“I was shocked,” Saritha tells Happiest Health. “The first time I found out about the anomalies, I was at the radiology section where they were reading my report. Supporting and counselling me were clearly not in the radiologist’s responsibility. During my appointment with the gynecologist, she tried to explain everything to me and convinced me to go ahead with termination of the pregnancy. But it was a very difficult time for me — I had just received some devastating news that I wasn’t sure how to deal with.”
A week later, Saritha underwent an amniocentesis test (a prenatal test that can diagnose genetic birth defects and disorders) — and it confirmed the radiology reports. A week later she underwent a medical termination of pregnancy (MToP) procedure.
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Counselling — a must after pregnancy scan
What happened with Saritha was unfortunate, says Dr Anitha Manoj, senior consultant, obstetrics & gynecology, Sparsh Hospital, Bengaluru.
“These individuals need support — medically and psychologically. Being told that your fetus has birth defects can be agonising. Prospective parents going through prenatal scans need support and guidance from a mental practitioner and counselling from their gynecologist,” Dr Manoj says.
Counselling during prenatal scans for fetal anomalies
“The main aim of counselling is preparedness, and it should be given every step of the way,” says Dr Komal Chavan, senior consultant, obstetrics and gynecology, VN Desai Hospital, Mumbai.
Dr Chavan, who is also chairperson, Medical Disorders in Pregnancy Committee, Federation of Obstetric and Gynaecological Societies of India, says that in cases like Saritha’s, doctors want to be 100% sure about the anomaly being detected.
“Counselling is provided not just when an anomaly is detected but also before doing a test, says Dr Chavan. “After the test, we must explain to the parents the type of anomaly, its severity, the baby’s quality of life, the type of interventions required and at what stage — among many other things.”
Counselling should be interdisciplinary, a team effort
Dr Kolar, an obstetrician and maternal and fetal medicine specialist at Fernandez Hospital, Hyderabad, says that counselling in such cases is a two-way communication and most effective when done as a team.
If it is an anomaly involving the brain and the spine, Dr Kolar would involve a neurophysician, a neonatologist and a geneticist. “It should be a combined counselling,” she says. “The geneticist will offer their insights on the genetic basis for the disorder, the neonatologist explains how they will take care of the baby once it is born, and the neurophysician would tell them about any delay in milestones for the baby and what can be done to intervene early. Similarly, if it is an abnormality involving the kidneys, I would involve a pediatric nephrologist.
“Prospective parents sometimes do not understand that the scan is done to actually pick up abnormalities and not just to scan and say that everything looks good.”
Kate Carson from Massachusetts, USA, underwent medical termination of pregnancy at 35 weeks after her fetus was diagnosed with severe brain anomalies. She now works as a support person for prospective parents who have decided to terminate a pregnancy.
“I was so grateful that my genetic counsellor helped me break down what could be known from the scans and ultrasounds and amnio results, and what would be left up to chance,” says Carson. “She also helped connect me to local resources like specialised mental-health professionals and local support groups. She filled an important role as emotional support, listening to me if I wanted to talk about my feelings and express myself during the difficult days of navigating my baby’s diagnosis.”
Carson says that in a crisis, gathering information is the most important thing and the genetic counselling helped her understand the medical data she was receiving. She adds that two maternal-fetal medicine specialists also supported her in the interpretation of her ultrasound. She was well supported during diagnosis, but not when she chose to terminate pregnancy.
Dr Kolar adds that doctors should prepare prospective parents for financial hardships.
Takeaways
- Anomaly scan detects fetal structural abnormalities. If there is an anomaly, prospective parents require counselling.
- Since the main aim of counselling is preparedness and passing on information to the prospective parents, it should be provided at every stage.
- Counselling should be interdisciplinary and a team effort.
