Edvardsson Kristina, Mogren Ingrid, Lalos Ann, Persson Margareta, Small Rhonda
Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 87, Umeå, Sweden.
Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, Vic, 3000, Australia.
BMC Pregnancy Childbirth. 2015 Aug 27;15:195. doi: 10.1186/s12884-015-0632-y.
Ultrasound is a tool of increasing importance in maternity care. Midwives have a central position in the care of pregnant women. However, studies regarding their experiences of the use of ultrasound in this context are limited. The purpose of this study was to explore Australian midwives' experiences and views of the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and situations where maternal and fetal health interests conflict.
A qualitative study was undertaken in Victoria, Australia in 2012, based on six focus group discussions with midwives (n = 37) working in antenatal and intrapartum care, as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis.
One overarching theme emerged from the analysis: Obstetric ultrasound--a routine tool with far-reaching influence, and it was built on three categories. First, the category'Experiencing pros and cons of ultrasound' highlighted that ultrasound was seen as having many advantages; however, it was also seen as contributing to increased medicalisation of pregnancy, to complex and sometimes uncertain decision-making and to parental anxiety. Second, 'Viewing ultrasound as a normalised and unquestioned examination' illuminated how the use of ultrasound has become normalised and unquestioned in health care and in wider society. Midwives were concerned that this impacts negatively on informed consent processes, and at a societal level, to threaten acceptance of human variation and disability. Third, 'Reflecting on the fetus as a person in relation to the pregnant woman' described views on that ultrasound has led to increased 'personification' of the fetus, and that women often put fetal health interests ahead of their own.
The results reflect the significant influence ultrasound has had in maternity care and highlights ethical and professional challenges that midwives face in their daily working lives concerning its use. Further discussion about the use of ultrasound is needed, both among health professionals and in the community, in order to protect women's rights to informed decision-making and autonomy in pregnancy and childbirth and to curb unnecessary medicalisation of pregnancy. Midwives' experiences and views play an essential role in such discussions.
超声在产科护理中的重要性日益增加。助产士在孕妇护理中处于核心地位。然而，关于她们在这种情况下使用超声的经验的研究有限。本研究的目的是探讨澳大利亚助产士对产科超声作用的经验和看法，特别是在复杂妊娠的临床管理以及母婴健康利益冲突的情况下。
2012年在澳大利亚维多利亚州进行了一项定性研究，基于与从事产前和产时护理的助产士（n = 37）进行的六次焦点小组讨论，作为跨国超声研究（CROCUS）的一部分。使用定性内容分析法对数据进行分析。
分析得出一个总体主题：产科超声——一种具有深远影响的常规工具，它基于三个类别。首先，“体验超声的利弊”类别强调超声被视为有许多优点；然而，它也被视为导致妊娠医疗化加剧、决策复杂且有时不确定以及引起父母焦虑。其次，“将超声视为标准化且无需质疑的检查”阐明了超声在医疗保健和更广泛社会中的使用如何变得标准化且无需质疑。助产士担心这会对知情同意过程产生负面影响，并且在社会层面上，会威胁到对人类差异和残疾的接受。第三，“思考胎儿相对于孕妇作为一个人的问题”描述了关于超声导致胎儿“人格化”增加的观点，并且女性常常将胎儿健康利益置于自身利益之前。
结果反映了超声在产科护理中产生的重大影响，并突出了助产士在日常工作中使用超声时面临的伦理和专业挑战。卫生专业人员和社区都需要进一步讨论超声的使用，以保护妇女在妊娠和分娩中知情决策和自主的权利，并遏制不必要的妊娠医疗化。助产士的经验和观点在这些讨论中起着至关重要的作用。
