I had my second scan Wednesday of last week – the mid-pregnancy one to check that there isn’t anything too blatantly obviously wrong with the baby. Since I seem to be going on from there to write a long and rather uninteresting saga about various associated details I will spare you any suspense over the main point by telling you up front, Douglas Adams-style, that there isn’t – all bits and pieces appear to be present and correct (insert standard disclaimer about error rates of scans and the possibility of having missed something).
I was a bit surprised to be given the Wednesday date, partly because I hadn’t expected the scan to be until a bit later (it’s a 20 week scan and by that Wednesday I was 18 weeks, 2 days) and partly because I wasn’t given much in the way of notice. The letter only went out the week before, which meant, since I leave early in the mornings before the post arrives, that I only saw it when I got home from work on Thursday evening. At which point, as chance would have it, it was going to be another three days before I was due to see anyone from work again – I’d booked the Friday off as Barry was having minor surgery on his shoulder and needed someone to take care of Jamie while he was having and recovering from anaesthetic, and, of course, we’d then be into the weekend. Has it not occurred to the ultrasonography department that some people could ideally do with some warning if they need to arrange time off work? I know I’m legally entitled to time off for pregnancy-related appointments, but it’s not something I want to abuse.
Fortunately, one of the few advantages of the ghastly Advanced Access system (you know, that wondrous new innovation of the government which means that people find themselves only able to get GP appointments by ringing up three hours in advance or something ridiculous like that) is that we don’t have many advance bookings and it’s actually quite easy to get time off at short notice. Still, I thought it only fair to check that the date I’d been given didn’t happen to be on a day when half the other GPs in the practice had already booked time off or anything, so I rang the practice first thing in the morning before leaving for the hospital. Unfortunately, it turned out that the assistant practice manager, who deals with requests for time off, was out at a meeting, together with the manager. They would be back in by 2.30, the receptionist told me. This was unfortunately of somewhat limited help, given that by 2.30 I would be in a hospital room trying to keep my toddler from demolishing the place while providing succour to my husband in the final minutes before he was wheeled down to be put under anaesthetic. If I’d tried hard enough I daresay I could have found a few minutes somewhere in all this to run up my mobile phone bill phoning the practice again to find out for sure whether or not I could get the time off (and then the scanning department to cancel if it turned out I couldn’t), but, frankly, there are limits to the lengths to which I felt I needed to go to give the scanning department sufficient notice of a cancellation of an appointment for which they couldn’t be bothered to give me sufficient notice in the first place. So I arranged with the receptionist to book me provisionally as being away that morning, and left it until Monday morning to find out whether I’d be able to get the time off or not. Fortunately, it turned out I could. If not, I’d have had to cancel the scan with only two days notice, and serve ’em right too for not telling me further in advance.
Incidentally, since I brought the subject up, Barry’s surgery all went OK. The surgeon couldn’t find a cause for his chronic shoulder pain, but the MUA (manipulation under anaesthetic – a technique that basically involves wiggling the shoulder around while the patient is anaesthetised and therefore can’t scream in pain, and strikes me as a slightly more sophisticated version of thumping the TV to get it to work) seems to have improved things somewhat, so we will wait and see on that one. There is also a lesson here for any doctor who ever deals with pain control – start by finding out exactly what the pain is. When Barry was in the recovery room, the anaesthetist titrated his IV morphine dose against his pain, a technique that involves injecting it very slowly while asking the patient whether or not they’re still having pain so that you only give them as much as they actually need. It’s a great idea in theory and usually works well in practice as well, but unfortunately Barry was too dopey from the anaesthetic at that point to clarify that his mumblings of "Yes, it hurts! It hurts!" actually referred not to his recently-incised shoulder but to the sling, which was too tight. When he became coherent enough to explain this, back in his room, and we got the sling off, his pain settled immediately, but by that time he’d had the entire dose of morphine unnecessarily. It took him until after ten o’clock to stop throwing up, in spite of the anti-emetic injections.
Anyway. All of that is by-the-by. To get back to the scan, the other issue I considered was whether having it slightly earlier than expected would be a problem in terms of what the ultrasonographer might or might not miss. (This part of it, I will clarify in fairness to the scanning department, was not so much their fault. I calculate all my dates from my ovulation date, which I know due to having charted my temperature at the time – however, pregnancy is traditionally counted from the first day of the last period without taking variations in cycle length into account, and therefore this is how anyone with my medical records has been calculating my dates. The difference is only four days, but adding this to the week of variation one way or the other that the scan department allow when figuring out the dates for scans, plus the minor variations on top of that according to what days they have appointments free, came out with, well, the 18 week and 2 days date I was given.)
So I posted the query over at Doctors.net.uk and a very nice helpful GP with an MSc in ultrasonography explained that, although it would make a difference to their chances of picking up any minor problems, they should be just as well able to pick up anything major at 18 weeks as at 20 weeks. (The exception, apparently, is a decreased chance of picking up heart defects, but it seems the chances of that are not great even at 20 weeks – for that, you’re better having a 24-week scan, not an option routinely offered on the NHS.) Anyway, this was fine by me – the major problems are what I care about picking up. If it means likely stillbirth or likely vegetable, I’d like to know. More minor things, I’m not bothered about picking up at this stage and can even see advantages in missing (i.e. not having to spend the rest of the pregnancy fretting over something I’m not going to be able to change anyway). So, I went ahead with the scan, and, as I said, all appears to be well.
The tough question, the one some people prefer to ignore: What would I have done if all hadn’t been well? I don’t know. Never having been faced with such a choice as a reality and not as a hypothetical situation, I never will know for sure. I do know that it’s an issue on which my feelings have changed according to just how hypothetical it’s been for me at any given time.
Up until the first time I got pregnant, I’d always felt sure that if I found out that I was pregnant with a fetus so severely disabled that it literally couldn’t survive after birth – really fundamental stuff like missing kidneys or the like – I’d find it a no-brainer to decide to go ahead with an abortion. A miserable no-brainer, but a no-brainer nevertheless. Not that I thought abortion was necessarily always the right thing for a woman even in that situation, and I could understand that women might want to go ahead with a pregnancy even then, but I was sure I wouldn’t want to – there was no way I could see myself dealing with months of joyful congratulations on my swelling belly if I knew all I actually had to look forward to was a dead baby.
Then I thought about the whole thing again the day before my scan with Jamie, trying to work out what I’d do if something was wrong, and suddenly realised that even if the situation was that dire there was no way I’d be able to face having an abortion. It was impossible, unthinkable. I couldn’t say that I loved the baby inside me because, at that point, I didn’t – happy terrified anticipation isn’t the same thing as love. I hadn’t realised what a strong bond I had with the-fetus-destined-to-be-Jamie until that point. Of course, I also don’t think I’d have been able to go through with a pregnancy had anything been fatally wrong, so I’m truly not sure to this day what I would have done, and, good god, am I glad I never had to find out. (I’ve sometimes wondered since if I’m the only woman ever whose primary reaction to the picture of her baby on the prenatal scan was delight at the presence of the kidneys.)
This time around? I’m not sure. This time, I do think that if something had been fatally wrong I’d have had an abortion. As grief-wrenching as the thought would be, I don’t find it as unthinkable as I would have done last time around. I don’t know whether this is because something about having a child already, having that focus, has made the thought of going on after such a tragedy less impossible; or whether it’s just that the situation is still that bit more hypothetical this time around than it was last time. After all, this time I had a scan at 15 weeks, and although that wasn’t officially aimed at anything other than checking that the heart was actually beating, I’m guessing that at that stage any really major abnormalities would probably have been visible and that the consultant doing the scan would at least have noticed in passing that something was badly amiss. I may or may not be right about this, but, correct or not, it’s a belief that at least meant I really wasn’t expecting anything in the way of nasty surprises on this scan.
A more cheerful issue on which I’ve changed my mind as time has gone on has been the whole issue of whether to find out the sex of the baby. I always used to be adamant that I wanted to wait and be surprised when the baby came out – an issue that sparked some dissent from my sister during my first pregnancy, as she was equally adamant that she did want to know and therefore expected me to ask. We were still in disagreement over this by the time the date of the 20-week scan in my first pregnancy arrived. Barry, meanwhile, held a middle-ground attitude that it might be quite nice to know if it so happened that the ultrasonographer should get a good view easily. My sister travelled up from London for the 20-week scan in my first pregnancy, so a certain amount of debate on the subject ensued as we headed for the scan.
There was then an intermission in the scan when Future Jamie, having wriggled and twisted into every other position imaginable, simply wouldn’t turn into the one position the ultrasonographer needed to check a final view of his spine. The ultrasonographer finally suggested that I go and sit outside for a bit in hopes that, given a bit more time, the baby would turn into a more optimal position. During this time we discussed the matter further and Barry commented that it had looked like a boy to him on scan. So, in the end, that was the curiosity that tipped me over the edge into asking – curiosity over whether or not my husband could read a scan correctly. The ultrasonographer, as it turned out, concurred with him, and that was how I did ultimately end up knowing Jamie’s sex before birth. I can’t say the lack of surprise particularly bothered me when Jamie was born – the whole experience felt quite surprising enough.
This time around, I decided beforehand to ask. After all, it was possible that the baby wouldn’t be in the right position for us to see at all, and it’s also possible for a scan result to be wrong. I decided that was enough uncertainty and surprise to keep me going, so I asked the ultrasonographer to tell me the gender if she happened to spot it. As it happened, the baby was in a position for her to get a good view; she told me that she could tell the gender with 95% certainty, which is as high a level as you can ever get from a scan. So, it seems we can anticipate with reasonable certainty that we will be getting a little girl.