Norwegian obstetricians’ experiences of the use of ultrasound in pregnancy management. A qualitative study

Edvardsson, Kristina; Fagerli, Tove Anita; Darj, Elisabeth; Holmlund, Sophia; Small, Rhonda; Mogren, Ingrid

doi:10.1016/j.srhc.2017.12.001

Cited by 11 publications

(30 citation statements)

References 31 publications

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“…The findings of the CROCUS study in Rwanda also demonstrated that health professionals not themselves performing ultrasounds have more liberal attitudes towards ultrasound use than health professionals performing these examinations 29. Health professionals sometimes fear that ‘routinisation’ of ultrasound as an unquestioned and integral part of pregnancy management can exert a negative impact on pregnant women’s informed consent, and that its increasing use for fetal examination may have consequences for how disability is viewed in society 25 26 30. The use of ultrasound may also reduce attention on important clinical parameters such as measurement of blood pressure and proteinuria 7 24.…”

Section: Discussionmentioning

confidence: 99%

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

et al. 2019

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ObjectivesObstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.DesignA cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study.SettingHealth facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam.ParticipantsParticipants were 289 obstetricians/gynaecologists and 535 midwives.ResultsA majority (88%) of participants agreed that ‘every woman should undergo ultrasound examination’ during pregnancy to determine gestational age. Participants reported an average of six ultrasound examinations as medically indicated during an uncomplicated pregnancy. Access to ultrasound at participants’ workplaces was reported as always available regardless of health facility level. Most participants performing ultrasound reported high-level skills for fetal heart rate examination (70%), whereas few (23%) reported being skilled in examination of the anatomy of the fetal heart. Insufficient ultrasound training leading to suboptimal pregnancy management was reported by 37% of all participants. ‘Better quality of ultrasound machines’, ‘more physicians trained in ultrasound’ and ‘more training for health professionals currently performing ultrasound’ were reported as ways to improve the utilisation of ultrasound.ConclusionsObstetric ultrasound is used as an integral part of antenatal care at all selected health facility levels in the region of Hanoi, and access was reported as high. However, reports of insufficient ultrasound training resulting in suboptimal pregnancy management indicate a need for additional training of ultrasound operators to improve utilisation of ultrasound.

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Section: Discussionmentioning

confidence: 99%

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

et al. 2019

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“…Our previous qualitative research within the CROss Country Ultrasound Study (CROCUS) in Norway has demonstrated that Norwegian obstetricians experience challenges associated with provision of ultrasound and prenatal diagnosis services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents [16]. From our quantitative CROCUS Study in Norway we have reported midwives’ and obstetricians’ views on how many ultrasound examinations should be part of standard care during pregnancy [17].…”

Section: Introductionmentioning

confidence: 99%

A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives’ experiences and views on the role of obstetric ultrasound

Edvardsson

Fagerli

Darj

et al. 2019

BMC Pregnancy Childbirth

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BackgroundMidwives 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.MethodsA 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.ResultsMidwives 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.ConclusionsMidwives 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 materialThe online version of this article (10.1186/s12884-019-2178-x) contains supplementary material, which is available to authorized users.

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“…Obstetricians sensed parents' misperceptions regarding scans 26 and explained this by highlighting that ultrasound is frequently used when complications are not expected 28 . This lack of understanding in parents made the task of communicating news harder for staff 26,28 …”

Section: Resultsmentioning

confidence: 99%

“…Studies in HCPs found that delivering unexpected news was challenging for HCPs 26,30 . Some said it carried a high emotional toll; they both feared these events occurring and then ruminated on them once they had passed 26,30 . Some HCPs drew on the positive aspects of their work and collegial support to cope 30 …”

Section: Resultsmentioning

confidence: 99%

“…Our results suggest these details are important; interventions should provide guidance on the exact behaviours and phrases which could be employed in relation to different pregnancy complications. Second, there are certain situations which HCPs find particularly challenging, including the communication of news which is uncertain and communicating when parents have brought families with them 26,28,30 . Evidence‐based guidance should address these.…”

Section: Discussionmentioning

confidence: 99%

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Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences

et al. 2020

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Expectant parents report negative experiences of receiving unexpected news via ultrasound. There is a need to improve communication in this setting, but a lack of understanding on how to achieve this. This systematic review aimed to synthesise findings from qualitative studies exploring experiences of expectant parents or healthcare professionals when a fetal abnormality or unexpected finding was identified via ultrasound. MEDLINE, EMBASE, CINAHL and PsycINFO were searched using three blocks of terms (fetal abnormalities; ultrasound; experiences). Qualitative studies exploring the disclosure of pregnancy complications during ultrasound examinations were included and analysed using meta‐ethnographic synthesis. The review was conducted according to PRISMA and eMERGe guidelines. The review identified 28 studies. News delivered via ultrasound can be viewed as a journey involving five phases (expectations of ultrasound scans; discovery; shock; decisions and planning; adaptation). How well this is navigated depends upon the extent to which information needs and support needs are met. Ultrasound is a uniquely challenging situation to communicate difficult news as there is the potential for news to be communicated immediately. Care quality could be improved by the provision of written information and the use of correct terminology to describe abnormalities.

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Norwegian obstetricians’ experiences of the use of ultrasound in pregnancy management. A qualitative study

Cited by 11 publications

References 31 publications

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study

A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives’ experiences and views on the role of obstetric ultrasound

Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences

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