Abstract
Over the last 20 years, second-trimester ultrasound has become a routine aspect of antenatal care in Western countries. As ultrasound screening is offered to low-risk women, the examination is frequently seen as non-threatening, even as a social event. With a background rate of fetal abnormality at 2–3 %, it is unsurprising that most women’s experiences of ultrasound screening are extremely positive. However, given recent advances in technology and an increased focus on the detection of anomalies, some women will inevitably receive bad news. The identification of a fetal abnormality at a routine ultrasound examination is traumatic, not least because it is so unexpected. By understanding why this is the case we, as practitioners, can learn how to impart bad news both sensitively and responsively. From the instant an abnormal finding is detected, interactions between caregivers and parents intensify, and what is said and how it is said become central, as couples attempt to cope with and adapt to an unforeseen and at times unpredictable future. Evidence exists that when faced with bad news some women have a high preference for information whereas others avoid negative information, preferring to delay engagement until the diagnosis is confirmed. This chapter explores the link between information preference and coping style. Suggestions on how to recognize cues and identify the parent’s favored coping style are offered so that clinicians can tailor information to match parental preferences, improve couples’ experiences of receiving bad and ambiguous news, and reduce occurrences of suboptimal care.
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References
Baillie C, Hewison J. Should ultrasound scanning in pregnancy be routine? J Reprod Infant Psychol. 1999;17:149–57.
Campbell S, Smith P. Routine screening for congenital abnormalities by ultrasound. In: Rodeck CR, Nicolaides KN, editors. Proceedings of the 11th study group of The Royal College OF Obstetricians and Gynaecologists. London: RCOG; 1983.
Drugen A, Greb A, Johnson MP, Krivchenia EL, Uhlmann WR, et al. Determinants of parental decision to abort for chromosome abnormalities. Prenat Diagn. 1990;10:483–90.
Ekelin M, Crang-Svalenius E, Dykes A-K. A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination. Midwifery. 2004;20:335–44.
Eurenius K, Axelsson O, Gallstedt-Fransson I, Sjoden P-O. Perception of information, expectations and experiences among women and their partners attending a second-trimester routine ultrasound scan. Ultrasound Obstet Gynecol. 1997;9:86–90.
Folkman S, Lazarus R. An analysis of coping in a middle-age community sample. J Health Soc Behav. 1980;21:219–39.
Horowitz M. Stress response syndromes. Northvale, NJ: Jason Aronson Incorporated; 1992.
Hyde B. An interview study of pregnant women’s attitudes to ultrasound scanning. Soc Sci Med. 1986;22:589–93.
Janoff-Bulman R. Shattered assumptions: towards a new psychology of trauma. New York, NY: The Free Press; 1992.
Katz Rothman B. The tentative pregnancy: prenatal diagnosis and the future of motherhood. London: Pandora Press; 1988.
Kolker A. Advances in prenatal diagnosis: social-psychological and policy issues. Int J Technol Assess Health Care. 1989;5:601–17.
Lalor JG. Routine antenatal ultrasound, reassuring or anxiety-provoking? A descriptive study. Unpublished M.Sc. Thesis. Trinity College, University Of Dublin, 2000.
Lalor J, Begley C. Fetal anomaly screening: what do women want to know? J Adv Nurs. 2006;55:11–9.
Lalor J, Begley C, Galavan E. A grounded theory study of information preference and coping styles following antenatal diagnosis of foetal abnormality. J Adv Nurs. 2008;64:185–94.
Lalor J, Begley C, Galavan E. Recasting hope: a process of adaptation following fetal anomaly diagnosis. Soc Sci Med. 2009;68:462–72.
Lalor JG, Devane D. Information, knowledge and expectations of the routine ultrasound scan. Midwifery. 2007;23:13–22.
Lalor J, Devane D, Begley C. Unexpected diagnosis of fetal abnormality: women’s encounters with caregivers. Birth. 2007;34:80–8.
Lalor J, Devane D, McParland P. (2007) Ultrasound screening for fetal abnormality in Ireland: a national survey. Ir J Med Sci. 176(3):175–9
Lalor J, Devane D, Mc Parland P. Ultrasound screening in Ireland: how effective is the service? Ir Med J, 2006b; 99, 264–6.
Landsman I. Crises of meaning in trauma and loss. In: Kauffman J, editor. Loss of the assumptive world. A theory of traumatic loss. New York, NY: Brunner-Routledge; 2002.
Larsen T, Nguyen TH, Munk M, Svendsen L, Teisner L. Ultrasound screening in the 2nd trimester. The pregnant woman’s background knowledge, expectations, experiences and acceptances. Ultrasound Obstet Gynecol. 2000;15:383–6.
Lazarus R, Launier R. Stress-related transactions between person and environment. In: Pervin L, Lewis M, editors. Perspectives in interactional psychology. New York, NY: Plenum; 1978.
Miller S. When is a little information a dangerous thing? Coping with stressful life-events by monitoring versus blunting. In: Levine S, Ursin H, editors. Coping and health. New York, NY: Plenum Press; 1980.
Miller S, Mangan C. Interacting effects of information and coping style in adapting to gynecologic stress: should the doctor tell all? J Pers Soc Psychol. 1983;45:223–36.
Mitchell LM. Women’s experience of unexpected ultrasound findings. J Midwifery Womens Health. 2004;49:228–34.
Morgan PD, Fogel J, Rose L, Barnett K, Mock V, et al. African American couples merging strengths to successfully cope with breast cancer. Oncol Nurs Forum. 2005;32:979–87.
Parkes C. Psycho-social transition: a field of study. Soc Sci Med. 1971;5:101–15.
Parkes C. Bereavement as a psychosocial transition: processes of adaptation to change. J Soc Issues. 1988;44:53–65.
Proud J. Some problems encountered in obstetric ultrasound scanning. Midwives Chron. 1985;98:289–90.
Rapp R. Testing women. Testing the fetus. New York: Routledge; 1999.
RCOG. Report of the RCOG Working Party on ultrasound screening for fetal abnormalities. London: RCOG Press; 1997.
Rotter J. Generalized expectancies for internal vs. external control of reinforcement. Psychol Monogr. 1966;80:1–28 (Whole Number 609).
Stainton M, Mcneil D, Harvey S. Maternal tasks of uncertain motherhood. Matern Child Nurs J. 1992;20:113–23.
Statham H, Green J, Kafetsios K. Who worries that something might be wrong with the baby? A prospective study of 1072 pregnant women. Birth. 1997;24:223–33.
Statham H, Solomou W, Green J. Continuing a pregnancy after the diagnosis of an anomaly: parents’ experiences. In: Abramsky L, Chapple J, editors. Prenatal diagnosis: the human side. 2nd ed. Cheltenham: Nelson Thornes; 2003.
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Lalor, J.G. (2015). Giving Bad and Ambiguous News. In: Paley Galst, J., Verp, M. (eds) Prenatal and Preimplantation Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-18911-6_7
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DOI: https://doi.org/10.1007/978-3-319-18911-6_7
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