Abstract
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.
Highlights
Midwives are the main providers of routine antenatal care services including the routine ultrasound examination in Norway
The results from the analysis of the focus group discussions (FGDs) and the individual interviews are described in three main categories I: Ultrasound plays a central role in pregnancy management; II: Ultrasound contributes to the fetus being viewed as a patient; and III: Midwives may have ambivalent feelings about its use
This study shows that performing obstetric ultrasound can be very rewarding work for midwives and that they can experience ultrasound as helping expectant parents to connect with their “child” and gain reassurance about fetal health
Summary
The ultrasound examination can be perceived by expectant parents as a medical examination and 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. Use of Doppler ultrasound for assessment of umbilical blood flow has been shown to have the potential to detect placental insufficiency, fetal anemia, and to reduce perinatal death without increasing medical interventions [3]. Continued advances in obstetric ultrasound have made prenatal management of some birth defects or fetal malformations a reality [4]. Expectant parents may view the ultrasound examination as a social event for establishing contact with their “unborn child” [7]. A cautious approach to ultrasound has been described as necessary to ensure safety in fetal development, especially in the use of Doppler ultrasound in pregnancy [2]
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