Midwife's role in helping women choose method of TOPFA The midwife can play a key role in helping a woman decide which method of termination is right for her. Discussion around options for TOPEA may begin even before a woman has entered the screening pathway. National guidance on the consent process for fetal anomaly screening, clearly states that health professionals should have sufficient knowledge and understanding of the implications of screening tests to include the offer and choice of continuing or terminating the pregnancy for serious fetal anomaly, and be able to describe these to women (NHS FASP, 2on). This falls within a midwife's remit and discussion about TOPEA at an early stage in the screening pathway may assist a woman's decision about whether screening is the right option for her. Further along the screening pathway, where a woman is considering diagnostic testing, awareness of the options available to her regarding termination should abnormality be confirmed, may influence choice of diagnostic test. Eor example, amniocentesis, which carries a lower miscarriage risk than an earlier CVS, may be a preferable option for women with the knowledge that diagnosis at a later gestation does not exclude the option of a surgical termination. It will be important that a midwife explores these options with women to help ensure fully informed decision making.
British Journal of Midwifery • May 2014 Vol 22, No 5 333
CLINICAL PRACTICE
Once abnormality is diagnosed and the decision to end the pregnancy has heen made, awareness of the factors that may influence women's decision making over method of TOPEA, can help midwives best support women through this process. Attitude to abortion, religious beliefs and emotional coping style were all themes shown to exert influence over women's decision making between medical and surgical procedures in the second trimester (Kerns
etal, 2001). Equally important is the introduction of other factors that may not have been considered. Eor example, whether genetic testing or post mortem, if relevant, would be possible with a specific method of TOPEA. Some women may want to think about where the termination takes place. Some may prefer a venue away fi-om their local maternity unit. Others will be more comfortable with a hospital setting. Exploring whether the woman wishes to see the baby afterwards and the options for momentoes and photographs may also influence choice of method. Many of these factors are discussed in greater detail in the following sections. Introducing these options in a sensitive manner is especially important as choice of method could ultimately affect how women recover and cope with grief after ending a desired pregnancy (Kerns et al, 2on).