Table 2.
Recommended approach to pregnancy counseling in women with kidney failure
| Domain | Suggested approach |
|---|---|
| Timing | Raise potential motherhood as early as feasible to allow planning |
| Prospectively discuss the best window for pregnancy | |
| Allow sufficient time for evolution of discussions over multiple visits | |
| Review and revisit discussions at regular intervals | |
| Communication | Support the woman’s right to pursue pregnancy (or not) |
| Avoid making women defend their choices | |
| Avoid judgmental comments or “forbidding” pregnancy | |
| Explain risks without catastrophizing | |
| Provide hope where possible | |
| Identify and include any other key persons (partner, family) | |
| Provide reassurance that care will be given | |
| Patient values | Identify and acknowledge patient goals |
| Do not assume motherhood is desired by all | |
| Acknowledge grief related to limitations to motherhood | |
| Understand how fears are balanced with desire for parenthood | |
| Define external pressures, obligations and feelings of guilt | |
| Decision-making | Acknowledge the decisional burden |
| Identify how much decisional control women want | |
| Assess risk based on individual clinical context | |
| Understand how risks and decisions are rationalized | |
| Determine individual appetite for “risk” | |
| Facilitate autonomy and decisional ownership | |
| Adopt shared decision-making approaches | |
| Information | Identify how much information women want to have |
| Discuss maternal and fetal risks, long-term health impact, potential pregnancy outcomes, likely pregnancy management and progress | |
| Refer to other services (obstetrical, maternal-fetal medicine, genetic, reproductive medicine) for additional information and counseling | |
| Actively facilitate and address questions |