Prenatal counselling and associated tests have become routine parts of prenatal care in many countries (Reid, 1990). The main intentions are to offer women the choice about whether to continue with a pregnancy when a fetus is impaired, and to contribute to reducing the incidence of disability with its attendant distresses and costs (HTA, 1998). This chapter reviews contrasting views about prenatal counselling, its advantages and disadvantages. Medical and counselling images of disability are compared with the views of adults who have conditions that are tested for prenatally. The evidence poses questions for bioethical reflection about the nature of disability (is it mainly physical impairment or social restrictions?) and about the possible impact of prenatal screening and counselling on maternal–fetal relationships. These questions include not only personal, mother–child relationships, but also the way that parenting generally, like pregnancy, may be becoming tentative and provisional, instead of the unconditional acceptance of the child as ‘a gift of God’ common in traditional rhetoric, at least, if not in practice.

Prenatal counselling

Prenatal testing and counselling have expanded since prenatal diagnosis of Down's syndrome, thalassaemia and sickle cell anaemia began through amniocentesis in the late 1960s. Chorionic villus sampling (cvs), another diagnostic test which also draws fetal material from within the maternal abdomen, has since been developed.