Terry’s Story When you first meet you can see Terry has been crying. You introduce yourself and try and establish a rapport with her. Terry say’s that she has just had a scan and it is obvious that...

Terry’s Story When you first meet you can see Terry has been crying. You introduce yourself and try and establish a rapport with her. Terry say’s that she has just had a scan and it is obvious that there is something wrong with her baby. Terry provides you with her handheld antenatal record. You can see from her notes that Terry is 23, in a stable relationship, works as a teller at the local Commonwealth Bank and that this is her first baby. You also note that her blood group is A Rh positive, that by dates she is 19+3 weeks gestation and that the scan was a routine (morphology) scan. You confirm all of this with Terry. Terry is on her own and you enquire if anyone can come and stay with her. She states that she has phoned Jack (her partner) and he is on his way. You know that Terry is going to need support so it’s important that someone is with her when they discuss the problem. Jack arrives within a few minutes and you leave them together. As you walk out of Terry’s single room the obstetrician (Joan) arrives. You have a brief meeting. Joan tells you that the scan has revealed an anencephalic baby at 19-20 weeks gestation. Terry continued... You accompany the obstetrician (Joan) to Terry's room. Joan introduces herself to Terry and her partner Jack. Terry is crying and Jack looks pale and bewildered. Joan then explains to them the results of the scan, what anencephaly is, what happens and how the baby is incompatible with life. She then proceeds to tell them what they can expect over the next few days and what their management choises are. in essence, the couple could choose to continue the pregnancy and give birth with the knowledge that the baby will not live, or they could opt for a termination of pregnancy in the next few days. Late Trimester termination of pregnancy Legistation differs around Australia as to the gestation at which medical termination of pregnancy can occur. The paper by Borgatta et al (2011) titled Labour induction abortion in the second trimester outlines the management of late trimester termination of pregnancy. Terry and Jack's decision You talk to Terry and Jack about the issues involved in inducing Terry into labour, how long the process might take, the ethical issues about Terry's baby being on the boundary of being less than 20 weeks and what it means if it is greater than 20 weeks (or 400gms in weight) and the possible costs associated with the differences between the two 'legal' terms. You talk to them about all the issues and tell them that the choice is theirs. You provide them with the opportunity to go home and discuss their options and talk to their families. Terry and Jack decide to take your suggestion and go home and talk to their family about their options. Neither have any religious or cultural objections to a termination but they just want some time together. They phone you later that night to say they have decided to terminate the pregnancy before it reaches the 20 week mark and would like to come in tomorrow to start the process. They do not want a funeral or its associated costs. You arrange for them to arrive the next morning. Terry was induced into labour the next morning. After 36 hours Terry spontaneously birthed her baby girl in the bath together with the placenta. The baby was an obvious anencephalic but you were prepared and assited Terry and Jack to hold their baby, wrapped in such a way as to allow a nice photo to be taken. After asking Terry and Jack's permission, you were able to provide lasting memories though footprints and photos. Terry and Jack had a very good look at their little girl. You had prepared them well for the sight of their little one and they were not as frightened as they thought they might be. In fact they held her in their arms and had a number of photos taken with her. They decide to call their baby 'Anna' after Terry's grandmother who died last year. Terry then decided they would like to have a funeral and bury her beside the grandmother. Terry was just 19.6 weeks gestation so technically under the law this is classified as a termination prior to 20 weeks gestation. Terry wants to know Anna's weight. You weigh Anna and she weighs 390gms. Terry and Jack go home Terry and Jack wish to go home as soon as possible. At first they wanted to take Anna with them but decided they would stay a few more hours and then say their 'goodbyes'. Before they are discharged from hospital you talk to them about a number of issues including suppression of lactation and linking them in to community supports. They have also been booked in to see Joan again in two weeks to check that everything is OK after the birth. Question What feelings and emotions can be experienced by grieving families and how do these impact on the grieving process?