Views and attitudes of pregnant women on decision making for LTOP for severe fetal abnormalities.
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Date
2011
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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.
Description
M. Med. University of KwaZulu-Natal, Durban 2011.
Keywords
Pregnant women--Attitudes., Late-term abortion., Pregnancy--Complications., Foetus--Abnormalities., Theses--Obstetrics and gynaecology.