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Dr Stephen Cole is an obstetrician and RANZCOG-certified sub-specialist in Maternal-Fetal Medicine. This August he will discuss ‘Multiple Pregnancy and Fetal Anomalies: Risks, Opportunities and Ethical Considerations in the era of Fetal Surgery’ at the 2016 Obstetric Malpractice Conference in Melbourne. Stephen was kind enough to answer a few questions as we look forward to the upcoming conference.
- What have been some of the highlights of your career so far, in particular in your work around performing fetal surgery and the diagnosis and management of fetal abnormalities?
Steve: Working in the field of “high risk” or complex pregnancy care can be both ethically and emotionally challenging, and also incredibly rewarding. This is particularly true in the field of complex multiple pregnancy. Helping a family to achieve a successful pregnancy outcome that otherwise may not have been attained is enormously satisfying. I frequently get cards, letters and photos from families many years down the track, and see their children growing up.
Perhaps the thing that I am most excited by though is my involvement in the establishment of the Victorian Fetal Therapy Service. As clinicians we are usually working at helping one patient at a time. We don’t often get the opportunity to be involved in something bigger. Helping to establish a completely new, cutting edge service in Victoria which will benefit thousands of women is something that I will always be proud of.
- As part of your role you offer pre-pregnancy counselling services for women with medical conditions, or who face the prospect of a complicated pregnancy. What are some of the ethical considerations you take into account?
Steve: For most women, the thought of embarking on a pregnancy is an intimidating but exciting experience. Some women however have to confront more challenging obstacles to realise their dreams of having a baby. In some cases maternal medical conditions may mean that the life or long term health of the woman may be at risk. Helping women to realistically understand and assess the risks that she may be exposing herself to, and balancing them against her desire to have a family can be tricky. Gone are the days when doctors tell patients that they shouldn’t embark on pregnancy (in all but a tiny minority of cases). And certainly gone are the days when women unquestioningly accept that advice. We are now much more conscious of patients’ autonomy, and their rights to even make decisions that we may not necessarily agree with. Informed consent is a guiding principal, however it is questionable as to whether patients can ever have “truly” informed consent.
Similarly, the risks of adverse outcomes for the child need to be considered. These may include the risks associated with extreme preterm birth, or the risks of being born with a severe disorder that may have major impacts on quality of life. Again, frank and balanced discussions exploring all options is required.
- Your address at the conference will discuss ‘Multiple Pregnancy and Fetal Anomalies: Risks, Opportunities and Ethical Considerations in the era of Fetal Surgery’. Without giving too much away about your upcoming presentation, are you able to explain some of the key considerations in relation to fetal surgery.
Steve: Fetal surgery is still a relatively new and evolving speciality, and it’spotential roles will no doubt increase over time. The first proven, and still most common indication for fetal surgery is a specific complications of monochorionic (single placenta) twins known as twin-twin transfusion syndrome. Fetal surgery for this condition has been transformative. A condition with near-100% lethality for babies now results in good outcomes in the vast majority of cases.
Fetal surgery for other conditions is still in it’s infancy, and while such interventions have the potential for improvements in outcomes for babies, this is often at the expense of increased risks for mothers. Balancing these potential benefits against genuine maternal risks is a clinical and ethical challenge.
- Are there any presentations from the 8th Obstetric Malpractice Conference that you are particularly looking forward to?
Steve: Doctors and lawyers often view clinical events from completely different perspectives and agendas, and it is always fascinating to explore and be challenged by those differences. To this end, I am really looking forward to the presentation by Kevin Connor SC, reviewing the case of Mongomery V Lanarkshire Health Board. I am keen to view the case “through lawyers’ eyes”, and reflect on ways that the case may influence how we as doctors can better counsel our patients.
Stephen will join 16 other expert speakers at this years conference. Click here for more details.
