The influence of termination of pregnancy for foetal abnormality on subsequent reproductive decision-making

Termination of pregnancy for foetal anomaly (TOPFA) is a complex emotional journey characterised by different emotional responses. Parents may go through a period of grief and mourning after a perinatal loss, and their reaction can have a lasting effect and influence subsequent reproductive decisions.

We explored how reproductive decisions after TOPFA are made and how a rainbow pregnancy, a pregnancy after perinatal loss, is experienced by men and women. The objective was two-fold: first, to understand the prospective perceptions of participants following TOPFA, who still desire a pregnancy; and second, to analyse the retrospective perceptions of participants who successfully fulfilled their child wish. This study used a generic qualitative descriptive approach to understand the impact of TOPFA on reproductive decisions. In total, 20 semi-structured interviews were conducted with parents who experienced TOPFA between 15 and 33 weeks of gestation due to an unknown aetiology.

The emotional longing for a child was persistent. Although the decision-making process became more complex. Choosing for a subsequent pregnancy was no longer a carefree decision nor experience. Participants with an active desire to have children after TOPFA kept on searching for a positive experience. While those who fulfilled their desire to have children, still mentioned a continuing grieving process and a search for answers.

Reproductive decisions and the experience of a rainbow pregnancy after TOPFA are marked by previous existential perinatal experiences, and the previous loss remained present. Our results suggest that a tailored medical and psychosocial follow-up of pregnancies after TOPFA is crucial.