* Author Topic: Guide to Termination for Medical Reasons TFMR  (Read 6563 times)

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Offline Dory10

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Guide to Termination for Medical Reasons TFMR

The main purpose of an ultra sound scan during pregnancy is to check that all is well with the pregnancy and baby.  Sadly sometimes a routine scan will reveal that the baby has abnormalities.  These may be very obvious and a clear diagnosis can be given, more often the scan will show indicators or markers that the baby may have a certain condition.
Hearing the news that there are concerns about the health of your baby is devastating, confusing and isolating.  Walking back out of the scan room into the waiting area where couples chat excitedly, sharing pictures feels surreal.  Depending what has been identified at the scan and the stage of pregnancy a range of further tests or examinations may be offered and sadly these will not come immediately.   The waiting between them can be one of the hardest parts.


Test and Examinations

At this stage you may be referred on to a FMU (Fetomaternal Unit) either within your own hospital or at a larger one near by as they have the specialists that can offer more tests and examinations and confirm a diagnosis.
You may be offered an amniocentesis or CVS test.  This is to check for a chromosomal abnormality such as Downs, Edwards or Pataus Syndromes.  The tests involve inserting a small needle into the abdomen and taking a small amount of amniotic fluid (amniocentesis) or placenta (CVS).  With both of these tests there is around a 1:100 risk of miscarriage.
Extra more detailed ultra sounds will usually be carried out by a consultant specialising in a specific area or a FMU specialist.  You may also be offered an MRI scan which will provide clear all round images of the baby.


What are my options?

If the extra tests and examinations confirm a particular condition then the impact on your babyís health will be clearly explained to you.  It may be that your babyís condition is incompatable with life or that it will be life limiting.  Your baby may have sensory problems, issues with balance and mobility or learning difficulties.  It may be that at this stage of pregnancy the full extent to how a condition may affect your baby is still not clear.

Ultimately it is your decision about what happens next.  You will have the options available to you explained clearly and if at this stage you havenít already been in tough with a support organisation such as ARC (Antenatal Results and Choices) http://www.arc-uk.org/  then  you might find it helps to speak to a support worker, most are parents that have been in this situation themselves.



Making the hardest decision of all

After all the tests and waiting there will come a time when you sadly have to decide whether or not to continue with the pregnancy.  You will not be rushed into making this decision and it needs to be the right one for you and your partner and family.  It will be something that takes into account all the information you have been given and will almost certainly rock any previous thoughts and beliefs.  It may be that for religious or cultural reasons it is something that you are unable to consider. 


What happens next?

Depending on your stage of pregnancy, there are different options.  Prior to around 14 Ė 15 weeks of pregnancy a d&e (dilation and evacuation) procedure can be offered, this is carried out under general anaesthetic.  Sometimes this is offered later in a pregnancy and is something you would need to discuss with your specialist.

There is an option to be medically induced with oral tablets and pessaries.  This will mean that you go into labour and deliver your baby.  If you are more than around 20-21 weeks pregnant, an injection is also offered to endure that the babyís heart has stopped beating prior to inducing labour.  This procedure is carried out under local anaesthetic and the needle is inserted through your abdomen much in the same way as an amniocentesis test is.  The tablets will be given to you in hospital and an appointment made about 48 hours later for you to go in and have the pessaries that will induce labour.  It is important to contact your hospital straight away if you start to have abdominal cramps, bleeding or your waters break and you are at home.

A cesarean section would only be offered in cases where the motherís health is in danger.

Hospital arrangements differ from area to area but usually a delivery before 20 weeks takes place in a gynae ward or womenís health unit and after 20 weeks you will probably be in a birth centre or labour ward.  Speak to your hospital about where you are going to be and what arrangements they may have, some have special rooms for couples who are going to deliver a sleeping baby.  They may warn you that if you are going to be on a labour ward you might hear babies crying and see pregnant ladies and newborn babies.  In reality the rooms are heavily sound proofed and they will do their up most to shield you from these things.


What should I take to hospital?

You will need to take a change of clothes, toiletries, a towel, slippers, dressing gown and some large pants or disposable maternity pants.  You will need to wear a sanitary towel/maternity pad afterwards.  It is also handy for your partner to have a change of clothes too.
Maternity pads/ super strength sanitary towels and if you were further along in your pregnancy, breast pads. 
There can be a lot of waiting and so some drinks, snacks will be useful as can electronic games, magazines and puzzle books for both yourself and partner.

Make sure you have change for the carpark and any meals or snacks your partner may need to buy.   You will be given meals but he/she wonít.
A fully charged phone and charger in case you need to contact people whilst you are in hospital.

Depending on your stage of pregnancy you may want to take in a small outfit or blanket for your baby.  Speak to hospital staff about what is appropriate, your baby may be too small for even premature clothing but can be wrapped lovingly in a special blanket afterwards. 
You might want to take in a small teddy for your baby, sometimes it is nice to buy two the same, one to leave with your baby and one to take home with you.

This might sound strange and it isnít right for everyone but taking a camera, even if it remains tucked away in your bag, gives you the option of taking your own photos of your baby if you want to.


Afterwards

Please remember that it is completely a personal decision as to whether or not you wish to see or hold your baby afterwards.  You can change your mind at any time and the nurses or midwives will answer any questions and will be happy to describe your baby before you decide.  Usually the hospital will offer to take photos that are then kept in the motherís medical notes so that at any point in the future you can ask to see them. 

It is completely natural to be nervous about seeing and holding a sleeping baby, you may worry what he/she looks like, donít put pressure on yourself, see how you feel.  It might help to see a photo first.
You will be given time to spend with your baby and in the case of later losses usually other family members are welcome to visit you if this is something you would like.

The hospital will be able to arrange for a Chaplain to visit you and bless your baby or equally they will welcome visits from any faith leaders.

The nurses or midwives will usually offer to take hand and footprints of your baby too and sometimes will give you a little memory box provided by charities such as SANDS.

Prior to 24 weeks gestation a baby doesnít receive a birth certificate but you can download one from SANDS or create your own, which the hospital staff will be happy to help you fill in.
Please donít be afraid to ask about any of these things and get ideas from support organisations such as SANDS https://www.uk-sands.org

You may decide that you wish for a post mortem to take place so that you can learn the full extent of your babyís condition or any implications for future pregnancies.  This will be fully explained to you by the hospital staff.  Usually your baby will be returned to the hospital with in 1- 2 weeks  but the results can take up to 12 weeks to return.

The hospital will discuss funeral arrangements with you, before 24 weeks gestation there is no legal requirement to have a funeral but many parents wish to have one.  The hospital can arrange this for you or you can organize this yourself through a local undertaker.  If the hospital arranges the funeral you can be asked to be informed when it is taking place, usually this will be a group funeral with other babies and their families. 

In cases of a later loss it may be that you have already prepared the babyís bedroom or nursery.  Coming home to face this room can seem unbearable, remember you donít have to think about what to do with anything right away.  It might be something you wish to leave for a while or pack away yourselves.  Some couples find it easier if friends or family do this for them so that they can look through things at a later stage.  There are no right and wrongs.

Most high street shops are also happy to accept returns of baby items in these sad circumstances even if the usual return periods have expired.

You can also sign up to a baby mail preference service so that you donít receive any baby related mail from companies even those that you may have previous signed up with such as Emmaís Diary or Bounty.  Here is a link to register your details  http://www.mpsonline.org.uk/bmps/


Support

You may feel that you need support at different times.  You may feel numb, sadness, anger, fear, confusion or a mixture of many different emotions. Please donít feel alone, sadly there are many women that have been in this position and it is important to seek help if you need it.  Organizations like ARC and SANDS have helplines, online support and meetings.  It may not be something you want to access but they are there at any point, days, weeks, months and years afterwards.  Here is a link for our coping after pregnancy loss thread https://www.fertilityfriends.co.uk/forum/index.php?topic=334678.70


Thinking of the future

Please see our Guide to Trying again after a loss https://www.fertilityfriends.co.uk/forum/index.php?topic=337963.0




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