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Ending a pregnancy for fetal abnormality

Ending the pregnancy by induction

The physical and emotional demands of ending a pregnancy, which ever method was used, were usually intense and unforgettable - even for women who had gone through childbirth before. Though several women said they preferred to go through labour and delivery because it preserved the baby's dignity, other couples were shocked to discover they could not have the baby removed surgically or by caesarean section. (See also 'Finding out how the pregnancy will end'.)

 

She was willing to go through labour because she felt it would be better for her and more natural...

She was willing to go through labour because she felt it would be better for her and more natural...

Age at interview: 39
Sex: Female
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Well, basically they gave me 17 weeks as the sort of cut-off point, where if you really want to you can still have a surgical procedure under general anaesthetic. I was past that, so in a way I wouldn't have had that choice. But I felt that, even if I'd been two weeks, if it had been two weeks earlier, I would have still wanted a labour birth because I think to me it had to do with dignity of the baby. And I wasn't, I mean at the time I wasn't even too aware of what a surgical termination entails. And I found out later, so I'm even more glad that I did go for a labour one. 

Because unfortunately in a, when you have a surgical termination in a way the good thing for you is that you don't have to go through it and there's no pain involved, and the baby is just out and you don't even see it, and it's almost as if it never happened in a way. But the, when the baby is taken out it's not sort of taken out whole, and to me I mean I couldn't have had that. 

So, and I also felt that nothing could be, I mean the physical pain couldn't have been bigger than the, you know, sort of spiritual pain, and I felt that that was a very small thing com-, to go through compared to the actual big picture. So to me, you know, I didn't fear the pain, I felt it was a necessary step to go through because, you know, the baby was alive and the baby should have been born the normal way. So I think it was the right thing for me. 
 

Women who are more than 12 or 13 weeks' pregnant are likely to be artificially induced so that they go through labour and deliver the baby vaginally. When women felt supported by medical staff - that is when they were prepared for what was likely to happen, when they were looked after by skilful and experienced staff, and when they had already thought about what they wanted to happen to the baby afterwards - they were more likely to feel they coped well with a difficult and traumatic experience.  

 

She felt her medical team were compassionate and supported her throughout her treatment.

She felt her medical team were compassionate and supported her throughout her treatment.

Age at interview: 37
Sex: Female
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They were very good, I mean they were just so kind. I'm very lucky in that respect because I've heard so many stories that hospitals weren't good, and that midwives and all, you know, the specialists and that, were not compassionate. But mine were, I was very very lucky. 

But I also, what helped me was that I took control of the situation. I knew what I wanted, I knew exactly how I wanted it to go. I didn't ask them what I could do. I said, 'I want to do this. This is how I want things to go. I want to see my baby. I want to hold my baby', you know, 'I want to take her down to the morgue. I', you know, it was all 'I' and 'me and [husband] obviously, you know, and [husband] was like, 'Do whatever you want to do, I will go along with you'. You know and he was fine.  

So I knew exactly what I wanted, which helped I think because they didn't have to sort of tiptoe around me thinking, 'Am I doing the right thing?' you know. I knew, I told them exactly or asked them, you know, to sort of help me get what I wanted. So they were, they were really good. 

So I went in on the Tuesday, and what they do is they give you three pessaries, which induces the labour. So they gave me the first pessary on the Tuesday, which actually takes quite a, well, 24 to 48 hours to start to work. So you have that, in some hospitals I know you stay, they said that I could stay but I wanted to come home. So I came home and then went back two days later to actually be induced and have the second pessary and the third pessary. And then that was when I gave birth to [the baby]. 

Where did that happen? Where did you give birth?

I was actually asked whether I wanted to go on to a side ward, a general ward, and do it that way, have a private room obviously. They said, 'Some ladies want to go onto maternity, some ladies don't'. And I said, 'Well, I'm having a baby, and I'm sure that [baby] would want to be with other babies.' So I went onto the maternity ward and they gave us a room of our own with a double bed and everything - a family room they called it - so we went in there. 

I had the first pessary at 10 o'clock and they, I mean they were really good, you know, plenty of sort of tea and biscuits.  And then the next one was at 1, and by this time the la-, the labour was s-, quite sort of strong and you know it was moving on [coughs]. I had the next one at 10, the next one at 1, and she was born at half past seven in the nighttime. Yep.

And when, I mean, at what point did she die?

She actually died in my arms. They did say that, this was quite strange, because they explained all this to me, they were all very very good, very thorough, and I asked all the questions that I needed to know because I didn't want to feel that at any stage that I would regret anything or wish that I had have done something but I didn't. Because I knew that living with the guilt that I was going to was going to be hard enough, but I wanted to be happy, or as happy as I could be, that things had gone exactly the way I wanted them to be, go.  

So I said that I wanted her passed straight to me, that I wanted her to stay with me for the night, all these things. So when she was, when she was actually born they said, 'Some babies do actually take a first breath'. Because there is actually another way that you can do it as well. Some hospitals can actually inject the baby's heart, which will actually, the baby will die then inside the mum's tummy, and then be delivered that way, so the baby will be born dead obviously. But I didn't want that. So then she just died in my arms. Yeah, it was only, it was only a matter of seconds.

Induction means that women will be being given a pill (usually mifepristone) which will begin to soften the cervix over a two day period. Some women found it difficult to swallow the pills because they marked the final point of the pregnancy and there was 'no turning back'. 

Some women found the delay between taking mifepristone and going into labour was unsettling and 'surreal' because having taken the pills they were then sent home to wait for labour to begin. Most women couldn't stop thinking about the baby and wondering if s/he was still alive. They felt they didn't know how the pill affected the baby.

 

She worried that the pills would hurt her baby and wished health professionals had shown more...

She worried that the pills would hurt her baby and wished health professionals had shown more...

Age at interview: 34
Sex: Female
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I didn't have anything, actually. Unless I'm totally and utterly forgetting it, I don't think I had anything. We went from making the decision on, when I had the scan, making the decision to being told there was, again, there was a problem with [baby's] development, with his development with the amniotic fluid. We then made the decision that there was, we were going to terminate the pregnancy there and then. And we were then taken to a room to wait, which we did. 

And it was the same room and, again, there was no, there was no information. But I think I, you know, at that stage you've sort of made your decision, and we waited for about an hour I think, and then I had to take a pill to prepare my body for labour. 

But again, I wasn't really aware, I wasn't overly familiar with what was going to happen you know. I knew I had to give birth to the baby, but, you know, wasn't overly familiar with how it would happen I have to be honest with you. 

So I was given a pill, and that was extremely hard to swallow. I was informed categorically by the hospital, that the pill was only to prepare my body for the birth and that it wouldn't harm the baby because I was absolutely paranoid about 'was this pill going to kill the baby, why was I taking this pill'? But eventually I took it, which is quite hard to do. And then we came home for 2 days which is what you have to do. And again, 2 days of you know - well you know the outcome so that was very difficult. I can't really remember what we did to be honest with you. 

What did you take 'preparing your body for labour' to mean?

To release hormones so that the cervix would open and the muscles would relax and the baby would be able to come out. 

We were told that the baby may be born alive, and that if the baby was born alive there would be no attempts made to resuscitate the baby. We would be able to hold the baby immediately - so we were told that - but that's what I took it to mean. My main concern was that the pill didn't actually hurt [the baby], it didn't kill him. I didn't want that. I hadn't thought about the death of the baby at all. I hadn't thought how that would happen. 

And I think that a lot of more focus needs to be put on, I would have liked, actually... a lot more focus would have... there's a huge focus on your well-being, tremendous focus on your well-being as a woman, and your health, which of course is terribly important, and that was one of my, one of my husband's major concerns throughout the whole thing was my well-being over and above the baby's. And the hospital very much focuses on this, and it's very much how your well being is looked after, and very little, actually, to do with baby. It's sort of a foregone conclusion, 'well the baby... pretty much know the result anyway, you know, let's concentrated on you'. 

 

Describes how upset she felt as she went about her normal routines at home knowing her baby was...

Describes how upset she felt as she went about her normal routines at home knowing her baby was...

Age at interview: 31
Sex: Female
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On the Tuesday we went back to our own hospital, where they gave me a pessary which would soften the cervix and induce labour, but it wouldn't work for 24, 48 hours. So we had that, went to the gynae ward and had that, and then came home. And it was then a case of the Tuesday and Wednesday just going about life as normally as we could do. 

How did that feel? Was that easy to do?

Just that your whole life's falling apart but you're in Sainsbury's wandering round doing your shopping, and it's quite surreal really. But then it was afterwards as well. So it was just a case of doing what we could and telling people, because I just couldn't bear that people might ring or come to our house and, and just maybe drop themselves in it and say, 'Oh, how's things?' And so I just felt that I had to beat people to it and let everybody know. 

And the few things we had bought for the baby we were frantically packing away and putting in the loft because I couldn't bear to see them round the house. But luckily we'd only bought a handful of things, so it wasn't a massive job.  

So on the Thursday I went to the hospital in the morning, and we went on to the gynae ward, where we had a separate room. And the sister, nursing sister introduced herself to us. And straight away I said to her, 'You do know that we want this baby and we're not having a termination because we've just decided we don't want it and I...'. She said, 'Of course you know - I know exactly what's happened.' But I was worried that she might think the baby was fine and we were just coming in for a late termination because we'd decided all of a sudden we didn't want this baby. 

So straight away obviously, she knew anyway, but I just didn't want her to think badly of us. I felt, 'Well, we feel bad enough as it is without worrying that other people are judging us and thinking, 'oh... well, and they don't even want this baby.'  
 

She felt as if she had cut off her baby's life support system and found waiting for labour to...

She felt as if she had cut off her baby's life support system and found waiting for labour to...

Age at interview: 38
Sex: Female
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Anyway we'd signed the consent form. And the consultant explained that I would have to take some medication, and that it may stop the baby's heartbeat, it, and then I would go into hospital 48 hours later.  

This period of 48 hours was very, very traumatic in the fact that we'd, our decision was made, we kind of, we were sure in ourselves, there was no problem with us not being sure, but we knew what we'd got to face. And we also knew that our baby was alive and well. And it was just very difficult. 

And we had started, I'd started grieving, and I just really wanted to spend time just kind of cuddling my bump and being kind of with her, because I knew, the way it's when you know somebody is going to die, and you know exactly nearly to the day when somebody is going to die, and you're perhaps turn-, turning off that life support system, and you know you've got 48 hours to sit and be with them. So it was very, it was very hard. We didn't eat or sleep or, it was a very bad time.  

I was very keen to get to hospital, because kind of kept waiting for the, for this to happen. And in some ways it sounds funny but we wanted to get on and so just wan-, you just wanted to get on really, and for the actual birth to be over, and then we could start our grieving. 

Few women knew the name of the pill they were given or understood exactly what it was for. Most were told the pills 'prepared the body for labour' but interpreted this information differently - some thought the pills softened the cervix, others that the pills stopped the baby's heart beating. Several said that mifepristone changed their hormone balance. Mifepristone is a hormone and “It works by blocking the effects of the hormone progesterone” which is needed to maintain a pregnancy (NHS Choices August 2016).

Some people may experience heavy bleeding after an induction to end the pregnancy because part of the placenta had been left behind in the womb. This usually means returning to hospital or staying in the hospital for more treatment - usually D & Cs – and this can add to the distress a women may be feeling.

Injecting the baby and inducing the delivery

Women expecting a baby whose anomalies were discovered at the 18-20 week scan or later and have reached 21 weeks 6 days or more will be offered an injection to end the baby's life before induction and labour begins. The injection (known medically as feticide) stops the baby's heartbeat and means s/he will not be born alive. Some women were sent home for two days after the injection and returned to hospital for labour and delivery. One woman said that her body changed afterwards and that her stomach seemed 'flat and sunken'. Another woman who wanted her baby to be born alive so that s/he could die in her arms refused the offer of an injection and decided to be induced.  

For some parents, the thought of a 'lethal injection' going into the baby was almost unbearable, however several others compared the feticide procedure with having an amniocentesis. Most women acknowledged that the procedure was handled with as much professionalism and sensitivity as possible by doctors and other healthcare professionals, but said that no matter how well they were treated they were still deeply upset by the experience. 

 

He recognises he is being illogical about the injection but he saw it as a 'dreadful intrusion'.

He recognises he is being illogical about the injection but he saw it as a 'dreadful intrusion'.

Age at interview: 45
Sex: Male
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I mean that was a very sort of, it, when you come rationally to it all, I mean you're terminating the pregnancy, you know, and you're using drugs that the mother wouldn't normally have, that would harm the fetus dreadfully anyway. So, you know, rationally it's ridiculous, but it just seemed terribly violent... to have the heart injected. You know, there's a normal, supposedly, it's not normal but, fetus with a heartbeat pumping away, there it is and suddenly there's this dreadful intrusion into this little being that just stops its heart. Whereas I suppose going into a termination where you're sort of induced maybe there's, the trauma is even worse for the fetus. Who knows? 

Did you ever ask the doctors that?

We, no, not the doctors, I talked to the midwife about that, and I seem to remember a sort of quite sensible conversation about, 'Well, we can't possibly know. But, however, you know, they are sort of sleeping, inducing-type drugs, relaxing-type drugs that the mother's taking, and we can only imagine that would have a similar effect on the fetus'. I mean it's horrible, you know... whatever you do and however you do it, it's a very uncomfortable - well that's an understatement - experience so' But, yes, it was better not to have to inject the baby's heart, but when I think about that rationally I can't think why really.

Some health professionals used the word 'feticide' in their explanations which some women found upsetting because the word made them think of 'homicide' or 'infanticide'. Some felt that feticide was too brutal or cruel a word and was inappropriate in their case. Most parents knew of the word or had read it on consent forms, but several used the word 'injection' instead.

 

She found the word 'feticide' very difficult to accept and preferred to say 'putting the baby to...

She found the word 'feticide' very difficult to accept and preferred to say 'putting the baby to...

Age at interview: 40
Sex: Female
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It was quite late in gestation by then, that baby was 24 weeks so I can remember the first time I felt really upset by the whole experience was when she talked about something she called 'feticide', which I found and still find really unhelpful language. 

And I knew what they meant, because you know I'd heard of you know, 'infanticide' and I knew 'fetus' but I still find that very difficult language. I sort of, for me it had almost a criminal - I don't know - phraseology about it. But she kept using that word, and afterwards I did talk to her about that word and said I'd found it quite difficult. And she was very matter of fact in describing the process of injecting potassium chloride into the baby's heart, and I felt that was all very sort of frank and florid language that I really didn't need to hear at that point. 

And it would have and I can remember paraphrasing back to her, [using] 'putting the baby to sleep' which was the language that I felt more comfortable with, but nevertheless she stuck with it and the leaflet used that kind of language. But I did find that probably the most difficult part of talking through termination. 
 

When the injection took place - usually in a specialist fetal medicine centre - women valued being in a quiet, darkened room and appreciated it when doctors didn't try to talk to them. A woman who had gone through a selective termination of one of her twin babies, described how crowded the room had seemed at the time and how difficult it had been to cope with other people watching her at such a difficult time.

 

She felt isolated and alone even though there were about 9 medical staff in the room watching her.

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She felt isolated and alone even though there were about 9 medical staff in the room watching her.

Age at interview: 43
Sex: Female
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But I do remember when they did the injection into my stomach, which is very much like having an amnio really, where they're sticking a needle in, and I couldn't really watch it on the screen. I think I tried to, but part of me didn't want to watch it either. I think I could see the needle going through my stomach, and he turned the screen away. And he made me hold onto his hand, onto his arm, which I think is something he does, whether to kind of centre you or I don't know really, for comfort. And he, he said, 'Twin two is dead,' just after he'd done it, and that was very hard. And part of me felt that having said, 'Twin two's dead' was very callous, but actually I think, maybe being a nurse myself, I was trying to look beyond it, and I think he was leaving us with no doubt as to what had happened. And that was probably very good because otherwise we might have gone away still wondering whether our little boy was still alive or not.  

I must say, when I was having the scan just before I had the fetal reduction and when he was doing the fetal reduction, the room was packed, absolutely packed. I mean in my mind's eye of not really being terribly with it at the time, it seemed like there were 20 people in there. Probably in reality there were 8 or 9 plus my husband and I, because it's a very large [city] teaching hospital. I would have thought it's not something they do every day, maybe they do, I don't know, but people need to learn. 

And I remember lying on the table and he'd done it, and I sat up and my husband was, I was crying, and my husband was cuddling me, and I remember all these people just looking and staring. And I didn't care, I actually didn't care that they were there. I wasn't embarrassed that I was crying, I didn't feel anything. But it was quite voyeuristic - is that the word - it was very much people looking almost helpless, and not you know, they were totally not, oh, sorry, not involved. It was very much, you know, that they, there's nothing they could have done. And it, and I kind of, you have these flashbacks where I can actually see these two people, one sitting on the table crying, the other cuddling them, and a circle of people around them just looking. You know, if I could paint, that is probably what I would do, which would probably really depict the isolation that you have there, two people in the middle and people around. 

And I think that's, maybe that's the... the most startling thing about it is the isolation. It's the fact that, thank God, not many people understand where you are at that time. But I think that's very difficult.  

People generally preferred not to say much about how they thought the injection worked. Several wondered if it hurt the baby. Understandably most parents found the procedure extremely upsetting however skilfully and sympathetically they were cared for. They also recognised that it must be a difficult job for doctors, but couldn't think of any way to make it better.

Consultant obstetricians have different ways of carrying out the procedure - some inject the baby's heart, others inject the umbilical cord where there are no nerve endings. Also some consultants sedate the woman before injecting her and ask partners to leave the room - but in other hospitals partners were permitted to stay in the room and women were not sedated before the injection.

 

He had been asked to leave before his wife had the injection but he wished he could have remained...

He had been asked to leave before his wife had the injection but he wished he could have remained...

Age at interview: 45
Sex: Male
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I'd liked to have been there for that yeah, because I'd like to have been there for my wife. Even despite the fact that she was heavily drugged, and didn't really know what was going on, I'd like to have been there the moment that she didn't know what was going on. And I think it's like when you wake up from a big dream or something horrible has happened in your life, and you wake up and feel alright then it hits you the moment you get to consciousness, suddenly, bam, there it is. And I'd like to have been there for that moment - and I wasn't. So it would have been better for her and for me if I could have been there. 

Why do you think the consultant sent you out?

I don't know - I suppose because it's a very defining moment, and one that I suppose he wants to protect you from, or she.
 

Last reviewed July 2017.
Last updated June 2014.

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