Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

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dc.contributor.author Power, S
dc.contributor.author Meaney, Sarah
dc.contributor.author O'Donoghue, Keelin
dc.date.accessioned 2021-11-19T14:53:46Z
dc.date.available 2021-11-19T14:53:46Z
dc.date.issued 2020-09-15
dc.identifier.citation Power, S, Meaney, S. and O'Donoghue, K. (2020) 'Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study', BJOG: An International Journal of Obstetrics and Gynaecology, 128(4), pp. 676-684. doi: 10.1111/1471-0528.16502 en
dc.identifier.volume 128 en
dc.identifier.issued 4 en
dc.identifier.startpage 676 en
dc.identifier.endpage 684 en
dc.identifier.issn 1470-0328
dc.identifier.uri http://hdl.handle.net/10468/12243
dc.identifier.doi 10.1111/1471-0528.16502 en
dc.description.abstract Objective: To explore fetal medicine specialists' experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. Design: Qualitative study. Setting: Fetal medicine units in the Republic of Ireland. Population: Ten fetal medicine specialists from five of the six fetal medicine units. Methods: nvivo 12 assisted in the thematic analysis of semi-structured in-depth face-to-face interviews. Main outcome measures: Fetal medicine specialists' experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. Results: Four themes were identified: 'not fatal enough', 'interactions with colleagues', 'supporting pregnant women' and 'internal conflict and emotional challenges'. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and 'restrictive' legislation were identified that 'ostracised' severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and 'stretched' resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to 'provide full care for women'. Conclusions: Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. Tweetable abstract: The implementation of termination services for fatal fetal anomaly is complex and requires institutional support. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons, Inc. en
dc.rights © 2020, John Wiley & Sons Ltd. This is the peer reviewed version of the following item: Power, S, Meaney, S. and O'Donoghue, K. (2020) 'Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study', BJOG: An International Journal of Obstetrics and Gynaecology, 128(4), pp. 676-684, doi: 10.1111/1471-0528.16502, which has been published in final form at: https://doi.org/10.1111/1471-0528.16502 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. en
dc.subject Fatal fetal abnormality en
dc.subject Termination en
dc.title Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Keelin O'Donoghue, Obstetrics & Gynaecology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: k.odonoghue@ucc.ie en
dc.internal.availability Full text available en
dc.date.updated 2021-11-19T14:43:27Z
dc.description.version Accepted Version en
dc.internal.rssid 542288462
dc.internal.wokid WOS:000578727100001
dc.description.status Peer reviewed en
dc.identifier.journaltitle BJOG: An International Journal of Obstetrics and Gynaecology en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress k.odonoghue@ucc.ie en
dc.identifier.eissn 1471-0528


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