Select Committee on Health Written Evidence


APPENDIX 46

Memorandum by Antenatal Results and Choices (MS 55)

  Antenatal Results and Choices (ARC) is the only national charity that provides non-directive information and support to couples throughout the antenatal screening process and when a significant abnormality is diagnosed in their unborn baby. Continued support is offered to parents whatever decision they make about the future of the pregnancy. ARC also works with health professionals to improve the care that parents receive. We work closely with the Royal Colleges and are members of the Antenatal Sub Group of the National Screening Committee and the working group producing the NICE Guideline on Antenatal Care.

  Not all pregnant women go on to become new mothers. Modern antenatal care can now screen and diagnose a range of fetal abnormalities. When parents are given a diagnosis of abnormality in their unborn baby they have two choices to continue with the pregnancy with the prospect of their baby needing special care, treatment and in some cases palliative care or they have the choice to end the pregnancy.

  This group of women need particular skills from their carers. They need staff who are competent in presenting information about screening tests, in enabling informed choice, in breaking bad news and in bereavement care. If parents are to live with the consequences of their decision they need to know it is one based on full and accurate information presented in a way which enables them to make choices that are appropriate to them, they need time to assimilate that information and they need staff who are both competent and confident in presenting such information.

RECOMMENDATIONS

    —  A review of who should offer screening programmes should be undertaken. Is it the role of the midwife as part of routine antenatal care?

    —  Standards of training need to be determined.

    —  Who provides such training should be determined.

    —  Training should be made available to all disciplines this includes midwives, sonographers and obstetricians.

    —  Training should be mandatory in order to ensure a high quality screening and prenatal diagnosis service.

  ARC has provided training for health professionals in this field for many years. We use our unique insight into the needs of parents who go through antenatal screening and are faced with the many dilemmas which it poses to inform our training. Working with the National Screening Co-ordinators ARC has delivered training to regional and local screening co-ordinators, midwives, sonographers and doctors throughout England. We also participate in seminars, lectures and study days on post graduate courses and with Royal Colleges.

  The main themes that have emerged from our work are:

    —  Staff do not feel fully informed about current screening programmes.

    —  They need training in basic communication skills.

    —  They need training in communicating risk.

    —  They do not understand the components of informed choice.

    —  They need training in how to break bad news.

    —  They need training in non-directive decision making.

    —  They need training in bereavement care.

  Although some of these areas are being addressed by the Antenatal Sub Group of the National Screening Committee and an infrastructure is evolving, there will always be a need for external organisations with specific skills to work with and train health professionals in maternity care.

  ARC would be pleased to give oral evidence to the Select Committee.


 
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