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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