Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

Figures & data

Table 1. Characteristics of midwives (n = 23) participating in focus group discussions (FGDs).

FGD	Workplace: rural/urban hospital	n	Mean age (years)	Work experience as a midwife (years) mean (range)
A	Urban	3	32.7	2.7 (2–4)
B	Rural	6	34.8	12.5 (7–19)
C	Rural	2	30.5	6.5 (3–10)
D	Urban	5	30.6	3.2 (2–6)
E	Urban	3	37.3	7.5 (2.5–15)
F	Urban	4	29.5	3.9 (0.1–7)
All		23	32.6	6.5 (0.1–19)

Table 2. Key domains in the CROss Country Ultrasound Study (CROCUS) interview guide.

The midwives’ experiences and views of:

1. The role of obstetric ultrasound for clinical management of complicated pregnancy.

2. The role of obstetric ultrasound in comparison to other surveillance methods during complicated pregnancy.

3. Clinical situations where the interests of maternal and foetal health conflict.

4. Whether the woman may be considered to act as an instrument for foetal treatment.

5. If/when the foetus can be regarded as a person.

6. Situations where the foetus has been regarded as a patient with his/her own interests.

7. Their professional role in relation to other occupational groups working with obstetric ultrasound examinations or the outcomes of these examinations.

8. Their perception of the community’s views of obstetric ultrasound.

9. Other issues in relation to ethical aspects of the use of obstetric ultrasound.

Table 3. Examples of text, codes and categories generates from content analysis of focus group discussions.

Text	Codes	Categories
It would be good if there was a nurse or a midwife trained in ultrasound at the health centre level	Ultrasound training for nurses and midwives	Advocating for development of maternity care
	Good with ultrasound at health centres
Every woman wants to use echography, and if you don’t perform it, she does not feel happy at all, even if you give her other types of care required. She feels that something important is missing	Everyone wants ultrasound	Differing views on use of obstetric ultrasound
	Women not happy at all being without ultrasound at antenatal care visits
	Women valuing ultrasound more than other examinations
	Other types of care required in addition to ultrasound
	Something important is missing without ultrasound

Table 4. Theme, categories and subcategories.

Theme	Categories	Subcategories
Balancing increasing demands and modern technology in the context of limited resources	Limited resources cause shortcomings in maternity care	Challenges due to insufficient and unequal distribution of resources
		Lack of physicians means increased responsibility for midwives
	Advocating for development of maternity care	Obstetric ultrasound – only the duty of physicians’?
		Midwives arguing for change in maternity ultrasound services
	Differing views on use of obstetric ultrasound	Obstetric ultrasound not always an undisputed tool
		Pregnant women demanding ultrasound
		Religious and spiritual beliefs clashing with modern technology
	Balancing maternal and foetal health interests	Prioritising maternal health interests Enduring treatment for the sake of the foetus
		Respecting pregnant women’s autonomy in counselling