Ill Fated Ultrasound and Midwife Visits

I wish I could make this shorter but, for all those interested in my experience with NHS care over here…

We had an ultrasound scheduled shortly after my 21st week of pregnancy. We had been disappointed at a previous scan because at 16 weeks many of my friends had been able to tell the sex of their baby and when I asked if we might be able to find out I was told the policy was the sex wasn’t divulged until the 20 week scan. (Note the difference between, no, we can’t tell but no we DON’T tell.)

The 21 week ultrasound was to be a bit different because it would be performed by a “fetal medicine specialist” due to a great deal of concern from the consultant (twin specialist) that I had missed the opportunity for Down syndrome screening during my move to the U.K. With a single pregnancy the screening can be done until 16 weeks but with twins the cutoff was 14. This did not particularly matter to me because all it would do is give you an idea of the odds and help you determine if you would warrant an amniocentesis which I had already decided I didn’t want. (In my totally nonmedical opinion, a twin pregnancy is high risk enough I didn’t want to throw a large needle into the mix.) We thought that having a doctor doing the scan was fantastic because it was going to be very thorough and they would be taking all kinds of measurements so SURLEY we would find out the sex of these babies.

We waited outside a scan room reserved for multiples and high risk pregnancies. Under NHS you are held to a strict time table. If you have one baby, you get a 15 minute ultrasound. If you have two babies you get a 30 minute ultrasound and if you are having a fetal monitoring scan you are given 45 minutes to an hour depending on how long it takes to take the babies measurements. The woman in the room before me looked very sick and was wheeled out of the room. When Trey and I were called in one of the first things I said was “we are so excited to hopefully get to find out the sex of the babies today!” The consultant (specialist) responded “Oh, I don’t think that’s very likely” in a cold disconnected manner. I just thought “well, I have been praying for these babies to be turned the right way for four weeks and I just drank the first Starbucks I have had since moving to the U.K. so we will just see how likely it is.” She then asked me why I was seeing her for a scan that day (you always have to tell the doctor why you are there… love the preparation.) I replied with the details about missing Down syndrome screening and she said again “so why are you here to see me?” I again said that my consultant had made the appointment and so I followed her instruction. She responded “And who is your consultant?” in a hostile tone. I told her to which she gave a humph and moved on. The whole conversation all I could think was “oh thank God my consultant it is not you.” I still have yet to actually lay eyes on my consultant. I see a doctor that works with her for my antenatal visits.

I lay down and she began looking at the babies without a word. I said, “I assume you see two heartbeats and both of the babies look OK.” She said “yes.” After a several moments of silence with her clicking around taking measurements I began to ask “…and what is that… and what is that… oh OK what is that…” expecting she would take the hint and eventually begin telling me what she was measuring. Instead after several exchanges like this she said “please don’t ask me any more questions.” Finally upon seeing what was clearly a girl on the monitor I said “can you at least tell me what I am looking at there?” No response. Towards the end of the ultrasound she announced in the most uninspired, disinterested tone I think the words have ever been uttered: “I think we have one boy one girl.” And that was that. After a lot of prodding she could not get the measurements of the boy’s face and proceeded to take both hands around the ultrasound wand, bang it onto my stomach and yell “I cannot get this baby to show me his face!” She hit me so hard I felt it for two days and had a cut next to my belly button. At the end of the ultrasound when I asked for pictures, she gave me one picture of one of my babies and threw the rest in the trash.

So that was bad and it completely freaked me out that she had banged on my stomach so hard but the whole time I was thinking, she is a doctor, she knows what she’s doing. I decided I would ask my midwife about it in the appointment I had with her the following week. I hadn’t actually been to the clinic where my midwife team practices so I set out early. I had a hard time finding it and was almost late which really gets me flustered. After I sat in the waiting room and was called back to my appointment I was surprised to see that the midwife I had spoken two twice was not who was assessing me at this appointment. I thought that the same midwife saw you through your prenatal care and came for the birth. The midwife took my notes (you keep your own medical records here and they call them notes) and began to look through them. She looked at the page from the previous midwife’s notes and said that they needed my blood type but the test the midwife took was inconclusive. If you have read my previous entry about the adventure to take my blood you already know what happened there. I explained that the midwife sent me to the phlebotomist and not to worry, the blood tests were performed. She said well, I don’t see your blood type here and if you are negative you will need the Rho- GAM shot. I explained that I was a negative blood type and would need that. She said she would go check the computer for my blood test results. When she came back she still could not find them (she was also very flustered.) I told her I had seen my blood type in my notes and could show it to her if she would just hand them to me. She said never mind, she would just take my blood and then she would know if I would need the shot or not. I replied “Listen, you aren’t going to be able to draw my blood so just trust me. My blood type is in my notes. It is negative. I only know about the Rho- GAM because when I met with the consultant three weeks ago, she explained… as she was looking at my labs… that because I was a negative blood type I would need to get it. Now, if you will just hand me my notes I can show you where it says…” she walks out of the room and goes to get the equipment to draw blood.

She comes back into the room, ties both my arms, unsuccessfully poking around for a vein, and then asks me where were they able to draw your blood last time. I pointed to a vein in my hand. She ties off my forearm and sticks the needle into the desired vein. Nothing comes out so she begins to prod and dig at it. She does this for quite a while until my skin begins to bubble up behind the needle and turn slightly blue. She is still digging away when I say “Um, that will be enough thank you.” She pulls the needle out, bandages me up and says “do you think you could get a copy of your labs when you go to hospital next?” At this point I am ready to scream. She then hands me a piece of paper and begins to go over the glucose test I will need to have performed. She tells me to come back to the clinic November 20th and we will do the test there. I read the sheet and it lays out a timeline, basically drink the liquid and in exactly one hour have your blood drawn. It specifically states that if you don’t have your blood drawn exactly one hour after drinking the drink the test is inconclusive. I take it upon myself to say to the midwife “don’t you think I should do this at the hospital?” She says that it is usually performed there. I reply “you just saw how well I give blood, don’t you think I should be at the hospital where I can go to the phlebotomist to have my blood drawn after the test so I don’t end up taking it twice?” She concedes and writes me orders. The whole time I am thinking “why am I the one telling you this?”

Now the appointment is winding up and I told her I had several questions. She literally says to me “we don’t have time for that.” I am fighting back tears at this point and say in a chocked voice “well there are some things I am concerned about and I don’t have anyone else to ask.” She allows me to ask one question where I asked about the consultant hitting me in the stomach during the ultrasound. She talked to me about my rights and when I started to ask one question she asked me to go take a urine test. I go to the bathroom and completely fall apart. I am sure she thinks I am taking forever and when I pull myself together and go back to the exam room, as she is testing my sample, I decide to ask my other questions. “We don’t have a car and the hospital requires you leave with the babies in car seats, can my husband push the babies home in the pram? Will someone going to talk to me about my options for the birthing process…?” She does not answer, tells me my test results then leaves the room. I sit, not knowing what is going on when in she comes pushing a pram and followed by a woman with a tiny baby. She is profusely apologizing to the woman saying “I’m so sorry, I know you have been waiting a long time, I am so very sorry, come in and have a seat.” She then looks at me and says “Sarah, I trust you can see yourself out.” I leave the office and again burst into tears (I have never cried so much in my life as I have during this pregnancy and I sincerely hope this persistent symptom resolves itself after the babies are settled into a routine.) I cried all the way home, even through the grocery store that I stopped at on the way.

By the time I got home I resolved the only way I was going to get through this was to take it upon myself to make sure Trey and I became educated. Within the week, I had enrolled us in two twin clubs; one called TAMBA, the Southwest London Twins Club, a parenting course at our church and scheduled a tour of the maternity ward and the NICU at our hospital. TAMBA is more educational and focuses on advocating the rights of parents of multiples within NHS. They also host classes around the city with guest speakers as well as a prenatal course specifically designed for twins and multiples which I dished out the £139 (OUCH) for. The Southwest London Twins Club is more social. The moms bring their babies for coffee breaks to each other’s houses and attend holiday parties as well as quarterly meetings. Hopefully, we will be able to build our confidence in ourselves enough to know what to expect and reduce the stress associated with the healthcare system here.