Are Nonstress Tests Stressful? A Qualitative Study of Patient Perceptions of Antenatal Surveillance

INTRODUCTION: Antepartum fetal surveillance, including nonstress tests, is designed to reduce the incidence of stillbirth. Despite widespread use, there is limited data regarding its efficacy and shared decision-making is advised. Our objective was to evaluate pregnant women's understanding of the rationale for antepartum fetal surveillance and explore its impact.

METHODS: Seventeen subjects undergoing scheduled nonstress testing at a large medical center in Portsmouth, Virginia, USA were recruited for this qualitative study. Semi-structured interviews using a standardized guide were conducted and assessed using thematic analysis.

RESULTS: Review of the interview transcripts identified the emergence of five themes and nine subthemes. Several subjects highlighted logistical challenges and costs (both financial and nonfinancial) associated with more frequent visits. Participants referred for antenatal testing appear to have a narrow knowledge of its components, indications, and limitations and are unaware of the implications of abnormal results. Despite a high degree of uncertainty and costs incurred, most women were willing to undergo testing and generally found the process to be a source of comfort.

CONCLUSION: Our thematic analysis of participants' perceptions suggests that during antepartum fetal surveillance, shared decision-making either does not always occur or that it is not fully optimized. Efforts to improve this process could emphasize more open communication, providing patient-centered, evidence-based information, and actively incorporating individual narratives into the counseling processes.