When a pregnancy issue is suspected
Aim to provide kind and empathic care and to communicate clearly and sensitively when a fetal anomaly is suspected. Listen carefully to the words the woman and her partner use and take those words into consideration when responding.
Women and partners tell us that communication and support received at this point has a long term impact on their subsequent adjustment to loss.
What do we need to do?
- Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
- When possible, prepare the woman and her partner for difficult news by informing them something may be wrong as soon as it is suspected.
- If possible, prepare yourself for giving difficult news by gathering information and consulting with colleagues.
- Find a quiet and private place to deliver the news and/or explain it further. This might mean giving the news in the scan room but explaining next steps elsewhere. If over the phone, check the woman is in a suitable environment to have the conversation.
- If a problem is suspected during ultrasound examination:
- Be aware of both your verbal and non-verbal communication.
- Give information on scan findings. Do not give false reassurance and explain if a second opinion is required.
- Give the woman and her partner an opportunity to see the screen and offer to show them what you have seen.
- Offer a scan photo because this may be important to memory making. Offer to keep a printed copy in the notes if they would prefer.
- Ask the woman whether she would like her partner or a support person present, or if she has brought children with her whether she would like them to leave.
- Use clear, straightforward language, with no euphemisms or jargon.
- Do not make assumptions about how the woman or her partner feels about a diagnosis, or any decisions she may make – communicate empathically and follow their lead on language (for example, some may prefer using ‘baby’ rather than ‘fetus’).
- Communicate with the woman and her partner in a supportive and non- directive way, giving them time to absorb the news.
- Share the known facts about the diagnosis and make sure the woman and her partner know what will happen next.
- Explain any reasons for a delay for further care (for example, further scans). If a referral to a different unit and travel is required, explain the reason for this. Acknowledge that uncertainty and delays can be difficult. Provide written information and signpost online information.
- Give the woman and her partner a named key contact with contact details - a template contact card is available.
- Offer to contact the primary midwife.
- Explain how support organisations would be able to help and offer their contact details.
- Check the woman and her partner can get home safely and if not, help them to think about other options.
- Record the care plan on the woman’s maternity record including planned continuity of care and key contact.
Next steps
- Acknowledge how difficult this decision must be. Allow women and partners time to take in information and ask questions. Acknowledge that women and partners will need time to make their decision.
- Give the woman and her partner the time they need to decide what they want, supporting them to understand the implications of their decisions, and let them know they can change their minds. Be clear about timelines if there are necessary cut-offs (such as when your hospital stops offering the surgical method).
- Offer to refer the woman and her partner to the spiritual care/chaplaincy team.
- Make sure the woman and her partner know when and how to communicate with their key contact if they have questions or changed their minds.
After receiving our diagnosis at the hospital, we were given details of a support organisation by a bereavement midwife. We had a lengthy discussion around our son’s diagnosis and were offered further tests for genetic disorders which we declined, we were then asked to have a think about further tests and speak about it at our next appointment.
How will we know we have achieved our aim?
Women and partners will tell us they were treated with respect and kindness by staff and received clear information that was sensitive to their individual needs.
Staff will say they feel confident and competent when communicating difficult news to women and partners.