French midwives' practice of termination of pregnancy for fetal abnormality. At what psychological and ethical cost?
OBJECTIVE
To study the clinical, emotional and moral difficulties that French midwives encounter in the labor ward while performing termination of pregnancy (TOP) for fetal abnormality.


METHODS
Six public maternity hospitals located in the Ile de France region, two of which were referral centers for prenatal diagnosis (PND) and TOP.


METHODS
Questionnaire survey


RESULTS
Ninety-two of 115 midwives responded. Sixty-five percent of the midwives reported that their role in the labor ward during TOP was difficult. Aspects contributing substantially to the perceived difficulties were the midwives' responsibility to provide psychological support to patients and the emotional distress of the midwives themselves. Seventy-five percent reported that they were concerned about the child being alive in cases of late TOP. Twenty-five percent of the midwives reported moral conflicts due to personal, cultural or religious background, mainly for particular indications. There was a consensus about the clinical management of TOP. Overall, midwives with professional experience, training, and those who worked in a referral center reported fewer difficulties.


CONCLUSIONS
It is necessary to improve institutional support available within maternity units to alleviate the difficulties midwives face in their roles. The need for training/updating midwives about psychological and ethical aspects of TOP should also be considered.
Garel
M
M
INSERM, UMR S149, IFR 69, Epidemiological Research Unit on Perinatal and Women's Health, Villejuif, F-94807 France. garel@vjf.inserm.fr
Etienne
E
E
Blondel
B
B
Dommergues
M
M
D000028:Abortion, Induced / Q000941:ethics / Q000523:psychology*; D001291:Attitude of Health Personnel; D003696:Delivery Rooms; D004644:Emotions; D005260:Female; D005333:Fetus / Q000002:abnormalities*; D005602:France; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology; D008297:Male; D008880:Midwifery; D009014:Morals; D011247:Pregnancy