Genetic counseling -- the postcounseling period: II. Making reproductive choices

Qualitative analysis of transcripts of follow-up interviews with 53 parents who had had genetic counseling was undertaken to characterize the process by which childbearing decisions were made and to determine how counselees resolved the problems created by being at risk. Although specific issues to be resolved varied with a parent's perception of his or her situation, all those who considered having subsequent children attempted to limit the uncertainties they faced and to neutralize those consequences perceived as most problematic. To do so, counselees uniformly inferred from factual information and experiences available to them how they could manage the possible consequences of taking a chance. Factors influencing a parent's ability to make a clear decision included the presence of a previous normal child, the diffusion of decision-making responsibility to others, and recognition that one had already managed the worst. When these "facts" could not be processed to provide a sense of coping, parents either decided against reproduction and took appropriate action or made a "non-decision" about reproduction by choosing to leave conception to chance. These various tactics allowed parents to create a "least-lose" option in terms of their child-bearing choices. This analysis of how parents make reproductive decisions, along with previous findings, suggests that being at risk both creates common problems and elicits common responses from counselees. Moreover, it highlights the importance of recognizing parents' perceptions of their situation to understand how their deliberations are structured and how factual information influences their ultimate choices.