A routine tool with far-reaching influence: Australian midwives’ views on the use of ultrasound during pregnancy

BMC Pregnancy and Childbirth

Rhonda Small²  Margareta Persson¹  Ann Lalos³  Ingrid Mogren³  Kristina Edvardsson² 

[1] Department of Nursing, Umeå University, Umeå SE 901 87, Sweden;Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne 3000, Vic, Australia;Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, SE 901 87, Sweden

关键词: Qualitative studies;    Prenatal diagnosis;    Pregnant women;    Obstetrics;    Obstetric ultrasound;    Maternal rights;    Fetus;    Ethics;    Midwives;   

Others  :  1222840
DOI  :  10.1186/s12884-015-0632-y

 received in 2015-02-17, accepted in 2015-08-21,  发布年份 2015

【 摘 要 】

Background

Ultrasound is a tool of increasing importance in maternity care. Midwives have a central position in the care of pregnant women. However, studies regarding their experiences of the use of ultrasound in this context are limited. The purpose of this study was to explore Australian midwives’ experiences and views of the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and situations where maternal and fetal health interests conflict.

Methods

A qualitative study was undertaken in Victoria, Australia in 2012, based on six focus group discussions with midwives (n = 37) working in antenatal and intrapartum care, as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis.

Results

One overarching theme emerged from the analysis: Obstetric ultrasound – a routine tool with far-reaching influence, and it was built on three categories. First, the category‘Experiencing pros and cons of ultrasound’ highlighted that ultrasound was seen as having many advantages; however, it was also seen as contributing to increased medicalisation of pregnancy, to complex and sometimes uncertain decision-making and to parental anxiety. Second, ‘Viewing ultrasound as a normalised and unquestioned examination’ illuminated how the use of ultrasound has become normalised and unquestioned in health care and in wider society. Midwives were concerned that this impacts negatively on informed consent processes, and at a societal level, to threaten acceptance of human variation and disability. Third, ‘Reflecting on the fetus as a person in relation to the pregnant woman’ described views on that ultrasound has led to increased ‘personification’ of the fetus, and that women often put fetal health interests ahead of their own.

Conclusions

The results reflect the significant influence ultrasound has had in maternity care and highlights ethical and professional challenges that midwives face in their daily working lives concerning its use. Further discussion about the use of ultrasound is needed, both among health professionals and in the community, in order to protect women’s rights to informed decision-making and autonomy in pregnancy and childbirth and to curb unnecessary medicalisation of pregnancy. Midwives’ experiences and views play an essential role in such discussions.

【 授权许可】

   
2015 Edvardsson et al.

【 参考文献 】

• [1]Sippel S, Muruganandan K, Levine A, Shah S. Review article: use of ultrasound in the developing world. Int J Emerg Med. 2011; 4:72. BioMed Central Full Text
• [2]United Nations Population Fund (UNFPA). The state of the world’s midwifery. A universal pathway. A woman’s right to health. New York: UNFPA; 2014.
• [3]Molander E, Alehagen S, Bertero CM. Routine ultrasound examination during pregnancy: a world of possibilities. Midwifery. 2010; 26(1):18-26.
• [4]Stein W, Katunda I, Butoto C. A two-level ultrasonographic service in a maternity care unit of a rural district hospital in Tanzania. Trop Doct. 2008; 38(2):125-6.
• [5]Kimberly HH, Murray A, Mennicke M, Liteplo A, Lew J, Bohan JS, Tyer-Viola L, Ahn R, Burke T, Noble VE. Focused maternal ultrasound by midwives in rural Zambia. Ultrasound Med Biol. 2010; 36(8):1267-72.
• [6]Swanson JO, Kawooya MG, Swanson DL, Hippe DS, Dungu-Matovu P, Nathan R. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol. 2014; 34(7):508-12.
• [7]Stevens G, Thompson R, Kruske S, Watson B, Miller YD. What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports. Patient Educ Couns. 2014; 97(1):114-21.
• [8]Chew C, Halliday JL, Riley MM, Penny DJ. Population-based study of antenatal detection of congenital heart disease by ultrasound examination. Ultrasound Obstet Gynecol. 2007; 29(6):619-24.
• [9]Garcia J, Bricker L, Henderson J, Martin MA, Mugford M, Nielson J, Roberts T. Women’s views of pregnancy ultrasound: a systematic review. Birth. 2002; 29(4):225-50.
• [10]Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T, Martin MA. Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women’s views. Health Technol Assess. 2000; 4(16):i-vi.
• [11]Edvardsson K, Small R, Persson M, Lalos A, Mogren I. ‘Ultrasound is an invaluable third eye, but it can’t see everything’: a qualitative study with obstetricians in Australia. BMC Pregnancy Childbirth. 2014; 14:363. BioMed Central Full Text
• [12]Saumure K, Given LM. Data saturation. In: The SAGE Encyclopedia of Qualitative Research Methods. Given LM, editor. SAGE Publications, Los Angeles; 2008: p.196-7.
• [13]Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2):105-12.
• [14]Soltani H, Sandall J. Organisation of maternity care and choices of mode of birth: a worldwide view. Midwifery. 2012; 28(2):146-9.
• [15]Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ. 2002; 324(7342):892-5.
• [16]Patterson JA, Roberts CL, Ford JB, Morris JM. Trends and outcomes of induction of labour among nullipara at term. Aust N Z J Obstet Gynaecol. 2011; 51(6):510-7.
• [17]Hilder L, Zhichao Z, Parker M, Jahan S, GM C. Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69. AIHW, Canberra; 2014.
• [18]Nursing and Midwifery Board of Australia. National competency standards for the midwife. Melbourne: Nursing and Midwifery Board of Australia; 2006.
• [19]Hood L, Fenwick J, Butt J. A story of scrutiny and fear: Australian midwives’ experiences of an external review of obstetric services, being involved with litigation and the impact on clinical practice. Midwifery. 2010; 26(3):268-85.
• [20]Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004; 180(6 Suppl):S57-60.
• [21]de Jong-Pleij EA, Ribbert LS, Pistorius LR, Tromp E, Mulder EJ, Bilardo CM. Three-dimensional ultrasound and maternal bonding, a third trimester study and a review. Prenat Diagn. 2013; 33(1):81-8.
• [22]Sedgmen B, McMahon C, Cairns D, Benzie RJ, Woodfield RL. The impact of two-dimensional versus three-dimensional ultrasound exposure on maternal-fetal attachment and maternal health behavior in pregnancy. Ultrasound Obstet Gynecol. 2006; 27(3):245-51.
• [23]Pretorius DH, Gattu S, Ji EK, Hollenbach K, Newton R, Hull A, Carmona S, D’Agostini D, Nelson TR. Preexamination and postexamination assessment of parental-fetal bonding in patients undergoing 3-/4-dimensional obstetric ultrasonography. J Ultrasound Med. 2006; 25(11):1411-21.
• [24]Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2013; 11:CD007529.
• [25]Redshaw M, Henderson J. Fathers’ engagement in pregnancy and childbirth: evidence from a national survey. BMC Pregnancy Childbirth. 2013; 13:70. BioMed Central Full Text
• [26]Dahl K, Kesmodel U, Hvidman L, Olesen F. Informed consent: attitudes, knowledge and information concerning prenatal examinations. Acta Obstet Gynecol Scand. 2006; 85(12):1414-9.
• [27]Garcia E, Timmermans DR, van Leeuwen E. Reconsidering prenatal screening: an empirical-ethical approach to understand moral dilemmas as a question of personal preferences. J Med Ethics. 2009; 35(7):410-4.
• [28]Ahman A, Runestam K, Sarkadi A. Did I really want to know this? Pregnant women’s reaction to detection of a soft marker during ultrasound screening. Patient Educ Couns. 2010; 81(1):87-93.
• [29]Potter BK, O’Reilly N, Etchegary H, Howley H, Graham ID, Walker M, Coyle D, Chorny Y, Cappelli M, Boland I et al.. Exploring informed choice in the context of prenatal testing: findings from a qualitative study. Health Expect. 2008; 11(4):355-65.
• [30]Gregg R. “Choice” as a double-edged sword: information, guilt and mother-blaming in a high-tech age. Women Health. 1993; 20(3):53-73.
• [31]Liamputtong P, Watson L. The voices and concerns about prenatal testing of Cambodian, Lao and Vietnamese women in Australia. Midwifery. 2002; 18(4):304-13.
• [32]Berg SF, Paulsen OG, Carter BS. Why were they in such a hurry to see her die? Am J Hosp Palliat Care. 2013; 30(4):406-8.
• [33]Guon J, Wilfond BS, Farlow B, Brazg T, Janvier A. Our children are not a diagnosis: the experience of parents who continue their pregnancy after a prenatal diagnosis of trisomy 13 or 18. Am J Med Genet A. 2014; 164A(2):308-18.
• [34]Janvier A, Farlow B, Wilfond BS. The experience of families with children with trisomy 13 and 18 in social networks. Pediatrics. 2012; 130(2):293-8.
• [35]Farlow B. Choosing the road less traveled. Curr Probl Pediatr Adolesc Health Care. 2011; 41(4):115-6.
• [36]Walker LV, Miller VJ, Dalton VK. The health-care experiences of families given the prenatal diagnosis of trisomy 18. J Perinatol. 2008; 28(1):12-9.
• [37]Redlinger-Grosse K, Bernhardt BA, Berg K, Muenke M, Biesecker BB. The decision to continue: the experiences and needs of parents who receive a prenatal diagnosis of holoprosencephaly. Am J Med Genet. 2002; 112(4):369-78.
• [38]Chaplin J, Schweitzer R, Perkoulidis S. Experiences of prenatal diagnosis of spina bifida or hydrocephalus in parents who decide to continue with their pregnancy. J Genet Couns. 2005; 14(2):151-62.
• [39]Chandler M, Smith A. Prenatal screening and women’s perception of infant disability: a Sophie’s Choice for every mother. Nurs Inq. 1998; 5(2):71-6.
• [40]Zechmeister I. Foetal images: the power of visual technology in antenatal care and the implications for women’s reproductive freedom. Health Care Anal. 2001; 9(4):387-400.
• [41]Petchesky RP. Fetal images - the power of visual culture in the politics of reproduction. Feminist Stud. 1987; 13(2):263-92.
• [42]Kruske S, Young K, Jenkinson B, Catchlove A. Maternity care providers’ perceptions of women’s autonomy and the law. BMC Pregnancy Childbirth. 2013; 13:84. BioMed Central Full Text
• [43]Edvardsson K, Small R, Lalos A, Persson M, Mogren I. Ultrasound’s ‘window on the womb’ brings ethical challenges for balancing maternal and fetal health interests: obstetricians’ experiences in Australia. BMC Medical Ethics. 2015; 16:31. BioMed Central Full Text
• [44]Li Z, Zeki R, Hilder L, Sullivan E. Australia’s mothers and babies 2011. Perinatal statistics series no. 28. Cat. no. PER 59. AIHW, Canberra; 2013.
• [45]Curtis E, Redmond R. Focus groups in nursing research. Nurse Res. 2007; 14(2):25-37.