How The Film '20 Weeks' Is Shedding Light On Fetal Anomalies

Director Leena Pendharkar’s 20 Weeks is a lot of things. It’s movie about a whirlwind relationship on the rocks. It’s a woman’s journey from not wanting kids to becoming a fierce defender of her own child. It’s an intimate movie of emotional immediacy.

And all that revolves around one couple, Ronan (Richard Riehle) and Maya (Anna Margaret Hollyman), and their 20 week ultrasound results.

Type “20 week ultrasound” into Google and most of what you get is “20 week ultrasound — it’s a girl/boy!” pictures. We all know that pregnancy marker as the time when the baby’s sex is finally, obviously revealed. But as the UK’s National Health Service explains, the 20 week ultrasound also known as an anomaly scan. Meaning that this scan checks to see that your baby is developing normally in all sorts of different ways. In detail, the ultrasound examines, the baby’s bones, heart, brain, spinal cord, face, kidneys and abdomen.

Common conditions that can be diagnosed this way include “anencephaly, open spina bifida, cleft lip, diaphragmatic hernia, gastrochisis, exomphalos, serious cardiac abnormalities, bilateral renal agenesis, lethal skeletal dysplasia. Edwards’ syndrome, or T18and Patau’s syndrome, or T13,” among others. Mismeasurements of certain bones can lead doctors to suspect other syndromes, including the Pierre Robin Sequence that Pendharkar’s baby was eventually born with.

If there is an anomaly, the cavalcade of tests begin. Fetal geneticists get involved, and the time starts ticking: if you want to terminate, you only often have a small window, if any, to do so. While the characters in the movie are told they have a child with missing fingers and a small chest cavity, Leena Pendharkar and her partner were gobsmacked with the news that their baby had a jawbone measuring under size. All of these indicators can be nothing — or they can be signs of a serious genetic abnormality.

When the 20-week ultrasound shows atypical results, doctors often ask for an amniocentesis. This test, according to the Mayo Clinic, uses a (giant) needle to extract amniotic fluid from the mother’s womb. The fluid contains fetal cells, which can be analyzed for hundreds of anomalies. But in 20 Weeks, Pendharkar shows us potential risks of that test — Maya is exhausted and in pain; she eventually leaks amniotic fluid and needs to spend a night in the hospital.

Throughout all this, the couple has not shared their news — with anyone. No one talks about what is happening. Pendharkar said she felt the same.

“I googled, of course, but still, I didn’t know who to turn to, or who to talk to, except my husband, and how to really process it,” she said. “That caused me to go down a pretty deep, dark, black hole … I wish I would have told a couple of my friends, and let them support me. There were times when I wanted to, but I really didn’t know where to begin. I just felt this overwhelming paralysis when it came to the subject, and I didn’t really know what to say, or begin to get into it. It’s such a rare and serious thing for a 20 weeks test to go wrong, and honestly, something I don’t think people can wrap their head around, unless they’ve really been through it. I don’t know that I had the tools to even know what might have made me feel better in the moment, either.”

She was afraid, she says, of getting blamed. She blamed herself for a long time. This seems a commonality in mothers of children who turn up with anomalies: Ronan and Maya immediately ask, “What could we have done?” But there’s no support there for women. Pendharkar eventually found a Facebook support group, which was massively helpful for her (Maya at one point tells Ronan that she wishes he would join the Facebook group and find some help there, but he’s unwilling). But there’s also a deep sense of shame — shame of having a baby that may have complications and shame that if the anomaly is bad enough, the couple may make the decision to abort.

Pendharkar moves around the subject of abortion in her film. Maya never wanted a child to begin with, and at one point, enters Planned Parenthood before the diagnosis, only to flee. Ronan tries to get her to say that if the anomaly is bad enough, they’ll do the “right thing.” By which he means terminate. Maya pushes back. She doesn’t want to terminate her child now. This is her child. She’s moved from a reluctant carrier to a mother. As much as Ronan wants to be a dad, he can’t leap past his doubts, and it’s that fracture that ultimately strains their relationship.

Pendharkar says after her daughter was born, she found the Facebook group, a massive help which “was our saving grace. People on that board are a wealth of knowledge and information, and I don’t think we could have gotten through it without that. We had a safe space to share stories, ask questions, and sometimes even just share tears. I also think some of the feeding therapists were helpful. I think it would be great if fetal medicine doctors could point their patients to some of these resources.” She also thinks that while her care was good, “the genetic counselors could have pointed us to a few places to look or go, to read more about what happens next.”

We need, she says, to talk about these issues more. “Technology and what it can do for people is advancing at a rapid rate, without the deeper discussions of how these things affect people’s lives. We can make babies in a test tube, we can predict potential health issues, but we don’t know what to say to a parent when something goes very wrong, we they don’t know where to turn.”

She also says, “I think women should have all possible options available—to keep the baby, to terminate, with the support and education that is necessary. Rather than it being a politicized issue, women should have the right to keep the baby or not, and not feel judged, or meant to feel like what they are doing something wrong.”

What a lonely, terrible, dark thing for a woman to carry on her own. What a horrific burden: to abort a wanted child, and to be afraid to tell anyone. This is what we need to erase. Regardless of your stance on abortion, regardless of whether you consider yourself pro-choice or pro-life, you need to look at these women, who have been given these terrifying results, and meet them where they are with compassion and love, woman-to-woman. We need to learn these words: I see your grief. I’m sorry for your baby. Would you like to talk about it?

“It would be so great if there was a way for women to talk about this,” Pendharkar says. “In shooting the film, so many women came forward to tell me their stories of what had happened to them, and how they had to terminate. They often mentioned not having told anyone, either.”

Only by talking about it will the shame begin to erode. Only then will women stop carrying this terror of these anomalous 20-week ultrasound results alone. Only when we see movies like 20 Weeks will we begin to realize the pain and sorrow that women go through every day with issues like this.

Only then will we learn the strength to sit with them in their grief — and how to find help if those women become us. Pendharkar has done the world a great service with 20 Weeks, and it’s rare that a film has so much to tell us, so much to show us about ourselves. It’s imperative that, as a community of women, we listen.

You can view the 20 Weeks trailer here.