Ahmed S, Bryant LD, Cole P. Midwives' perceptions of their role as facilitators of informed choice in antenatal screening. Midwifery.. 2013; 29:(7)745-750

Alexander E, Kelly S, Kerzin-Storrar L. Non-invasive prenatal testing: UK genetic counselors' experiences and perspectives. Journal of Genetic Counseling.. 2015; 24:(2)300-311

Antenatal Screening Wales. Policy, standards and protocols 2019 – 7.0 and 8.0 antenatal screening for Down's syndrome, Edwards' syndrome and Patau's syndrome, standard 7.8. 2019. (accessed 2 July 2020)

2 All ER 188. 1957;

Brownsword R, Wale J. Testing times ahead: non-invasive prenatal testing and the kind of community we want to be. Modern Law Review.. 2018; 81:(4)646-672

Cernat A, De Freitas C, Majid U, Trivedi F, Higgins C, Vanstone M. Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women's experiences. BMC Pregnancy Childbirth.. 2019; 19

Cioffi J. Expanding the scope of decision-making research for nursing and midwifery practice. International Journal of Nursing Studies.. 2012; 49:481-489

Cramer E. The Impact of professional language interpreting in midwifery care: a review of the evidence. International Journal of Childbirth.. 2017; 7:(1)18-30

Diamond-Brown L. ‘It can be challenging, it can be scary, it can be gratifying’: obstetricians' narratives of negotiating patient choice, clinical experience, and standards of care in decision-making. Social Science and Medicine.. 2018; 205:48-54

Haith-Cooper M. Mobile translators for non-English speaking women accessing maternity services. British Journal of Midwifery.. 2014; 22:(11)795-803

Ikhilor P. O, Hasenberg G, Kurth E, Asefaw F, Pehlke-Milde J, Cignacco E. Communication barriers in maternity care of allophone migrants: experiences of women, healthcare professionals, and intercultural interpreters. Journal of Advance Nursing.. 2019; 75:(10)2200-2210

Montgomery v Lanarkshire Health Board. UKSC 11. 2015. (accessed 25 September 2020)

Mordel v Royal Berkshire NHS Foundation Trust. EWHC 2591 (QB). 2019. (accessed 5 August 2020)

Moyo M, Goodyear-Smith FA, Weller J Healthcare practitioners' personal and professional values. Advances in Health Sciences Education.. 2016; 21:257-286

NHS England. Service specification no.16. NHS fetal anomaly screening programme – screening for Down's syndrome, Edwards' syndrome and Patau's syndrome. 2017. (accessed 7 August 2020)

Non-invasive prenatal testing: ethical issues. 2017; 1-149

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 9 October 2020)

Sanders J, Hunter B, Warren L. A wall of information? Exploring the public health component of maternity care in England. Midwifery.. 2016; 34:253-260

Tavares N QC Mordel v Royal Berkshire NHS Foundation Trust (2019) (QBD; Jay J; 8 October 2019; [2019] EWHC 2591 (QB)). J.P.I, Law 2020. 1:C4-C6

First Trimester Combined Screening for Trisomy 13 and Trisomy 18. External review against programme appraisal criteria for the UK National Screening Committee (UK NSC), Version 5. 2013; 1-57

Wulff CB, Gerds TA, Rode L, Ekelund CK, Petersen OB, Tabor A. Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147 987 singleton pregnancies. Ultrasound Obstet Gynecol.. 2016; 47:(1)38-44

Understanding Mordel: obtaining informed consent for trisomy screening

02 February 2021
Volume 29 · Issue 2


The landmark decision of Montgomery has established that the patient's right to self-determination and autonomy underpins the doctrine of informed consent. The case of Mordel threw into question the process of obtaining informed consent and whether it was being sufficiently secured in the context of Down's syndrome screening. This case conveyed a paradigm shift to the role of the midwife and sonographers when obtaining consent for screening and the requisite legal standard of care they owe to expectant parents. However, many key issues remain unanswered from the decision in Mordel, in particular, what steps must healthcare professionals take to discharge their duty of care in the process of securing informed consent from expectant parents for screening.

Screening for fetal anomalies during the antenatal period remains a controversial issue in midwifery and reproductive health practice. The traditional ‘Down's syndrome’ antenatal screening pathway is currently going through a period of significant development across England and Wales. Between 2016–2018, following the UK National Screening Committee ([UK NSC], 2013) recommendations, both NHS England (2017) and Wales implemented the new ‘trisomy’ screening pathway (Antenatal Screening Wales, 2019).

‘Trisomy’ is the medical term used to describe the presence of an additional chromosome in some or all of the cells of a person. For example, trisomy 21, or Down's syndrome, is characterised by an additional chromosome 21. Under the new pathway, Down's syndrome (trisomy 21), the most common chromosomal condition detected antenatally would be joined by the second and third most commonly detected chromosomal conditions, Edwards' syndrome (trisomy 18) and Patau's syndrome (trisomy 13), to form the ‘trisomy’ screening pathway.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month