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Open Access Research article

Prenatal screening for congenital anomalies: exploring midwives’ perceptions of counseling clients with religious backgrounds

Janneke T Gitsels–van der Wal12*, Judith Manniën1, Lisanne A Gitsels3, Hans S Reinders2, Pieternel S Verhoeven3, Mohammed M Ghaly4, Trudy Klomp1 and Eileen K Hutton15

Author Affiliations

1 Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands

2 Faculty of Theology, VU University Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands

3 University College Roosevelt, Lange Noordstraat 1, 4331 CB Middelburg, Netherlands

4 Center for Islamic Legislation & Ethics (CILE) Hamad Bin Khalifa University Qatar Foundation, P.O. Box 34110, Doha, Qatar

5 Department of Midwifery Education Program, McMaster University, 50 Main Street East, Hamilton, Canada

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BMC Pregnancy and Childbirth 2014, 14:237  doi:10.1186/1471-2393-14-237

Published: 19 July 2014

Abstract

Background

In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives’ perceptions and practices regarding taking client’s religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives’ knowledge of whether pregnancy termination is allowed in Islam.

Methods

This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in the Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study.

Results

Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client’s religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives’ own religious backgrounds were independent of whether they paid attention to the clients’ religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups.

Conclusion

While many midwives took client’s religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.

Keywords:
Counseling; Islam; Prenatal screening; Termination; Cultural competency; Shared decision-making; Congenital anomalies; Religion