“I can’t find a heartbeat. The foetus is dead.”
Imagine walking into an ultrasound suite, filled to the brim with excitement, ready to see your new baby on screen, maybe even in 3D. Instead, the worst minutes of your life unfold before your eyes. As you look back, what you remember isn’t how you felt, it isn’t the last time you saw your baby lying there, motionless, on the screen. The thing you remember most was the feeling of the sonographer’s words hitting you like a slap across the face. The brutal blow of each phrase. Even now, years later, they still feel sore, like a bruise. As an advocate and journalist investigating early pregnancy loss in this country, I hear this story, or variations of it, every single day.
Like all aspects of medicine and medical care, there are a multitude of skills that make a clinician an excellent practitioner. The ability to retain information, to put together seemingly disparate symptoms to come up with a diagnosis. Or maybe catch the things that others have missed. Some need the surgical abilities to operate under pressure or suture up a wound so perfectly there’s no scar at all. These are skills that can elevate clinicians to some of the highest levels of medicine.
But one thing all clinicians need is the ability to be empathetic, to care about their patients or to adequately articulate information, whether good or bad. Good news is a much easier proposition. But bad news can be catastrophic. And, unfortunately, the people conducting ultrasound are not always empowered or taught how to engage in this sort of conversation. When delivered badly it can contribute to years of compounded trauma or even mental illness. Especially in the world of miscarriage, but also any adverse pregnancy outcomes.
Another common story I hear is one of total silence. The healthcare worker conducting the ultrasound who doesn’t look at you, much less speak to you. You leave the clinic without any information, at least happy you got to see your little peanut in black and white. Then, out of nowhere, you get a phone call from your doctor. It’s not good news. All you want is to be able to turn back time, walk back into the room, and have a moment to look on the screen and say goodbye. If you’d known, maybe you would have asked for a photo. But instead you just had silence. Perhaps even a nod when you asked if everything looked OK.
In a cultural shift, the Australasian Society for Ultrasound in Medicine is set to announce the release of guidelines for parent-centred communication in obstetric ultrasound. Asum acknowledges that ultrasound professionals need support to know how to deliver bad news to patients, but also that patients have the right to hear what’s going on rather than wait in a vacuum where they have no idea there’s a problem, are anxious because they know there’s a problem but they don’t know what it is or they have had previous problems in pregnancy and need peace of mind.
Development of the guidelines was initiated by Samantha Thomas, inspired by the work of her PhD, which she completed two years ago at the University of Sydney. She led a multi-disciplinary team comprising medical professionals, sonographers, patient advocates and academics.
“Many sonographers were stressed because they did not have any training or consistent departmental protocols which encourage a collaborative approach and gave them the support needed when faced with unexpected or adverse obstetric findings,” she says.
The guidelines are targeted at a wide range of people, including student and qualified sonographers, radiologists, obstetricians, specialists, nurses and midwives. They have been trialled in a pilot rollout in Perth and Sydney, with Asum reporting a “high rate of parent and clinician satisfaction”.
“Sonographers are on the frontline conducting these scans and parents are telling us delayed communication from the day of the scan until the next time they see a doctor concerns them,” says Asum’s chief executive, Lyndal Macpherson.
“This is not only about communicating findings with parents but also equipping sonographers to share their communication with the reporting doctor so there is a clear understanding of the information being shared across all professionals in the care team.”
Patient-centred care is the much-lauded holy grail of best-practice medicine but, in an age where our medical system is hideously under-funded, too often patients are made to feel on the outer of their own care.
It’s an important step forward to recognise the trauma of adverse or even just challenging findings during pregnancy. These guidelines will go a huge way to supporting the parents who don’t enjoy the happy, joyous, problem-free pregnancy that everyone hopes for when they start the journey towards parenthood.
