ASSESSMENT OF KNOWLEDGE, EXPECTATION, AND BELIEFS OF PREGNANT WOMEN ON ANTENATAL ULTRASOUND

ABSTRACT

 

This research work was designed to investigate the influence of the educational process during a routine obstetric ultrasound on Maternal-Fetal Attachment (MFA) and maternal behavioral changes in pregnancy. Using a prospective and cross-sectional design, 289 pregnant women who had a singleton and uncomplicated pregnancies, with no history of mental illness, not primigravidas, and whose gestational ages ranged from 16 weeks to 30 weeks, were enlisted from referrals for a routine obstetric scan at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. The 2-Dimensional ultrasonography was performed using a real-time ultrasound unit, with a 3.5 MHz sector probe and a 5 MHz linear probe. Three questionnaires were used in the study and consisted of the demographic questionnaire, the Maternal-Fetal Attachment Scale (MFAS), and the Health-Habit questionnaire (HHQ). The demographic questionnaire was used to collect the personal data of the subjects. The MFAS which consisted of 24 items on a 5-point Likert scale, was used to assess the influence of the educational process on MFA. The HHQ, which consisted of 19 items, was used to assess the influence of the educational process on maternal behavioral changes in pregnancy. The MFAS and HHQ were distributed to the participants, pre- and post- ultrasound scans. During the ultrasound examination, the fetal ultrasound image was explained and discussed with the mother who was allowed to ask questions. Data were categorised according to maternal characteristics, MFA scores, and nutritional/dietary habits. Percentage responses, frequencies, mean scores, and standard deviation of the demographic data, MFA score, and maternal nutritional/ dietary habits scores were computed and analyzed using the SPSS 15.0 version program. Paired t-test was used to compare the pre-and post- mean values. ANOVA was used to compare the values of more than two means. Chi-square was used to compare the frequencies of more than one group. Results indicated that the mother’s‟ total MFA pre-mean score increased significantly (p=0.0001) from 3.34±0.18 to a post-mean score of 3.74±0.20, after the ultrasound experience. The pre-mean scores of all the areas involved in the HealthHabit Questionnaire (HHQ) also significantly improved after the educational process during an ultrasound examination. The pre-mean health habits regarding maternal nutritional/dietary status increased significantly (p=0.0001) from 2.51±1.02 to a postman score of 3.04±0.83 while that of maternal alcohol consumption decreased significantly (p=0.000) from 1.52±0.63 to a post-mean score of 1.13±0.38. The health habit regarding compliance with antenatal care also significantly improved (χ=70.60; p=0.0001). These results show that the educational process during routine obstetric ultrasound positively influences MFA and maternal behavior during pregnancy.

 

CHAPTER ONE

INTRODUCTION

1.1     BACKGROUND OF THE STUDY

Maternal-Fetal Attachment (MFA) is a term used to describe the relationship between a pregnant woman and her fetus (Salisbury et al, 2003). This is the extent to which women engage in behaviors that represent an affiliation and interaction with their unborn child (Cranley, 1981). MFA is known to improve maternal care and is associated with positive neonatal outcomes (Verny & Kelly, 1981, Ji Ek et al 2005; Facello, 2008). Literature provides empirical evidence that MFA typically increases as pregnancy progresses, and positive MFA predicts positive birth outcomes (Cannella, 2005).

The poor neonatal outcome which is largely represented by high maternal and infant mortality and morbidity rate, still pose a serious challenge in Nigeria (Mukhtar et al, 2007). Poor or non-utilization of antenatal/delivery care and poor dietary habits, among others, have been highly associated with maternal complications and poor perinatal outcomes (Owolabi et al, 2008; Sanusi and Oredipe, 2002; Mamman et al, 2002).

Routine obstetric sonography has been known to improve neonatal outcomes (SaariKemppainen et al, 1990). It assists in the attachment process by accentuating the individuality and separateness of the fetus and is now globally recognized as one of the ways through which maternal mortality can be reduced (Durbin, 1999; Mubuuke et al, 2009). Several research studies have examined the experience of women undergoing routine obstetric ultrasound scanning. Their findings suggest that for women with normal pregnancies and low risk for complications, viewing the fetus on ultrasound generally is a most positive, reassuring, and significant event (Campbell et al, 1982). Women usually are eager to see their babies‟  ultrasound images in utero. Areas that show motion, such as the beating of the heart and extremities, get a major amount of attention and seem to provide mothers with significant reassurance about the health of their fetus (Kohn et al, 1980). Further studies showed that ultrasound exams have a “significant psychological effect on parental attitudes toward each other and the fetus” (Zlotogorski, et al, 1997).

The educational process may be involved in routine obstetric ultrasound (Boukydis, 2002) which has been proven to be beneficial to obstetric management (Hyde, 1986). This process involves the sonographer spending just a few extra time (3 minutes) with a mother-to-be during her 2- or 3-/4-dimensional fetal ultrasound examination to demonstrate, explain and discuss the fetal ultrasound image (Boukydis et al, 2006) using language that is simple, and appropriate while avoiding “slips of the tongue” (Lumley, 1990) and allowing the mother to interact and allowing the mother to self-initiate behavior (Boukydis, 2002).

There is a growing body of evidence that a mother viewing prenatal sonograms of her fetus may or can increase positive feelings towards the fetus (Lumley, 1990), which influences maternal attachment to the fetus at an early stage of pregnancy (Ji Ek et al, 2005). This educational process was found to be an effective nursing intervention to promote Maternal-Fetal Attachment since women who received fetal ultrasound education were found to have a higher MFA than those who did not. (Jee, et al, 2002).

However, whether the educational process during routine obstetric ultrasound influences maternal-fetal attachment in this locality, has not been documented.

It is well known that maternal nutritional status, and physical health among others directly affect the intrauterine fetal environment and are associated with some maternal and infant health outcomes during and after pregnancy (Lindgren, 2001; Wilkinson and Tolcher, 2010). However, due to our peculiar socio-economic and cultural circumstances, that negatively affect the perinatal outcomes, adequate positive maternal health practices are yet to be achieved (Sanusi, 2002).

The maternal-fetal attachment has been positively associated with prenatal health practices, as well as being considered both a developmental task of pregnancy and an indicator of adaptation to pregnancy (Callister, 2002; Lindgren, 2001).  Women on a healthy diet have greater levels of maternal-fetal attachment than women on an unhealthy diet.  Prenatal interventions, especially the mother‟s viewing of the fetus during ultrasound examinations, in pregnancies in which there is high psychosocial risk and active substance abuse have the potential to increase maternal-fetal attachment and reduce the risk of behaviors that may harm the fetus and compromise the health status of the pregnancy (Pollock and Percy, 1999).

The viewing of the fetal image via ultrasound in pregnancy before any bodily cues are experienced has superseded the earlier importance of quickening the mother‟s realization of actual life inside the womb (Gloger-Tippelt, 1989; Lumley, 1990) and may contribute towards stronger feelings of attachment to the unborn child (Lerum and LoBiondo-Wood, 1989) and enhanced health behavior during pregnancy (Dykes and Stjernqvist, 2001). The educational process surrounding the visualization of one‟s own baby during an ultrasound examination accelerates maternal-fetal attachment as is evidenced by the mother‟s improved health practices that include better nutrition and decreased consumption of nicotine and alcohol (Durbin, 1999). Increased and strengthened Maternal-Fetal Attachment that results from viewing the obstetric ultrasound seemed to be beneficial by reducing potentially harmful maternal behavior (Berman et al, 1997). However, whether the educational process during routine obstetric ultrasound involves a change in the health-related behavior of the mother in our locality is yet to be ascertained.

This study, therefore, aims at studying the influence of the educational process that goes on during routine obstetric ultrasound on maternal-fetal attachment and maternal behavioral changes during pregnancy in our locality.

The study will provide information that may improve the use of the educational process during the routine obstetric ultrasound and also raise society‟s consciousness on the role of the educational process during a routine obstetric ultrasound on improved neonatal outcomes.

 

1.2    PURPOSE OF THE STUDY

The aims of this study are to:

1. Determine if the educational process during obstetric ultrasound examination influences maternal-fetal attachment in this locality.
2. Determine if the educational process during ultrasound examination influences maternal health practices as represented by:
   1. Maternal nutritional/dietary habits
   2. The intake of alcohol.
   3. The compliance with antenatal drugs/care, in this locality.

1.3     SIGNIFICANCE OF THE STUDY

1. The study will provide information that may improve the use of the educational process during routine obstetric ultrasounds.
2. This study will also raise society‟s consciousness on the role of the educational process during a routine obstetric ultrasound on improved neonatal outcomes.

1.4      HYPOTHESES

(H₀)₁.  The educational process involved in obstetric ultrasound examination has no significant influence on Maternal-Fetal Attachment.

(H₀)₂.  The educational process involved in obstetric ultrasound examination has no significant influence on maternal dietary habits.

(H₀)_3.  The educational process involved in obstetric ultrasound examination has no significant influence on the maternal intake of alcohol.

(H₀)_4.  The educational process involved in obstetric ultrasound examination has no significant influence on maternal compliance with antenatal drugs and care.

 

1.5   SCOPE OF THE STUDY

This study is a prospective study that was carried out between November 2009 and

August 2010 at the University of Nigeria Teaching Hospital (UNTH), Ituku, Ozalla, Enugu. The study population includes women between 16-30 weeks of normal

singleton pregnancy who met the selection criteria.

 

1.6   DEFINITION OF TERMS

The definition of the following terms will serve to clarify the concepts used in this study:

Routine Obstetric Ultrasonography: Routine obstetric ultrasonography is defined as a screening procedure that is done on low-risk pregnant women (Skupsi et al, 1995). Low-risk pregnant women refer to those without clinical indication for an ultrasound.  The routine protocol consists of views of anatomic features as well as a thorough search for detail of any abnormality in anatomy. This consists of the fetal skull and intracranial anatomy, face, heart and chest, abdomen, kidneys, spine, extremities, placenta, amniotic fluid, uterus, and other structures. In obstetric ultrasound practice, the technique can facilitate attempts to evaluate the fetal size, fetal maturity, and fetal/placental position, as well as provide additional diagnostic data.

Diagnostic Toxicity: This is defined by Lumley (1990) as the negative impact of routine obstetric ultrasound scans produced by incompetent healthcare providers during the procedure itself. Lumley refers to it as “slips of the tongue” or “incorrect diagnosis”, identification of structures that cannot be deciphered and language that is unfamiliar and alarming to mothers.”

Maternal-Fetal Attachment/Bonding: The term “bonding” and “attachment” are used interchangeably. It is described as the maternal feelings of affection and enduring commitment to the fetus.  This is defined by Cranley (1981) as “The extent to which women engage in behaviors that represent an affiliation and interaction with their unborn child”.

Maternal Health Behaviour/Practices: These are activities in which the pregnant woman engages that affect her health and the health of the fetus and later infant outcomes. Positive health practices include proactive measures such as seeking prenatal care, eating well, gaining the recommended amount of weight, obtaining dental care, and abstaining from illegal drugs, and alcohol (Lindgren, 2001).

Ultrasound Educational Process: This process involves spending just a few extra minutes ( about 3 minutes) with a mother-to-be during her fetal ultrasound exam to demonstrate, explain and discuss the fetal ultrasound image (Boukydis et al (2006).

Lumley (1990) referred to the educational process in her research as “sonographer feedback”, and felt it was a critical factor since it accounted for discussion, explanation, and interpretation of the ultrasound images.

ASSESSMENT OF KNOWLEDGE, EXPECTATION, AND BELIEFS OF PREGNANT WOMEN ON ANTENATAL ULTRASOUND

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