What's wrong with using the F word? A systematic integrative review of how the fetus is talked about in situations of fetal demise or high risk of fetal loss

© 2019 Elsevier Ltd Background: Limited research exists that investigates the language parents and health professionals use when faced with a high-risk likelihood of fetal demise or an instance of fetal loss. This review examines the language used when referring to the ‘fetus’ in these cases to better understand the meaning different groups might ascribe to the fetus and how their word choice may reflect their strategies for managing in these situations. Methods: An integrative review of primary, peer-reviewed research was conducted. A systematic search of seven databases was undertaken, articles critiqued and summarised using the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA). The comprehensive process of data analysis and synthesis followed a constant comparison approach. Results: The 23 included studies represented the voices of women, their partners, obstetricians, nurses, midwives and allied health professionals. Five major themes emerged with the main finding being that the term ‘Baby’ is the most widely recognised word used in instances of fetal loss and high risk of fetal demise. Conclusion: History, science and law all influence how the fetus is understood and discussed within society. This review contributes new insights into our understanding of the term ‘fetus’ emphasizing the need for further research into the way the fetus is addressed and dealt with in instances of fetal loss or high risk of fetal loss within Maternity care practices

Ultrasound's 'window on the womb' brings ethical challenges for balancing maternal and fetal health interests : obstetricians' experiences in Australia

BACKGROUND: Obstetric ultrasound has become a significant tool in obstetric practice, however, it has been argued that its increasing use may have adverse implications for women's reproductive freedom. This study aimed to explore Australian obstetricians' experiences and views of the use of obstetric ultrasound both in relation to clinical management of complicated pregnancy, and in situations where maternal and fetal health interests conflict. METHODS: A qualitative study was undertaken as part of the CROss-Country Ultrasound Study (CROCUS). Interviews were held in November 2012 with 14 obstetricians working in obstetric care in Victoria, Australia. Data were analysed using qualitative content analysis. RESULTS: One overall theme emerged from the analyses: The ethical challenge of balancing maternal and fetal health interests, built on four categories: First, Encountering maternal altruism' described how pregnant women's often 'altruistic' position in relation to the health and wellbeing of the fetus could create ethical challenges in obstetric management, particularly with an increasing imbalance between fetal benefits and maternal harms. Second, 'Facing shifting attitudes due to visualisation and medico-technical advances' illuminated views that ultrasound and other advances in care have contributed to a shift in what weight to give maternal versus fetal welfare, with increasing attention directed to the fetus. Third, 'Guiding expectant parents in decision-making' described the difficult task of facilitating informed decision-making in situations where maternal and fetal health interests were not aligned, or in situations characterised by uncertainty. Fourth, 'Separating private from professional views' illuminated divergent views on when the fetus can be regarded as a person. The narratives indicated that the fetus acquired more consideration in decision-making the further the gestation progressed. However, there was universal agreement that obstetricians could never act on fetal grounds without the pregnant woman's consent. CONCLUSIONS: This study suggests that medico-technical advances such as ultrasound have set the scene for increasing ethical dilemmas in obstetric practice. The obstetricians interviewed had experienced a shift in previously accepted views about what weight to give maternal versus fetal welfare. As fetal diagnostics and treatment continue to advance, how best to protect pregnant women's right to autonomy requires careful consideration and further investigation