title: Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds.
abstract: BACKGROUND
  In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives' perceptions and practices regarding taking client's religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives' knowledge of whether pregnancy termination is allowed in Islam.
  
  
  METHODS
  This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in The Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study.
  
  
  RESULTS
  Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client's religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives' own religious backgrounds were independent of whether they paid attention to the clients' religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups.
  
  
  CONCLUSIONS
  While many midwives took client's religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands. janneke@hllp.nl.
authors.forename: Janneke T
authors.initials: JT
authors.lastname: Gitsels-van der Wal
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.forename: Lisanne A
authors.initials: LA
authors.lastname: Gitsels
authors.forename: Hans S
authors.initials: HS
authors.lastname: Reinders
authors.forename: Pieternel S
authors.initials: PS
authors.lastname: Verhoeven
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Ghaly
authors.forename: Trudy
authors.initials: T
authors.lastname: Klomp
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
mesh_terms: D000025:Abortion, Eugenic; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000235:genetics; D003376:Counseling; D054521:Cultural Competency; D004314:Down Syndrome / Q000175:diagnosis; D005260:Female; D005820:Genetic Testing; D006801:Humans; D007514:Islam; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D009426:Netherlands; D011247:Pregnancy; D012068:Religion and Medicine; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal