Lack of Preparation for Child Bearing Decisions: Surveying Prenatal Patients for Awareness

Background: Although being prepared is valued in most endeavors, little research has explored women’s preparedness to make decisions within the context of a pregnancy. Decisions about whether to use prenatal screening and testing (including nuchal translucency ultrasound screening that indicates risk for Down syndrome and other fetal anomalies)  are frequently viewed as non-decisions and few consider the possibility that using prenatal screening may lead to information that indicates higher risk of fetal anomaly or other critical information that requires decisions in pregnancy.  Priming (exposure to a situation before it is encountered directly) is known to influence decisions.  Knowing more about the baseline of pregnant women’s exposures to priming and/or knowledge and thought about decision-making in pregnancy may allow us to help them be better prepared if critical decisions must be made in the context of an affected pregnancy.

Methods: The Prenatal Testing Survey (PTS) includes scales assessing health locus of control, depression, state/ trait anxiety, risk behavior, pregnancy history, and hypotheticals about potential pregnancy problems and whether the patient had considered that possibility and what their decision would be.  It also has a question about women’s knowledge of the reason for their current medical appointment.  The PTS was distributed to all women in the waiting area as they attended their Nuchal Translucency ultrasound screening from March 2008 to December 2010 and was completed by 659 women. Here, we include data about preparedness and whether the woman had considered varied pregnancy decisional points.

Findings: The sample approximated the demographics of New Jersey, one of the most diverse states in the nation. Half (48%) of the women claimed to have planned their pregnancy and another 19% stated they had not tried to avoid pregnancy. Despite a robust protocol of informed consent for the NT, 6-10% could not accurately answer the reason for their appointment. More than half claimed that they had considered what they would do if “there was something wrong with the baby” with 67% believing they would “keep the baby”; 14% believing they would end the pregnancy; and 28% undecided about an outcome. More than 56% endorsed the item that they “never thought anything could be wrong.”

Conclusions/ Implications: Although we know that hypotheticals are notoriously unable to predict real-life action, these results indicate that at least half of the women had not considered the possibility of an outcome indicating that fetal health could be compromised.  Without considering that possibility, women have not had the opportunity to consider decision options, engage support from partners, nor engage in fully informed decision-making as they are adhering to mis-information that the NT ultrasound is about “seeing the baby” or learning its sex. In short, many pregnant women are poorly informed about the possible information they may learn during prenatal screening and testing, and enter the need for decision-making about fetal/ pregnancy complications with little priming or preparedness.