Enjeux éthiques et cliniques de la consultation anténatale dans le cadre des malformations de membres

Antenatal consultation in a multiprofessional reference center for limb malformations leads us to consider various clinical and ethical issues, given that every encounter is unique. How do we treat couples, still reeling from the shock of prenatal diagnosis, in order to help them think of “the real child” and mourn “the imaginary child”? It is necessary to take the time and think carefully to each case separately in this particular clinical practice that challenges the medical teams' common practices. The patient (fetus) being present/absent, we can evoke a real translation of the patient subject into the couple. How to reconcile the couple's mental temporality with the medical temporality? Communicating medical information on the unborn child can be experienced by the couple as “information-overload”. What is good or better to say? How to keep a certain neutrality when announcing the diagnosis? The concept of “normality” is questioned. We know the importance of the words we use to talk about the child and their impact on child/parent relationship. How do healthcare professionals manage not to judge (in place of the couple) whether the discovered malformation is “acceptable” or “unacceptable”? How to resist banalization and routine in our practice and avoid minimizing the malformation in order to reassure the couple about the future of the unborn child?