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All staff involved in the care of a woman or couple facing a possible termination of pregnancy are advised to discount tamsulosin 0.4 mg prostate image adopt a non-directive, non-judgmental and supportive approach. The guidance on termination includes a section on this however, and states that a decision by a woman to continue her pregnancy must be fully supported and it should not be assumed that, even in the presence of an obviously fatal fetal condition, a woman will choose to have a termination. Members are advised that it can be helpful to use appropriate literature and the help of external agencies, such as Antenatal Results and Choices (see Paragraph 2. This is thought to stem from a range of factors, including the lack of time that is available to discuss screening with women, the challenge of conveying complex information, language barriers and a lack of knowledge about Down’s syndrome. In particular, the verbal information about Down’s syndrome being given by healthcare professionals to pregnant women and couples, particularly after a diagnosis of fetal anomaly, was heavily criticised by the families of people with Down’s syndrome who we heard from. There was concern that healthcare professionals, when imparting information following a diagnosis, tend to focus on the medical problems associated with the condition, such as heart problems, 176 Royal College of Obstetricians and Gynaecologists (2010) Termination of pregnancy for fetal abnormality in England, Wales and Scotland, available at. Information about the social aspects, we heard, can be the kind of information in which women with a prenatal diagnosis of Down’s syndrome are particularly interested so as to help them answer questions such as: where will my child go to school It was argued that, without a rounded picture of what life with a person with Down’s syndrome may hold, an informed decision about whether to continue or terminate the pregnancy cannot take place. In addition, we heard anecdotally that Edwards’ and Patau’s syndromes are often presented only in light of the associated high rates of stillbirth and death in early infancy. Research has found that, when discussing a prenatal diagnosis, specialists typically gave parents a better idea of what to expect during pregnancy and after birth than non-specialist obstetricians and this helped them feel more confident, less uncertain and more secure with their care. The existing guidance is clear that women should understand that it is their choice whether to have screening or not, and that all staff involved should adopt a non-directive, non-judgmental and supportive approach. However, we heard a number of cases in which women felt that 182 It is important to note that what is considered to be balanced information is, to some extent, a matter of judgment, and a focus on only positive information might equally be thought to be providing an unbalanced picture of genetic conditions. More subtly, the way in which language is used can convey messages, positive and negative, about a healthcare professional’s views on screening choices and about choices to continue or terminate a pregnancy. Some respondents were concerned about there being a lack of time to discuss prenatal screening with a midwife at the one-hour booking appointment. Research suggests that healthcare professionals may view the consent process for prenatal diagnostic testing differently depending upon whether it is an invasive or non-invasive test. They are usually not well prepared for the possibility of a positive result, nor are they adequately prepared for what would follow on from this result. The way the results should be delivered will vary depending on what the results reveal and the preferences of the woman or couple. When a prenatal diagnosis is being delivered, research has found that parents commonly require a significant amount of detailed information to process the news, and that parents benefit from written 184 Brownsword R and Wale J (2016) the development of non-invasive prenatal testing: some legal and ethical questions Annual Review of Law and Ethics 24. An experimental study of health care professionals Patient Education and Counseling 78: 24-8. Parents were found to feel most confident in their healthcare professional when they were given thorough and concrete explanations of possible causes of the anomaly, options for the fetus during pregnancy and after birth, current success stories and the complete range of functioning they might expect for their child, as well as when this information was communicated to parents quickly, preferably within 24 hours. Healthcare professionals must be able: to provide accurate and balanced information about prenatal tests and the conditions being tested for; to provide decision-making support in a non-directive manner; and to deliver results in an appropriate way.

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