Interview AN26

Age at interview: 36

Brief Outline:

Routine screening experiences, including nuchal scan.

Background:

Healthy baby born 2002, pregnant with second baby.

She described the screening process as a 'Pandora's box' where one decision leads to another.

Yes, we'd had some discussion about it, and I think we were of the opinion that we'd have to take it very, very, very carefully, very cautiously. 

But I think we both were agreed of why we were entering into this screening process, because I always think of it a bit like a, it's like a Pandora's Box, or a potential Pandora's Box, that if you start some screening, there's going to be an outcome of that screening, and then you have to make a choice. 

And then you are led to another path, and then you have to make another choice, and so on and so on. And all the time the pregnancy is progressing, and the clock ticks, and the baby is growing and getting bigger. 

So in my own mind, I was very much taking it one step at a time, and I think we were very, very much agreed with that - that there was really little point in thinking, 'Well, if this happens, this is what we're going to do. If this happens, that's what we're going to do.' But what we were agreed about was that we should assess what the risk factor for this pregnancy was so that we have a starting point. Because if you don't have any information to begin with, then you're none the wiser. And we wanted that information.

She looked for information on the internet but found it too technical. You need to know what questions to ask.

I have a fairly open mind about screening. There's always that concern I suppose that you're not getting enough information. 

Even for you as someone who is very well informed?

Yeah. I think there's always that feeling that, 'Have I missed something? Do I know the right questions to ask?' Because that's the key, isn't it? You've got to know the questions to ask, and how do you necessarily know what those questions are if you don't know the information? 

Or where you go to look to start with, because often you're just, you're seen around eight weeks pregnant, and suddenly four weeks time you've got this nuchal test, so what, where do you go? What do you do? 

Are there particular areas of information you feel that you've missed out on something, or it's just a general concern?

I did think, 'Where am I going to look? I just need to really reacquaint myself with - maybe things have changed, maybe it's all different to what I knew.' So I do remember I did try and look at a couple of websites for some information, but I have to say I did find it quite technical and academic, which isn't necessarily very helpful when really you just want plain English and some straightforward ways of just how you get that information backed up.

So it was very thin on the ground, I have to say. I do remember doing that actually, and feeling quite, 'Oh no.'
 

Seeing her baby during the nuchal scan was wonderful but it was alarming that staff talked to each other, not to her.

And what was the experience like?

From what I recall about it, it was, it seemed to go on for quite some time. It felt like it was very detailed. There were also two doctors doing it, and I think one was learning, so we were sort of in a teaching environment, which was fine, I felt OK with that.  

I can't remember whether we were asked whether that was all right or not actually. I think it was kind of assumed that it would be OK that, you know, I'd be scanned and there'd be these two doctors talking about what they could see on the screen in a sort of a removed way. And also sort of calling a senior colleague in when they weren't quite sure what was what. So that was a bit alarming, at some stages. 

Did they find anything?

No. I think it was more about accuracy. I think they were more concerned about actual measurements. And they had a few concerns about the technicalities of the equipment. Which was all very well and good, but you know, this was the first time that we were going to see a picture of our baby and it did take a little bit of just taking a deep breath and kind of try to go with the flow of the situation, really.

What was wonderful about it was obviously seeing, you know, our baby. But also we got to hear the heartbeat for the first time and that was actually quite overwhelming. And very, very special actually. So it was a bit of a mixed experience. 

How do you think they should have handled it?

Hmm, I think they perhaps should have just introduced the fact that they, you know, that somebody was learning, and not assumed - you know, I think there was just an assumption that, 'Oh, here's the next group of people coming in and oh, they'll just know that we're teaching here.'  

So I think that would have just, you know, that would have just made the situation fine. But because they didn't explain and because they didn't say that, you know, they might actually be talking amongst themselves and it didn't necessarily mean that there was anything wrong, I think that that could have just smoothed things over a little bit from the start.
 

In her second pregnancy, she was anxious that the sonographer doing the nuchal scan seemed rushed. She needed more reassurance.

I know the second time round the nuchal was done at the other, not the local hospital and very different actually, very different, in the sense that it was done much quicker, and that was because there was no teaching situation going on.

The scanner was very rushed - I felt she was very rushed. And there was, obviously they'd had some hiccup administratively in the day because all these women had turned up and the list should have been cancelled. And there was all sorts of things happening. And so she was stressed out, and I was very much aware of that, and I just thought I just hope you're doing your measurements properly. 

So I just had to keep calm about that and just try and relax. But, you know, she did it, and it was just done, it was just much more, 'Oh, I've done this before, so I know what it's about, so let's just see what the test comes back as.' And as it turned out, again it came back as low risk, but because I'm a year older of course the adjusted risk is going to be slightly different.  

And I needed a bit more reassurance that it was still OK. I do remember that. But she was OK about that. She did take the time out to explain that there was no action that she would have, you know, that she would have recommended, so that was OK.
 

It would be sensible for sonographers at the 20-week scan to check the woman is properly informed and explain how they will communicate.

They're a professional in their own right so they must, you know, the first thing they just must be courteous and professional. And I think that probably a good scanner is somebody who will just, you know, just introduce themselves, say what, how long it may take, what the purpose is.  

I think it doesn't hurt to just reiterate what you're there for, you know. Again you know, some people just turn up and they're not really certain of why they're there. They've just been told to go to that scan room and, you know, 'Twenty weeks - you're going to have this done.' So I think it doesn't hurt just to reiterate what's the purpose of the scan, that sometimes they may not say anything and that doesn't necessarily mean that there's any problem, and it might mean that they just need to take a little bit more time in looking for something.  

So it's just taking that little time at the beginning to sort of set the scene of the next twenty minutes, or the next half an hour, I think. And I think for the scanner to say, 'If you have any questions,' you know, either, - whatever, you know, depending on what the scanner likes, you know - to take questions as they come up or at the end, or whatever way it's agreed.  

But I think that's just such a simple thing to do, and to me such an obvious thing to do that it's the sort of thing that always - well, you know, it's one of those things that can get missed out. 

But I think, what I've noticed with all scanners is that they just take a few seconds at the start where the screen is directed at them only - and you know, obviously that's just to make sure that there is a heart beat there and that they know that before they swing the screen round so that you can see it too. So I've noticed that with, you know, the two scans that - three - four scans that I've had, that they always do that to check first.

Have they ever said to you that's what they're doing first?

No, I think it's a very subtle thing I think that they do, that they sit down and they tap in whatever information they have to do, and then it's a very quick, you know, the scanner's placed on your abdomen and it's a very brief few seconds look, and then they'll swing the - as if you're not to know any different. And perhaps that's OK. Perhaps that's OK. 

Because at the end of the day the scan is, it is a stressful thing if you're not used to that environment, if you're not used to having tests done. So maybe, you know, you don't want to over-do the information.
 

Staff seemed uncommunicative on the day of her 20-week scan, and she felt anxious something might be wrong.

Well, the twenty week scan was done at this local hospital, and I can remember being very excited about it, because I thought we were going to see a really good picture of the baby' So I was quite excited about this anomaly scan. And it was a very cold day. I think it might have even been New Year's Eve or something. It was very close to the holiday, I remember that.  

And it took us a little while to find. And it was very unfortunate that there was little communication, we felt, between the scanner and ourselves. It was almost as if they just wanted to get through their quota of women for that day. And I'm sure it's because it was the holiday period, that's the only thing I can think of that, you know, that they really didn't want to be there.  

So whilst it was lovely seeing, again it was lovely seeing our baby on the scan, there was a definite lack of attention to us. And I must admit I came away feeling really worried, because I felt that I hadn't seen anything, that it was sort of vaguely indicated to me that that was the heart and vaguely indicated that that was, you know, that was the spine. And I do remember coming away feeling really disappointed, you know, deflated that I hadn't come away reassured that everything was OK.  

Deep down I think I knew, you know, in my heart of hearts that if there was a problem I think instinctively I would know. But there was just something about it that made me think, 'Oh, what a let-down, what a complete let-down.' And just felt very upset about it really. It did take me quite a while afterwards to sort of get past that. 

And I remember when I eventually went to the hospital where I had my daughter, I actually requested another scan, because I just thought, 'Oh, I think they've missed something.' because I was churning it over in my mind so much I had to be talked to, really. And they said, 'Don't, you know - they've written down here everything that they've seen. Don't worry about it, you know. They obviously have done what they were supposed to do.'  

But it was just that, it was the feeling that, because they didn't communicate - it was just, there was no sort of pleasantries I suppose, and it doesn't take much to give a brief smile to somebody, you know. You're not asking for too much.