title: Antenatal counselling for congenital anomaly tests: an exploratory video-observational study about client-midwife communication.
abstract: OBJECTIVE
  antenatal counselling for congenital anomaly tests is conceptualised as having both Health Education (HE) and Decision-Making Support (DMS) functions. Building and maintaining a client-midwife relation (CMR) is seen as a necessary condition for enabling these two counselling functions. However, little is known about how these functions are fulfilled in daily practice. This study aims to describe the relative expression of the antenatal counselling functions; to describe the ratio of client versus midwife conversational contribution and to get insight into clients' characteristics, which are associated with midwives' expressions of the functions of antenatal counselling.
  
  
  METHODS
  exploratory video-observational study.
  
  
  METHODS
  269 videotaped antenatal counselling sessions for congenital anomaly tests provided by 20 midwives within six Dutch practices.
  
  
  METHODS
  we used an adapted version of the Roter Interaction Analysis System to code the client-midwife communication. Multilevel linear regression analyses were used to analyse associations between clients' characteristics and midwives' expressions of antenatal counselling in practice.
  
  
  RESULTS
  most utterances made during counselling were coded as HE (41%); a quarter as DMS (23%) and 36% as CMR. Midwives contributed the most to the HE compared to clients or their partners (91% versus 9%) and less to the DMS function of counselling (61% versus 39%). Multilevel analyses showed an independent association between parity and shorter duration of antenatal counselling; (β=-3.01; p<0.001). The amount of utterances concerning HE and DMS during counselling of multipara was less compared to nulliparous.
  
  
  CONCLUSIONS
  antenatal counselling for congenital anomaly tests by midwives is focused on giving HE compared to DMS. The relatively low contribution of clients during DMS might indicate poor DMS given by midwives. Counselling of multipara was significantly shorter than counselling of nulliparous; multiparae received less HE as well as DMS compared to nulliparous women.
  
  
  CONCLUSIONS
  our findings should encourage midwives to reflect on the process of antenatal counselling they offer with regards to the way they address the three antenatal counselling functions during counselling of nulliparous women compared to multiparae.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: linda.martin@INHOLLAND.nl.
authors.forename: Linda
authors.initials: L
authors.lastname: Martin
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Obstetrics & Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada. Electronic address: huttone@mcmaster.ca.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Faculty of Theology, VU University, Amsterdam, The Netherlands. Electronic address: evelienspelten@yahoo.com.
authors.forename: Janneke T
authors.initials: JT
authors.lastname: Gitsels-van der Wal
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: Jt.vanderwal@vumc.nl.
authors.forename: Evelien R
authors.initials: ER
authors.lastname: Spelten
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway; Obstetrics & Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada; Faculty of Theology, VU University, Amsterdam, The Netherlands. Electronic address: Kuiper.fleur@gmail.nl.
authors.forename: Fleur
authors.initials: F
authors.lastname: Kuiper
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: m.pereboom@vumc.nl.
authors.forename: Monique T R
authors.initials: MT
authors.lastname: Pereboom
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway. Electronic address: S.vanDulmen@nivel.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
mesh_terms: D000328:Adult; D003142:Communication; D003376:Counseling; D005260:Female; D006266:Health Education / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008880:Midwifery / Q000379:methods / Q000592:standards*; D009426:Netherlands; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000523:psychology; D011296:Prenatal Diagnosis / Q000379:methods* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Antenatal genetic counselling; Congenital abnormalities; Doctor–patient relation; Video recording