PhD in Nursing Science Program

Elizabeth Davies Howard

Women’s Decisional Conflict, Anxiety, and Coping Strategies Following Diagnosis of Fetal Abnormality


Dissertation under the direction of Professor Lynda LaMontagne


For most women pregnancy is a positive transition in their life. The diagnosis of a fetal abnormality creates an uncertain outcome for the transitional process of becoming a parent. A prenatal diagnosis of fetal abnormality is characterized as an emotionally devastating and profoundly stressful event for women because it involves making difficult reproductive choices such as continuation of pregnancy with no intervention, elective termination, or, in selected cases, experimental fetal therapy. This descriptive correlational study examined the relationships among women’s decisional conflict, anxiety, and coping strategies following a diagnosis of fetal abnormality. Fifty-five women who had a confirmed diagnosis of fetal abnormality prior to 24 weeks gestation were interviewed. Standardized instruments were used to obtain data on women’s decisional conflict, anxiety and coping strategies. Overall, women had low levels of total decisional conflict, but high levels of uncertainty in choice, moderately high levels of anxiety and used proportionately more emotion-focused than problem-focused coping strategies. Women who received a diagnosis of a lethal fetal abnormality had higher anxiety and uncertainty in choice than women who received a non-lethal diagnosis. Women’s level of anxiety and use of escape-avoidance coping also were found to be significant predictors of decisional conflict. The findings of this study provide a deeper understanding of the decision dilemma and the pattern of coping as important factors affecting women’s resolution of the decisional conflict following diagnosis of fetal abnormality.