Obstetricians presenting amniocentesis to pregnant women: Practice observed

Abstract

The aim of this study is to describe how obstetricians present amniocentesis to women eligible because of their age and hence increased likelihood of having a child with Down's syndrome and other chromosome abnormalities. Routine antenatal consultations between 25 women and 17 doctors were tape recorded. Presentations focused upon the risks of fetal abnormality, and the risks of pregnancy loss following amniocentesis. The word risk was used to denote probability and frequently used in conjunction with words to denote value. Although obstetricians frequently presented probabilistic information, this tended to be presented in a binary fashion, that is, as denoting either high or low risk. Equivalent probabilities were described as low in connection with fetal loss, and high in connection with Down's syndrome. The probabilities of these two events were contrasted on half the occasions when they were presented. Implicit in obstetricians' presentations of amniocentesis was an assumption that all women would or should undergo the procedure. Information concerning the range of conditions detected at routine amniocentesis were infrequently mentioned and never described. The results of this descriptive study illustrate that information germane to decisions of whether to undergo amniocentesis is frequently presented in such a way as to encourage uptake of the test, rather than to foster informed decision-making.