Giving Bad and Ambiguous News

Abstract

Over the last 20 years, second-trimester ultrasound has become a routine aspect of antenatal care in Western countries. As ultrasound screening is offered to low-risk women, the examination is frequently seen as non-threatening, even as a social event. With a background rate of fetal abnormality at 2–3 %, it is unsurprising that most women’s experiences of ultrasound screening are extremely positive. However, given recent advances in technology and an increased focus on the detection of anomalies, some women will inevitably receive bad news. The identification of a fetal abnormality at a routine ultrasound examination is traumatic, not least because it is so unexpected. By understanding why this is the case we, as practitioners, can learn how to impart bad news both sensitively and responsively. From the instant an abnormal finding is detected, interactions between caregivers and parents intensify, and what is said and how it is said become central, as couples attempt to cope with and adapt to an unforeseen and at times unpredictable future. Evidence exists that when faced with bad news some women have a high preference for information whereas others avoid negative information, preferring to delay engagement until the diagnosis is confirmed. This chapter explores the link between information preference and coping style. Suggestions on how to recognize cues and identify the parent’s favored coping style are offered so that clinicians can tailor information to match parental preferences, improve couples’ experiences of receiving bad and ambiguous news, and reduce occurrences of suboptimal care.