Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Elizabeth Anne Kinsella

2nd Supervisor

Jeff Nisker

Joint Supervisor


This thesis examines the process of informed decision-making for low-risk women in their first pregnancies as they consider whether or not to participate in non-invasive, non-diagnostic prenatal screening.

Using a social constructionist approach with a theoretical lens of feminist bioethics, data from three sources were used to consider different aspects of the process of informed decision-making about prenatal screening. Data obtained from patient education materials, Society of Obstetricians and Gynecologists of Canada policy documents, and interviews with pregnant women were examined using the principles of constructivist grounded theory.

Findings are presented in the form of four integrated articles, addressing the issues of: I) the potential for metaphors and figurative language in prenatal patient education materials to be implicitly or explicitly directive; II) different counseling strategies and decision-making models for health care providers to consider when striving to offer prenatal screening in a way which supports autonomous informed choices; III) the type and content of information that women have identified as necessary to consider themselves informed when preparing to make a decision about participation in prenatal screening; IV) a proposed model for the ways in which information from different sources is sought, received, and interpreted by women engaged in the process of making a decision about prenatal screening.

Informed decision-making about prenatal screening is a complex issue, requiring significant efforts on the part of the health care professional offering screening, and necessitating careful consideration by the woman making the choice. Given an understanding of the complex social context within which these screening tests are offered and chosen, the process of informed decision-making may be more challenging than suggested by current policy and public education documents.