When I first posted that I had completed a book on "wrongful birth", the first two questions were something akin to: "Pray, what is wrongful birth?" Prior to reading "Handle With Care", I was unaware that there was such a concept as "wrongful birth". Our learned friends in developed countries have coined the term to refer to "A medical malpractice claim brought by the parents of a child born with birth defects. It alleges that negligent treatment or advice (or lack thereof) deprived them of the opportunity to avoid conception or interrupt a pregancy." More often than not, it is brought against the OB but it is the Malpractice Insurer that defends the case and pays for any damages awarded. I googled "Wrongful Birth" and was amazed at the cases that have been brought against Obs and Gyns in developing countries. I wondered what my Dad (God Bless His Soul), My Uncle and my Brother would reposit from a professional standpoint because the plaintiff's case lies on the premise that the OB did not do their job.
After I read the book, someone posted that a child had been born in Kitale - a town in Kenya - with 4 heads and female genitalia on one head and male genitalia on a leg. With my newly founded knowledge on "wrongful birth", my response was that the patient should have been aware - through ultrasounds and scanning - that there was something wrong with her pregancy. She should not realise that she has unfully developed foetuses after birth. Someone reminded me that this position is fraught with many challenges. In Kitale, such services are not available and some patients may not even realize they were pregnant in good time or that certain medicines should not be taken during a pregnancy Ignorance and lack of access to proper health facilities are Kenya's bane. As our country waxes lyrical about free maternity health care - and others take this as the licence to breed - medical practitioners should dialogue with policy makers to ensure that the free maternity services include sonograms and high quality ultrasound scans. Otherwise in this case, the "Wrongful Birth" claim should be taken against the government.
Back to the story. I found some comments by medical practioners to my post quite insightful and interesting if Kenya is to achieve Vision 2030.
"On a serious note, Obstetricians should tell us how accurate tests to detect congenital anomalies are. A search on the internet will show several cases where an antenatal test suggested an abnormality in a fetus but mother refused to terminate and went on to have a perfectly normal child. How accurate are those scans and genetic testing even when done at the right time?"
"Our Obstetrics practice is a bit rudimentary. I will say with confidence that we do not do any genetic testing at required time of 14 to 18 weeks and we rarely do obstetrics scans recommended at 18 weeks to check for fetal malformations. However, I find the case above rather interesting because in Type III OI, the neonate maybe born normal but bones deteriorate as child grows. With high resolution scans, one can easily pick out fetal anomalies quite accurately but requires well trained sonographers who are equally knowledgeable in anatomy."
"What we lack is a national prenatal screening program and its unfortunate that anomaly scan is not even part of focused prenatal care. Genetics is only a fraction of it. Good prenatal diagnosis is mainly dependent on the ultrasound. Its a pity that a woman can carry conjoined twins incompatible with life to term and only come to learn of it after hours of labour and eventual cs. Although Obstetrics has always been a 'high risk' profession, this can be minimised if we learn to work as a team and not make individual decisions. Osteogenesis Imperfecta can easily be diagnosed by ultrasound and the woman given options. In an organised healthcare system this can be achieved"
"This case highlights again the changing face of medical practice. Central to this is communication skills. Listening and clearly documenting the patient's ideas, beliefs and expectations is now the norm. Litigation is part and parcel of our profession. Unfortunately comm skills not taught in med school. I and my colleagues trained abroad have had to re-learn the hard way incorporating defensive medicine into our practice. I also see it as inevitable outcome in Kenya particularly with increased access following 'free services'"
In conclusion, I found it difficult to agree with the jury who found for the plaintiff a case of "wrongful birth" and awarded her USD 8 million in damages. I agree however that "although the decision to interrupt a pregancy is the patient's, she should have good quality prenatal information". The issue is that the patient should be given information to enable her make an informed decision about what is best for her. This book would make an interesting study for an Obs and Gyn Class.
