What the patient wants to know

Ideally, it should be couples who should be encouraged to discuss all of theimplications. Theadvicewill vary according to the pathology and the clinical setting. Nevertheless, the questions are straightforward: Should I get pregnant? Will my pregnancy be complicated? Will I have a live and healthy baby? Will I have problems after my pregnancy? The answers should be equally straightforward and must be based on fact, not on anecdote. Even if some of the answers are not favourable, many women will choose to go ahead for a pregnancy or with the pregnancy, in an effort to re-establish a normal life in the face of chronic illness. In some cases this may bring them into conflict with their medical advisers and indeed, some women do not seek advice until already pregnant. This may lead to ethical dilemmas regarding clinicians' duties of care towards women who ignore advice. Attempts are being made to differentiate 'healthy' and 'pathological' levels of assumed risk and to understand the psychology of women who pursue parenthood despite substantial risk to their own health and that of their unborn child.

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