Should I get an early pregnancy scan? How early? And is it free?

• experienced bleeding
• had certain types of fertility treatment
• had recurrent miscarriages
• previously experienced an ectopic pregnancy

These sorts of early pregnancy scans are usually done on the NHS at an Early Pregnancy Assessment Unit.

If you don't have a history of recurrent miscarriage, a previous ectopic pregnancy or a medical reason (like bleeding) for an early pregnancy scan, you won't be offered one on the NHS.

Sadly, that word 'recurrent' in 'recurrent miscarriage' is important here: you're extremely unlikely, we're afraid, to be offered an early NHS scan if you've had one or even two miscarriages.

If you're looking for reassurance that all is well with your pregnancy – perhaps because you've had a miscarriage before – and you feel you can't wait for that until your routine NHS 12-week scan, you can arrange, and pay, for an early scan at a private scan clinic.

At how many weeks can you have an early pregnancy scan?

A pregnancy ultrasound scan can be carried out from around 6 weeks.

"The earliest you can really scan to actually see anything is about 6 weeks after your last period," says Gill Harrison, professional officer for ultrasound at the Society and College of Radiographers.

"If your dates are a little off and your pregnancy turns out to be any earlier than this, you'll almost certainly be asked back for a second scan.

"If you're able to wait until about 7 weeks, then we will be able to see the heartbeat much more clearly."

How do you get an early pregnancy scan on the NHS?

If you meet the medical reasons we've outlined above (What are the reasons for having an early pregnancy scan?), call your midwife or GP and they will almost certainly refer you to your hospital's Early Pregnancy Assessment Unit for an early pregnancy scan.

In some NHS areas, you may also be able to self-refer to your local hospital's Early Pregnancy Assessment Unit (EPAU or, sometimes, EPU), if your local NHS Trust offers that option.

If you do self-refer, remember that EPAUs are often in high demand, so it's highly likely that, if you don't fit any of the medical criteria, you won't get an appointment to be seen.

This can be really hard if you've had a previous miscarriage – but not recurrent ones – and you're worrying like crazy about your new pregnancy.

"It's totally understandable that a woman who is pregnant after miscarriage wants the reassurance of an early scan," says Ruth Bender Atik from the Miscarriage Association. "But the truth is most EPUS get an awful lot of traffic and an awful lot of concerned, anxious people, so they can't usually tell women to come in for an early scan unless there's pain and bleeding or some pressing previous history."

If it's purely reassurance you’re looking for, you'll need to pay – and arrange – for a scan privately.

What can you see at an early pregnancy scan?

Your baby is developing really quickly during the early weeks of your pregnancy, so a scan of your baby will look very different from week to week...

• At 6 weeks: Your baby will just about visible and measures around 0.5cm. This is the earliest a heartbeat could be detected.
• At 7 weeks: Your baby will be about 1cm long, with a heartbeat of about 160 beats per minute. The scan in our main picture, above, is of a 7-week-old baby.
• At 8 weeks: Your baby is growing at about 1mm a day, and will now measure around 1.6cm. You may be able to start to identify the head and body.
• At 9 weeks: Your baby is nearly fully formed, and you may be able to make out the head, body and limbs.
• At 10 weeks: Your baby is now around 3.8cm and you should be able to see them bobbing about and making jerky movements.

Can you have an early pregnancy scan at 5 weeks?

It's unlikely, as it's going to be difficult to see anything clearly before at least 6 weeks.

However, a doctor may order a scan as early as this if they suspect a pregnant women may have an ectopic pregnancy (where the fertilised egg implants itself outside your womb, usually in one of your Fallopian tubes). This scan would not be used to assess the baby's health – sadly an ectopic pregnancy cannot be saved – but to quickly confirm the position of the fertilised egg. An ectopic pregnancy is potentially life-threatening for the woman, so it does need to be diagnosed swiftly.

Will it be an internal or an abdominal scan?

Very early scans are likely to be transvaginal (internal) scans but they can sometimes be abdominal (external) scans, like you have at the routine 12-week dating scan. Quite often, the tranvaginal scan is preceded by an abdominal one.

"In the very early weeks of pregnancy when the baby is very small," says Gill Harrison, "the sonographer may want to look with an abdominal scan first. They will usually then ask for your consent to do a transvaginal scan. This second type of scan allows us to see things much more clearly earlier in a pregnancy."

Different sonographers will take different approaches, though, so be ready for different options. And remember that there is no pressure to do this: any scan offered to you is your choice to have (or not).

What happens at an transvaginal scan?

Unlike an abdominal scan, you don't need a full bladder, so you'll be asked to go for a pee before the scan begins.

We'll let Abby from our MadeForMums Community, who had an early scan at 8 weeks, explain what happens next:

"You go into the scanning room and you'll be asked to take your trousers/skirt and pants off and put a sheet round yourself. There'll be changing room where you can do this.

"Then you shuffle onto the bed and they get this probe, which looks a a tiny stick, and put some jelly-like lubricant on it. They ask you to put your knees up and open your legs, like when you're having a smear. They gently insert the probe and have a good look at the picture they can see on the screen. Then, they turn the monitor to you and show you."

"They showed me the screen almost straightaway," adds Anne from our MadeForMums Community, who had an early scan at 7 weeks."They'd checked for a heartbeat and you could see a little flutter."

Does a transvaginal scan hurt?

"It's not painful but might feel bit weird," shares Berly from our MadeForMums Community. "I've had a couple of them and they've been fine. They don't insert the probe all the way in but they do wiggle it about a bit to get the images they need."

Do you get a photo afterwards?

If you've having an NHS scan, it's possible but you shouldn't expect one. It all depends on your hospital's policy on this – and obviously very much on what happens as a result of your scan.

If you go privately, you should be given a picture, if all seems well with your baby. "With a viable pregnancy, we would give you a photo of your baby and a heart trace as standard," confirms Jan Steward, Director and Co-Founder of the private ultrasound provider Ultrasound Direct.

What are the pros and cons of a private early pregnancy scan?

We know – from personal experience and from other parents and parents-to-be in our MadeForMums Community – that waiting for the routine 12-week NHS scan can feel like an age, especially if you’re feeling anxious that your pregnancy may not be progressing well.

So it's understandable to want to book an early scan privately, just for some reassurance. We conducted a snap poll of the pregnant women and new mums in our MadeForMums Community and 24% of the 236 who responded said they had booked a private early scan for reassurance. Of course, our poll wasn't big enough to be more than anecdotal but it does suggest that it's not uncommon to feel anxious enough to want to pay for an early scan.

But before you go ahead and book your early scan, it's worth thinking through all the pros and cons of having one:

The pros

• It can be reassuring, especially if you've miscarried before. "We see so many women in the early stages of pregnancy," says Jan Steward. "Having a scan at this time can provide vital reassurance."
  This is certainly how Rachel from our MadeForMums Community, whose first pregnancy ended in miscarriage, felt. "When I got pregnant again," she says, "I booked a private scan for 7 weeks and it was so reassuring. We heard his little heartbeat and saw that he was growing as he should be. They say a happy relaxed mummy leads to a healthy baby, so if a scan will help you achieve that, then go for it."

• It can bring a healthy sense of relief. Of course, you don't need to have experienced a miscarriage to feel anxious. And if your anxiety is overwhelming you, having an early scan can be a huge release of worry. "I’m such a worrier," says Laura from our MadeForMums Community. "I couldn't imagine waiting weeks more to know if there was anything actually in there. They turned the screen round and said. 'Yep, everything is great'. And I'm feeling a lot of relief."

The cons

• You might not get a clear answer. 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 explained, above) that 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. "I had 2 early scans," says Kirsty from our MadeForMums Community. "The first was at 6 weeks and they could see a sac but no heartbeat, then I had another at 8 weeks that showed a heartbeat. It was an agonising wait. I would say leave it until 8 weeks so you know for sure. Going too early as I did just resulted in more worry.”
• The reassurance might not last. Suppose the sonographer is able to pick up a pregnancy and heartbeat: wonderful! But do know that 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 Jane Fisher, director of the antenatal testing-support charity Antenatal Results and Choices (ARC). "By the time they've got to the carpark, they're saying, 'But what about tomorrow?'"
  "And it's true that a pregnancy scan can only tell us what is happening at the time. It isn't predictive of miscarriage and many issues will only be picked up at a later date."
• You may, sadly, get bad news. This, of course, is the result we all dread. But it's something that's worth giving some thought to because, if it does happen to you, you'll be at a private clinic, not your NHS hospital. So, although the private clinic may well treat you with incredible kindness and understanding, it can often still be up to you to contact your NHS GP or midwife for follow-up care.

Essentially, you need to go into the process with your eyes open. "If you want to pay for an early private scan, that's fine and it can be just the right thing for you," says Jane Fisher. "But it’s important to think through the different scenarios first and make sure you are being scanned by an appropriately trained professional."

What questions should you ask when you book an early private pregnancy scan?

There are no end of private scan companies. Look for ones with good reviews and recommendations and check that the company has qualified sonographers and CQC registration.

And before you book your scan, ask:

• Are you equipped to do early transvaginal scans?
• What experience do your sonographers have at performing transvaginal scans?
• What is the plan if the sonographer can't detect a heartbeat or baby? If this means I'll need a second scan, will I need to pay again?
• What will happen after the scan is finished?
• What is the referral pathway if it is bad news? Will I have to refer myself back to the NHS or will you do this for me?

Are there any risks to my baby in having an early pregnancy scan?

"Ultrasound scans have been used in antenatal care for over 30 years and there is no evidence to suggest that they are harmful to you or your baby," says Jane Fisher.

Saying that, it's probably sensible not to have repeated early pregnancy scans, if there's no medical need for them. "Repeated ultrasound exposure in the embryonic period should be avoided unless clinically indicated,"¹ the Royal College of Obstetricians and Gynaecologists recommend. "This is based on a precautionary principle, not because there is evidence of any harm."

Pic: Getty

References:

^{1 Ultrasound from Conception to 10+0 Weeks of Gestation. Royal College of Obstetricians and Gynaecologists. March 2015}

Read more:

• 12 week dating scan: what to expect
• Early pregnancy: why am I bleeding?
• How pregnancy changes your breasts, week by week