with a covering on that is lubricated and inserted into your vaginal canal, you will need to remove your pants if you consent to this, you can always ask to come back in a week to give baby time to grow!
You may also be asked to empty your bladder to help the baby move into a different position to help get some of the measurements, I was asked to 'half' empty my bladder which was interesting!
The Sonographer will likely be quiet whilst taking the measurements, this doesn't mean anything is wrong just that they are concentrating! If you feel anxious don't be afraid to ask.
If they do pick up any concerns they will likely briefly discuss these with you and book you an appointment with a Dr on the same day to discuss the results. With my first baby I was asked if I had had any bleeding (I had) and told I had a subchorionic hematoma (a collection of blood in the uterine lining), I had an appointment with a consultant on the same day who explained this to me and arranged an extra scan.
Should the 12-week scan hurt?
The resounding answer to this on the internet it no, and that you may feel 'a little pressure'.
However, we all have different pain tolerances and our bodies are undergoing huge changes! In the first trimester, you may have cramps and round ligament pain whilst everything grows and stretches, add to that a very full bladder, and that 'slight pressure' may feel more than a bit uncomfortable.
A quick search on Mumsnet comes up with hundreds of women complaining about rough treatment and pain during the 12-week ultrasound. The Sonographer does need to apply pressure to get accurate views of the baby to measure everything they need to measure but this should not be painful! If it is painful you need to ask them to stop.
You can move your body, shake your hips, turn to the side, or walk around, there are plenty of alternative things that are not painful that you can do to help the Sonographer get that measurement, alternatively, you can come back for a different appointment in an hour or two or in a few days.
Speed efficiency and convenience are not good enough reasons to go though a painful examination when there are alternatives.
Will I get a scan picture of my 12 week scan at LGI?
Yes, you will get the chance to take home a picture.... but you will have to pay for it!
It will cost £7 for two mounted photos or £10 for four.
What should I do with my 12-week scan pictures?
It is tempting to put them in a frame however the sunlight will fade these precious memories so it is best to keep them in an album or in a memories box.
Do not keep them in your paper maternity notes as they could easily fall out or get lost in your hospital or midwife appointments!
Can I record my 12-week scan?
Yes! There may well be a sign telling you photos or videos are not allowed and if you do so your appointment will be terminated, the NHS website gives the following reasons:
Distraction
Recording or taking photos can distract the sonographer and make it harder for them to see the screen. This could lead to them missing important signs.
Privacy
The sonographer and other staff should be able to do their job without being recorded.
Distressing events
It may be distressing to record or photograph if any problems are identified during the scan
However, although hospitals are not public places they are places that the public reasonably has access to, and we have the right to take pictures and film in public spaces.
We also have the right to NHS services, and it is unreasonable for this to be taken away because you took a photo or video.
There is no data protection issue as you have a right to your own data, as long as you do not film the Sonographer there is no breach of their privacy.
So if you wish to film, feel free to challenge this rule, they are probably just worried you won't pay them for scan pictures.
In Summary
12-week scans are a big milestone, they also present us with one of the first opportunities for us to make informed decisions (do you want a scan, do you want the screening?) and to practice how to advocate for ourselves in clinical environments.
The Sonographer and how they treat you can make a big difference in how you look back on what should be a happy memory, so if you are unhappy with how they treat you, or the scan is painful you need to speak up!
If you would like to learn more about making informed decisions during pregnancy and birth, and how to advocate for yourself and your birth rights, check out my virtual doula packages so I can support you to feel empowered in taking the next steps!
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