Antenatal Counselling
Why Do I Need to See a Paediatric Surgeon Before My Baby is Born?
It’s now routine for expectant families to have antenatal ultrasound scans, to check on the condition of the pregnancy. In some cases there is an unexpected finding with your baby. Unexpected findings (fetal anomalies) may involve a number of systems in the baby. If the Maternal and Fetal Medicine (MFM) team think the condition will need surgery to fix it after baby is born, they will invite a Paediatric Surgeon to talk to the family about what to expect.
What Conditions Could My Baby Have?
Paediatric Surgery covers a broad range of conditions and diagnoses which are congenital. These include:
- Oesophageal conditions: oesophageal atresia occurs when the oesophagus does not develop normally, leading to a disconnection.
- Lung conditions: These include congenital anomalies of the lung tissue.
- Congenital diaphragmatic hernia: a condition where the diaphragm has a hole in it, allowing gut contents to pass up (herniate) into the chest cavity.
- Abdominal wall defects: conditions where the front of the abdomen doesn’t develop normally, allowing gut to herniate outside the abdomen. Gastroschisis and exomphalos/omphalocoele are two examples of this.
- Gut atresias: where the gut does not develop in continuity, leading to obstruction and dilatation of the gut inside the abdomen.
- Kidney and bladder anomalies: a broad range of conditions, ranging from swelling and dilatation of the kidney; to small, missing, or abnormally positioned kidneys.
Does every Fetal Anomaly Need a Paediatric Surgeon?
No – there are anomalies treated by other clinicians; such as heart conditions, cleft lip, bony anomalies. Not all conditions need surgery, but it makes sense to us to have a specialist talk with you about your baby’s condition.
The MFM team will ask the appropriate specialists to talk with you about your baby, and what you might expect after they are born.
Can Everything be Diagnosed Antenatally?
No – some conditions do not have signs antenatally, and only become apparent after the baby is born.
Some conditions are suspected antenatally, based on findings which indicate a pattern suggesting a possible or probable diagnosis.
Some conditions, like abdominal wall defects, are easier to spot antenatally.
What will the Paediatric Surgeon Talk to Me About?
The Paediatric Surgeon will first talk with the MFM team, to get that team’s perspective on what is happening with your baby. The surgeon will then review any scans or tests you have had done, to determine what the most likely diagnosis is.
Then they will talk with you and your family. This consultation will follow the ‘WE CARE’ pathway:
“WE” is finding out what you know, and “CARE” is about our conversation and planning with you.
- What: what do you already know about your baby’s condition. What have you been told already; what have you read?
- Expectations: what are your expectations for this pregnancy?
- Condition: what can we tell you about the condition your baby might have? How certain are we this is the diagnosis? What other conditions could look like this antenatally?
- Associations: some conditions have common associations, other anomalies that tend to occur in clusters in one baby. What are these possible associations, and how do they affect the pregnancy and the baby?
- Roadmap: what are the next steps during pregnancy. Are there any interventions which might be considered before baby is born? This part of the conversation is about ongoing pregnancy support
- Expectations: what is likely to happen at delivery and afterwards? What investigations might the paediatric surgical team need? What operations might be planned, and what is their likely outcome? This part of the conversation is about postnatal care and support.
Will My Baby Need an Operation Before they’re Born?
Perhaps – there are a small number of conditions where antenatal intervention is possible and beneficial.
Operating on a baby before it is born poses risks to both the baby and to the mother. Any intervention therefore has to make a greater difference to the baby than simply waiting until baby is born, and then intervening.
Some interventions are done because without them the baby will not survive to delivery. Other interventions are done because we have found they make a greater difference to the eventual outcome for babies if they’re done before birth. The surgeons and MFM team will discuss these in much more detail.
When to Contact Your Surgeon?
Antenatal consultations can be very emotional. Every parent-to-be expects their pregnancy to go smoothly, with a healthy baby at delivery. It’s a shock when the scan shows a possible or probable problem, and it often takes time for that to sink in.
We are always happy to come back after the first antenatal consultation, to answer any further questions you might have.
Related Information
For more details on conditions that may require antenatal counselling, please visit our Neonatal Conditions page.