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A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound
Umea Univ, Dept Clin Sci Obstet & Gynecol, S-90187 Umea, Sweden.
Umea Univ, Dept Clin Sci Obstet & Gynecol, S-90187 Umea, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
Trondheim Reg & Univ Hosp, Natl Ctr Fetal Med, St Olavs Hosp, Trondheim, Norway.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, NTNU, Trondheim, Norway.ORCID iD: 0000-0002-8311-4956
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 33Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BMC , 2019. Vol. 19, article id 33
Keywords [en]
Pregnancy, Ultrasonography, Midwives, Qualitative research, Norway
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-375866DOI: 10.1186/s12884-019-2178-xISI: 000455891900001PubMedID: 30651083OAI: oai:DiVA.org:uu-375866DiVA, id: diva2:1285261
Funder
Swedish Research Council, 2014-2672Forte, Swedish Research Council for Health, Working Life and WelfareVästerbotten County CouncilAvailable from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved

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