As we launch our Fetal MRI portfolio, Dr Elspeth Whitby explains how a research project on MRI in early-life autopsy made her realise what an impact a radiologist can have on bereaved parents.
She found that MRI images can help to create and manage a woman’s feelings during pregnancy and increased her own understanding of her role in the process.
End of or start of life
When a baby or infant dies, MRI can be used as a minimally invasive method to replace formal autopsy. Dr Elspeth Whitby explains how, not only does this provide scientific information, but with the interpretive and sensitive communication skills of the radiologist it helps to provide some answers and fill gaps for devastated and grieving parents. Here she talks through the unexpected learning which came out of an innovative and groundbreaking research project.
As part of my work as a consultant radiologist I am involved in a minimally invasive autopsy service where magnetic resonance imaging (MRI) is used along with a number of other investigations that can replace the formal autopsy. Over the last 12 months I have embarked on a 30-month interdisciplinary project which aims to explore the use of visual technologies in post-mortem, bringing together researchers, medical practitioners and technology manufacturers to examine how clinical applications of these technologies (such as MRI) are impacting upon professional practice and parental experiences of loss.
This project, entitled ‘End of or Start of Life?’, developed from my previous work with a medical sociologist (Dr Kate Reed) looking at the value of the fetal MRI image to patients and professionals. A published paper from this original study argues that MRI can both create and manage women’s feelings of uncertainty during pregnancy. While it may not always provide women with unequivocal answers, the detailed information provided by the MRI images combined with the interpretative and communication skills of the radiologist enables women to navigate what can be difficult and emotional issues.
We think this current research on MRI in early-life autopsy will build on the original study about pregnancy and is important for a number of reasons:
- It will benefit bereaved parents by providing information about potential choices they may have over fetal and infant autopsy;
- It will raise general public awareness around prenatal and neonatal loss and contribute to reducing the silence and taboo which many parents who experience early life loss experience;
- It will contribute to the ongoing professional development of pathologists and related professionals through informing professional guidelines and educational materials on visual technology use in autopsy;
- It will provide information about how parents and other professionals feel about the use of this technology and therefore help to ensure that UK policy on autopsy is developed and applied in a way that is sensitive to practitioners and parents.
Personally my involvement in the work has allowed me to understand the needs of my patients and their families. I have had time to explore areas neglected by medical staff due to time pressures and the lack of insight into the importance of small details. When their baby is going to have a post-mortem, families need to know about what happens, who has contact with their most precious bundle and when. They don’t always need the detail I had assumed they’d want in terms of medical information about the post-mortem process, but rather more seemingly ‘mundane’ details for example: who holds their baby, how they hold them and place them on the scanner table.
Telling a bereaved mother that I was the person who held her baby boy, carried him, dressed and wrapped in a blanket, to the scanner and talked to him as I placed him on the scan table in the required position – as I would any baby in my clinical practice – resulted in tears from his mother and father. These were followed by a very emotional hug and a comment from mum that she could finally ‘let go’ as I had put her mind at rest that he had been well looked after when she couldn’t be with him during the post-mortem. To them this part of his ‘life’ was a blank space that they could not fill and this left them feeling helpless. Being able to tell them about the process allowed them to fill this space and to understand what had happened. They knew that he had been cared for, and that they had done all they could as his parents.
The most frequent request for information is ‘who will look after my baby when I can’t be there?’ No parent wants to be separated from their baby. I have underestimated the importance of such detail before, assuming that medical information is more important as this is what I have been trained to provide. I am beginning to understand more about parents’ complex needs, and hopefully I now provide an opportunity for all patients and parents I am involved with to obtain this information. The conversations I have with patients have changed from a medically-centred approach to a wider, more social approach. For example I have been able to book longer appointments and build in flexibility so no one feels rushed.
And so, I hope my continued involvement with the social research work can widen my understanding further and hopefully improve the services we provide. For instance, being part of this research has helped to inform my involvement in the production of a video that talks parents through the MRI post-mortem process which they can watch whenever, if ever, it suits them.
If you are interested in this topic, you may be interested in learning more. Take a look at the new BIR Fetal MRI Portfolio
Dr Elspeth Whitby
Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust.
Her clinical and research interests are based around MR Imaging of the fetus and neonate. She provides a national service for Fetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the fetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.
She is currently Vice President for Education at the BIR, helping to improve the educational scope and methods of delivery of educational events for all BIR members.
Dr Whitby was the recipient of the first BIR/Bayer Make it Better Award for her work in minimal fetal and neonatal invasive autopsy.