Views and attitudes of pregnant women on decision making for LTOP for severe fetal abnormalities.

Abstract

Aim: To study the views and attitudes of pregnant women with a severe fetal anomaly towards late termination of pregnancy (LTOP). Methods: Data was collected over a 3 month period using a pen and paper semi-structured interview of pregnant women with severe fetal abnormalities (lethal and non-lethal) detected after 24 weeks gestation at a tertiary / quaternary hospital. The interview was conducted during pregnancy and within 2 weeks after delivery. All women had prior counselling about their fetal anomaly by healthcare workers at the Fetal Unit. A variety of demographic and socio-economic characteristics were compared between the women that underwent termination of pregnancy (TOP) and those that continued with their pregnancy. The interview was conducted over approximately 30 minutes in the privacy of a counselling room or side ward. Informed consent was obtained from all participants and the study received ethical approval. The responses were analyzed using a statistical package with descriptive statistics calculated. A p-value of <0.05 was used for statistical significance. Results: During the study period, 15 pregnant women with severe fetal anomalies were interviewed. Of these, 5 (33%) women requested TOP and 10 (66%) opted to continue with the pregnancy. The mean (range) maternal age for those continuing with the pregnancy was 25 (20-32) years; and in those requesting termination was 31 (22–35) years. The patients who continued with pregnancy were significantly younger than those who decided to terminate (25 vs 31 years; p<0.05). The mean (range) parity was 1 (0-3) in the patients who continued with pregnancy and 2(1-3) in the patients who terminated. Eighty five percent of the women were Christians and there was no significant difference in their choices. Majority of the women indicated that their partners and immediate family members influenced their decision-making. Before delivery, the common reasons for continuing with the pregnancy included: fear of killing an unborn baby, the baby is God’s gift and the baby will be well after it is born, let nature take its course and there should be no interference to the pregnancy. All women indicated that they were given sufficient time by the hospital staff to make their own decision about their unborn baby after the options were explained. For those that opted to terminate the pregnancy, the main reasons were the cost implications of raising an abnormal baby; baby will suffer during life and unable to cope with severely handicapped child. Post delivery, most women felt that they made the correct choice after seeing the baby. Conclusion: Despite the small numbers, this study illustrates that even whilst pregnant with an anomalous fetus, women’s views and attitudes towards late TOP for severe fetal anomaly are variable. The younger primigravida are more likely to continue with the pregnancy in the hope that the baby will be born normal. Good support from partners / family after delivery was associated with a more favourable response towards decision-making for LTOP. Follow up larger studies assessing the long-term views and attitudes of women towards late TOP will be important for comparison with initial decision-making process and future prenatal counselling.