Pregnancy termination due to fetal anomaly: Clinical considerations

Abstract

Although there has been increased recognition in the research literature of the profound grief reaction following pregnancy termination due to fetal anomaly, many medical caregivers continue to assume mistakenly that responses are much milder, akin to elective abortion. This paper details the additional psychological burdens and tasks demanded by this pregnancy loss ‐the moral and marital challenges in making the decision of whether to terminate, the psychological quandary of whether a pregnancy or a life has been ended, the amplified shame and reluctance to share this loss with others due to current societal controversy regarding elective abortion, and the uncertainty of what to tell one's children about this loss. Clinical implications, recommendations, and case examples are offered.

Interaction between caregivers and families expecting a malformed child

“…It indicates that the goal of interaction between caregivers and families expecting a malformed child is to support families in finding their own resources to cope with their basic questions. It is important to support their own coping strategies, and to alleviate grief and possible feelings of guilt and inferiority (Leon 1995).…”

“…In particular, the surprising diagnosis is a great shock to parents. After the initial shock, feelings of guilt or denial are commonplace (Dallaire et al . 1995, Leon 1995, Chitty et al .…”

“…1993, Lorenzen & Holzgreve 1995, Chitayat & Babul‐Hirji 2000). The decision about pregnancy interruption is painful, and parents' feelings towards the child are often conflicting (Iles & Gath 1993, Seller et al . 1993, Zeanah et al .…”

Untitled

“…It is important, however, to draw a distinction between women who undergo an elective abortion of an unintended and unwanted pregnancy and those who terminate a wanted pregnancy due to fetal anomaly. Elective abortion based on a woman's wish not to bear and parent the child commonly has few psychological consequences 10,[22][23][24][25] .…”

“…For patients in a lowrisk routine pregnancy with an abnormal diagnosis, they too must make a rapid decision to continue or terminate the pregnancy. As Leon 10 explains, the profoundly difficult decision that each partner faces of whether to terminate the pregnancy is further complicated by the need to come to some mutual agreement, as a couple, in the short amount of time while the pregnancy clock ticks. Often there is not sufficient time to digest and absorb the shock of the news before undergoing the termination itself.…”