Preconception Case Studies

(links to other case studies can be found at the bottom of this page.)

1. HEATHER & IAN.

Heather and Ian are both in their early 20’s. Heather works in the local pharmacy as a cashier, Ian is a labourer for the local council. They met at a school disco when they were both 13 and have been together ever since. Last year they married in the village church. It was Heather’s dream to have a white wedding and there are pictures of the big event all around their flat.

When she was 2 years old Heather had her first epileptic fit. It was serious, her mother says, and ever since Heather has needed anti-epileptic medication. Her condition has been hard to manage, she has continued to have fits throughout her lifetime, though not very often now. She has to take two types of tablets to keep her fits under control. Ian also has epileptic fits, although his only started when he was 10 years and he is well-controlled on his medication. Because of their history of fitting, neither Ian nor Heather have a driving licence. For this reason they both need to live quite close to work.

Heather is keen to have a baby. She read in a magazine that women thinking of having a baby should take folic acid before and during pregnancy, to lower the chance of having a baby with spina bifida. She asks her practice nurse about this. He is unsure but uses the internet to get some preliminary information, then asks her to come back to the clinic the following week. In the meantime, he contacts the pharmacy and learns that because Heather is in the high risk group (women who take anti-epileptic medication are more prone to have a child with spina bifida) she should be prescribed a higher dose than other women in the population. When Heather returns the next week he advises her to start taking folic acid 5mg per day and to continue to take it until she is at least 12 weeks pregnant.

The couple are overjoyed when the pregnancy test is positive 5 months later. The midwife refers Heather for specialist care because of her epilepsy and continues to offer her support and education. The serum screening test for Down syndrome is discussed. Heather and Ian feel because of their own health problems and inability to drive that they would find it difficult to raise a child with a serious physical disability. The midwife takes blood for serum screening at 16 weeks of pregnancy and arranges a detailed ultrasound scan for Heather at 19 weeks.

The serum screening test result does not indicate a high risk of Down syndrome; Heather and Ian breathe a sigh of relief. They both go to the clinic for the ultrasound and are very distressed when they are told that the fetus has a spina bifida.

Heather’s midwife comes to the flat and they all talk about the options that Heather and Ian have. Although very upset, they still feel that having the baby is not in the best interests of the child, and decide to terminate the pregnancy. The practice nurse is aware of what has happened and refers the family for bereavement counselling.