Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Two sides of the same coin – an interview study of Swedish obstetricians’ experiences using ultrasound in pregnancy management

Authors: Annika Åhman, Margareta Persson, Kristina Edvardsson, Ann Lalos, Sophie Graner, Rhonda Small, Ingrid Mogren

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman’s reproductive freedom. The purpose of this study was to explore Swedish obstetricians’ experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict.

Methods

A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis.

Results

The theme that emerged in the analysis ‘Two sides of the same coin’ depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman’s health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety.

Conclusions

The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician’s position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.
Literature
1.
go back to reference Stanton K, Mwanri L. Global Maternal and Child Health Outcomes: the role of obstetric ultrasound in low resource settings. J Prev Med. 2013;1(3):22–9. Stanton K, Mwanri L. Global Maternal and Child Health Outcomes: the role of obstetric ultrasound in low resource settings. J Prev Med. 2013;1(3):22–9.
2.
go back to reference Kongnyuy EJ, van den Broek N. The use of ultrasonography in obstetrics in developing countries. Trop Doct. 2007;37(2):70–2.PubMed Kongnyuy EJ, van den Broek N. The use of ultrasonography in obstetrics in developing countries. Trop Doct. 2007;37(2):70–2.PubMed
3.
go back to reference Garcia J, Bricker L, Henderson J, Martin MA, Mugford M, Nielson J, et al. Women’s views of pregnancy ultrasound: a systematic review. Birth. 2002;29(4):225–50.PubMed Garcia J, Bricker L, Henderson J, Martin MA, Mugford M, Nielson J, et al. Women’s views of pregnancy ultrasound: a systematic review. Birth. 2002;29(4):225–50.PubMed
4.
go back to reference Makhlouf M, Saade G. Should second trimester ultrasound be routine for all pregnancies? Semin Perinatol. 2013;37(5):323–6.PubMed Makhlouf M, Saade G. Should second trimester ultrasound be routine for all pregnancies? Semin Perinatol. 2013;37(5):323–6.PubMed
5.
go back to reference Alfirevic Z, Stampalija T, Gyte G. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2013;11:CD007529.PubMed Alfirevic Z, Stampalija T, Gyte G. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2013;11:CD007529.PubMed
6.
go back to reference Whitworth M, Bricker L, Neilson J, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 2010;4:CD007058.PubMed Whitworth M, Bricker L, Neilson J, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 2010;4:CD007058.PubMed
7.
go back to reference Georgsson Ohman S, Waldenstrom U. Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample. Ultrasound Obstet Gynecol. 2008;32(1):15–22.PubMed Georgsson Ohman S, Waldenstrom U. Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample. Ultrasound Obstet Gynecol. 2008;32(1):15–22.PubMed
8.
go back to reference Molander E, Alehagen S, Bertero C. Routine ultrasound examination during pregnancy: a world of possibilities. Midwifery. 2010;26(1):18–26.PubMed Molander E, Alehagen S, Bertero C. Routine ultrasound examination during pregnancy: a world of possibilities. Midwifery. 2010;26(1):18–26.PubMed
9.
go back to reference Ekelin M, Crang-Svalenius E, Dykes AK. A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden. Midwifery. 2004;20(4):335–44.PubMed Ekelin M, Crang-Svalenius E, Dykes AK. A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden. Midwifery. 2004;20(4):335–44.PubMed
10.
go back to reference Eurenius K, Axelsson O, Gällstedt-Fransson I, Sjöden P-O. Perception of information, expectations and experiences among women and their partners attending a second-trimester routine ultrasound scan. Ultrasound Obstet Gynecol. 1997;9:86–90.PubMed Eurenius K, Axelsson O, Gällstedt-Fransson I, Sjöden P-O. Perception of information, expectations and experiences among women and their partners attending a second-trimester routine ultrasound scan. Ultrasound Obstet Gynecol. 1997;9:86–90.PubMed
11.
go back to reference Fenwick J, Bayes S, Johansson M. A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be. Sex Reprod Healthc. 2012;3(1):3–9.PubMed Fenwick J, Bayes S, Johansson M. A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be. Sex Reprod Healthc. 2012;3(1):3–9.PubMed
12.
go back to reference Harpel TS. Fear of the unknown: ultrasound and anxiety about fetal health. Health. 2008;12(3):295–312.PubMed Harpel TS. Fear of the unknown: ultrasound and anxiety about fetal health. Health. 2008;12(3):295–312.PubMed
13.
go back to reference Thorup TJ, Zingenberg H. Use of ‘non-medical’ ultrasound imaging before mid-pregnancy in Copenhagen. Acta Obstet Gynecol Scand. 2015;94(1):102–5.PubMed Thorup TJ, Zingenberg H. Use of ‘non-medical’ ultrasound imaging before mid-pregnancy in Copenhagen. Acta Obstet Gynecol Scand. 2015;94(1):102–5.PubMed
14.
go back to reference 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.PubMed 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.PubMed
15.
go back to reference Fasouliotis SJ, Schenker JG. Maternal–fetal conflict. Eur J Obstet Gynecol Reprod Biol. 2000;89(1):101–7.PubMed Fasouliotis SJ, Schenker JG. Maternal–fetal conflict. Eur J Obstet Gynecol Reprod Biol. 2000;89(1):101–7.PubMed
16.
go back to reference Deprest JA, Devlieger R, Srisupundit K, Beck V, Sandaite I, Rusconi S, et al. Fetal surgery is a clinical reality. Semin Fetal Neonatal Med. 2010;15(1):58–67.PubMed Deprest JA, Devlieger R, Srisupundit K, Beck V, Sandaite I, Rusconi S, et al. Fetal surgery is a clinical reality. Semin Fetal Neonatal Med. 2010;15(1):58–67.PubMed
18.
go back to reference Andersson-Ellström A. Mödrahälsovård, sexuell och reproduktiv hälsa [Antenatal Care, Sexual and Reproductive Health]. Stockholm: Svensk Förening för Obstetrik och Gynecologi; 2008. Andersson-Ellström A. Mödrahälsovård, sexuell och reproduktiv hälsa [Antenatal Care, Sexual and Reproductive Health]. Stockholm: Svensk Förening för Obstetrik och Gynecologi; 2008.
19.
go back to reference Ferm Widlund K, Gunnarsson C, Nordin K, Hansson MG. Pregnant women are satisfied with the information they receive about prenatal diagnosis, but are their decisions well informed? Acta Obstet Gynecol Scand. 2009;88(10):1128–32.PubMed Ferm Widlund K, Gunnarsson C, Nordin K, Hansson MG. Pregnant women are satisfied with the information they receive about prenatal diagnosis, but are their decisions well informed? Acta Obstet Gynecol Scand. 2009;88(10):1128–32.PubMed
20.
go back to reference Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.PubMed Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.PubMed
22.
go back to reference Cook RJ. International human rights and women’s reproductive health. Stud Fam Plann. 1993;24(2):73–86.PubMed Cook RJ. International human rights and women’s reproductive health. Stud Fam Plann. 1993;24(2):73–86.PubMed
23.
go back to reference McLean SAM. The moral and legal boundaries of fetal intervention: whose right/whose duty. Semin Neonatol. 1998;3(4):249–54. McLean SAM. The moral and legal boundaries of fetal intervention: whose right/whose duty. Semin Neonatol. 1998;3(4):249–54.
24.
go back to reference Leung JLY, Pang SMC. Ethical analysis of non-medical fetal ultrasound. Nurs Ethics. 2009;16(5):637–46.PubMed Leung JLY, Pang SMC. Ethical analysis of non-medical fetal ultrasound. Nurs Ethics. 2009;16(5):637–46.PubMed
25.
go back to reference McNay M, Fleming JE. Forty years of obstetric ultrasound 1957-1997: from A-scope to three dimensions. Ultrasound Med Biol. 1999;25(1):3–56.PubMed McNay M, Fleming JE. Forty years of obstetric ultrasound 1957-1997: from A-scope to three dimensions. Ultrasound Med Biol. 1999;25(1):3–56.PubMed
26.
go back to reference van Bogaert L-J, Dhai A. Ethical challenges of treating the critically ill pregnant patient. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):983–96.PubMed van Bogaert L-J, Dhai A. Ethical challenges of treating the critically ill pregnant patient. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):983–96.PubMed
27.
go back to reference Kvande L. From politics to ethics--obstetric ultrasound in 1980's and 1990's. Tidsskr Nor Laegeforen. 2008;128(24):2855-2859. Kvande L. From politics to ethics--obstetric ultrasound in 1980's and 1990's. Tidsskr Nor Laegeforen. 2008;128(24):2855-2859.
28.
go back to reference Women, reproductive health and international human right. Prog Hum Reprod Res. 1999;50:2-4. Women, reproductive health and international human right. Prog Hum Reprod Res. 1999;50:2-4.
29.
go back to reference 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(1):363.PubMedPubMedCentral 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(1):363.PubMedPubMedCentral
30.
go back to reference 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.PubMed 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.PubMed
31.
go back to reference Minkoff H, Marshall MF, Liaschenko J. The Fetus, the “Potential Child”, and the Ethical Obligations of Obstetricians. Obstet Gynecol. 2014;123(5):1100–3.PubMed Minkoff H, Marshall MF, Liaschenko J. The Fetus, the “Potential Child”, and the Ethical Obligations of Obstetricians. Obstet Gynecol. 2014;123(5):1100–3.PubMed
32.
go back to reference Rink BD. Maternal-fetal care starts and ends with the mother. Am J Obstet Gynecol. 2012;206(5):374–5.PubMed Rink BD. Maternal-fetal care starts and ends with the mother. Am J Obstet Gynecol. 2012;206(5):374–5.PubMed
33.
go back to reference Davis AS, Chock VY, Hintz SR. Fetal centers and the role of the neonatologist in complex fetal care. Am J Perinatol. 2014;31(07):549–56.PubMed Davis AS, Chock VY, Hintz SR. Fetal centers and the role of the neonatologist in complex fetal care. Am J Perinatol. 2014;31(07):549–56.PubMed
34.
go back to reference Brown SD, Ecker JL, Ward JRM, Halpern EF, Sayeed SA, Buchmiller TL, et al. Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter? Am J Obstet Gynecol. 2012;206(5):409.e401–11. Brown SD, Ecker JL, Ward JRM, Halpern EF, Sayeed SA, Buchmiller TL, et al. Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter? Am J Obstet Gynecol. 2012;206(5):409.e401–11.
35.
go back to reference Brown SD, Donelan K, Martins Y, Sayeed SA, Mitchell C, Buchmiller TL, et al. Does professional orientation predict ethical sensitivities? Attitudes of paediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination. Reproductive ethics. J Med Ethics. 2014;40:117–22.PubMed Brown SD, Donelan K, Martins Y, Sayeed SA, Mitchell C, Buchmiller TL, et al. Does professional orientation predict ethical sensitivities? Attitudes of paediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination. Reproductive ethics. J Med Ethics. 2014;40:117–22.PubMed
36.
go back to reference Åhman 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.PubMed Åhman 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.PubMed
37.
go back to reference Åhman A, Lindgren P, Sarkadi A. Facts first, then reaction—Expectant fathers’ experiences of an ultrasound screening identifying soft markers. Midwifery. 2012;28(5):e667–75.PubMed Åhman A, Lindgren P, Sarkadi A. Facts first, then reaction—Expectant fathers’ experiences of an ultrasound screening identifying soft markers. Midwifery. 2012;28(5):e667–75.PubMed
38.
go back to reference Mensah YB, Nkyekyer K, Mensah K. The Ghanaian woman’s experience and perception of ultrasound use in antenatal care. Ghana Med J. 2014;48(1):31–8.PubMedPubMedCentral Mensah YB, Nkyekyer K, Mensah K. The Ghanaian woman’s experience and perception of ultrasound use in antenatal care. Ghana Med J. 2014;48(1):31–8.PubMedPubMedCentral
39.
go back to reference Lalor J, Devane D. Information, knowledge and expectations of the routine ultrasound scan. Midwifery. 2007;23(1):13–22.PubMed Lalor J, Devane D. Information, knowledge and expectations of the routine ultrasound scan. Midwifery. 2007;23(1):13–22.PubMed
40.
go back to reference Hayat Roshanai A, Ingvoldstad C, Lindgren P. Fetal ultrasound examination and assessment of genetic soft markers in Sweden: are ethical principles respected? Acta Obstet Gynecol Scand. 2015;94(2):141–7.PubMed Hayat Roshanai A, Ingvoldstad C, Lindgren P. Fetal ultrasound examination and assessment of genetic soft markers in Sweden: are ethical principles respected? Acta Obstet Gynecol Scand. 2015;94(2):141–7.PubMed
41.
go back to reference Sandelowski M. Channel of desire: fetal ultrasonography in two user-context. Qual Health Res. 1994;4:262–80. Sandelowski M. Channel of desire: fetal ultrasonography in two user-context. Qual Health Res. 1994;4:262–80.
42.
go back to reference Yeo G, Lim ML. Maternal and fetal best interests in day-to-day obstetrics. Ann Acad Med Singap. 2011;40(1):43–9.PubMed Yeo G, Lim ML. Maternal and fetal best interests in day-to-day obstetrics. Ann Acad Med Singap. 2011;40(1):43–9.PubMed
43.
go back to reference Vlemmix F, Warendorf JK, Rosman AN, Kok M, Mol BWJ, Morris JM, et al. Decision aids to improve informed decision-making in pregnancy care: a systematic review. BJOG. 2013;120(3):257–66.PubMed Vlemmix F, Warendorf JK, Rosman AN, Kok M, Mol BWJ, Morris JM, et al. Decision aids to improve informed decision-making in pregnancy care: a systematic review. BJOG. 2013;120(3):257–66.PubMed
44.
go back to reference Elwyn G, Rix A, Holt T, Jones D. Why do clinicians not refer patients to online decision support tools? Interviews with front line clinics in the NHS. BMJ Open 2012, 2(6). doi:10.1136/bmjopen-2012-001530. Elwyn G, Rix A, Holt T, Jones D. Why do clinicians not refer patients to online decision support tools? Interviews with front line clinics in the NHS. BMJ Open 2012, 2(6). doi:10.​1136/​bmjopen-2012-001530.
45.
go back to reference Lawson KL, Pierson RA. J obstet gynaecol canmaternal decisions regarding prenatal diagnosis: rational choices or sensible decisions? J Obstet Gynaecol Can. 2007;29(3):240–6.PubMedPubMedCentral Lawson KL, Pierson RA. J obstet gynaecol canmaternal decisions regarding prenatal diagnosis: rational choices or sensible decisions? J Obstet Gynaecol Can. 2007;29(3):240–6.PubMedPubMedCentral
Metadata
Title
Two sides of the same coin – an interview study of Swedish obstetricians’ experiences using ultrasound in pregnancy management
Authors
Annika Åhman
Margareta Persson
Kristina Edvardsson
Ann Lalos
Sophie Graner
Rhonda Small
Ingrid Mogren
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0743-5

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue