Should I have an early reassurance scan if I'm pregnant again after miscarriage?
Early pregnancy can be a nerve-wracking time if you’ve had a miscarriage before. So should you book an early scan to calm your nerves? We talk through the pros and cons
In the early weeks of pregnancy, before the official booking-in appointment and 1st NHS 'dating' scan, we all worry about our baby and whether it's OK. But, when you’ve previously had a miscarriage, those worries can, understandably, register off the scale. So much so, in fact, that having an early 'reassurance' scan, either privately or on the NHS, can seem to be the best way to relieve your anxiety.
But is it?
"Very often, women who are pregnant after a miscarriage will want an early scan because they want to feel reassured," says Ruth Bender Atik from the Miscarriage Association. "But there are pluses and minuses."
Here, we take a look at what those pluses and minuses are – and explain – so you can decide for yourself whether to have an early scan or not...
What is an early scan – and how early on in pregnancy can I have it?
An early scan is an ultrasound scan (usually an internal – or transvaginal – one), carried out before you're 12 weeks pregnant, to provide reassurance, check for any potential problems with the pregnancy or to confirm that a pregnancy is not ectopic.
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You're unlikely to be offered an early scan any earlier than 6 weeks into your pregnancy because, before then, the sonographer (the person carrying out the scan) won't be able to see anything conclusive.
"At 6 to 6.5 weeks, you can sometimes see a pregnancy sac with a tiny fetus and heartbeat," says Ruth. "But sometimes you can’t. If you can’t, it may be because it’s too early.''
''Or it may be that your dates are a few days out. That’s particularly important if you’ve had a loss recently, because very often the first few cycles after a miscarriage are different from normal. It can make it very hard to figure out when you might have ovulated and when you might have conceived.''
Waiting until 7 or 8 weeks may give you a better chance of a reassuring outcome. But it's by no means a given. ''We would normally say to people that between 7 or 8 weeks would be a better time," says Ruth. "Your sonographer should be able to see a pregnancy, a sac and a heartbeat by then – but again, if they can’t, you may have to come back for another scan a week or 2 later."
What are the advantages of having an early scan?
If you have an early scan and your sonographer can see a pregnancy sac and detect a heartbeat, then the sense of relief can be wonderful.
"I’m such a worrier, I couldn't imagine waiting weeks more to know if there was anything actually in there," says Laura, who took part in our MadeForMums Bump Project research after having an earlier miscarriage. "They turned the screen round and said. 'Yep, everything is great'. And I'm feeling a lot of relief."
And detecting that fetal heartbeat during an early scan is certainly a reassuring sign: according to research carried out by Liverpool Women's Hospital on pregnant women with a history of recurrent miscarriage, those whose scans detected a heartbeat at 6 weeks "had a 78% chance of the pregnancy continuing"; at 8 weeks, this rose to 98%, and at 10 weeks it was 99.4%.
What are the drawbacks of having an early reassurance scan?
The drawbacks boil down to 2 key things:
- You may not get a definitive answer
- If you do get an answer and you are reassured, your anxiety may not go away
If you go for an early scan – particularly one around the 6/7 week mark – your sonographer may not be able to detect a heartbeat. This could be a sign of an early miscarriage or it could just be (as we've seen above) it's just too early to see anything. If this is the case, you'll probably be asked to come back for a repeat scan in a couple of weeks’ time.
It’s important to think about how you might feel in this situation. "If you don’t see what you want to see because it’s too early, for example," says Ruth, "then you’re going to be in limbo, and you may feel even more anxious."
And, then even if the sonographer is able to pick up a pregnancy and heartbeat, it’s not unusual for any reassurance you feel to be quite short-lived.
"People often tell us is that the scan's reassuring for about 15 minutes," says Ruth. “By the time they’ve got to the carpark, they’re saying, 'But what about tomorrow?'"
This was certainly how MadeForMums Chat forum user KIRBY96 felt. "I had an early scan at 7 weeks and saw a healthy baby with a heartbeat," she posted. "My next scan is Friday and I’m so nervous and panicking so much.”
As Liz Halliday, Deputy Head of Midwifery at Private Midwives says, "A scan can only tell us what is happening at the time. It isn’t predictive of miscarriage and it is unlikely to show any abnormalities that might be picked up at a later date."
Which is why MadeForMums Chat forum user Honeybeemummy, didn't feel she could stop worrying and worrying until her baby began to move. "Even though I had had three scans before before my 12-week scan," she posted, "and had seen heart beating and then I had private scans every 2 to 3 weeks as well as NHS ones, it wasn't until after about 30 weeks when the movements get very strong and regular that I began to relax."
So, if I do decide to have an early scan, can I get one on the NHS?
Maybe. But you should be prepared for being told that you can't – and therefore, if you still wanted one, would need to pay for one at a private scan clinic.
If you're actually experiencing pain or bleeding, or have had several miscarriages or an ectopic pregnancy in the past, your GP may well refer to for an early scan at your local NHS Early Pregnancy Unit (EPU) straightaway.
But, because EPUs are often in high demand, it's quite likely that, if you don't fit any of the criteria above, you'll be unable to be seen.
"Generally speaking, most EPUs get an awful lot of traffic and an awful lot of concerned, anxious people," says Ruth. "They don’t usually tell women to come in for an early scan unless there's some pressing previous history," explains Ruth.
What happens if I book a private scan?
"Some people want to pay for a private scan, which is fine," says Ruth. "But it’s important to think through the different scenarios."
You can find local private scan companies on Google but do look for one that has qualified monographers and is CQC-registered. And check that they're equipped to do an early transvaginal scan.
And, before you book, ask what their procedure is if they can detect a heartbeat: will they ask you back for a later scan and, if so, will you be asked to pay again? And what do they do if the news is bad? Are they able to refer you for NHS follow up or will you have to do this yourself?
Whether or not you opt for an early scan is a completely personal choice: what’s right for one person may not be right for someone else. Once you have considered the pros and cons, you will be in a better place to decide whether it’s the right move for you.
- Pregnancy after miscarriage: what you need to know
- Early pregnancy scans: what happens and how do I get one?
- When's the right time to tell people I'm pregnant again?
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