The speed and development of prenatal diagnosis techniques has been little short of explosive (De Crespigny and Savulescu, 2002 ). The importance of psychological and psychotherapeutic help for women and couples following the prenatal diagnosis of a malformation is clearly mentioned in the literature (Leither et al, 2002).
Following the introduction of the alpha-feta protein screening for neural tube defects in the 1970’s, low alpha-feta protein level for Downs Syndrome in the 1980’s, multiple markers seen on ultrasound in the 1990’s there is now, after the millennium, combined ultrasound and biochemistry for a more precise risk identification. These developments have radically changed the approach towards optimizing the sensitivity, specificity and positive and negative predictive values of screening (Evans et al 2002).
The choice of words used to describe a condition or to inform women about the level of risk of an adverse event occurring may significantly affect how that woman perceives that condition or risk (Abramsky and Fletcher, 2002). Some tests give definite answers, these are diagnostic tests such as amniocentesis or chorionic villus sampling. Other tests only indicate risk, such as the triple test or nuchal translucency scan, these are screening tests.
Pregnant women should be informed about the purpose of any screening test before it is performed, and her right to either accept or decline the test should be made clear (National Institute for Clinical Excellence, 2003). Midwifery literature reflects an increasing awareness of the psychological costs of screening to a mother (Van den Akker, 1995 ; Downie, 1994 ; Grayson, 1996 ; Massay-Davis, 1998, cited in Lee, 2000) and concern is now being raised about the possible psychological emotional and psychical effects of prenatal diagnosis on postnatal life.
Midwives involved in prenatal screening need to be aware of their own feelings about screening and disability. They should be involved in the planning of any future antenatal screening programmes within their workplace and highlight factors such as lack of time and knowledge which may inhibit their ability to facilitate informed choice (Williams et al, 2002). This assignment will evaluate the literature to determine the current state of knowledge around the area of prenatal diagnosis of fetal abnormality, existing practice and support networks for parents.
Rees (1997) describes a literature review as a clear process that can be followed in three stages, locating the literature, extracting relevant detail and writing the review. Literature searches using the Midirs and Cinahl databases were carried out in preparation for this assignment. Further information was obtained from the medical library and sources including many support organisations available to assist parents.
This assignment will look at prenatal screening and diagnostic tests. Furthermore it will address the difficult choices that parents can face and the information they receive to help make these choices. Lethal and non-lethal abnormalities will be considered and the situation regarding termination of pregnancy in Northern Ireland. Finally grief and loss will be addressed and throughout the assignment, the focus will be on the midwives role in providing support to parents.