Psychological reactions and coping strategies of Sri Lankan women carrying fetuses with lethal congenital malformations

Abstract

Introduction Termination of pregnancy is a popular option for pregnancies complicated by lethal congenital malformations (LCMs). In Sri Lanka, where abortion laws are restrictive, this is not available. We studied the psychological responses and coping strategies of women who had to continue their pregnancies knowing the baby had a LCM.Setting A teaching hospital in Sri Lanka.Study design Qualitative inquiry.Method We conducted a semi-structured interview of 10 women whose fetuses were diagnosed to have a LCM. Results All women showed a grief reaction on hearing the news and were distressed about having to carry a futile pregnancy. Eight women were grateful they knew of the abnormality because it prepared them for the birth better, while the other two wished they had not known. They all found having to share facilities with 'normal' women to be painful. Seven women who received 'routine' antenatal care felt that the doctors were ill-equipped to deal with their situation. All felt that abortion should be legalised for LCMs. All engaged in religious rites believed Conclusions The diagnosis of a LCM causes severe distress and psychological reactions, which the staff dealing with these women should be aware of. Ideally, they should be provided care with minimum contact with other women, taking into account the futility of the pregnancy. Engagement in religious rites, even though with unreal expectations, may possibly help them in the long term bereavement process.

Psychological effects of fetal diagnoses of non‐lethal congenital anomalies on the experience of pregnant women during the remainder of their pregnancy

“…Antenatal diagnoses of congenital anomalies, including lethal congenital anomalies, [1][2][3][4] uncorrectable non-lethal congenital anomalies, [5][6][7] and correctable non-lethal congenital anomalies that can be treated surgically after delivery, [8][9][10][11][12][13][14] have all been shown to cause psychological trauma in pregnant women. Faced with psychological distress, pregnant women who receive these diagnoses employ a variety of coping strategies.…”

Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation

“…Senanayake et al (2006) believe that the staff dealing with these women should be aware. In the present study, we found that the woman may not fully understand all the information about the fetal malformation, which requires greater attention by health professionals who carry out the case.…”

“…However, some women are grateful for the antenatal diagnosis because it allows them to deal with the situation. In this respect, religious beliefs can trigger erroneous feelings of hopefulness and facilitate an attitude of acceptance of the fetal malformation (Senanayake et al, 2006). The use of ultrasonography for the detection of fetal anomalies has become widespread in many countries.…”

Fatally flawed? A review and ethical analysis of lethal congenital malformations

“…Antenatal diagnosis of a severe congenital malformation is associated with profound grief, sadness and anger. [1][2][3] In many parts of the world diagnoses of this nature are often followed by decisions to terminate a pregnancy, particularly where the condition is associated with a high rate of prenatal (or stillbirth) or neonatal death. [4][5][6][7] Those conditions with the poorest prognosis are often labelled 'lethal'.…”