Incorrect pre-natal diagnoses

Recently when the largely manufactured ‘scandal’ surrounding pro-life counselling and crisis pregnancy centres (CPCS) hit the headlines, some members of the pro-life movement were extremely keen to denounce un-scientific or allegedly un-ethical practice and disassociate themselves from such groups, in order that they would not be tarred with the same brush.

While this was understandable in many ways, I have come to the conclusion that harsh and over-the-top criticisms (of which I have been personally guilty myself) should be avoided where possible and any  public critique or correction should be done with charity. With that in mind, it is nonetheless important that if the pro-life movement wants to be afforded any credibility, that we do not seek to ignore or brush under the carpet any errors but rather confront the charges often laid at our door by pro-choicers and if they have any validity, publicly seek to address any shortcomings both in terms of attitudes, approaches and information given out to women.

It is in this spirit that I therefore wish to offer the following comment.

This morning, a story has appeared in the Daily Mail, regarding the case of a pregnant woman who was seconds away from taking pills to terminate her pregnancy following a diagnoses of pre-natal death. Fortunately the mother insisted upon a second scan when she returned to the hospital a few days later which demonstrated that her baby was in fact alive. The little girl has now been born, is making good progress despite being born with some congenital abnormalities, the NHS trust involved has come to an out of court settlement and most importantly changed their procedures to ensure that women are always given access to a second scan to confirm the original diagnoses before taking any action to end the pregnancy.

Admittedly I am extremely sensitive about this topic, not least because it is about now that I would have been giving birth to our baby Raphael, had he or she lived. Nonetheless, it was disappointing to see this story being picked up and spun by the normally responsible Life Charity, as follows:

I’m not denying that it is an important pro-life story and no doubt it will be picked by SPUC in their regular news round-up, however there is little point in highlighting a problem, without suggesting a viable solution. The point which is being missed, not only by the Daily Mail, but also by LIFE, is not that a woman should have multiple scans as screening is allegedly often wrong, rather that she should have access to a second independent expert opinion, as soon as possible after the original diagnosis.

In the case of Mrs Wiggins, the lady featured in the story, she should not have been sent home without a second opinion or confirmation as to the status of the baby. A second scan should not be offered days later, or immediately preceding a termination, but on the same day as the diagnosis. No woman beyond 10 weeks in pregnancy should be sent home with a provisional diagnosis that her baby has probably died but she needs to come back a few days later or in a week’s time to confirm.

If you are told that your baby has died, you should be in no doubt whatsoever, and, to be fair, cases like this are thankfully rare. Recently there has been a question mark over the diagnoses of early miscarriages, which means that organisations concerned with maternal health need to work together to ensure that existing guidelines are adhered to and the advice given to women should include advice to seek a second opinion as well as a wait and see approach before terminating a suspected silent miscarriage in the very early stages, where there is often a margin of error in terms of  dates and measurements.

I found the story distressing, as would any woman who had experienced a silent miscarriage, because like Mrs Wiggins I only had one scan and this therefore raises the horrifying possibility that I may have terminated a living child. In my case I am as confident as I can ever be that the baby had died, for a number of reasons. Firstly, the person carrying out the scan spent quite a long time examining the baby in silence before telling me that there was no heartbeat and I could see for myself that the baby was not moving. Secondly, the scan was not carried about by a midwife on a maternity ward, but a qualified  radiographer who specialised in ultrasound. Thirdly, her diagnosis was not only confirmed by her colleague recording the measurements, but a third party, whom she immediately telephoned and asked them to come to verify her findings. So while the scan  took place on a single occasion, it was confirmed by 3 different medical professionals.

This should be the model of care for all women in order to minimse distress and enable them to take the decision as to their next course of action. In my case what continued to cause distress, was due to the fact that this had occurred at the end of the first trimester, my body had not acknowledged that the baby had died and so was continuing to chuck out pregnancy hormones meaning that the foetal sac was still growing and I was still feeling pregnant and growing larger. As can be imagined I am acutely sensitive to any suggestion that I may have inadvertently killed a healthy baby, as would most women be who were in a similar situation. Casting doubt over whether or not the diagnoses were correct, is irresponsible unless you are going to offer supportive resources.

Which is why pro-life groups need to ensure that they don’t jump on sensational stories which could compound the hurt and distress of women, but offer a measured response, including reassurance that these cases are in the minority and that if there is room for any doubt, then women should not rush to terminate a suspected silent miscarriage. Better still join forces with miscarriage support groups to campaign for better treatment.

What doesn’t help is using this case to cast doubt upon the reliability of pre-natal screening. Recently there have been some notable mistakes with parents mistakenly told that their babies are disabled, but in the majority of cases, the diagnoses are correct and parents take the agonising decision to abort after several detailed scans at a later stage. While we must objectively state that such abortions cannot be condoned, neither should we do anything to compound the grief and trauma of the parents, including casting doubt on pre-natal screening and diagnoses.

Pre-natal screening is not in an of itself an evil – so long as it is used for therapeutic effect, to heal and cure babies and advance the cause of fetal and neo-natal medicine which should be curative. While we should be wary that there is scope for error, neither should we reject screening as unhelpful or out of hand. Personally if one of my children were to be born with a disability I would want to know in order that we could adequately prepare and be in a position to support our child and provide optimum care.

The right of disabled babies and children to life, should not be conflated with issues surrounding misdiagnosis and pre-natal screening not least because it runs the risk of implicitly condoning or justifying those cases where the diagnoses is correct.

Pointing out that sometimes mistakes in pre-natal screening can occur should always be accompanied by relevant advice and support in case you are affected by these issues. It’s always tempting to maximise the pro-life element of these stories and jump on the outrage bandwagon but not always the most responsible course of action.

Pro-life must always be pro-woman, it must remember that it has a duty of care to all women, which includes those of us who have experienced the pain of miscarriage and abortion. That must by necessity include telling the truth but neither must it install a sense of fear, panic or distress in those who are struggling in the aftermath of losing a child, but instead offer sensible advice, reassurance and accurate medical information and access to counselling and healing for women who may be affected.

5 thoughts on “Incorrect pre-natal diagnoses

  1. Some 20 or so years ago a friend had a baby die in utero and was sent home to await am appointment to clear her uterus. The wait struck me as so cruel as was the consultant who told her the event was her fault, her poor diabetic control. Maybe a bit off topic but pregnant women need the utmost kindness and care, which it would seem now cannot be given due to ‘pressure on services’.

    1. I agree and to some extent I have sympathy with the midwife who carried out the original scan, who was probably doing her best while working under severe pressure. The experience of multiple pregnancies over the last few years has revealed the shortcomings in maternity care, where units are impossibly stretched due to lack of staff.

  2. “No woman should be sent home with a provisional diagnosis that her baby has probably died but she needs to come back a few days later or in a week’s time to confirm.” I’ve had this happen on two occasions, and in both cases it was the correct thing to do. In early pregnancy, when they can’t be sure of dates and there may not yet be a heartbeat, it’s obviously good practice (and the only option) to come back for another measurement after a period of time. Two or three healthcare professionals looking at the same inconclusive information isn’t much use. Besides, there are usually other indications that the foetus has stopped growing, such as bleeding or a noticeable drop in hormone levels.

    1. I probably should have clarified in that there is a difference in the 6 week mark, and the case of Mrs Wiggins, the lady in the story and myself who were diagnosed around the 12 week mark. In both of our cases an ultrasound would certainly be able to ascertain whether or not the baby or foetus was alive and had a heartbeat.

  3. I think you’re making too much of a tweet. I interpreted the point that Life were making differently. It was simply to say that prenatal diagnosis isn’t perfect. So parents be on your guard and ask questions. Life is precious and doctors aren’t always right.

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