Parents' expectations, experiences and reactions to a routine ultrasound examination during pregnancy

The overall aim of this thesis was to describe parents’ expectations, experiences and reactions to a routine ultrasound examination during the second trimester of pregnancy and to develop, test and use a questionnaire. The aim was also to conceptualize the parents’ experiences and ways of handling the situation when the diagnosis was a non-viable fetus. The data for this thesis was collected between 2001 and 2007. The work started qualitatively and inductively with interviews using the Grounded Theory method for data collection and analysis of 22 women’s and 22 men’s expectations experiences and reactions to routine ultrasound examination with normal findings. The results were used during the instrument development of the PEER-U questionnaire. The procedure included a pilot study where 126 parents answered both parts of the questionnaire. Factor analysis and statistical tests for validity and reliability were performed. The PEER-U questionnaire was then used for deductive testing of the results of the qualitative study with a one year cohort in which 2183 parents (1258 women and 925 men) answered both parts of a two-part (before and after ultrasound) questionnaire. The questionnaire included the PEER-U scale with an ultrasound specific state of mind index and the scales state and trait anxiety (STAI) and sense of coherence (SOC) as well as demographics. A follow-up Grounded Theory interview study was performed with 15 parents from the cohort who had been given a diagnosis of a non-viable fetus. The results from the qualitative parts showed that the parents expected to get a confirmation of a normal and apparently healthy child during the ultrasound. For parents with normal results, the ultrasound was experienced as very positive and they started to feel like a family. Afterwards these parents were left with a feeling of relief. Parents who received the diagnosis of a non-viable fetus experienced a collision between hopes and facts. They felt deceived by a false sense of security as the condition was unexpectedly discovered during a routine examination. These parents required clear information and focused on what would happen next. The need for a general and individual care plan was evident as was the need for a follow-up initiated by the care-givers. The development of the PEER-U questionnaire resulted in 30 items to measure parents’ expectations and 23 items to measure their experiences and reactions. Internal consistency, calculated by Cronbach’s coefficient alpha, was 0.77 for the “before ultrasound” part of the PEER-U questionnaire and 0.75 for the “after ultrasound” part. The results from the cohort study showed that both parents’ degree of worried state of mind decreased after the ultrasound but their sense of coherence remained stable. In a gender comparison the women’s state anxiety decreased significantly while the men showed no significant change. Before the examination the women showed a significantly higher degree of worried state of mind in relation to ultrasound than the men while afterwards the situation was reversed. The findings show that parents easily accept fetal diagnosis that gives them a visual evidence of the fetus. This should be remembered when new forms of fetal diagnosis are introduced in the future. Their state of mind in relation to ultrasound can be measured with the ultrasound specific state of mind index. Further research might improve the questionnaire and make it better adapted for use when the parents have experienced adverse findings during a routine ultrasound examination

Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate

Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units.

Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden.

Objective: to conceptualise mothers’ and fathers’ thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. Design, setting and participants: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. Findings: the basic social process was confirmation of a new life. The four categories, visualising—the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents’ process towards confirmation of a new life. The caregivers’ way of assisting and supporting the process by information and treatment was very important to parents. Key conclusions and implications for practice: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life

Danish women's experiences of the rebozo technique during labour:A qualitative explorative study

AbstractObjectiveThe study aimed to explore women's experiences of the rebozo technique during labour.MethodsThis was a qualitative study based on individual telephone interviews, analysed by means of qualitative content analysis and inspired by interpretive description. 17 participants were recruited from two different-sized Danish hospitals and identified by applying a purposeful sample strategy.ResultsThe main theme expressed the women's overall experience with the rebozo: “Joined movements in a harmless effort towards a natural birth”. The women experienced that the technique created bodily sensations, which reduced their pain, and furthermore they expressed that it interrelated the labour process and produced mutual involvement and psychological support from the midwife and the women's partner. The rebozo technique was in most situations carried out because the midwife suspected a foetus malposition.ConclusionThe experiences of the rebozo technique were overall positive and both of a physical and psychological nature. The results indicate that health professionals should view rebozo as an easy accessible clinical tool with high user acceptance and possible positive psychological and clinical implications. The study contributes with a deeper and more nuanced understanding of a topic where only limited knowledge exists, however, efficacy studies are warranted

First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period : Implications for early parenthood preparation

Objective to describe first-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period. Design a qualitative study was conducted and data was analysed with a phenomenographical approach. Setting and participants 15 first-time fathers were recruited from three postnatal units in southern Sweden and interviewed approximately one month after their baby was born. Measurements and findings three categories and 14 conceptions about fathers' experiences of their preparation emerged from the data. ‘Acquiring knowledge and forming realistic expectations' was essential for ‘Developing strategies' and ‘Being facilitated and supported' enhanced these processes. Key conclusions and implications for practice supporting fathers to develop strategies for life with a new baby and providing expert guidance to fruitful and accurate information may help the construction of a fatherhood identity and strengthen the fatherhood role. The findings can be used to develop a parental preparation for early parenthood that will correspond to fathers' needs

Swedish high school students' knowledge and attitudes regarding fertility and family building

<p>Abstract</p> <p>Background</p> <p>Infertility is a serious problem for those who suffer. Some of the risks for infertility are preventable and the individual should therefore have knowledge of them. The purposes of this study were to investigate high-school students' knowledge about fertility, plans for family building and to compare views and knowledge between female and male students.</p> <p>Methods</p> <p>A questionnaire containing 34 items was answered by 274 students. Answers from male and female students were compared using student's <it>t</it>-test for normally distributed variables and Mann-Whitney <it>U</it>-test for non-normal distributions. The chi-square test was used to compare proportions of male and female students who answered questions on nominal and ordinal scales. Differences were considered as statistically significant at a <it>p</it>-value of 0.05.</p> <p>Results</p> <p>Analyses showed that 234 (85%) intended to have children. Female students felt parenthood to be significantly more important than male students: <it>p </it>= <it><</it>0.01. The mean age at which the respondents thought they would like to start to build their family was 26 (± 2.9) years. Men believed that women's fertility declined significantly later than women did: <it>p </it>= <it><</it>0.01. Women answered that 30.7% couples were involuntarily infertile and men answered 22.5%: <it>p </it>= <it><</it>0.01. Females thought it significantly more likely that they would consider IVF or adoption than men, <it>p = </it>0.01. Men felt they were more likely to abstain from having children than women: <it>p = <</it>0.01. Women believed that body weight influenced fertility significantly more often than men: <it>p = <</it>0.01 and men believed significantly more often that smoking influenced fertility: <it>p </it>= 0.03. Both female and male students answered that they would like to have more knowledge about the area of fertility.</p> <p>Conclusions</p> <p>Young people plan to start their families when the woman's fertility is already in decline. Improving young people's knowledge about these issues would give them more opportunity to take responsibility for their sexual health and to take an active role in shaping political change to improve conditions for earlier parenthood.</p