Women’s experiences of prenatal screening and diagnosis. In: Abramsky L, Chapple J, editors. Prenatal Diagnosis. Boston: Springer US; 1994. pp. 37-53. [DOI: 10.1007/978-1-4899-3027-9_3]

Interpreting Low-Income Latinas’ Amniocentesis Refusals

As with other medical care, low-income Latinas turn down prenatal genetics services, including amniocentesis, more than any other U.S. group. Amniocentesis is a medical procedure that provides information about a fetus‘ health. Virtually all conditions the test detects are untreatable other than by induced abortion. Because little is known about why Latinas accept or decline amniocentesis and the role ethnicity might play in their decision, we sought to address these issues. We first identify factors associated with amniocentesis acceptance and refusal in a group of Mexican-origin women. We then described the actions those who refused took after turning down the test and their explanations for their acts. We show that while study participants‘ ideas about what put their pregnancies at risk were often at odds with those of clinicians, their objectives were similar: to reduce risk and maintain hope in the face of uncertainty.

A survey on worries of pregnant women--testing the German version of the Cambridge worry scale

Background

Pregnancy is a transition period in a woman's life characterized by increased worries and anxiety. The Cambridge Worry Scale (CWS) was developed to assess the content and extent of maternal worries in pregnancy. It has been increasingly used in studies over recent years. However, a German version has not yet been developed and validated.

The aim of this study was (1) to assess the extent and content of worries in pregnancy on a sample of women in Germany using a translated and adapted version of the Cambridge Worry Scale, and (2) to evaluate the psychometric properties of the German version.

Methods

We conducted a cross-sectional study and enrolled 344 pregnant women in the federal state of Baden-Württemberg, Germany. Women filled out structured questionnaires that contained the CWS, the Spielberger-State-Trait-Anxiety Inventory (STAI), as well as questions on their obstetric history. Antenatal records were also analyzed.

Results

The CWS was well understood and easy to fill in. The major worries referred to the process of giving birth (CWS mean value 2.26) and the possibility that something might be wrong with the baby (1.99), followed by coping with the new baby (1.57), going to hospital (1.29) and the possibility of going into labour too early (1.28). The internal consistency of the scale (0.80) was satisfactory, and we found a four-factor structure, similar to previous studies. Tests of convergent validity showed that the German CWS represents a different construct compared with state and trait anxiety but has the desired overlap.

Conclusions

The German CWS has satisfactory psychometric properties. It represents a valuable tool for use in scientific studies and is likely to be useful also to clinicians.

Suspicious findings in antenatal care and their implications from the mothers' perspective: a prospective study in Germany

BACKGROUND

Antenatal care services are well established in Germany, with at least 10 routine antenatal consultations per pregnancy. Although many individual antenatal screening procedures and tests have been assessed in clinical trials, little is known about the overall prevalence of suspicious findings in routine antenatal surveillance and about related effects on psychological maternal well-being. The objectives of this study were to evaluate the views of pregnant women on prevalence, type, and consequences of suspicious findings during antenatal care; to assess related worries and anxiety; and to compare the reports of risk factors by these women with the antenatal records.

METHODS

We enrolled 360 pregnant women participating in antenatal classes in the Rhein-Neckar area, Germany. They were followed up from the beginning of antenatal classes to the puerperium using self-administered structured questionnaires that covered previous antenatal consultations and related worries. The Spielberger State-Trait Anxiety Inventory was used to assess current and general levels of anxiety. Antenatal records were also analyzed. Postnatally, pregnancy outcomes were assessed by telephone interviews.

RESULTS

Two-thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings reported that they were acutely worried. The suspected problem often did not materialize: 13 (81.3%) of 16 suspected malformations and 34 (81%) of 42 suspected growth-retarded babies were in the normal range. Many suspicious findings reported by mothers were not documented in the antenatal records.

CONCLUSIONS

Contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable worries. More research is needed to evaluate the long-term impact and consequences of suspicious or false screening results in routine antenatal care.

Taking antenatal group B Streptococcus seriously: women's experiences of screening and perceptions of risk

BACKGROUND

Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening.

METHODS

Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences.

RESULTS

Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and "moral," of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women.

CONCLUSIONS

Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently "best for baby," relatively easy for them to undergo, and part of routine antenatal care.

Prenatal testing: the perceptions and experiences of Muslim women in Australia

This paper examines how Muslim women perceive and experience prenatal testing. In addition, we look at women's partners and their opinions relating to prenatal testing. The paper is based on in-depth interviews with immigrant women who identify themselves as followers of Islam and are now living in Australia. The women have, in general, positive attitudes toward prenatal testing, particularly ultrasound. However, some are ambivalent about amniocentesis. Despite their doubts, women tend to accept prenatal testing as they believe it is routine in antenatal care and confirms their own perceptions of being a 'normal mother', who should accept advice from their doctors. Women's partners also play an important role in the acceptance of prenatal testing among women in this study. We argue that women's perceptions and subjective experience of prenatal testing should be taken into account when providing prenatal services to them. Women need to be given a choice rather than being pressured and made to conform to the routinization of prenatal testing which as taken place in the Australian health care system. Only then will we see sensitive health care provided for women in general and for Muslim immigrant women in particular.

Women's decision-making in prenatal screening

With serum screening (MS-AFP and hCG testing for Down's syndrome) women have to make several decisions in a limited time: whether to participate in the screening in the first place; then, if increased risk for fetal abnormality is detected, whether to have a diagnostic test, and finally, what to do if fetal abnormality is detected. The aim of this study was to examine how women themselves in an unselected population describe their decision-making in the different phases of serum screening. Women receiving a positive result from serum screening in two Finnish towns from September 1993 to March 1994 and a group of individually matched controls were invited to semistructured interviews; 45 index and 46 control women (79% of those invited) participated between their 29th and 37th weeks of gestation (mean 31 weeks). Although serum screening was most often presented as voluntary or as an option, half the women described participation as a routine or self-evident act; only one-fourth of the women described actively deciding about participation. After a positive screening result, women's reactions to diagnostic tests, and their intentions if disability would be detected, varied greatly. Most of the women actively decided about having diagnostic tests, but for 23% participation in diagnostic testing was called a self-evident act. Women's intentions regarding abortion varied from a firm decision to abort to a firm decision not to abort, and many remained ambivalent. Prenatal screening, which demands the making of several decisions in a limited time and is offered to all pregnant women as part of established maternity care, is not based on every participant's active decision-making and thus creates an ethical problem. This problem should receive special attention from those who develop, introduce and decide on new health care practices.

Who worries that something might be wrong with the baby? A prospective study of 1072 pregnant women

BACKGROUND

Little is known about the normal range and pattern of pregnant women's worry about something being wrong with the baby, or how this relates to other factors. The objective of this study was to examine the extent to which women are worried about the possibility of something being wrong with the baby relative to other worries they may have, and to determine whether demographic, experiential, attitudinal, and personality characteristics are associated with this worry.

METHODS

Longitudinal data were collected from 1072 pregnant women who completed postal questionnaires at 16, 22, and 35 weeks of pregnancy. Multivariate statistical techniques were used to determine which variables were independently related to worry about the baby.

RESULTS

Worry that something might be wrong with the baby was one of the most prevalent worries at 16 weeks, although not as widespread a source of extreme worry as miscarriage or giving birth. Worry dropped in midpregnancy but rose again at 35 weeks. The most important factors related to this worry were perceived likelihood that something might be wrong with the baby and trait anxiety, although negative mood, previous pregnancy outcomes, and initial reactions to the current pregnancy all demonstrated significant, independent effects.

CONCLUSIONS

Women who answered "Don't know" to "Have you any reason to think that your baby might be more likely than any other to have some sort of a problem?" had consistently high anxiety throughout pregnancy. We suggest that this question be asked routinely in early pregnancy to identify these potential worries and, it is to be hoped, reassure them at an early stage.

Women's experiences of prenatal serum screening

BACKGROUND

Maternal serum screening is used to detect pregnancies at risk for Down syndrome and neural tube defects, but most positive test results (6.6% of all) are false positives. This study examined the influence of positive test results on women's experiences of pregnancy.

METHODS

The study population was all 67 pregnant women who received a positive result on serum screening in two Finnish towns from September 1993 to March 1994. For each case woman a control woman, matched for age, parity, education, and previous miscarriages, was selected. Of those invited, 45 case women and 46 control women (79%) responded to semistructured interviews.

RESULTS

Of the 45 case women, 2 underwent termination of pregnancy after the diagnosis of an abnormality and 1 had a miscarriage. Of the remaining 42, 7 decided not to undergo further diagnostic tests, for 2 women the second serum test was normal, and 33 had amniocentesis or chorionic villus sampling. The positive screening result and wait for the final results negatively affected the emotional well-being of most of these 33 women, and 6 were still worried after receiving final reassuring results. Of the 46 control women, 17 felt some worry or fear regarding abnormality in their fetus.

CONCLUSION

The significant negative psychosocial effects of serum screening should be taken into account by caregivers when deciding whether and how to institutionalize these tests as part of antenatal care.