Antenatal screening in the community: the views and experience of women in one general practice

Abstract

The publication of the Department of Health's 1993 report Changing Childbirth has prompted major changes in the organization of maternity care, with an emphasis on returning antenatal care to the community. Serum screening for Down's syndrome (triple test) is usually carried out and followed up in secondary care, and work relating to the psychosocial effects of the test has been hospital-based. The aims of this study were to examine the views of women regarding the process and effects of delivering the test as part of routine general practice-based antenatal care, with a view to considering how this care might be most appropriately managed. We sent a questionnaire to all women registered with a fundholding practice who were offered the triple test between 1992 and 1997. The main outcome measures were satisfaction with the way in which the test was offered, what women understood by positive/negative results, why some women declined the test, and satisfaction with obtaining results/follow-up. The response rate was 60.7%. The majority of women were satisfied with the way in which the test was discussed, but there was ambivalence with regard to the procedure for receiving results, including the counselling offered. Confusion over the meaning of the results (particularly negative results) was apparent. The test caused anxiety in many women. The need for continuity of advice and support when women are subsequently referred to secondary care for further tests was highlighted. The majority of women wish the test to be available for all. The conclusion we draw is that no abnormalities have been detected during the study period, raising questions about cost-effectiveness. However, the majority of women view the test as a means of making informed decisions about their pregnancies. Although limited to one practice, the issues associated with a broad range of aspects of care identified through an analysis of the experience both of women declining the test and those accepting it provide important insights into the practicalities of delivering antenatal screening tests in primary care.