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Influence of midwife communication on women's understanding of Down syndrome screening information

02 December 2019
20 min read
Volume 27 · Issue 12



To analyse how midwives communicate Down syndrome screening information and explore whether women's understanding of this information is influenced by midwives' communicative style.


Midwives (n=16) and women (n=100) were recruited from a regional NHS unit in the UK. A mixed-methods design encompassed two components; audio-recorded antenatal consultations to assess midwives' communication and quantitative surveys to assess women's understanding.


Midwife communication was not significantly related to women's understanding of Down syndrome screening information. However, qualitative thematic analysis revealed midwife communication was often insufficient in fully describing Down syndrome and screening. Communication was not very interactive, midwives dominated conversations and did not sufficiently check women's knowledge/understanding.


Policymakers need to consider these findings. Deficits in midwife communication in relation to established screening practice needs to be addressed through additional training ahead of full implementation of non-invasive prenatal testing into midwifery practice.

All pregnant women in England, Wales and Scotland are offered screening for Down syndrome at their first antenatal (booking) appointment with their midwife (UK National Screening Committee [UK NSC], 2007). Information provided by midwives aim to enable women to make an informed choice to accept or reject screening (de Jong et al, 2014).

With the introduction of non-invasive prenatal testing (NIPT) into the NHS, ensuring women are making informed decisions is vital due to the test's increased accuracy (UK NSC, 2016). If midwives can effectively communicate current Down syndrome screening infor mation and support infor med decision-making, then it will be easier to incorporate NIPT into practice.

National Institute for Health and Care Excellence ([NICE], 2019) guidelines for antenatal care outline that ‘good communication between healthcare professionals and women is essential’; language is key to this. However, oral and written health information is often too complex for the average individual to understand (DeWalt et al, 2004). In attempting to describe aspects of language which could enhance understanding, Adams et al (2009) suggest using plain language, limited ‘medical jargon’, diagrams and checking clients' understanding.

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