Testing for fetal abnormality in routine antenatal care

Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?

OBJECTIVE

To explore if an information film about prenatal examinations affects pregnant women's worry and anxiety.

METHODS

Randomized controlled study. The intervention was an information film about prenatal examinations. Data was collected in gestational week 26 by a questionnaire including the STAI (State-Trait Anxiety Inventory) instrument and further questions about worry. A total of 184 women in the intervention group and 206 in the control group filled in the questionnaire.

RESULTS

There were no statistically significant differences between the groups neither in state nor trait anxiety. Regarding worry about the possibility of something being wrong with the baby and worry about giving birth, there were no statistically significant differences between the groups. The women stated that to see the film increased their worry rather than decreased it.

CONCLUSION

An informational film as additional information to complement written and verbal information about prenatal testing does not appear to increase women's anxiety and worries. However, the informational film may cause worry at the time of viewing which should be taken into consideration.

Discovery of soft markers on fetal ultrasound: maternal implications

OBJECTIVE

to explore women's experiences of referral to tertiary care on the basis of uncertain ultrasound findings.

DESIGN

a qualitative method using Rice and Ezzy's thematic analysis approach. Data were gathered through two in-depth interviews over a six to eight-month period.

PARTICIPANTS

a total of 20 interviews were conducted among pregnant women, purposively recruited at a tertiary facility. Inclusion criteria were based on detection of an isolated soft marker in an otherwise normal pregnancy.

DATA ANALYSIS

interview data were transcribed and data were subjected to thematic analysis.

FINDINGS

mothers journeyed through a temporal sequence of adjustment following referral to specialist services. Four distinct phases were identified: realisation; making sense of events; anxious waiting; and having no clear resolution.

CONCLUSION

trends of increasing prenatal surveillance together with advancing technology make this study timely and of global interest. Findings suggest that women identified as 'at risk' before being discharged uneventfully may be prone to attachment issues and a host of other difficulties. The complexities inherent in this experience should be of interest to a broad range of health professionals. An appreciation of this experience may assist midwives and other health professionals to provide more meaningful maternal support to women identified as 'at risk'.

Risky professional boundaries

This paper examines the role of various boundaries in giving both professional groups and individuals a sense of identity that provides both with status and legitimacy. Close attention is paid to the boundaries between personal and professional identities and values. Sociologists working with a discursive approach argue that professional identity and status are achieved through the rhetorical presentation of certain values and responsibilities as personal, and therefore outside the boundaries of professional practice. This paper takes this argument forward, by arguing that in particular contexts, certain kinds of values are consciously articulated as personal and incorporated into the defence of professional legitimacy. Bringing personal claims inside professional boundaries is further evidence of the fluid and negotiated quality of the boundary between personal and professional values and notions of self. The paper consists of a discussion of the construction of professional boundaries, professional involvement in risk, issues raised by antenatal screening and analysis of a study of a group of professionals involved in antenatal screening. The paper explores the circumstances within which even senior professional groups and individuals look to representations of the personal self as a defence against critiques of their professional practice. Where the risks that professionals generate and interpret are medically ambiguous and socially contentious the abstract professional and medical framework is insufficient and other rhetorical values become resources in securing the professional role.

Who worries that something might be wrong with the baby? A prospective study of 1072 pregnant women

BACKGROUND

Little is known about the normal range and pattern of pregnant women's worry about something being wrong with the baby, or how this relates to other factors. The objective of this study was to examine the extent to which women are worried about the possibility of something being wrong with the baby relative to other worries they may have, and to determine whether demographic, experiential, attitudinal, and personality characteristics are associated with this worry.

METHODS

Longitudinal data were collected from 1072 pregnant women who completed postal questionnaires at 16, 22, and 35 weeks of pregnancy. Multivariate statistical techniques were used to determine which variables were independently related to worry about the baby.

RESULTS

Worry that something might be wrong with the baby was one of the most prevalent worries at 16 weeks, although not as widespread a source of extreme worry as miscarriage or giving birth. Worry dropped in midpregnancy but rose again at 35 weeks. The most important factors related to this worry were perceived likelihood that something might be wrong with the baby and trait anxiety, although negative mood, previous pregnancy outcomes, and initial reactions to the current pregnancy all demonstrated significant, independent effects.

CONCLUSIONS

Women who answered "Don't know" to "Have you any reason to think that your baby might be more likely than any other to have some sort of a problem?" had consistently high anxiety throughout pregnancy. We suggest that this question be asked routinely in early pregnancy to identify these potential worries and, it is to be hoped, reassure them at an early stage.

Ultrasound examinations in pregnancy: some suggestions for debate

OBJECTIVE

to ascertain the number of ultrasound examinations a sample of women received in pregnancy.

DESIGN

a retrospective review of 50 sets of case notes of women delivering consecutively in one maternity unit.

SETTING

a large maternity unit in Northern England (approximately 5000 deliveries per year).

FINDINGS

the mean number of scans received was 2.6 indicating that many women receive an early 'dating' scan as well as a second trimester 'routine' scan.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

first trimester and early mid-trimester scans may be clinically indicated, but we are concerned that they are becoming routine without fundamental questions of safety and efficacy being answered by large controlled trials. In addition, little is known about the possible positive or negative psychological effects of early scans and there is no evidence that they are cost effective.