Two Working Party reports have been released by the RCOG (Royal College of Obstetricians and Gynaecologists), UK: 1. Fetal Awareness, and 2. Termination of Pregnancy of Fetal Abnormality. The first one updates the previous report published in 1997, while the second replaces the 1996 report.
Both reports were commissioned by the DoH (Department of Health, UK), after recommendations by the House of Commons Science and Technology Committee in 2008.
A wide range of stakeholders were involved in producing these documents, including scientists, doctors, midwives and lay representatives. Pertinent international scientific studies published since the 1990s were examined by the respective working parties, as was evidence submitted to the Science and Technology Committee. This was followed by an online public consultation. The public was also invited to submit their views. Both reports were thoroughly peer-review by academics, ethicists and legal experts.
To reflect both clinical practice breakthroughs and new research finding, both original documents were completely re-written. These two new reports contain data for clinicians (doctors), researchers and healthcare professionals and the report on Fetal Awareness includes a new chapter with practical information and advice to women and parents.
The main findings for Fetal Awareness include:
- The fetus cannot feel pain before 24 weeks because the connections in the fetal brain are not mature enough.
- While the fetus is in the chemical environment of the uterus (womb), it is in a state of induced sleep and is unconscious - according to evidence examined by the Working Party.
- The Working Party concluded that because the 24 week-old fetus has no awareness nor can it feel pain, using analgesia is of no benefit.
- As far as the short and long-term effects of the use of fetal analgesia post-24 weeks, more research is needed.
- It is not realistic to produce a definitive list of conditions that constitute 'serious' handicap, since accurate diagnostic techniques are as yet unavailable, the Working Party concluded. Similarly, it is difficult to predict the consequences of abnormality.
- The NHS (National Health Service) Fetal Anomaly Screening Programme should be centrally linked so that pregnancy outcomes with specific congenital abnormalities are monitored over time, the Working Party recommends.
- All women undergoing antenatal screening should be offered appropriate information and support.
- All staff caring for the mother must adopt a non-directive, non-judgemental and supportive approach in the case of a possible termination of pregnancy.
These two reports represent an extensive review of the scientific and clinical literature, and I am grateful to the many people who contributed and in particular to the members of the two working parties. I believe we now have robust and updated guidance for healthcare professionals.
Source: RCOG (Royal College of Obstetricians and Gynaecologists)
Written by Christian Nordqvist