Prenatal diagnosis is increasingly common. Whereas amniocentesis is typically performed in the second trimester, chorionic villus sampling (CVS) is a first-trimester procedure, which makes an earlier, safer abortion possible. However, CVS carries a slightly higher risk of miscarriage and other complications. In choosing a procedure, couples (with the aid of genetic counseling) must weigh the risks of miscarriage against the odds and implications of an abnormal diagnosis. Interviews with women who decided on abortions after amniocentesis or CVS and meetings with genetic counselors indicate that both types of abortion are more traumatic than is commonly realized. Both dash dreams and hopes. Termination after amniocentesis also forces the mother to take an active part in the life and death of a nearly viable fetus. Yet, because abortions for fetal abnormality are statistically rare, there is little societal understanding and minimal support for those who experience them. This is true of health care workers as well as for the couple's primary support group.
We analyzed interview data from 44 primarily white, middle-class women who had used the prenatal diagnostic technique of chorionic villus sampling (CVS: n = 24) or amniocentesis (n = 20). CVS provides earlier results but carries a somewhat higher risk of miscarriage. Amniocentesis clients were highly committed to the pregnancy and expressed considerable anxiety over the possibility of having to terminate it should an abnormality be diagnosed. CVS clients seemed less bonded to the fetus and less concerned about losing a pregnancy several termed "replaceable." Thus, with its first-trimester abortion decision, CVS redefines prenatal diagnostic issues for women.
Thirty non-MD genetic counselors from five cities described their pre-test interview for a client of advanced maternal age, indicating the frequency they addressed each of 16 topics. Near-universal were family history taking, procedural descriptions and complication rates, and the client's fetal risk level for certain disorders. Less frequently included were description of sex chromosome abnormalities with variable expression, choices if an abnormality is found, and description of actual abortion procedures (fewer than one-third always included this). Counselors cited client discomfort in minimizing abortion-related discussions. Both training programs and genetic services might stress conveying the differences in maternal risk associated with trimester of abortion, a factor arguably relevant to a client's informed decision making. Also, given U.S. demographic changes, they should consider increased staff training in cross-cultural counseling techniques.
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