18–20 week antenatal scan: being told something may be wrong

For some people the 18–20 week mid-pregnancy or ‘anomaly’ scan is the point at which they discover their baby may have a health condition. Many had not fully realised what the scan was for and were not expecting to hear this news. They were looking forward to seeing their baby and expecting reassurance.

All pregnant women should now be given by their midwife or GP the booklet ‘Screening tests for you and your baby’ by Public Health England, which gives detailed information about the types of scan offered and what they are looking for (see Resources section).

Very occasionally, parents were worried beforehand, including one woman who was worried but the news still came as a shock. Looking back many people stressed that although they did not want to frighten other parents unnecessarily, they would recommend having someone with you at the scan for support.

She did not really appreciate that the 20-week scan looks for particular conditions, despite…

Age at interview 38

Gender Female

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One woman had gone alone with her toddler and was stunned to be told her baby had a serious heart condition. This was a routine repeat scan because at the previous scan the baby had been in an awkward position.

She went for a routine repeat anomaly scan at 24-5 weeks in her second pregnancy, not expecting…

Age at interview 41

Gender Female

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For this group of parents, how staff behaved and spoke to them was very important. Small details such as introducing themselves by name and making sure they got the woman’s name right could make a big difference.

A couple whose baby was later confirmed to have a serious chromosomal condition (Patau’s syndrome) really valued the sonographer’s honesty and kindness, and that she called the baby ‘he’, not ‘it’. (Of course, some parents might not wish to know the baby’s gender, and staff should check this first).

At the 20-week scan, they valued the sonographer’s honesty and kindness. She called the baby ‘he…

Age at interview 39

Gender Female

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Parents often picked up that staff had spotted something unusual before anyone told them. Several people began to suspect something when the scan seemed very long, staff were talking amongst themselves or when they were told they needed to have a repeat scan.

She felt anxious when staff talked to each other and not to her, when they spotted the baby’s…

Age at interview 41

Gender Female

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The lack of communication in the 20-week scan in her first pregnancy and having to have a repeat…

Age at interview 26

Gender Female

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People understood how difficult it must be for staff communicating bad news, and why they are sometimes silent while they concentrated, but silence still makes people worry.

Staff have to concentrate while doing scans, but some initial reassurance and a friendlier manner…

Age at interview 38

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There is no easy solution which will suit everyone; some parents become anxious when staff suddenly go quiet after being chatty, but even when staff explain they will be silent parents cannot help worrying, especially if they have already had a bad experience. Sonographers undoubtedly face a difficult dilemma, given different people’s preferences and needs for information.

At the 20-week scan in her current pregnancy, the sonographer explained she would be silent, but…

Age at interview 34

Gender Female

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It is understandable that staff have to concentrate during scans, but it makes you anxious when…

Age at interview 36

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Most people said they would prefer to be kept informed during the scan. One woman described her anxiety in the waiting room between scans, and would rather have been told immediately that they suspected hydrocephalus.

She was worried in the waiting room between scans, and would rather have been told immediately…

Age at interview 39

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It was distressing to be asked to wait for a repeat scan, often in the main waiting area with other pregnant women, although later being shown into “the bad news room”, as one woman described it, was not much better.

She had to wait for a repeat 20-week scan in her current pregnancy when problems with the baby’s…

Age at interview 35

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One woman was reassured early on that there was a heartbeat, before the sonographer explained she would then be silent with the screen turned away. She was therefore not anxious initially. She felt the bad news was then communicated to her honestly and sensitively, and was based on a really thorough examination, but it took her quite a long time to grasp how serious the situation was.

The sonographer explained she would be silent at the 20-week scan in the woman’s first pregnancy…

Age at interview 23

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This was true for many people, including one woman who said the first person to scan her seemed bored and off-hand. He did mention the problems he was picking up during the scan, but perhaps not very sensitively. She saw another sonographer who was more sympathetic. Gradually it became clear the baby had severe health problems, but it was still hard to take in. (See also Deciding whether to have further diagnostic tests).

At the 20-week scan, the sonographer seemed bored. When he started to find problems she found it…

Age at interview 38

Gender Female

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Insensitive communication in her 20-week scan made her panic. She could not believe her baby had…

Age at interview 38

Gender Female

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Parents who later decide to end the pregnancy have few mementoes of their baby, and several would have valued a scan photograph to keep, but this may not be offered and in their shock parents may not think to ask or may not feel comfortable to.

She would have liked a scan photo to remember the baby, but was too embarrassed to ask.

Age at interview 39

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Some people were reassured by their 18–20 week scan, but later discovered something was wrong: see When screening does not detect the baby has a condition. Many experiences discussed here are common to other types of scan: see also Early dating scans and Combined screening for Downs syndrome and other abnormalities.