Memories of my first labour – a 20-hour marathon of pain, fear and Entonox-induced delirium – are somewhat hazy, but there is one moment that stands out with complete clarity: when the midwife held up my angry purple baby and said: "It's a girl."
It was a moment of pure elation. Not because I had a preference for a girl – I didn't, and had been happily certain it would be a boy – but because it was the point at which this mysterious being that I had carried for nine months suddenly became a real person.
For increasing numbers of parents, this moment comes at the 20-week scan. Finding out the sex in advance has become the norm, to the extent that the decision to not find out is seen as a bit deviant. After all, if the technology is there, why wouldn't you want to know?
I've heard people compare it to peeking at your presents before Christmas Day and then having nothing to look forward to. For me, the decision was never just about saving up the surprise for the big day. When I weighed up the pros and cons of knowing the sex of my second baby, I could come up with just one reason in favour of finding out – I had boxes of baby girls' clothes in the loft and I would know whether to hang on to them or take them to the charity shop. The reasons for not finding out seemed far more compelling, if at times bordering on the superstitious.
I was single for much of my thirties and therefore never took it for granted that I would have a family. So when I was lucky enough to get pregnant at 39, the idea that I would then suddenly start getting picky about whether I'd be buying pink or blue babygrows seemed preposterous. I was grateful to get a shot at motherhood at all.
A couple of early scans, which flagged up possible problems with the pregnancy (unfounded as it turned out), also served as a wake-up call that there were bigger things to worry about than which colour to paint the nursery. The 20-week scan is, after all, an "anomaly scan", designed to pick up serious structural abnormalities, a fact that can get lost in all the excitement about finding out the baby's sex.
This excitement is perhaps epitomised in the trend for "gender reveal" parties in the States, where the results of the scan are baked into a cake to be shared with family and friends at a special gathering (pink icing for a girl, blue for a boy). Earlier generations would have to wait for their sons and daughters to be born before the colour-coded gender stereotyping could begin; now we can begin the process while the baby is still in utero.
The messageboards of Mumsnet and other parenting websites bear witness to just how much some people invest in dreams of a boy or girl. On threads with titles such as "Gender disappointment, please help", mothers-to-be share their "devastation" at finding out that a longed-for daughter is a son (or vice versa), feelings that they would never admit to in real life. They describe feeling robbed of future shopping trips and pedicures with their fantasy daughters, or "grief" that their husband won't get to watch their son play football.
There is an argument that if you have a strong preference you should find out the sex so that you can "come to terms with it" before the baby is born, but many of the contributors to these online therapy sessions later say that their feelings of disappointment disappeared the moment they held their baby – another argument for not finding out. Surely, when handed their screaming bundle of joy, no one ever yelled at the midwife, "But this isn't what I wanted"?
Although a certain amount of curiosity is natural and we all indulge in daydreams about our future children, the fewer assumptions we make before the baby comes along, the better. Once the sex has been pinned down, the name tends to follow and before the first contraction, little Jessica or Jack's first five years are all planned out.
Of course, there is no right or wrong decision, and we're lucky to have the choice. But the whole experience of pregnancy and childbirth has become so medicalised and closely monitored that I find myself clinging gratefully to this last little pocket of mystery.
In a few short weeks, the wait will be over and, all being well, the tide of pink or blue teddies, balloons and cards from friends and relatives will slowly take over my flat. But for now, the nursery stays white. Joanne O'Connor
I'm embarrassed to admit it, but after my 20-week scan I cried like a baby. Not because the little dear was missing any vital bits, was the wrong size, or any other abnormality had been detected – the tears were down to the sonographer being unable to tell my husband and me our baby's sex. I was over the moon that our first child was developing normally, but we'd always been firmly in the want-to-know camp. Not knowing felt like an anticlimax.
Most people greeted our news with the main argument for waiting: "It'll be such a lovely surprise when the baby arrives!" My family made me see the funny side. On hearing that her grandchild had kept its legs in a tight ball during the scan, my Mum teased: "He/she is obviously as wilful as you!"
My older brother thought it was hilarious and instantly began referring to the baby as Leslie, Vivien and other unisex names. I laughed too, explaining that, when requested to move during the scan, our baby had turned to show us its back and bottom. Asked to perform, our baby basically mooned at us.
As the days passed, I too began to feel I'd been a brat. What a 21st-century indulgence to be able to find out the sex of your unborn child. A worrier by nature, I was acutely aware of the greater upsets we could've experienced at that scan. I'd never taken it for granted that I'd be able to have children and not one day has passed since we found out I was expecting that I haven't felt lucky.
I began to enjoy the ladies at the grocers guessing my baby's gender from the shape of the bump or the opinions of close friends about whether I was a boy or girl creator (the consensus? A boy). For a few brief weeks it felt more traditional, more romantic even, to wait for the big reveal.
But deep down I've never felt at home in the want-to-wait camp. And I feel that expectant people fall into two tribes. Now the technology exists and the possibility is there, it's a rare couple or individual that doesn't feel strongly either way about whether to find out.
I chastised myself that I was being controlling. But really I knew it wasn't that. Furthermore, my husband and I are opposed to dressing our child in gender-specific colours; we don't want to pick out nursery paint; and we definitely didn't want to have a "gender reveal" party (I'm not against such celebrations, but for us even posting the scan photo on Facebook felt self-indulgent, so we didn't).
Those in the want-to-know camp argue that knowing the sex makes name-choosing and bonding easier. But, despite the nausea, odd pains, heartburn and constipation inflicted by the pregnancy, by week 20 we already felt bonded and had boy and girl names we liked.
I can't say for certain what made us secretly go for a private scan five weeks after that inconclusive result. We knew we'd be delighted whatever the sex. And we don't have money to burn. But I do know that I'm a little bit nosey, a big bit impatient and, after a childhood spent with my head buried in books, overwhelmingly a dreamer.
We just wanted to be able to imagine our little family in one, five, 10 years' time and instinctively felt that would be easier knowing the baby's sex.
I realise that, if we're lucky and everything works out OK, it's only about three months before we get to experience that new life every day. But when we were told we were having a girl it felt a step closer. Who knows, maybe we'll regret finding out.
Right now, though, it feels like we'll experience so much excitement and emotion when our little girl arrives that there's no harm in sneaking a slice of it early. Imogen Carter
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It’s becoming increasingly uncommon for pregnant women to have their very first ultrasound at 20 weeks, though this used to be the first opportunity for most pregnant mums to be able to see their baby inside the uterus. It was a long wait to say the least. But now it’s more common for women to be having their second ultrasound at 20 weeks gestation; the first is generally offered at around 12 weeks to screen for chromosomal abnormalities.
Another name for the 20 week ultrasound is a foetal anomaly or foetal morphology scan and it can be done anytime between 18-20 weeks of gestation. If you don’t have the opportunity to have a screening ultrasound until 22 weeks of gestation, then this is fine as well. The purpose of this scan is to assess for foetal development and growth as well as providing a means of detecting any foetal abnormalities which may relate to their structural development. In addition, their period of gestation (to see if it matches with the mother’s dates), the position of the placenta and the baby’s heart, lungs and organs are all checked. It is also an opportunity for parents to find out the sex (gender) of their baby.Gender prediction is fairly accurate at this stage.
A 20 week ultrasound uses the same technology as all other trans abdominal ultrasounds. Using high frequency pulses of sound waves which pass from a transducer and then “bounce” off the internal structures of the baby and amniotic fluid surrounding it. Remember that the 20 week ultrasound is a diagnostic and screening scan – a medical procedure rather than simply a way for parents to have a peek at their little one. Of course, there are the additional benefits of getting to see your baby up close and personal but this is an added bonus to the real reason why a foetal morphology/anomaly ultrasound is done.
Do I have to have a 20 week ultrasound?
No you don’t, even if your healthcare professional recommends one. You still have the ultimate say in whether you consent to one or not. Some mothers prefer to wait and see what their baby looks like and want to leave nature to take its own course.
In fact, feelings can run very deep for some parents in relation to being confronted with their baby having a potential abnormality. For them, the issue of perhaps being faced with the dilemma of knowing what to do in terms of continuing with the pregnancy is enough to decline the recommendation of a screening ultrasound. Spiritual and religious beliefs also factor strongly.
Others are genuinely fearful of what the 20 week ultrasound may detect. They are unable to face their fears and choose to avoid the experience altogether. Occasionally, in cases where there is a family history of genetic disorders, counselling may be necessary to support parents in making the right choice.
Some parents prefer to retain the mystique and surprise of meeting their baby for the first time when it is born. There can also be the feeling amongst some couples that in days gone by, ultrasound was not available and the majority of pregnancies evolved into healthy, well, full term babies. Adopting this philosophy just sits well for some expectant couples.
Will the 20 week ultrasound be clear?
Yes, you’ll be amazed at what detail the ultrasound will provide. Be prepared to feel very connected with your baby and perhaps overwhelmed by feelings of love. Many mothers cry when they see their baby in such a realistic way and partners can feel similar feelings as well. For dads who’ve not experienced pregnancy symptoms first hand, seeing their baby on an ultrasound screen can the first time they really, truly believe the baby exists. Not that this is a commonly discussed issue but it is still a fact.
The ultrasound will pick up images of your baby’s organs in a series of cross sections. This can be confusing at first, until you become used to the images and your eyes adjust. Your baby’s bones will be white on the screen and the amniotic fluid will appear as black. Their tissues will be grey and have a speckled appearance.
What does a 20 week ultrasound detect?
Sonographers have a check list of what they need to look for when doing the 20 week ultrasound. They start off with the basics and work their way through a range of observations including:
- Checking how many babies are present. If this is your first scan it’s important to know if you are carrying one or more babies.
- The lie or position of the baby.
- Your baby’s spine and abdominal wall.
- The size, weight and general appearance of your baby.
- If the size of your baby is matching your gestational assessment.
- The position of the placenta and cord and the amount of amniotic fluid. If the placenta is assessed as lying low, a repeat ultrasound at 30 weeks gestation may be recommended.
- Your baby’s brain, heart, lungs, stomach, oesophagus and trachea, kidneys and general anatomy.
- The limbs, the fingers and toes (counted) the facial appearance and lips/palate.
- Measurements of your baby’s head, biparietal diameter, length and a measurement of their femur (long bone in the thigh) will also be taken. These measurements are compared with the “average” for babies of the same gestation.
Will my 20 week ultrasound detect all abnormalities?
No, the 20 week scan does not provide 100% detection of any or all abnormalities. On average around 50% are detectable and the remainder may not be apparent at the time of the scan or until birth. Heart defects and bowel obstructions in particular often don’t develop under later in gestation. It is estimated that around 40-70% of structural abnormalities can be detected at a 20 week ultrasound.
What if an abnormality is detected during my 20 week ultrasound?
Depending on the imaging service you have accessed, findings from your scan may be given directly to you and a report sent to your referring agent. Alternately, you may be advised to speak with your referring agent or an appointment may be made for you to speak with a specialist obstetrician.
The ultrasound findings will be examined and reported on by a specialist sonographer and/or radiologist. Depending on the level of concern, another ultrasound with further diagnostic testing may be ordered.
Sometimes an abnormality or “soft marker” is detected on ultrasound and this causes parents a lot of anxiety and stress. But in the coming weeks, as the pregnancy progresses, it’s not uncommon for slight deviations from normal to resolve themselves without any specific treatment or management. This is why a repeat ultrasound may be recommended
Are we having a boy or a girl?
One of the big bonuses of having a 20 week ultrasound is that it is possible at this stage of gestation to see if your baby will be a boy or a girl. But if you or your partners are keen to keep this a surprise until the baby is born, then tell the sonographer before they begin the procedure. If one of you wants to know but the other doesn’t then the sonographer might offer to write the baby’s gender on a piece of paper and place it in an envelope to be read later. But remember, the best the sonographer can advise is your baby is “likely” to be one gender or the other. No 100% guarantees of gender are provided from an ultrasound.
Be aware though that sometimes it is very clear on the screen what sex the baby is, so any plans to keep this a secret until you meet your little one face to face cannot be realised. Alternately, your baby may be lying in a position where it is not possible to see their genitals and unless they are willing to move around a bit, their sex will remain a mystery.
It’s common place for expectant parents to be given a photo and/or a DVD of their 20 week ultrasound. This can be viewed later on at your own leisure and if you want to, shared with your friends and family. It has become routine for imaging centres to request parents that no photographs or videos are taken during ultrasounds and any recordings or images can only be supplied by the sonography service.
This is due, in part, to the possibility of litigation if complications arise and they’ve not been detected during the ultrasound. You may also be asked to sign a disclaimer/permission form before your procedure.
What do I need to do to prepare for my 20 week ultrasound?
Nothing specific. Other than make the booking and ask your partner to be there as well. Allow some time for your appointment to be late or perhaps run overtime. This way you won’t be rushed and too stressed to enjoy it. Also, allow some time after the procedure for you and your partner to have a coffee or lunch to chat about the scan and how it went. The procedure normally takes around 45 minutes from start to finish. It’s not every day you’ll have a 20 week ultrasound and you’ll want to make the most of the experience.
You won’t need to have a full bladder for this ultrasound, unlike the 12 week one. But the sonographer may request you don’t wee for 30 minutes or so before your procedure as some urine in your bladder will help with visualising the baby. This is because a semi full bladder will help to push your uterus up higher in the pelvis, making it easier for the sonographer to see.
Don’t worry if the sonographer seems so focused on the procedure that they don’t constantly talk to you. Where there are good windows of time for them to describe what they’re looking at and are able to share this with you, they will.