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Åhman, A., Edvardsson, K., Fagerli, T. A., Darj, E., Holmlund, S., Small, R. & Mogren, I. (2019). A much valued tool that also brings ethical dilemmas: a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound. BMC Pregnancy and Childbirth, 19, Article ID 33.
Open this publication in new window or tab >>A much valued tool that also brings ethical dilemmas: a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound
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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
BioMed Central, 2019
Keywords
Pregnancy, Ultrasonography, Midwives, Qualitative research, Norway
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-162773 (URN)10.1186/s12884-019-2178-x (DOI)000455891900001 ()30651083 (PubMedID)
Available from: 2019-09-04 Created: 2019-09-04 Last updated: 2019-09-04Bibliographically approved
Holmlund, S., Lan, P. T., Edvardsson, K., Phuc, H. D., Ntaganira, J., Small, R., . . . Mogren, I. (2019). Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study. BMJ Open, 9, Article ID e031761.
Open this publication in new window or tab >>Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, article id e031761Article in journal (Refereed) Published
Abstract [en]

Objectives: Obstetric 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.

Design: A cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study.

Setting: Health facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam.

Participants: Participants were 289 obstetricians/ gynaecologists and 535 midwives.

Results: A 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.

Conclusions: Obstetric 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 ultraso

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
prenatal ultrasonography, health personnel, obstetricians, midwives, prenatal care, pregnancy, Vietnam
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-163499 (URN)10.1136/bmjopen-2019-031761 (DOI)31548354 (PubMedID)
Funder
Västerbotten County CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2013-2699Swedish Research Council, 2014-2672
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-26Bibliographically approved
Holmlund, S. (2019). Health professionals’ experiences and views related to obstetric ultrasound in Rwanda and Vietnam. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Health professionals’ experiences and views related to obstetric ultrasound in Rwanda and Vietnam
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Obstetric ultrasound has become an indispensable part of maternity care in high-income countries, where it is universally used for screening, diagnostic and surveillance purposes. In low-income countries, insufficient numbers of trained health professionals’ is commonly a barrier to obstetric ultrasound use. Globally, health professionals’ encounter complex clinical situations in which rapid technical improvements in fetal surveillance and pregnancy interventions are components that influence clinical decisions, thereby implicating maternal and fetal health outcomes.

Aims

The overall aim of this thesis was to explore health professionals’ experiences and views on the role of obstetric ultrasound in relation to clinical management, including ethical aspects, in two low-to-middle-income countries with different characteristics, cultures, religions and health care systems.

Methods

Study I (Rwanda) and Study III (Vietnam) are based on focus group discussions in which data were analysed using content analysis. Study I included six focus group discussions with 23 midwives recruited from six different hospitals in the area of Kigali and in the Southern province. Study III included four focus group discussions with 25 midwives working at three different hospitals in the Hanoi area. Study II (Rwanda) and Study IV (Vietnam) are cross-sectional studies using descriptive statistics, Pearson’s chi-square test and logistic regression analyses. A questionnaire, including items based on the results from previous qualitative studies, was used as the data collection tool. For Study II, health professionals (midwives, nurses, obstetricians, other physicians; N=907) working at 108 health facilities representing all provinces of Rwanda were recruited. Study IV constituted a regional sample of 824 health professionals (midwives, obstetricians/gynecologists) working at 29 health facilities in urban, semi-urban and rural parts of Hanoi, Vietnam.

Main findings

Obstetric ultrasound was regarded as a highly valued tool for pregnancy management in Rwanda as well as in Vietnam (Papers I–IV). In Rwanda, access to ultrasound was described as poor, especially for women living in rural areas (Paper I). In contrast, access to obstetric ultrasound was described as being very high in all health facilities in urban, semi-urban and rural areas of Hanoi (Paper III & Paper IV). In Rwanda, if a pregnancy was considered normal, obstetric ultrasound was not routinely performed (Paper I), while pregnant women in Vietnam were reported as undergoing several further ultrasound examinations in addition to the three examinations recommended by the Ministry of Health (Paper III). Midwives in Rwanda expressed a need to be trained in ultrasound, particularly those working at health centres in rural areas where ultrasound was rarely available (Paper I). A majority of health professionals (91%) also agreed that maternity care in Rwanda would improve if midwives were qualified to perform basic ultrasound examinations (Paper II). Sub-optimal pregnancy management due to a lack of or insufficient ultrasound training was reported by health professionals in both Rwanda (65%; Paper II) and Vietnam (37%; Paper IV). The use of obstetric ultrasound without medical indication was described as a troubling phenomenon, especially in Vietnam, where participants also reported that pregnant women sometimes replaced antenatal care surveillancewith ultrasound examinations (Paper III).

Conclusion

Obstetric ultrasound plays a significant role in pregnancy management in Rwanda, although access varies significantly. The findings indicate that physicians in Rwanda are in need of additional formal ultrasound training in order to increase the quality of ultrasound surveillance and to improve maternal and fetal health outcomes. To increase ultrasound access for all pregnant women in Rwanda, midwives could potentially be trained to perform basic ultrasound examinations. In the Hanoi area of Vietnam, ultrasound is a well-integrated tool in pregnancy management and access was high. However, overuse and commercialisation of obstetric ultrasound examinations were described as common and need to be addressed to achieve adequate allocation of resources. The rapid development of technology in maternity care needs to be accompanied by medical guidelines stating the appropriate indications for ultrasound surveillance.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019. p. 79
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2042
Keywords
Prenatal ultrasonography, pregnancy, midwife, obstetrician, health personnel, health professional, prenatal care, epidemiology, cross-sectional study, focus group discussion, qualitative content analysis, Rwanda, Vietnam
National Category
Medical and Health Sciences
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-163509 (URN)978-91-7855-087-6 (ISBN)
Public defence
2019-10-18, Stora Hörsalen, 5B, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-27 Created: 2019-09-24 Last updated: 2019-09-24Bibliographically approved
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P. T., Semasaka Sengoma, J. P., Kidanto, H. L., . . . Mogren, I. (2018). Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study. PLoS ONE, 13(12), Article ID e0208387.
Open this publication in new window or tab >>Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0208387Article in journal (Refereed) Published
Abstract [en]

Objectives: Implementation of ultrasound in antenatal care (ANC) in low-income countries has been shown to increase pregnant women’s compliance with ANC visits, and facilitate detection of high-risk pregnancies. In Rwanda, as in other low-income countries, access to ultrasound has increased significantly, but lack of training is often a barrier to its use. The aim of this study was to investigate Rwandan health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Methods: A cross-sectional questionnaire study was undertaken between November 2016 and March 2017, as part of the CROss Country UltraSound Study (CROCUS). Data were collected at 108 health facilities located in both rural and urban areas of Rwanda, including provincial, referral, district and private hospitals as well as health centres. Participants were obstetricians (n = 29), other physicians (n = 222), midwives (n = 269) and nurses (n = 387).

Results: Obstetricians/gynecologists/other physicians commonly performed ultrasound examinations but their self-rated skill levels implied insufficient training. Access to ultrasound when needed was reported as common in hospitals, but available to a very limited extent in health centres. The vast majority of participants, independent of health profession, agreed that maternity care would improve if midwives learned to perform basic ultrasound examinations.

Conclusions: Barriers to provision of high quality ultrasound services include variable access to ultrasound depending on health facility level and insufficient skills of ultrasound operators. Physicians in general need more training to perform ultrasound examinations. Implementation of a general dating ultrasound examination seems to be a relevant goal as most health professionals agree that pregnant woman would benefit from this service. To further improve maternity care services, the possibility of educating midwives to perform ultrasound examinations should be further explored.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-154875 (URN)10.1371/journal.pone.0208387 (DOI)000452204800030 ()30513102 (PubMedID)2-s2.0-85057761963 (Scopus ID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-09-24Bibliographically approved
Fagerli, T. A., Mogren, I., Adolfsson, A., Edvardsson, K., Åhman, A., Holmlund, S., . . . Eggebo, T. M. (2018). Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. Sexual & Reproductive HealthCare, 16, 1-5
Open this publication in new window or tab >>Midwives' and obstetricians' views on appropriate obstetric sonography in Norway
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 1-5Article, review/survey (Refereed) Published
Abstract [en]

Introduction: The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. Material and methods: This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Ultrasonography, Health care professionals, Non-medical ultrasound, Safety
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-151072 (URN)10.1016/j.srhc.2017.12.006 (DOI)000440877700001 ()29804752 (PubMedID)2-s2.0-85044744044 (Scopus ID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved
Edvardsson, K., Åhman, A., Fagerli, T. A., Darj, E., Holmlund, S., Small, R. & Mogren, I. (2018). Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study. Sexual & Reproductive HealthCare, 15, 69-76
Open this publication in new window or tab >>Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Objective: To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. Methods: A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). Results: Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. Conclusion: This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Ethics, Norway, Obstetrics, Pregnant women, Prenatal diagnosis, Ultrasonography, Qualitative search
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145366 (URN)10.1016/j.srhc.2017.12.001 (DOI)000424721100012 ()29389504 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
Holmlund, S., Ntaganira, J., Edvardsson, K., Semasaka Sengoma, J. P., Hussein, K., Ngarina, M., . . . Mogren, I. (2017). Health professionals' experiences and views of obstetric ultrasound in Rwanda. Paper presented at 10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017. European Journal of Public Health, 27(Suppl_3), 367
Open this publication in new window or tab >>Health professionals' experiences and views of obstetric ultrasound in Rwanda
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2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 367-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: The World Health Organizatiońs new recommendations for antenatal care (ANC) include one ultrasound examination before 24 weeks of gestation. Implementation of ultrasound in ANC in low resource countries has been shown to increase pregnant women’s compliance to ANC visits, and facilitate detection of high-risk pregnancies. The aim of this study was to explore Rwandan health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Methods: A cross-sectional questionnaire study involving physicians (n = 222), obstetricians (n = 29), nurses (n = 387) and midwives (n = 269) managing pregnant women in RWANDA was performed, as part of the CROss Country Ultrasound Study (CROCUS). Data were collected at 106 health facilities from November 2016 – March 2017.

Preliminary results: One third of the participants performed ultrasound examinations (32.3%) and the majority on a daily basis (60.1%). The ultrasound examination where most participants reported high level skills was evaluation of the fetal heart rate (69.0%). A majority reported no skills or low level skills (79.9%) for ultrasound examination of the fetal heart, aorta and pulmonary artery. A majority (65.0%) reported that lack of ultrasound training of the ultrasound operator sometimes led to suboptimal pregnancy management. Almost all participants (91.3%) agreed that ANC would be improved if midwives were qualified to perform basic ultrasound examinations.

Conclusions: The vast majority of health professionals in the study believed that maternity care can be improved if midwives learn to perform basic ultrasound examinations. Additional training of physicians performing obstetric ultrasound was also suggested to increase the quality of obstetric ultrasound surveillance and to further improve maternal and fetal health outcomes.

Key messages:

  • Physicians managing pregnant women need more training in obstetric ultrasound.
  • Midwives need to be educated in performing obstetric ultrasounds.
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143075 (URN)10.1093/eurpub/ckx189.167 (DOI)000414389804061 ()
Conference
10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2019-05-16Bibliographically approved
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P. T., Sengoma, J. P., Åhman, A., . . . Mogren, I. (2017). Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives' experiences and views of obstetric ultrasound. Global Health Action, 10(1), Article ID 1350451.
Open this publication in new window or tab >>Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives' experiences and views of obstetric ultrasound
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2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1350451Article in journal (Refereed) Published
Abstract [en]

Background: Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed.

Objectives: To explore Rwandan midwives’ experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects.

Methods: A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS).

Results: Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed.

Conclusions: Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda.

Keywords
Rwanda, nurse, midwives, ultrasonography, obstetrics, pregnant women
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-138408 (URN)10.1080/16549716.2017.1350451 (DOI)000406687700001 ()
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2019-09-24Bibliographically approved
Holmlund, S., Lan, P. T., Edvardsson, K., Ntaganira, J., Graner, S., Small, R. & Mogren, I.Suboptimal use of ultrasound examinations may result in underperformance of Vietnamese maternity care- A qualitative study of midwives’ experiences and views.
Open this publication in new window or tab >>Suboptimal use of ultrasound examinations may result in underperformance of Vietnamese maternity care- A qualitative study of midwives’ experiences and views
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective

To explore Vietnamese midwives’ experiences and views on the role of obstetric ultrasound in relation to clinical management, including ethical aspects.

 

Methods

Using a qualitative design, content analysis of focus group discussions with midwives (N=25) working at Departments of Obstetrics and Gynecology at three hospitals in urban, semi-urban and rural parts of Hanoi were performed. 

 

Results

Obstetric ultrasound was reported as being a highly valuable tool, although replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication was perceived as troubling. Participants generally viewed the fetus as a human being already at an early stage of pregnancy. However, when complications occurred, the pregnant woman’s health was mostly prioritized.

 

Conclusion

Although the use of ultrasound has many benefits during pregnancy, replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication is concerning and needs to be addressed. There is also a need to communicate the benefits of adequate antenatal care to pregnant women and caution about the non-beneficial use of repeated ultrasound examinations without medical indication. Additionally, non-medical ultrasounds consume limited healthcare resources and its use needs to be better regulated in Vietnam. 

Keywords
Ultrasonography Prenatal, Midwives, Vietnam, Maternal Health Services, Antenatal Care, Pregnant women
National Category
Medical and Health Sciences
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-163479 (URN)
Funder
Västerbotten County CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2014-2672
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-24
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3391-2308

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