“forthee....towhom% nosoundisdissonantwhichtellsoflife”% —coleridge

McNay, MargaretB; Fleming, J. E. E.

doi:10.1016/s0301-5629(98)00129-x

Cited by 417 publications

(5 citation statements)

References 187 publications

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“…The ultrasound examination came into use in Norwegian obstetric care in the 1970s, and it was first introduced as a routine examination in two maternity clinics in 1986 [8]. A National Centre for Fetal Medicine was launched in Trondheim in 1990.…”

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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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

View full text Add to dashboard Cite

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“…As competent adults, it has been argued that women have the right to determine what happens to their bodies, and interference without consent breaks the ethical principle of autonomy (41). Most pregnant women strive to improve their chances of having a healthy baby; however, there can be instances where pregnant women's health interests do not correspond to fetal health interests, giving rise to con ict situations (37,42). As mentioned above, a majority of the participants agreed with the statement, "Maternal health interests should always be prioritised over fetal health interests in care provided", and a vast majority also agreed with the statement, "Fetal health interests are being given more weight in decision-making, the further the gestation advances".…”

Section: Discussionmentioning

confidence: 99%

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

Mogren

Lan

Phuc

et al. 2023

Preprint

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Background: Obstetric ultrasound is a significant tool in the clinical management of pregnancy and is increasingly used globally. The status of the pregnant woman and the fetus may vary regarding clinical management, views in the community and legislation. The overall aim of the study was to investigate experiences and views among health professionals in Vietnam on different aspects of the fetus, prioritisation and potential conflicts between maternal and fetal health interests. Methods: A cross-sectional study design using a structured questionnaire. Eligible participants were obstetricians/gynecologists, midwives and sonographers. Public health facilities were purposively selected to obtain a representative sample in the Hanoi region, Vietnam. The final sample included 882 health professionals. Results: Participating health professionals were obstetricians/gynecologists (n=289; 32.7%), midwives (n=535; 60.7%) and sonographers (n=58; 6.6%). The mean age was 34.8 years, and mean years in the profession were 10.3. 60.3% of participants agreed that “The fetus is a person from the time of conception”. 19.7% agreed, and 60.5% disagreed with the statement, “The fetus is never a patient, only the pregnant woman can be the patient”. A majority of the participants (54.4%) agreed that “Maternal health interests should always be prioritised over fetal health interests in care provided”, whereas 18.7% disagreed, and 27.1% were neutral. 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). Conclusions: Our results indicate that a large proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. To a large extent, the fetus was considered a patient with its own health interests, although a majority gave 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 however and would need careful monitoring if this were to occur. Maternal reproductive rights might need to be further safeguarded.

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“…Likewise, the fetus has come to acquire a social identity by its public presence [ 14 ], a social status that before the introduction of imaging technologies was not acquired until after birth [ 13 ]. Modern medical capacity to visualise the fetus in the uterus, combined with increased capacity for fetal treatment, have also led health professionals conceptualising the fetus as a patient [ 15 , 16 ]. Moreover, it has contributed to individual rights being increasingly attributed to the fetus [ 17 ], and to some extent the woman has lost her central place in the pregnancy [ 13 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound’s ‘window on the womb’ brings ethical challenges for balancing maternal and fetal health interests: obstetricians’ experiences in Australia

et al. 2015

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BackgroundObstetric ultrasound has become a significant tool in obstetric practice, however, it has been argued that its increasing use may have adverse implications for women’s reproductive freedom. This study aimed to explore Australian obstetricians’ experiences and views of the use of obstetric ultrasound both in relation to clinical management of complicated pregnancy, and in situations where maternal and fetal health interests conflict.MethodsA qualitative study was undertaken as part of the CROss-Country Ultrasound Study (CROCUS). Interviews were held in November 2012 with 14 obstetricians working in obstetric care in Victoria, Australia. Data were analysed using qualitative content analysis.ResultsOne overall theme emerged from the analyses: The ethical challenge of balancing maternal and fetal health interests, built on four categories: First, Encountering maternal altruism’ described how pregnant women’s often ‘altruistic’ position in relation to the health and wellbeing of the fetus could create ethical challenges in obstetric management, particularly with an increasing imbalance between fetal benefits and maternal harms. Second, ‘Facing shifting attitudes due to visualisation and medico-technical advances’ illuminated views that ultrasound and other advances in care have contributed to a shift in what weight to give maternal versus fetal welfare, with increasing attention directed to the fetus. Third, ‘Guiding expectant parents in decision-making’ described the difficult task of facilitating informed decision-making in situations where maternal and fetal health interests were not aligned, or in situations characterised by uncertainty. Fourth, ‘Separating private from professional views’ illuminated divergent views on when the fetus can be regarded as a person. The narratives indicated that the fetus acquired more consideration in decision-making the further the gestation progressed. However, there was universal agreement that obstetricians could never act on fetal grounds without the pregnant woman’s consent.ConclusionsThis study suggests that medico-technical advances such as ultrasound have set the scene for increasing ethical dilemmas in obstetric practice. The obstetricians interviewed had experienced a shift in previously accepted views about what weight to give maternal versus fetal welfare. As fetal diagnostics and treatment continue to advance, how best to protect pregnant women’s right to autonomy requires careful consideration and further investigation.

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“forthee....towhom% nosoundisdissonantwhichtellsoflife”% —coleridge

Cited by 417 publications

References 187 publications

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

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

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

Ultrasound’s ‘window on the womb’ brings ethical challenges for balancing maternal and fetal health interests: obstetricians’ experiences in Australia

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