Infusing Caring for Abnormal Prenatal Ultrasound Findings

Monday, 9 November 2015

Jeanne Gottlieb, PhD, MSN, BSN, APRN, CNM
School of Nursing, University of Southern Maine, Portland, ME, USA


Purpose: The purpose of this presentation is to provide an interpretation of qualitative research for clinical practice. The specific aim of this research was to describe and interpret the meaning for women who experienced an abnormal prenatal ultrasound indicating a risk for a congenital, chromosome and/or genetic disorder.  The calls for technological competent care are often not heard by advanced practice nurses, nurses and other health professionals. The investigator sought to unfold stories of these women’s experiences to gain understanding within the context of their beliefs, values and attitudes. 


Methods: The method selected was van Manen’s hermeneutic phenomenology to explore the meaning of the lived experience of having an abnormal ultrasound.  The method describes and interprets the meaning though the process of written transcribing, translating and interpreting. 


Results: Ten essential themes were illuminated during the data analysis. These themes were: “Blindsided by Unexpected Findings,” “Fear,” “Loss,” “Threatened Safe Passage,” “Blocking,” “Alone in Silence,” “Detachment,” “Searching for Higher Powers,” “Watching and Wanting to Know,” and “Unresolved Reflection.” Each of these themes was supported by sub-themes, which created the richness of the experience. These sub-themes represented the diversity of the participants in their lived experience. The stories of each participant shared the complexity of their life worlds. The life worlds of lived time, lived space, lived human relation, and lived body gave insight to the existential dimensions and complexity of participants. 

The themes highlighted the essence of the lived experience of having an abnormal prenatal ultrasound. This routine non-invasive screening tool yielded many unexpected and profound experiences to the participants. Women were blindsided by the unexpected findings in ultrasound technology. They sought a pleasurable experience, but suffered with shock and disbelief. Some experiences resulted in a healthy birth of a newborn, while others had a perinatal loss. The participants remembered their journeys through the experience. The journeys were of suffering through this experience.

The participants wanted to know more about the condition and searched for answers. However, they were also cautious within their search, as they did not want to add to the burden of knowing. They coped by blocking information.  Many participants experienced the burden of the risks in silence and isolation. They had lived relations with others, but did not use these relations for support. They felt guilt and shame in not carrying a healthy baby. The participants felt that they had the sole responsible for carrying a successful pregnancy. The lived world of body reflected upon their changing bodies and desire to protect their self-image and babies.  Many women actively sought information about their baby’s condition. They suffered from the lack of knowledge for their decision-making. Their coping ranged from faith and hope to detachment in protecting themselves from harm. In reflection of their experience, they expressed missed opportunities.   Participants resented the lived time that they experienced in feeling fear and anxiety. They resented not having knowledge and opportunities for decision-making. The women missed the experience of enjoying their pregnancy.   Participants all reported contacts with specialists and genetic counseling sessions, but continued their search as they were not satisfied with the responses or available information.  The women described the technological supervision of their care, but recognized that health care providers lacked the recognition of their feelings and emotional turmoil. 


Conclusion: When women reflected upon their experiences of having an abnormal ultrasound, they shared a universal meaning of suffering. They used coping mechanisms or enduring that did not always relieve the suffering. For those that had healthy outcomes, they reflected upon the lost joy in pregnancy and birth. Women that had perinatal losses regretted not having the support they needed. Professional nursing was not present in the experiences of women. Caring was not present from technologists and medical health providers in their experiences. They were alone in suffering. Providers in not recognizing their misunderstandings and emotional fears abandoned women in their psychosocial and cultural needs.

Reproductive genetic technologies will continue to emerge in today’s health care. The ambiguity of findings provides a complex pathway for women and families for decision-making. As there is a threat to the infant, emotional turmoil erupts throughout the pregnancy. Knowledge of new technology and interpretation of results is essential for nursing in our highly technological society.

Nursing can advance upon nursing technology in becoming technologically competent and caring. Technology must be used to come to know the other, but not to infuse a barrier in human caring. Understanding the need for empathetic touch in technology will bring a reduction in suffering. 

In conclusion, the results reveal that nurses and health providers need to infuse human caring ways of being, knowing and doing within advanced technological environments.  The recommendations for caring include both a nursing presence and use of a variety of supportive and educational tools to alleviate their suffering.