Lalor, J., Devane, D., & Begley, C. (2007).Birth, 34, 80-88.

This qualitative study explored the experiences of women's encounters with caregivers after the diagnosis of fetal anomaly on routine second trimester ultrasound examination. Six main categories emerged, including information sharing, timing of referral, getting to see the expert, describing the anomaly to parents, availability of written information, and continuity of caregiver. Women who received prompt, clear information from caregivers at the initial point in the diagnostic process were more satisfied with their interactions with the caregiver than women who did not receive clear responses to their questions. Furthermore, all women desired a rapid access to the maternal fetal medicine specialist (MFM), preferably within 24 hours of the initial ultrasound scan. Some women described situations in which they were dissatisfied with their encounter with healthcare providers when they perceived insensitivity of the specialist delivering the news and when they did not receive sufficient detail about the prognosis or treatment available as quickly as they would have wished. Women consistently raised the issue of healthcare professionals' use of unsuitable language, including the inappropriate use of medical terminology. Most women said the diagnosis was explained through the use of a combination of fetal ultrasound images, percentile charts, and diagrams. They appreciated the use of visual images, but all described the need for supplementary written information either after the initial scan or after the appointment with the MFM, and they valued the continuity of seeing the same clinician(s) on repeated visits in developing a trusting relationship. Ultrasound examinations in pregnancy have become available to most women in developed countries as a routine aspect of care during pregnancy. This study highlighted the influence that personally held attitudes toward pregnancy management after an adverse diagnosis can have on women's care. Healthcare professionals should have adequate training on how to break bad news sensitively to a vulnerable population, because negative consequences are significant for all when unsupportive encounters occur.

Arwa Oweis