A report in today’s Irish Times claims that in 2016, 23,000 pregnant women did not have an anomaly scan. While it is possible that some of these women would have chosen not to have one, the more likely scenario is that they were never offered one. Anomaly scans, for those who don’t know, are generally carried out at around 20 weeks or halfway through the pregnancy. The purpose of them is to see if there are any possible problems (or anomalies) with either the foetus or the pregnant woman.
Of my two pregnancies, only one made it to the 20 week stage, and I did not have a scheduled anomaly scan. In my case, this was because I had opted for midwifery-led care provided at Cavan General hospital, and that scheme (at least in 2007) did not give the option of anomaly scans. I felt a little uneasy about that at the time, but I had been fully aware of that when I opted for midwifery-led care, so I didn’t let it bother me too much.
My pregnancy had been largely uneventful up until week 20 when I had a small amount of bleeding. It was very little, but as a precautionary measure I was transferred from midwifery-led care to consultant-led care. I had a scan carried out that day which did not show anything untoward and I was told I would be scanned again at 28 weeks. If that scan showed everything to be ok I was told I would be allowed to transfer back to midwifery-led care. I was very upset at having to leave midwifery-led care but remained hopeful that everything would progress ok and that at 28 weeks, I’d be allowed back.
The next eight weeks of my pregnancy were very uneventful and I was sure all was grand. Week 28 rolled around and off we went for the scan, deciding that we would ask the gender that day. The scan went well , the obstetrician (who we hadn’t met before owing me to being under midwifery -led care) chatted away to us about what he could see, informing us that baby was breech (which we didn’t know) and that it was very active (like who was he telling??). Then just as we were about to ask if we could find out the gender, he moved the probe over the baby’s head and went very quiet. Frighteningly so. I’ve written about that awful time in our lives before and won’t go over it all again in detail here.
Essentially, our baby had a very rare neurological condition which necessitated me being referred to a foetal anomaly specialist in the Rotunda and having a far more detailed and lengthy scan a week later. I was scanned frequently for the rest of my pregnancy as the baby’s head was enlarged and we had been told that she (we found out the gender at the Rotunda appointment) might need to be delivered at very short notice. I had been planning a very intervention free birth and ended up having to have a C section. It would have been potentially very dangerous – possibly fatal – for the baby if I had tried to deliver her vaginally and the implications for me of such a delivery were also deemed too risky.
Now, our case is rare. But bear in mind that I had been accepted onto a program for midwifery-led care (I’m not knocking that btw) and that I had not been scheduled for an anomaly scan. Until the bleeding at 20 weeks, I’d had a textbook pregnancy, with no cause for concern. Just think for a minute if I HADN’T had that episode of bleeding and hence had not had a scan at 28 weeks when her condition was picked up. Supposing my pregnancy had continued uneventfully and I’d gone into labour, what might have happened then? There was a chance – maybe not huge, but a chance nonetheless – that neither of us would have survived.
The Irish Times article quotes Louise O’Reilly TD, Sinn Féin health spokesperson, as saying that women outside the main cities in the State are not routinely receiving these scans. That contravenes international advice on the best care for both the woman and the foetus. Our daughter was born safely in Cavan at 39 weeks and is now 10. She has both physical and intellectual disabilities and our lives are not at all as we had envisaged. (That’s not the focus of this post, that’s just for anyone who wondered how things turned out) I was so relieved just to have her that I pretty quickly put the whole scanning issue out of my mind, until a couple of years later when as a member of a consumer group looking at maternity care in Cavan Monaghan hospital group, I was angered almost beyond words to hear a senior midwife say she didn’t think anomaly scans were a good idea because parents get alarmed if something is discovered. Take it from me, yes you get alarmed, but we would have been in a far worse position if our daughter’s condition had not been discovered prenatally and she had died during delivery.
Finding out that your unborn baby has health issues is frightening, terrifying, there’s no superlative that even comes close. But – and I am only speaking for my husband and myself here – we found it gave us time (10 weeks) to get over the initial shock, to try and learn something about the condition, to inform those closest to us. It also, and this was even more important, meant that the team at Cavan were prepared to deal with a possibly very sick baby at delivery. (As it turned out she roared her head off when lifted out and was very stable, but we were lucky in that sense.)
I saw on Twitter today women recounting how they had been told they couldn’t have an anomaly scan (unless they were willing to go private) for various reasons. The reasons given are not the main issue, although some are awful. It has been argued that it is the existence of the Eighth Amendment to our Constitution (Article 40.3.3) that has led to this situation. This amendment states “The state acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and as far as practicable, by its laws to defend and vindicate that right.” It has been argued repeatedly that this amendment is the reason why anomaly scans are not being routinely offered to pregnant women, as women would not be able to avail of a termination if they felt they wanted one. I’m not going to get into the whole debate around the Eighth Amendment here. I’m openly pro-choice and always have been. Our Minister for Health, Simon Harris, has been reported as saying the roll-out of anomaly scans across the State is a priority for his department. That is good to hear, but if as it seems, the Eighth Amendment is one of the reasons why that hasn’t yet happened, then that’s another reason for it to be repealed. Women have the right to make informed choices about their care in pregnancy, labour and childbirth. Anomaly scans are part of that information gathering process.