Interview AN09
Routine screening in two pregnancies – declined screening for Down’s syndrome. Family history of hydrocephalus led to early prenatal counselling but no risk identified.
Her first 20-week scan was professional but brief. The second time she had a specialist midwife…
Age at interview 29
Gender Female
Did you feel you were being adequately informed during it?
Yes I think so. The anomaly scan was done by the senior consultant in the scanning department, and as a result was extremely quick. And I know him, and know hes the, you know, the most qualified person to do that, you know, that scan, so in that sense I was very happy.
But in the actual experience of the scan was not particularly good because it was just a, you know, he could do it so fast, technically hes so good that hed been down the check list inside two minutes and after that was just doing things that interested him.
And there was, you know, yeah, he said, you know, "This is your babys face." And we wanted to know the sex, and he was a bit flippant about that, and I said, "No I really do want to know, go back and have a proper look." And of course he did, but it was all just all over very quickly and we didnt really see much.
Whereas this time Ive just had my anomaly scan, and it was a completely different experience because I was in the normal run-mill clinic and the scan, I think I was, we were very lucky, we had the scan done by a specialist midwife. And I didnt even know there were any midwives who did scanning, but apparently there are two.
And shes obviously made a conscious decision that it is a psychological experience for the parents, and given that it is, why not make it a nice one? She has the patter and, you know, it was lovely, we saw everything. We had it all explained in detail, and it was great.
She was referred to a prenatal diagnosis clinic because of anxiety about a family history of…
Age at interview 29
Gender Female
So my mothers story didnt quite add up somehow. She, it just wasnt clear what had been wrong with the baby. She knew that the baby had had hydrocephalus, but she didnt know what sort. And so I said this to my GP and my GP said, "Well Im just sending you straight to prenatal diagnosis."
So we went there, and they said, "Well lets say this babys got some form of hydrocephalus – do you know if it had any other neural tube defects?" So I had to say "No, I dont know." And they said, "Well do you know if it was a boy or a girl?" I said, "I know it was a boy." And the only inheritable form of hydrocephalus, the only sort of genetically disposed form that can be passed on that would, could possibly have affected me only affects boys, because its X-linked.
So she said, "Well, in that case probably we ought to try and find out what it was." So they tried to get my mums old medical records out of [specialist hospital] in London, which turned out to be a complete wild goose chase, and they initially said that they were in the bit of the building that had burned down so we couldnt have them and then they said oh no, theyd got that wrong, they were on microfiche but they couldnt read that.
So it took about two months to get a print-out of these records. And of course by this time the pregnancy was ploughing on, and so they decided to just do a scan at something like twelve or thirteen weeks, I think just to rule out anencephaly – although that didnt fit with hydrocephalus so I dont know how that – but anyway, because we didnt have the information the doctor just said, "Look, lets just do a scan at thirteen weeks."
Because what we didnt obviously want to do was find out something late. And of course that was completely normal. And then when we eventually got the notes about a month later, it turned out that it was all completely nothing that couldve ever conceivably affected my mothers children, that the baby had actually had a kind of tumour in its brain, and that the hydrocephalus was all secondary to that, and that actually advice about folic acid was entirely irrelevant and wrong.
So it all turned out to be nothing that could affect me. But it was quite a traumatic experience, almost not so much for me but for my mother, having to kind of re-live it again. And she never saw her old notes or anything like that, but she was made to think about it in a detail that she probably had chosen not to for years and years and years. And I didnt read the old notes either, but the consultant who did said they made pretty awful reading.
She did not want to know if her baby had Down’s syndrome but wanted to know about neural tube…
Age at interview 29
Gender Female
I mean I think thats something that people think about very differently. From my point of view, I knew that I wouldnt, if I knew I was having a baby with Downs syndrome I would not have a termination and given that, why know?
Now for some people theyd still want to know, theyd still want the information, but to get that information you have to have an amnio, and an amnio carries, you know, on a good day a one percent risk of miscarriage and I dont think Id take that risk.
So given that I wouldnt actually know, the only information Id have would be a high risk, and what is the point in that, you know? Even a risk of one in ten, actually the overwhelming probability is youre not going to be affected by it so why, so I just decided I didnt want the information at all. And maybe if Id been much older I wouldve felt diff-, you know, maybe if the baseline risk had been much higher, you know, if Id been thirty, thirty nine not twenty nine would I have differently about that, if I felt the risk was high?
I think I probably wouldnt have, because I would still feel the same about having a baby with Downs syndrome but I felt that I was quite clear about how I wouldnt follow the steps through and therefore there was no point in knowing the risk information. Because thats what it is you know, its a risk. It doesnt give you any answers, and I wouldnt have taken the next step I felt to get more answers.
Whereas for other things, certainly my husband felt diff-, you know. If, when we were, with the first, you know, in my first pregnancy when we were talking right at the beg-, you know, was there a big risk of a serious neural tube defect, and his attitude was, What, well what does that mean? And, you know, ultimately the very worst thing it means is anencephaly.
Well, the answer is I wouldve had a termination, thats not compatible with, you know, I wouldnt have carried on with the pregnancy with a baby that, you know, was never, ever going to live any time at all. So that was a very clear decision in the other direction.
She and her husband had different views about how they would cope with a child with physical or…
Age at interview 29
Gender Female
The things we discussed were spina bifida and Downs, and I think from my point of view I feel like my tolerance of having a disabled child is probably higher than average. You know, I think I would have to be convinced that a child was going to have a pretty ghastly quality of life to have a termination.
Were there any influences, do you think there were any influences on your particularly, like have you had friends with babies with particular conditions or…?
I havent, when I was younger I did nursing work with sort of teenagers with very profound learning difficulties and epilepsy and cerebral palsy, and maybe that has had an influence in the sense that I felt that a lot of those teenagers did have a quality of life.
And certainly Ive done, I mean, Ive run camping holidays for children with severe learning difficulties, including children with Downs syndrome, and in fact, you know, so I think Ive been in touch with, you know, with children with disabilities.
I know my husband feels probably irrationally different about the possibility of quite severe learning difficulties from quite physical disability, and if anything is less keen on the idea of, you know, choosing to have a child with a very severe physical disability because I think he, for himself he values the ability to do what he wants physically extremely highly, and he cant really imagine that not being a huge issue for an idividual.
Whereas I can easily imagine it not being a huge, especially if youve never had it. Whereas for him if, say, someone said to him "Look, quite frankly I can say to you this child will never walk," that for him would raise a serious question. Whereas for me it wouldnt raise the same serious question.
It is time-consuming for health professionals to inform people fully, especially about all the…
Age at interview 29
Gender Female
Do you think, and its maybe difficult to answer in a personal capacity because you never got as far as discussing Downs, say, but maybe from a professional capacity, do you think people are given enough information about what life would be like living with a condition to help them make decisions?
No, I think theyre probably given very little at all. But, you know, I dont, youd have, youd be talking about a different ball game, you know, for, as, now speaking as a professional. You know, when I see a woman who comes along and says, you know, Ive had a positive pregnancy test, theyve usually arrived in a ten minute appointment, and I usually tell them to book another appointment pretty swiftly so that theres more time.
But if you were really going to sit down and talk to somebody about, you know, what the, you know, the really broad and global implications of whats behind, you know, different screening tests, you know, youre talking about a couple of hours, you know, explaining to somebody what it would be like living with a child with Downs syndrome.
I mean, you know, thats a big job, because Downs syndrome is not one thing as well – its a spectrum of disability and you couldnt conceivably tell them.
No.
You know, what, where on that, theres just too many, you know. So, I wonder whether that would really help people make decisions as well, because youd just be raising more questions than, many, many more questions than you answered, probably.
Yes.
So I wonder how much…
Yes it just often seems to happen so quickly for people.
How much information, you know, would, is actually helpful. I mean, I think people need to know, they do need to know what the tests are theyve having done, and why theyre having them done, and what it means.
And if someone says to you, "Well, I dont know what Downs syndrome is," then you need, you have to explain. But I think, and, probably its assumed by most health professionals they say, "Well, do you want any tests to find out a risk of Downs syndrome?" and if somebody says yes or no or I dont know, I want to know more. But if they say yes or no I dont think thats pushed.