Women's Experience of Prenatal Ultrasound Examination
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Journal of Perinatology (2006) 26, 403–408 r 2006 Nature Publishing Group All rights reserved. 0743-8346/06 $30 www.nature.com/jp ORIGINAL ARTICLE Seeing baby: women’s experience of prenatal ultrasound examination and unexpected fetal diagnosis JE Van der Zalm and PJ Byrne John Dossetor Health Ethics Centre, University of Alberta, Edmonton, AB, Canada multiple gestation, congenital fetal abnormalities, fetal growth Objective: Although prenatal ultrasound (US) is a common clinical problems and amniotic fluid or placental abnormalities. Study of undertaking today, little information is available about women’s experience US as a perinatal diagnostic tool has focused on whether US of the procedure from the perspective of women themselves. The objective of improves perinatal outcomes,3–6 the psychological effect on this study was to explore women’s experience of undergoing a routine women and men of such an examination,7–9 perception and prenatal US examination associated with an unexpected fetal diagnosis. receipt of information,10–14 and the experiences of staff who 15,16 Study Design: Qualitative methods were used to explore the prenatal US perform US examinations. A 1998 Cochrane review of routine 17 18 experience of 13 women. Five women were given unexpected news of US focused only on physical outcomes, as did a later work. multiple pregnancy and eight women were given unexpected news of Reviewers of the work suggested a lack of research on women’s 19 congenital fetal abnormality. One in-depth audio-taped interview was experience of this type of procedure. conducted with each woman. Content analysis of interview data identified Other researchers have focused on specific aspects of breaking themes common to women’s experience of US. bad news in perinatal situations and the sequelae of such an action. Alkazaleh et al.20 surveyed 117 women with pregnancy Results: Identified themes of women’s experience of routine prenatal US complications detected sonographically. Sixty-seven women examination associated with an unexpected fetal diagnosis are: responded to their survey of broad characteristics of bad news experiencing the setting, sensing information, feeling connected/ transmission, reporting what women found helpful after being disconnected, the power of the image, and communication rules. given bad news. These researchers recommend further research Conclusions: Women’s experience of prenatal US examination is into the area of bad news transmission using other research influenced by physical and environmental factors and by the behaviors of designs. Detraux et al.21 tabulated retrospective quantitative data the US examiner. Behaviors of the examiner contribute to a woman’s from prenatal US diagnosis of fetal abnormality using a labeling of the US experience as positive or negative. Women identify developmental psychology perspective. Rempel et al.22 explored the being objectified by the examination and experience poor communication pregnancy decision-making processes of parents following an patterns after a fetal US diagnosis. Women’s description of the US screen antenatal diagnosis of fetal congenital heart disease using a image as a baby suggests it is a powerful influence on subsequent clinical qualitative design, describing parents’ postdiagnosis relationship and ethical decision-making about the pregnancy. and interaction patterns with health care professionals. Journal of Perinatology (2006) 26, 403–408. doi:10.1038/sj.jp.7211540 Owing to the lack of information about routine US scanning specifically from women themselves, the central goal of this Keywords: prenatal care; sonography; maternal experience; antenatal diagnosis; fetal anomaly research was to explore pregnant women’s experience of receiving unexpected news after a prenatal US examination. In this paper, we describe women’s perceptions of undergoing a routine prenatal US examination associated with an unexpected fetal diagnosis. Introduction Although routine ultrasound examination (US) in low-risk pregnancy has not been proven to be advantageous in terms of Methods perinatal mortality and morbidity, its use has become standard This investigation focused on the experience of women undergoing during pregnancy.1,2 Diagnoses resulting from prenatal US include a prenatal US examination rather than measuring a specific aspect of that experience, therefore qualitative methods were utilized.23 Correspondence: Dr PJ Byrne, John Dossetor Health Ethics Centre, 5-16 University Extension Centre, University of Alberta, Edmonton, AB, Canada T6G 2T4. The University of Alberta Regional Health Ethics Review Board Received 14 December 2005; revised 4 May 2006; accepted 5 May 2006 approved the research protocol. Women’s experience of prenatal US examination JE Van der Zalm and PJ Byrne 404 A convenience sample of 13 women was recruited into the study. examination during their current pregnancy at the time of the All participants believed that their pregnancy was progressing interview. Various US diagnoses were given to the participants: normally, until they received unexpected news following an US twins (4), triplets, diaphragmatic hernia, hydrocephalus, examination that had been considered to be routine. Women were sacrococcygeal teratoma, Turners syndrome, renal anomaly/ enrolled into the study after seeing a study advertisement at a dysfunction (2), and cardiac anomaly (2). Participants received perinatal clinic and contacting the researcher. Inclusion criteria their US diagnoses from 11 to 38 weeks gestational age. The time were: English speaking women with a low-risk pregnancy (as between receiving the diagnoses and participating in the interview defined by the Antenatal Risk Assessment, Alberta Prenatal Record) ranged from 1 to 22 weeks. who received an unexpected fetal US diagnosis. Mean age of the participants was 29.4 years, with an age range Twelve women were interviewed during various stages of of 22 to 39 years. For six of the women, this was a first pregnancy. pregnancy. One woman was interviewed 3 weeks postpartum as she Gestational age at the time of the interview ranged from 20 to 39 delivered her infant before an antepartum interview could occur. weeks, with one woman interviewing at 3 weeks postpartum. All of Data from this woman was included because the focus of this the women indicated that they were in a stable relationship with research was only the prenatal US experience rather than any other the father of their baby(ies). Nine women had planned this aspect of pregnancy experience. Before each interview, consent was pregnancy, and seven were aware of the fetal gender. The established and biographical data were obtained. All of the educational level of the women varied, with six completing college/ participants were interviewed once. Each interview lasted 1 to 2 h. university, five completing high school and two women indicating Interviews began with a general question about how the woman’s they had some high school education. Six of the 12 women who pregnancy had progressed thus far (e.g., ‘Tell me about your responded to a question relating to family income indicated an pregnancy’). Women then were invited to talk more specifically income greater than $50 000 per year. about any US examinations that they may have had during this pregnancy. All questions were open-ended and posed in a manner Experiencing the setting that allowed women time to reflect and elaborate on points they For women in this study, the US examination was a mechanism by considered important. Interviews were conducted until no new which they were reassured about fetal health and fetal details were information was revealed during data analysis.24 All interviews were documented and measured. As one woman said, ‘Seeing them on tape-recorded and transcribed verbatim. The interview transcripts ultrasounds and know, Ok, they’re doing well. There they are. and the tapes were reviewed by the researchers during analysis There are their hearts beating.’ The majority of women felt that meetings. Using the editing style described by Crabtree and Miller,25 they were passive objects, ‘lying on the table’ and having the content analysis of the narrative interview data was completed to procedure ‘done to’ them. All of the women could recall the minute identify meaningful segments of data. Once these segments were details of the examining room where the US was conducted, identified and reviewed, the researchers sorted and organized them describing perceptions of temperature, space and lighting, and into prominent themes and patterns among the themes, searching the placement of medical equipment, especially the US screen. for any patterns or relationships that connected them.25,26 Data They also described health care professionals who were in verification of the thematic analysis was conducted during specific the room at the time, including when they entered and exited sessions focusing on thematic review. Two additional researchers the room, where they stood during the examination, and who were invited to participate in these sessions and provide comments did or did not speak during the examination. As one woman to support or contradict the analysis. said, ‘He stood in front of mey.I was laying here and he was This data analysis yielded four main themes: experiencing the right here and the screen was right there. And I didn’t see US examination, the environment in which the US took place, anything.’ identification of and communication of unexpected news and Women described their physical sensations during the US