Down's syndrome screening : the perspective of women and midwives in Northern Ireland

The use of maternal serum screening to assess individual risk for Down's syndrome is now standard in many' countries and the increased uptake of screening has provoked concern about the potential impact on individuals and societal attitudes. As a serum screening test result indicates the level of risk rather than a diagnosis, the test may also be more difficult to explain to women. Under current law in NI women are not given the option to terminate if they have a positive diagnostic test unless it is in the interests of the mother's mental or physical well being which may affect the provision of universal screening for Down's syndrome and introduce decisional conflict for both women and professionals. The aim of the study was to explore the reasons why women accept or decline screening for Down's syndrome and the perspective of midwives who are involved in offering screening tests to pregnant women in Northern Ireland. The first phase of the study used survey methodology where 317 women who were offered screening were interviewed at two stages in their pregnancy: before and after screening had taken place. A focussed ethnographic approach was used in the second phase of the study and in-depth interviews with fifteen midwives were completed. Women identified several themes which influenced their decision to accept or decline screening but the key theme which emerged was the influence of health professionals on their decision making process. The findings from the midwifery interviews revealed the offer of screening is a difficult discussion with women where underlying negative perceptions of the test and a reluctance to discuss termination of pregnancy were influential. Midwives also experienced personal and professional conflict regarding their opinion of the test, their position in the organisational structure of antenatal care and ultimately their desire to care for women.EThOS - Electronic Theses Online ServiceGBUnited Kingdo