Women's subjective experience of the ultrasound examination during pregnancy

Virtually all pregnant women in New Zealand undergo an ultrasound examination during pregnancy. Previous studies have been conducted to find out how women feel about the ultrasound examination, however, these studies were carried out in specialist centres with adequate equipment and plenty of skilled staff. It is not known what happens to women and their families in busy hospital clinics or private facilities. This study has focussed on the ethical issues surrounding the use of ultrasound technology and the identification of any ethical issues raised by the women. By conducting this study I have greater understanding of how much women appreciate ultrasound examinations. However, the study shows that we need quality standards so that all women in the region can benefit equally. Based on the findings of this study, there is evidently a discrepancy between theory and reality. Health professionals fell short in their obligation to respect the woman and to promote her autonomy as a patient, and failed sometimes, to provide a quality service. This study was carried out using semi-structured interviews. Altogether forty one women took part and were interviewed after the ultrasound examination. The survey included closed questions about the presence of any health disorders, or complications arising from this or previous pregnancies. The survey also had open ended questions which collected more descriptive information. Quotes from the study participants are included in the discussion and serve to clarify and support the quantitative data. The data was analysed using qualitative and quantitative methods. This multiple approach to data collection and analysis in a single study has been referred to as triangulation. The questions were divided into six topics of interest; the reason or indication for the ultrasound examination; the nature of any costs or resource implications; the process of informed consent; the women's experience of the examination and what particular aspects they enjoyed; the possible issues of fetal or maternal rights; the influence of this technology upon women. The results show that half of the women in this study had no clinical indication for the examination. Motivation for attending for an ultrasound was in the belief that it was appropriate health care and also a strong personal desire to find out more about the baby. The cost of ultrasound examination may be quite high in that it was found that routine examinations were frequently repeated. Women were not well informed about the purpose of the examination or prepared for possible adverse outcomes. The level of benefit gained by the women from the ultrasound examination varied. Those undergoing endo or transvaginal ultrasound examinations however found this technique to be humiliating and unpleasant. The ultrasound examination can provide potentially threatening information about the fetus. This is because termination of the pregnancy is the 'treatment' most often suggested. The control gained from this medical technology was felt by the women to have more benefits for the health professionals than for themselves, although women valued the information as information about the baby just for its own sake. The predominant response by women to the examination was that it enhanced their personal knowledge of the baby. They felt an increased sense of attachment, and a strengthened need to protect and relate to the baby. The results of this study will be available for the women who participated, health professionals, and service providers. This research may help bridge the gap which currently exists in this area between women's subjective experience of technology, and the more objective attitudes as reported in the medical literature. The question of a clinically indicated ultrasound done well is not in question. The question of whether it is worth doing routinely involves values. At this level, elected representatives, the legal profession, patients’ advocates, or even better, women themselves should have a say. The Treaty of Waitangi establishes partnership as the foundation of social and political relationships in New Zealand. For this reason, if no other, experiences such as those described by women in this study should be recognised as valid evidence to be included in any debate about ultrasound services