Routinisation and constraints on informed choice in a one-stop clinic offering first trimester chromosomal antenatal screening for Down's syndrome.
OBJECTIVE
to explore routinisation and constraints on informed choice in a one-stop clinic offering first trimester antenatal chromosomal screening for Down's syndrome.


METHODS
recordings of booking appointments and pre-screening consultations in both a community and a hospital clinic setting.


METHODS
one antenatal clinic site in the UK offering first trimester nuchal translucency screening in combination with maternal serum screening.


METHODS
57 taped clinical consultations involving pregnant women and midwives and health-care assistants (HCAs).


RESULTS
midwives and HCAs expected women to make informed decisions about screening for Down's syndrome. However, midwives' attempts to maintain the normality of pregnancy and avoid discussions about potential scenarios, as well as their emphasis on the high accuracy rate of first trimester screening have routinised first trimester antenatal screening for Down's syndrome. Also, a general expectation in the clinic to take up screening and the constrained service context in which midwives and HCAs work had implications for women's informed choices.


CONCLUSIONS
directive information combined with lack of purposeful dialogue with pregnant women have constrained the process of information-giving about antenatal screening for Down's syndrome.


CONCLUSIONS
the provision of information about antenatal screening for Down's syndrome is a challenging role for midwives. Changes in midwifery practice resulting from continuing education as well as less constraining service contexts could improve the quality of information about antenatal screening for Down's syndrome.
School of Medicine Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. m.tsouroufli@uea.a.cuk
Maria
M
Tsouroufli
D000328:Adult; D000739:Anecdotes as Topic; D004314:Down Syndrome / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D007258:Informed Consent; D008880:Midwifery / Q000191:economics / Q000379:methods*; D009035:Mothers / Q000193:education; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000451:nursing*; D006113:United Kingdom; D055815:Young Adult