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Midwives' experience of offering anti-D immunoglobulin to women: The importance of choice

02 July 2016
12 min read
Volume 24 · Issue 7

Abstract

Background:

Informed decision-making around anti-D immunoglobulin (Ig) is important but complex, requiring consideration of individual factors to reach the most appropriate choices for individual women.

Aims:

This research aimed to develop understanding of midwives' practices when offering anti-D Ig to RhD-negative women.

Methods:

A descriptive, qualitative study was used. Two focus groups were held with 11 midwife participants from two Scottish maternity units. Data were analysed using thematic analysis within a framework approach.

Findings:

When offering anti-D Ig, midwives were limited in their ability to fully engage with women in a process of individual informed decision-making, due partly to their own knowledge and understanding and partly to organisational culture and support.

Conclusions:

When interventions are recommended and offered routinely, it is challenging to extend the principles of woman-centred individualised care to facilitate meaningful decision-making. More effort is required to understand the difficulties faced by midwives.

Informed decision-making enables women to make choices that reflect their own beliefs and preferences and is at the heart of provision of woman-centred care. There is evidence that women want information and choices in their care and there are well-established links between perceived control and improved emotional outcomes (Churchill and Benbow, 2000; Kirkham, 2004).

Around one in six pregnant women in the UK have an RhD-negative blood type, and are offered anti-D immunoglobulin (Ig) to prevent sensitisation with anti-D antibodies (maternal sensitisation). To be effective, anti-D Ig should be administered within 72 hours of a potentially sensitising event (such as antepartum haemorrhage) or the birth of an RhD-positive baby. Routine antenatal anti-D Ig prophylaxis (RAADP) has been recommended by the National Institute for Health and Care Excellence (NICE, 2008) since 2002 and is now widely offered during pregnancy in order to prevent silent maternal sensitisation (occurring without outward signs) during the third trimester.

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