Sot. Sci. Med. Vol. 36, No. 3, pp. 311-315, 1993 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFED Printedin Great Britain 0277-9536/93 $6.00 + 0.00 Pergamon Press Ltd WOMEN’S VIEWS OF ULTRASONOGRAPHY A COMPARISON OF WOMEN’S EXPERIENCES OF ANTENATAL ULTRASOUND SCREENING WITH CEREBRAL ULTRASOUND OF THEIR NEWBORN INFANT KAREN THORPE,’ LISA HARKER,’ ALLWN PIKE’ and NEIL MARLOW’ ‘Institute of Child Health, Royal Hospital for Sick Children, St Michael’s Hill, Bristol BS2 8BJ, U.K. and *Department of Child Health, Bristol Maternity Hospital, Southwell Street, Bristol BS2 8EG, U.K. Abstract-Ultrasound screening is now a routine procedure which forms part of antenatal care provision. Within this routine context ultrasound technology has been found to be generally acceptable and indeed is positively demanded by many women. This paper raises the question whether the routine presentation of ultrasound implicitly conveys the message that its use in antenatal care is both valuable and safe. It examines women’s views of ultrasound technology beyond a routine context. In a study designed to examine women’s reactions to cerebral ultrasound on their normal term infants mothers were asked their views and knowledge of ultrasound and a comparison with their antenatal experience of ultrasound was elicited. A generalized concern about ultrasound techniques was found to underlie many of the women’s comments. This raised questions concerning the current practice in the presentation of ultrasound to women attending for antenatal care. Key words-antenatal ultrasound, cerebral ultrasound, attitudes, beliefs, routine vs non-routine presentation INTRODUCI’ION Ultrasound screening is now a routine procedure which forms an integral part of antenatal care pro- vision. In a large number of maternity hospitals a one-stage ultrasound screening of pregnancies is conducted irrespective of the risk status attributed either to the mother or fetus. Such screening has been advocated as a valuable tool in detection of fetal abnormality, diagnosis of multiple pregnancy and confirmation of gestational age. Furthermore, beneficial psychological effects have been attributed to ultrasound screening. Ultrasound is reported to promote the bonding of the parents with the fetus [I], Some have suggested that ultrasound is a mediating factor in directing mothers’ health behaviour. The randomized control study of Waldenstrom and colleagues [2], for example, found that babies of mothers scanned had higher birth- weights than those of mothers who did not have ultrasound. The author’s hypothesize that this finding reflects a bonding effect whereby positive health behaviour (e.g. cessation of smoking) is mediated by the experience of ultrasound. Ultrasound screening is a non-invasive procedure and unlike other procedures used to screen the fetus (e.g. CVS, amniocentesis) does not require a long waiting period before a result can be conveyed to the mother. The procedure has not been found to provoke anxiety except when insufficient feedback is given [3,4]. With the provision of adequate feed- back it has been found to be a largely positive experience and indeed has been reported to be a reassuring to the mother [5]. The general accept- ability of the procedure to mothers and indeed their positive demands for it has become part of the justification for its use. In recent times, however, a number of questions have been raised about the routine use of ultrasound. Three major issues are prominent in this respect: (i) the value and accept- ability of routine use, (ii) safety and (iii) informed consent. While it has been shown to be an effective diagnostic tool in its use with high risk populations, randomized case-control studies of ultrasound screening in pregnancy have, to date, provided little support for its routine use with low-risk populations [2,6, 71. Ultrasound has undoubtedly been respon- sible for a decrease in the number of undiagnosed twins and there has been a commensurate decrease in perinatal mortality among twins. The existence of a causal relationship has not been established, how- ever. Waldenstrom et al. [2], for example, found that twins were diagnosed earlier in the group assigned to ultrasound but there were no differences between scanned and unscanned groups in subsequent neo- natal admissions. The claim that ultrasound scanning facilitates bonding must also be viewed as conten- tious [8,9], summarized the evidence concerning bonding as “patchy” and “overemphasized” while Oakley [8] argues that such bonding occurred pre- viously in the absence of ultrasound and is not attributable to the technology. Moreover, the serious adverse psychological effects of misdiagnosis (both positive and negative) following ultrasound must be considered [lo]. 311