Experiences of sonographers at scans where abnormalities have been found

[MairyHuff]

I am currently training to be a sonographer and am acutely aware of the difficulties in dealing with people when an I detect an abnormality on a scan.

I am keen to hear of your experiences and more importantly of how you would like the sonographer to act/help/explain things etc. I know how important this is and want to do everything I can to make sure I am as sensitive as possible and try not to make anything worse than it already is.

I have already been involved with some terrible abnormalities (I hate that word, but not sure how else to describe them) and have found that I am really quite emotional. Obviously it is of no help to the patient if I am blubbing away and I have never been quite that bad, but close to. I feel a bit of a fraud for feeling like this as I know the patient/partner etc will be feeling a thousand times worse.

If you have been in this unfortunate position would you rather the sonographer was 'professional and detached' or would some sign of genuine emotion (and it really is genuine) be of any comfort? I totally understand that the feelings of the sonographer etc are likely to be the furthest thing from your mind when you are hearing awful and probably unexpected news for the first time but if there is anything I can do to do this part of my job better then I'd like to try.

Sonography can be such a wonderful job, but terrible at the same time, but if I feel I can really try to understand the needs of a patient in this situation then I will have done the best 'job' I can. Sorry for the long post, but having been in this situation today I really felt like I need some advice on this. We get no 'official' training on this either how to deal with patients specifically, or how to handle our own feelings, of course I have asked the qualified sonographers, but I think it is more important to get some views from the 'other side' so to speak.

Thankyou for any experiences or advice you are able to share.

Both our sonographers were nice and joking about baby moving round a lot, one of them had me dancing round the room to get it to sit right
I think if possible its better to talk as you go along and tell couples of problems you see as you see them, the wait til the end is very nerve racking; however we have had problems come up on every scan, so wouldn't say our experiences have been good
However probably more to do with hospital policy more than anything else, we bought our tokens for the pictures, we were then refunded the money for the photos on both 12 and 20 week scan, due to abnormalities, my husband found it quite insulting
I do understand that lots of people would be fine with this though

I think showing some compassion would be a very good thing. Bad news is always horrendous, but I think it is better to err on the side of emotional reaction than stony professionalism.

You are never going to make things better for the parents, or take away the the problem, but a bit of compassion goes a long way.

At some point parents reflect back on the time that they had the first awful scan, and they don't really deserve having to explain away a sonographer's apparently unfeeling reaction by thinking "Well, she didn't have the training/she was overwhelmed, inexperienced, whatever".

Thanks for asking this, btw. I'm sure you'll be an excellent sonographer .

I think you're going to have to take your cue from the patient.

I would have preferred someone detached and professional, so that I felt I'd got all the information and that the scan had been done properly, iyswim.

Other people, no doubt, would prefer a less detached approach.

Hmm, difficult to get it right.

i homestly dont remember a thing about the sonographer when i had mmc. only being led out into a busy waiting room full of expectant couples and waiting for a room. i know i asked to be scanned again. the 1st person didnt explain anything. i needed to see it again and have ehat i was seeing explained in order to believe iyswim. sympathy and caring are good but too much emotionwould have been ott for me. i needed someone kind but in control and matter of fact. please make sure you have somewhere to take people yo talk before making them leave the room.

I think that is an impossible question really,I think professionalism is the way to go. You can be kind and professional, without being either detached or over empathetic. You being stony cold, or on the verge of tears are both inappropriate, there is a middle ground.

I remember having an early scan due to bleeding, the Lady was professional, she was kind to me and spun the screen around to show me as soon as she spotted a viable foetus. That is good empathy, it's what you do rather than showing how you feel.

Most sonographers will talk you through things as they are doing checks, this is good, some are inexperienced and need to concentrate on the screen, this is also fine.

I think tbh, genuine shows of emotion on your part would be unprofessional, just give information in a factual but sensitive way.

I cant get my head around the fact that you do not have any specific training. There is a charity called ARC (antenatal tests and choices) they support parents going through loss and difficult choices, and I know they do training for hospital staff, info packs and training days, maybe you could get in contact with them.
I found out at my 12 week scan that my baby was incompatible with life and the sonographer was very good, she got the consultant straight away, who happened to be her husband and they both spoke to us in a very natural and compassionte way. We had the termination the next day. We were not offered any photos of our baby and a week later I was realy devestated by this and my husband phoned the hospital and they said they would send us one. It arrived a week later with a hand written note by a sonographer saying they were sorry for our loss and hoping our angel was at peace, I'm crying as im writting this, was really touched that someone cared about our baby to do that, I have the note in her memory box . That is one personal touch I really appreciated.

Sorry I meant ARC -Antenatal results and choices.

When I had a ruptured ectopic pregnancy and the scan basically showed my womb full of blood, the sonographer went a bit red in the face but was calm and said something like, "Excuse me, I just need to call the consultant" and when I asked what was wrong she said, "The consultant will explain", I think she had to say that more than once. I thought that approach was absolutely fine.

What was nice was that I had the same sonographer in my later successful pregnancy and she was clearly really happy for me then!

Thanks for all your responses, some really useful thoughts.

It is difficult to get the balance between showing genuine empathy and a more detached professional approach that some people prefer.

I don't think many sonographers receive specific training in this area, although I might be wrong, I am being trained by one of the top unis for this subject and they don't offer this. My manager may well agree for me to go on a specific course though if I can find one.

Although it is no where near the emotions that the parents are feeling I know many of my colleagues are deeply effected by finding any abnormality/no heart beat. Of course it is expected as part of the job, but I do think there should be more support. I guess if you aren't effected by this sort of thing then you are probably in the wrong job.

I really do appreciate the stories and thoughts you have shared.

Hi I am a sonographer and I never had any specific training at uni but I really don't think it would have made any difference. Having also been a patient receiving bad news too I feel I can see it from both sides.
You can't learn empathy, compassion in a classroom. I can imagine if they did start teaching it would be another box ticking exercise. And some cushy job for someone who does'nt have the guts to do it themselves in the real world. The best think to do is learn off the people who do deal with it day in day out - i.e the sonographers you are training with. They all have their own ways of telling people bad news. Try and work with as many as possible and gradually you will work out your own way of doing things. You will also learn to take cues of the patient. Some want you to be straight to the point and professional, some want a big hug and to be more personal. You will work it out the more experience you get. Hope that helps xxxx

My first pregnancy ended in a missed miscarriage, which was discovered at the 12 week scan.

The sonographer immediately said "this doesn't look good", and "the baby stopped growing at 8 weeks". So I guess that was a pretty detached response. (well, she probably also said "I'm sorry"). I was happy with it.

In fact I would hate a medical professional get emotional about these things - because that would make me cry as well. I only cried when we left the hospital on the street.

For me I like detached and professional in my doctors. But I think some women like a quiet sensitive approach... (or am I wrong?)

It is nice of you to think about these things! Good luck for your career.

If the sonographer had started welling up while giving me the bad result I'd have been pretty pissed off. It's an extremely frightening situation as it is and if the sonographer can't hold it together then no matter how bad the news is, the poor mother is going to imagine it must be even worse. I'd also probably regard an over emotional response froma sonographer as a strong hint that they weren't very experienced. Not the kind of thing you want when dealing with bad news. Empathy, sensitivity and professionalism is the balance. Keep your own emotions for when the mother is out of the room.

My pg scans have all been good (just the bloods which are now a worry). But I have had horrid US experiences when previously diagnosed with cancer.

So my feelings are that you should talk the patient through what you're seeing: silence is the absolute worse thing for me. Whenever anything looks normal - say so, however small. Never whisper to a colleague (cheers gynae sonographer at Kingston - that really helped...). Explain why something is normal/abnormal ("I can see X, but normally it would look bigger/smaller etc"). With a baby, I always like to hear that there's a heartbeat as the first thing: "there's your baby, and there's its heart beating away".

With regard to emotion, I wouldn't mind a sonographer being happy for me, but I think I'd be angry if s/he got upset on my behalf. It's not going to help, and someone needs to stay calm to explain things. You getting upset is only going to prove what a bad situation it is (bit like an air hostess panicking in turbulence - not reassuring!), whereas I was always clutching at straws of hope during my bad US scans.

But I think the very fact that you're worried about how to react means you'll react appropriately: it's the sonographers who clearly just want to get through their patients for the day and treat you like a set of malfunctioning body parts rather than a human being who are so hurtful and make a horrible experience so much worse.

Not at scans but I've had bad news from other HCPs, and am a HCP and professional and factual is what I and I think most people I've seen through work want! facts, facts facts, usually repeated at least 3 times so it sinks in

I really don't care how the HCPs breaking MY bad news feel about it TBH, they should have coping mechanisms in place and keep professional and informative!

The sonographer I had with dd1 started off by saying ' Don't worry if I don't say anything at first. I need to take some mesurements and then when that's all done I'll explain it to you'. So we looked at the pictures whilst she did that and then had a nice 'explain' afterwards when she knew everything was fine. I thought that was quite good really as it allowed her to work without us passing out in panic.

With dd1 who wasn't growing properly, a student did the scan with a mentor with her. The student said, "Your placenta is packing up, basically". Her mentor said something like "You can't say that!" and explained I would need to see the consultant (who wasn't much better, saying "I see a red light ahead for this baby"!) She was fine (small, but fine). Not good overall!

With dd2, the sonographer made quite a few jokes about her big nose and how she took after me! This isn't of any importance in the scheme of things, but I was concerned after dd1 and this wasn't the right approach for me at the time!

I'd go with professional empathy. I agree that this sort of thing can't easily be learned in a classroom, but through experience and learning from others 'on the job'.

I had bad news following a high nt result... We were sent out the room as she told us baby wasn't in the best position and to go for a walk. We were laughing and joking about our cute little baby whilst commenting on how miserable we thought the sonographer was! Turns out she was on the phone to the consultant whilst we were out the room. When we went in she told us the result was high and the consultant would see us the next day. I honestly can't remember how she told us etc it was all such a blur! I don't like the being kept in the dark part whilst she called the consultant though. My baby had a hernia in his diaphragm and it was very serious as nearly all his organs had entered his chest. We were given a very low survival rate by the specialist and that followed with us having to make a very difficult decision to set our little boy free. She was honest and open, a true professional but also human too. She referred to our baby as babe or cherub and I liked the fact she saw him as more than just a foetus.

I'm currently 31 weeks and after having abnormalities before it is really important for me to be talked through the scans otherwise I study their faces so intently! My 20 week sonographer was fab she talked through everything she was doing and that helped me so much!

I had a mmc at 11 weeks. Sonographers words were "I'm sorry, it is not good news". She had been cold and distant from the moment we walked in. I kind of hated her, until she silently handed me a tissue. And then I understood, professional rather than too matey helps all concerned if the news is bad.

Just my opinions but for what they are worth:
I remember the sonographer offensive when I had an 11 week miscarriage years ago. We had been trying for a long time, charting my fertility obssessively etc. I understand he needed to question my dates, but his unwillingness to accept them frankly felt like a challenge to my intelligence and honesty. "Are you sure of your dates?" then accept yes or no!
If there is a problem don't make the parents wait until the end of the scan! The information you are gathering belongs to them and will affect nobody else more profoundly. Show them the relevant bits and explain why they are problematic, it will help them understand and, if need be, in the greiving process.

I know the compassionate, touchy-feely stuff will likely come from nurses when you've moved on to your next patient, but you can be kind. Pass tissues, give privacy for the mother to dress afterwards. Say you're sorry and show some warmth.

Thank-you for taking the time and trouble to ask, and good luck with your career.

At my 12 week scan we were told it looked like there had been twins, but one hadnt survived.

I liked the way the lady spoke to us. She seemed to zoom in on the healthy baby and we looked at that and asked questions. she then said 'on a sadder note, it looks like there were 2' With which she moved on the screen to show us the other sack. Again we asked questions about it.

I'm not sure we had the 'usual' reaction to this, we werent and havent been upset by this, i think the fact that we had one healthy one in there was enough. If anything i was more intrigued and fascinated by it.

I was told by my sonographer that I was overparanoid when I was pregnant and not feeling kicks, she asked me to stop coming in all the time and the baby was fine as she was turning round she just wasn't 'a very kicky baby' (she was annoyed because I was pretty paranoid having lost my son 9 years previously). She was a totally heartless bitch imo. Turns out, sadly, that my 'paranoia' was right and my little girl couldn't move or breathe when she was born and we had to switch her life support off when she was 2 weeks old. When I got pregnant again 3 months later I refused to see her, the lady I did see had a little cry when she had read my history and the scan showed my baby waving and kicking and I thought it was lovely. I would have liked the 1st sonographer to take my feelings on board a little and understand my paranoia instead of dismissing my feelings, more often than not a mother just knows when something isn't right and this should be taken on board.

The sonographers I have had giving me bad news were both kind, calm, sympathetic and professional. I think they got the balance right. I have some pretty dark memories of those scans but their sympathy was and is still much appreciated. You have to save your tears for afterwards, though it is touching that you are affected, shows you are human!

I think waiting while they scan and don't say anything is very hard for the patient. I prefer being talked through it.

I also had one follow up scan to confirm an ectopic and the sonographer and nurse just talked among themselves and then both just walked off. Thank god DH was there to chase after them and ask if it definitely was an ectopic, as I was frozen and in a state of undress! That is definitely not ideal, god know what they were thinking - probably get this woman down for surgery!

Oh and information is good - at my MMC, the sonographer said "the baby is only 3 cm long" and that really helped as I realised there it was over right there and then.

I suffered two missed miscarriages, the first the sonographer was very detached and really uncaring IMO, where as with the second they were ever so nice, they said that they were ever so sorry and offered me a hot drink and a private room, tissues, and time to get myself together,

Just that little bit of care made the whole process emotionally more easy to deal with

I was on my own at 17 weeks when my mmc was discovered. The midwife tried with a Doppler to find a heartbeat, then called for a registrar, who then called for a consultant. The midwife held my hand, and the consultant said 'I'm very sorry to tell you this, but we cannot find a heartbeat'...
They were both very gentle, and seemed very sad and concerned for me, but gave me a lot of information too.