Counseling about Fetal Anomalies

How I Practice Video Series 
Dr. Dana Block-Abraham DO, FACOG
Baltimore, MD

I often see patients whose babies have been diagnosed with significant anomalies or diseases and one of the things that I found is most important to emphasize to the patient is that this is nothing she did or she did not do to create this problem for her baby. I think the patient finds a lot of comfort when you as a physician say, ‘Hey, this isn’t your fault. This is not because of something, a choice you made or a choice you did not make.’ And because I often see these patients with fetal anomalies, I find myself very frequently counseling regarding delivery around the limits of viability and when I do this I prefer not to give specific percentages to patients as far survival or neurodevelopmental outcomes if possible. Rather I like to say, ‘it’s a relatively high possibility or a relatively low possibility that this may happen to your baby’. And I find that that is sometimes acceptable to patients, more often than not but it helps better council them because they’re not set on it being the higher or lower percentage point, if you will. I also always remind them that it is always absolute if something happens to their baby even if they fall in the lower probability within that counseling. I also really try to emphasize that there is a difference between life, which is having a heartbeat and being able to breathe on your own, and quality of life, to live a fulfilling life like you and I. And for that, the definition is different for everybody and the ideal that parents have for their children is different depending on the family situation and in my counseling I try to emphasize that difference and help lead them along the thought process of what it really means to them and how that impacts any decisions that they might make. I find that one of the most important things to do in these situations is to really partner with the patient to prompt her with questions that help her think along these lines and help her make the best decisions and comfort her as she makes the decisions that are right for her situation and her family. This is how I practice.. 

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