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Johnson B, Shakes P, Maylea C. Prenatal testing technologies in Australia: Unintended clinical and emotional complexities in underprepared systems. Soc Sci Med 2024; 361:117368. [PMID: 39353224 DOI: 10.1016/j.socscimed.2024.117368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 09/05/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024]
Abstract
The past decade has seen technological advances in prenatal screening technologies rapidly integrated into clinical practice. These technologies have revolutionised healthcare and raised complex socio-ethical issues such as equitable access, medical commercialisation, and new eugenics. However, the important issue of the impact of these technologies on healthcare professionals is receiving less attention. Exploring this issue in the Australian context, we conducted a survey from August to November 2022, targeting health and allied health professionals who work with parents in the perinatal period who have received a fetal diagnosis. We received 75 substantive responses from a diversity of professionals, including sonographers, midwives, genetic counsellors and medical providers. In this article, we consider the unintended impacts of prenatal screening technologies on healthcare workers, drawing from Ziebland et al., 's 2021 unintended consequences framework. Our reflexive thematic analysis produced three key themes: "Unintended Clinical Complexities", "Adapting Work Practices to Keep Up in Systems that Lack", and "Unintended Intensification of Emotional Labour". Prenatal testing technologies have intentionally increased early testing and fetal information, offering veiled promises of increased certainty in pregnancy. However, our analysis highlights that these advancing technologies also generate more ambiguous results, creating unintended clinical and emotional complexities for healthcare providers. Workers must manage increased clinical uncertainty and constant change, creating intensified emotional labour in under-prepared systems. We conclude by identifying the need to recognise the impacts of advancing prenatal screening technologies on healthcare workers and for targeted professional training to prepare healthcare professionals for the complexities introduced by these new technologies.
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Affiliation(s)
- Belinda Johnson
- RMIT University, GPO Box 2476, Melbourne VIC 3001 Australia.
| | - Pieta Shakes
- James Cook University, 1 James Cook Drive, QLD 4811 Australia.
| | - Chris Maylea
- La Trobe University, 5 the Agora, Bundoora VIC 3083, Australia.
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Mogren I, Thi Lan P, Phuc HD, Holmlund S, Small R, Ntaganira J, Sengoma JPS, Kidanto HL, Ngarina M, Bergström C. Vietnamese health professionals' views on the status of the fetus and maternal and fetal health interests: A regional, cross-sectional study from the Hanoi area. PLoS One 2024; 19:e0310029. [PMID: 39259744 PMCID: PMC11389908 DOI: 10.1371/journal.pone.0310029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
Obstetric ultrasound is an important tool in managing pregnancies and its use is increasing globally. However, the status of the pregnant woman and the fetus may vary in terms of clinical management, views in the community and legislation. To investigate the views and experiences of Vietnamese health professionals on maternal and fetal health interests, priority setting and potential conflicts, we conducted a cross-sectional study using a structured questionnaire. Obstetricians/gynecologists, midwives and sonographers who manage pregnant women in maternity wards were invited to participate. We purposively chose public health facilities in the Hanoi region of Vietnam to obtain a representative sample. The final sample included 882 health professionals, of which 32.7% (n = 289) were obstetricians/gynecologists, 60.7% (n = 535) midwives and 6.6% (n = 58) sonographers. The majority of participants (60.3%) agreed that "The fetus is a person from the time of conception" and that maternal health interests should always be prioritised over fetal health interests in care provided (54.4%). 19.7% agreed that the fetus is never a patient, only the pregnant woman can be the patient, while 60.5% disagreed. Participants who performed ultrasounds were more likely to agree that fetal health interests are being given more weight in decision-making the further the gestation advances compared to those who did not perform ultrasounds (cOR 2.47, CI 1.27-4.79: n = 811). A significant proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. While the fetus is often considered a patient with its own health interests, a majority of participants did give priority to maternal health interests. Health professionals appear to favour increased legal protection of the fetus. Strengthening the legal status of the fetus might have adverse implications for maternal autonomy. Measures to restrict maternal autonomy might require close observation to ensure that maternal reproductive rights are protected.
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Affiliation(s)
- Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Ho Dang Phuc
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Skelton E, Webb R, Malamateniou C, Rutherford M, Ayers S. The impact of antenatal imaging on parent experience and prenatal attachment: a systematic review. J Reprod Infant Psychol 2024; 42:22-44. [PMID: 35736666 DOI: 10.1080/02646838.2022.2088710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Medical imaging in pregnancy (antenatal imaging) is routine. However, the effect of seeing fetal images on the parent-fetal relationship is not well understood, particularly for fathers or partners, or when using advanced imaging technologies. This review aimed to explore how parent experience and prenatal attachment is impacted by antenatal imaging. METHOD Database searches were performed between September 2020 and April 2021 Inclusion criteria were English language primary research studies published since 2000, describing or reporting measures of attachment after antenatal imaging in expectant parents. The Pillar Integration Process was used for integrative synthesis. FINDINGS Twenty-three studies were included. Six pillar themes were developed: 1) the scan experience begins before the scan appointment; 2) the scan as a pregnancy ritual; 3) feeling actively involved in the scan; 4) parents' priorities for knowledge and understanding of the scan change during pregnancy; 5) the importance of the parent-sonographer partnership during scanning; and 6) scans help to create a social identity for the unborn baby. CONCLUSION Antenatal imaging can enhance prenatal attachment. Parents value working collaboratively with sonographers to be actively involved in the experience. Sonographers can help facilitate attachment by delivering parent-centred care tailored to parents' emotional and knowledge needs.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, City University of London, London, UK
| | - Rebecca Webb
- Centre for Maternal and Child Health Research, City University of London, London, UK
| | | | | | - Susan Ayers
- Centre for Maternal and Child Health Research, City University of London, London, UK
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Tatterton MJ, Fisher MJ, Storton H, Walker C. The role of children's hospices in perinatal palliative care and advance care planning: The results of a national British survey. J Nurs Scholarsh 2022. [DOI: 10.1111/jnu.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Michael J. Tatterton
- School of Nursing and Healthcare Leadership, Faculty of Health Studies University of Bradford Bradford UK
- Bluebell Wood Children's Hospice North Anston UK
- International Children's Palliative Care Network c/o Together for Short Lives Bristol UK
| | - Megan J. Fisher
- School of Nursing and Healthcare Leadership, Faculty of Health Studies University of Bradford Bradford UK
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Roro MA, Aredo AD, Kebede T, Estifanos AS. Enablers and barriers to introduction of obstetrics ultrasound service at primary care facilities in a resource-limited setting: a qualitative study in four regions of Ethiopia. BMC Pregnancy Childbirth 2022; 22:278. [PMID: 35366824 PMCID: PMC8976309 DOI: 10.1186/s12884-022-04609-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The World Health Organization (WHO) recommends a minimum of eight ANC contacts during pregnancy, of which having one ultrasound examination before 24 weeks of gestation is indicated. Ultrasound plays a significant role in the surveillance and management of high-risk pregnancies. However, the obstetric ultrasound coverage in resource limited settings remains low. Evidence examining the barriers and facilitators to obstetrics ultrasound use in a resource-limited setting like Ethiopia is lacking. This qualitative study explored the facilitators and barriers to introducing obstetric Vscan Access ultrasound in primary health care facilities in Ethiopia.
Methods
The study employed a qualitative descriptive exploratory study design using in-depth interviews (IDIs) and focus group discussions (FGDs). The study participant were mothers who have had recent birth, community members, maternal and newborn service providers, and their managers. We employed an inductive thematic analysis to analyze the data.
Result
We conducted a total of ten FGDs, three with community members and seven with maternal and newborn service providers, and 52 IDIs with the service providers and health facility managers. Two major themes, health system related and client-related factors, emerged from the analysis. The health system related enablers include increased knowledge and skill of the providers, improved mothers and providers’ motivation, increased service utilization, and improved quality of maternal and newborn care (MNC), and enhanced referral system. The health system related barriers include service interruption, staff shortage/workload, and the providers’ limited capacity. Under the main theme of client-related factors, barriers include perceived limited knowledge and skills of providers and the small size of the ultrasound machine while the facilitators include mothers’ needs and interest in ultrasound scan, availability of free of charge ultrasound service, and increased demand for ultrasound scan service.
Conclusion
Our data suggest that the health system provides an enabling context to introduce limited obstetric ultrasound service and routinely provide the service through mid-level maternal care providers at primary health care level in resource limited settings. Overcoming the health system and client related barriers will maximize and sustain the use of the technology.
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Moncrieff G, Finlayson K, Cordey S, McCrimmon R, Harris C, Barreix M, Tunçalp Ö, Downe S. First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers. PLoS One 2021; 16:e0261096. [PMID: 34905561 PMCID: PMC8670688 DOI: 10.1371/journal.pone.0261096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.
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Affiliation(s)
- Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Kenneth Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Sarah Cordey
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebekah McCrimmon
- School of Health and Community Studies, University of Central Lancashire, Preston, United Kingdom
| | - Catherine Harris
- Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
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Werner H, Castro P, Lopes J, Ribeiro G, Araujo Júnior E. Maternal-fetal physical model: image fusion obtained by white light scanner and magnetic resonance imaging. J Matern Fetal Neonatal Med 2020; 35:4427-4430. [PMID: 33207976 DOI: 10.1080/14767058.2020.1850682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physical fetal models developed from three-dimensional (3D) ultrasound or magnetic resonance imaging (MRI) scan data may be used for medical education purposes, for parental counseling/multidisciplinary team management and to improve the maternal-fetal attachment (MFA) in blind pregnant women. PURPOSE We proposed a new technique to create a maternal-fetal physical model by using MRI scan data to improve the MFA. METHODS For the construction of the maternal-fetal physical model, two different processes were used. For the internal part of the maternal-fetal physical model, we used the segmentation and the 3D reconstruction made from the MRI scan data, and for the outside, we performed 3D scanning by using a white light scanner. After obtaining the 3D models, we used a registration tool to position them in alignment. CONCLUSION Maternal-fetal physical models improve the MFA by using both tactile and visual sensations of the pregnant woman and her fetus.
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Affiliation(s)
- Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Pedro Castro
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Jorge Lopes
- Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Gerson Ribeiro
- Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.,Medical course, Municipal University of São Caetano do Sul (USCS), São Paulo, Brazil
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Reiso M, Langli B, Sommerseth E, Johannessen A. A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway. BMC Pregnancy Childbirth 2020; 20:641. [PMID: 33087091 PMCID: PMC7579829 DOI: 10.1186/s12884-020-03333-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Performing obstetric ultrasound is part of midwifery practice in Norway. Knowledge of these midwives' working situation can enhance understanding of what their work involves and the challenges they encounter in their practice. The aim of this study was to gain insight into how midwife sonographers perceive their work in obstetric ultrasound. METHODS A qualitative study with individual interviews was conducted in 2018. Midwives (n = 13) with a postgraduate ultrasound qualification who performed obstetric ultrasound in private clinics and/or the public health sector were included. All four regional health authorities in Norway were represented. The data gathered were analysed using content analysis. RESULTS The analysis resulted in three main themes. (1) Working as a midwife sonographer involves a holistic approach. By practising their competence, in both midwifery and sonography, they could answer questions and reassure pregnant women. The participants also had a feeling of great responsibility in their work. (2) Being part of a professional environment in obstetric ultrasound was important for professional interaction, belonging and learning. (3) Developing and maintaining competence as a midwife sonographer had a positive influence on midwives' motivation and confidence, and allowed for more variety in their work. CONCLUSIONS Holistic care of the pregnant woman, her partner and the unborn baby was an important part of the participants' work. They wanted to meet colleagues within their field, develop their expertise and have influence over their work situation. Organizational factors seemed to affect the participants' overall ability to practise their skills and thus also their job satisfaction.
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Affiliation(s)
- Magnhild Reiso
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, NO-7491, Trondheim, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway.
| | - Berit Langli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, NO-7491, Trondheim, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway
| | - Eva Sommerseth
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway
| | - Aud Johannessen
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway
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Lou S, Petersen OB, Lomborg K, Vogel I. How do geneticists and prospective parents interpret and negotiate an uncertain prenatal genetic result? An analysis of clinical interactions. J Genet Couns 2020; 29:1221-1233. [PMID: 32453502 DOI: 10.1002/jgc4.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
Variants of unknown significance (VUS) and susceptibility loci (SL) are a challenge in prenatal genetic counseling. The aim of this study was to explore how such uncertain genetic results are communicated, negotiated, and made meaningful by genetics healthcare providers and couples in the actual clinical setting where results are delivered. The study was based on an anthropological approach and the material consisted of observations and audio-recordings from 16 purposively sampled genetic counseling sessions where prenatal testing had identified an inherited or de novo VUS or SL result. Field notes and transcripts from audio-recordings were analyzed using thematic analysis. The analysis identified a number of specific interpretations and strategies that clinical geneticists and couples collectively used for dealing with the ambiguity of the result. Thus, the analysis resulted in a total of three themes, each with 3-4 subthemes. The theme 'Setting the scene' describes the three-stage structure of the consultation. The theme 'Dealing with uncertainty' includes 'normalizing strategies' that emphasized the inherent uncertainty in human life in general and 'contextualizing strategies' that placed the result in relation to the surrounding society, where technological developments lead to new and unforeseen challenges. The theme 'Regaining control' includes interpretations that made the knowledge useful by focusing on the value of being prepared for potential, future challenges. Other strategies were to book an extra scan-to reconfirm fetal structural health and to reconnect to the pregnancy. Finally, inquiring about the sex was clearly a way for the couple to signal their investment in the pregnancy. Based on the analysis, we propose that these interpretations served to transform and reduce ambiguity through a process of reconfiguring the biomedical information into knowledge that resonated with the couples' lifeworlds. In this process, both geneticist and couples drew on wider social and moral concerns about uncertainty and responsibility.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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Harris KW, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Uncertainty of Prenatally Diagnosed Congenital Heart Disease: A Qualitative Study. JAMA Netw Open 2020; 3:e204082. [PMID: 32369178 PMCID: PMC7201310 DOI: 10.1001/jamanetworkopen.2020.4082] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Parents who receive a prenatal diagnosis of congenital heart disease may experience more short- and long-term stress than those who receive a postnatal diagnosis. To identify potential interventions to ameliorate that stress, the longitudinal emotional experience of parents must first be understood. OBJECTIVE To better understand parents' accounts of their own prenatal experience, particularly aspects they found to be stressful or challenging, and to identify strategies to improve support. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included analysis of transcripts of audio recorded telephone interviews with pregnant mothers and their support persons, as applicable, who were referred to and seen at the Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May 2019 to August 2019 with an initial likely diagnosis of complex congenital heart disease at any gestational age. Data analysis was conducted from August 2019 to November 2019. MAIN OUTCOMES AND MEASURES An applied thematic analysis approach was used to code and analyze professionally transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was assessed and confirmed routinely. One author coded all transcripts; a second author independently reviewed one-fifth of the transcripts at fixed intervals to ensure that interrater reliability remained greater than 80%. RESULTS Twenty-seven individuals from 17 families participated in 42 phone interviews during pregnancy, 27 conducted at the first time point after the initial prenatal cardiology consultation and 15 at the second time point after a follow-up prenatal cardiology visit. Most interviewees were mothers (16 interviewees [59%]; median [interquartile range] age, 30.0 [27.3-34.8] years) or fathers (8 interviewees [30%)], with a few support individuals (3 interviewees [11%]) (median [interquartile range] age of family member or support individual, 30.0 [26.0-42.0] years). Initial fetal diagnoses included a range of severe congenital heart disease. Uncertainty was identified as a pervasive central theme and was related both to concrete questions on scheduling, logistics, or next steps, and long-term unknown variables concerning the definitiveness of the diagnosis or overall prognosis. Practitioners helped families through their framing of uncertainty at various time points including before, during, and after the clinic visit. CONCLUSIONS AND RELEVANCE Families walk an uncertain path following a fetal diagnosis of severe congenital heart disease. The challenges faced by the cardiologists caring for them overlap in many ways with those experienced by pediatric palliative care practitioners. Potential future interventions to improve parental support were identified in the areas of expectation setting before the referral visit, communication in clinic, and identity formation after the new diagnosis.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
- School of Law, Vanderbilt University, Nashville, Tennessee
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Wadrup F, Holden S, MacLeod R, Miedzybrodzka Z, Németh AH, Owens S, Pasalodos S, Quarrell O, Clarke AJ. A case-note review of continued pregnancies found to be at a high risk of Huntington's disease: considerations for clinical practice. Eur J Hum Genet 2019; 27:1215-1224. [PMID: 30890781 DOI: 10.1038/s41431-019-0375-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/17/2018] [Accepted: 02/02/2019] [Indexed: 11/09/2022] Open
Abstract
Huntington's disease (HD) is a severe neurodegenerative condition that impacts the whole family. Prenatal diagnosis by direct or exclusion testing is available for couples at risk of transmitting HD to their children. An ethical problem can arise after prenatal diagnosis for HD if a known 'high risk' pregnancy is continued to term: international guidelines emphasise that this situation should be avoided where possible, as it removes the resulting child's future right to make an informed, autonomous decision about predictive testing. The UK Huntington's Disease Predictive Testing Consortium recorded 21 pregnancies that were tested, identified as high-risk and then continued. In this qualitative study, health professionals reviewed the case notes of 15 of these pregnancies. This analysis generated guidelines for clinical practice. It is recommended that practitioners: (i) remind couples of the long-term consequences of continuing a high risk pregnancy, (ii) ensure couples understand the information provided, (iii) collaborate closely with other professionals involved in the couple's prenatal care, (iv) prepare couples for the procedural aspects of prenatal diagnosis and a possible termination of pregnancy, (v) allow time for in-depth pre-test counselling, (vi) explain the rationale for only making prenatal diagnosis available subject to conditions, whilst allowing for human ambivalence and acknowledging that these 'conditions' cannot be enforced, (vii) monitor the whole clinical process to ensure that it works 'smoothly', (viii) recommend couples do not disclose the result of the prenatal test to protect the confidentiality and autonomy of the future 'high-risk' child, and (ix) offer on-going contact and support.
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Affiliation(s)
- Felicity Wadrup
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon Holden
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Academic Department of Medical Genetics, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Rhona MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Zosia Miedzybrodzka
- University of Aberdeen College of Life Sciences and Medicine, Division of Applied Medicine, Aberdeen, UK.,NHS Grampian Clinical Genetics Service, Medical Genetics, Aberdeen, UK
| | - Andrea H Németh
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shan Owens
- Hywel Dda UHB (Milford Haven Health Care Centre, Yorke St, Milford Haven, Pembrokeshire, Wales, UK.,All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Sara Pasalodos
- Genomic Medicine Unit, Navarrabiomed, Biomedical Research Centre, Pamplona, Spain
| | - Oliver Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, OPD II Northern General Hospital, Herries Road, Sheffield, UK
| | - Angus J Clarke
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK.
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Åhman A, Edvardsson K, Fagerli TA, Darj E, Holmlund S, Small R, Mogren I. A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound. BMC Pregnancy Childbirth 2019; 19:33. [PMID: 30651083 PMCID: PMC6335783 DOI: 10.1186/s12884-019-2178-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 01/04/2019] [Indexed: 02/03/2023] Open
Abstract
Background Midwives are the main providers of routine antenatal care services including the routine ultrasound examination in Norway. The ultrasound examination can be perceived by expectant parents not only as a medical examination but also as a social event facilitating attachment to their fetus. This study explores Norwegian midwives’ experiences and views on the role of ultrasound in clinical management of pregnancy. Methods A qualitative study design was applied. Twenty-four midwives who all performed obstetric ultrasound examinations were recruited for focus group discussions and individual interviews. Data collection took place in 2015 in five hospitals in two different regions of Norway. Data were analyzed using qualitative content analysis. Results Midwives described obstetric ultrasound examinations as very valuable although doing ultrasounds placed high demands on their operational and counselling skills. Increasing requests for ultrasound from pregnant women were mentioned. Advancements in ultrasound diagnosis were considered to have put the fetus in the position of a patient, and that pregnant women declining ultrasound could be viewed as irresponsible by some health professionals. Ethical concerns were raised regarding the possibility of pregnancy termination when fetal anomalies were detected. Fears were also expressed that prenatal diagnoses including those following ultrasound, might create a society where only ‘perfect’ children are valued. However, participants stressed that their intention in performing ultrasound was to optimize pregnancy outcome and thereby assist expectant couples and their unborn children. Conclusions Midwives in Norwegian maternity care services describe obstetric ultrasound as very valuable, playing a central role in pregnancy management by optimizing pregnancy outcomes. Although high demands are placed on operators’ technical skills and counseling, midwives described performing obstetric ultrasound as very satisfying work. However, midwives believed that expectant parents’ approach to the ultrasound examination, both its medical value and the precious images obtained of the fetus, could put extra strain on the midwives performing ultrasounds. The potential of ultrasound to detect fetal anomalies and the possibility that this may lead to termination of pregnancy, seemed to create some ambivalent feelings in midwives towards its use. Electronic supplementary material The online version of this article (10.1186/s12884-019-2178-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden. .,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Tove Anita Fagerli
- National Center for Fetal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Darj
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.,Reproductive Health, Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
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Buyukbayrak EE, Soysal S, Anik Ilhan G, Yavuzer O. What do expectant parents know about antenatal ultrasound screening? J Matern Fetal Neonatal Med 2018; 33:1811-1817. [PMID: 30261776 DOI: 10.1080/14767058.2018.1530209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: We aimed to investigate and compare the background knowledge and attitudes of pregnant women and their partners about antenatal ultrasound scans.Materials and methods: A cross-sectional survey was conducted in a university perinatology clinic. Pregnant women and their partners who underwent the first trimester ultrasound scan or the second trimester anomaly scan were invited to complete a questionnaire which contained items on their sociodemographic characteristics, knowledge, and attitude.Results: In total, 500 eligible expectant mothers and their partners (220 in the first trimester and 280 in the second trimester) were recruited. The knowledge and attitude of expectant mothers and fathers were statistically similar. Working status, education level, and presence of chronic disease were the factors affecting the number of correct answers in both expectant mothers and fathers. The knowledge levels of both the expectant mothers and fathers were similar in the first and second trimesters.Conclusions: Pregnant women's and their partners' attitudes and knowledge on antenatal ultrasound scans were similar and generally satisfactory.
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Affiliation(s)
- Esra Esim Buyukbayrak
- Marmara University Medical Faculty, Department of Obstetrics and Gynecology, Pendik Education and Training Hospital, Istanbul, Turkey
| | - Sunullah Soysal
- Marmara University Medical Faculty, Department of Obstetrics and Gynecology, Pendik Education and Training Hospital, Istanbul, Turkey
| | - Gokce Anik Ilhan
- Marmara University Medical Faculty, Department of Obstetrics and Gynecology, Pendik Education and Training Hospital, Istanbul, Turkey
| | - Ozlem Yavuzer
- Marmara University Medical Faculty, Department of Obstetrics and Gynecology, Pendik Education and Training Hospital, Istanbul, Turkey
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Emotional Effect of the Loss of One or Both Fetuses in a Monochorionic Twin Pregnancy. J Obstet Gynecol Neonatal Nurs 2018; 47:137-145. [DOI: 10.1016/j.jogn.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/18/2022] Open
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Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:1-5. [PMID: 29804752 DOI: 10.1016/j.srhc.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/19/2017] [Accepted: 12/31/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. MATERIAL AND METHODS This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. RESULTS The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. CONCLUSION The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.
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Edvardsson K, Åhman A, Fagerli TA, Darj E, Holmlund S, Small R, Mogren I. Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management. A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:69-76. [PMID: 29389504 DOI: 10.1016/j.srhc.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/27/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. METHODS A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. 'The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. CONCLUSION This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.
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Affiliation(s)
- Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Tove Anita Fagerli
- National Center for Fetal Medicine, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway.
| | - Elisabeth Darj
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway; Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden.
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
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Larsson M, Berglund M, Jarl E, Tydén T. Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection? Ups J Med Sci 2017; 122:254-259. [PMID: 29299974 PMCID: PMC5810230 DOI: 10.1080/03009734.2017.1408723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. METHODS A longitudinal survey in early and late pregnancy among 2393 women in Sweden. RESULTS Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. CONCLUSIONS Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.
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Affiliation(s)
- Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Sweden
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Vinayak S, Sande J, Nisenbaum H, Nolsøe CP. Training Midwives to Perform Basic Obstetric Point-of-Care Ultrasound in Rural Areas Using a Tablet Platform and Mobile Phone Transmission Technology-A WFUMB COE Project. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2125-2132. [PMID: 28716434 DOI: 10.1016/j.ultrasmedbio.2017.05.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 05/09/2023]
Abstract
Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, review of images by a radiologist, communication between midwife and radiologist, use of this technique to identify high-risk patients and improvement of the education and teleradiology model components. The midwives had no previous experience in ultrasound. They were stationed in rural locations where POCUS was available for the first time. After scanning the patients, an interim report was generated by the midwives and sent electronically together with all images to the main hospital for validation. Unique software was used to send lossless images by mobile phone using a modem. Transmission times were short and quality of images transmitted was excellent. All reports were validated by two experienced radiologists in our department and returned to the centers using the same transmission software. The transmission times, quality of scans, quality of reports and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 min but reduced to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the pregnancies and diagnoses on the basis of reports generated by the midwives. Only 1 discrepancy was found in the midwives' reports. Scan results versus actual outcomes revealed 2 discrepancies in the 20 patients identified as high risk. In conclusion, we found that it is valuable to train midwives in POCUS to use an ultrasound tablet device and transmit images and reports via the internet to radiologists for review of accuracy. This focus on the identification of high-risk patients can be valuable in a remote healthcare facility.
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Affiliation(s)
- Sudhir Vinayak
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya.
| | - Joyce Sande
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Harvey Nisenbaum
- Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Christian Pállson Nolsøe
- Department of Abdominal Surgery and Gastroenterology, Ultrasound Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Lou S, Jensen LG, Petersen OB, Vogel I, Hvidman L, Møller A, Nielsen CP. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies. Prenat Diagn 2017; 37:731-743. [DOI: 10.1002/pd.5093] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/24/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
| | - Lotte Groth Jensen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Olav Bjørn Petersen
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ida Vogel
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Møller
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Department of Public Health; Aarhus University; Aarhus Denmark
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Thomas GM, Roberts J, Griffiths FE. Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:893-907. [PMID: 28326555 DOI: 10.1111/1467-9566.12554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The premise that ultrasound technologies provide reassurance for pregnant women is well-rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals' practices.
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Affiliation(s)
| | - Julie Roberts
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
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Holmlund S, Ntaganira J, Edvardsson K, Lan PT, Semasaka Sengoma JP, Åhman A, Small R, Mogren I. Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives' experiences and views of obstetric ultrasound. Glob Health Action 2017; 10:1350451. [PMID: 28764602 PMCID: PMC5645676 DOI: 10.1080/16549716.2017.1350451] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed. OBJECTIVES To explore Rwandan midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects. METHODS A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed. CONCLUSIONS Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda. RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institute, Sweden.
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Affiliation(s)
- Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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