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Parents, professionals and a pandemic: An exploration of the influence of antenatal imaging on prenatal bonding

Skelton, E. (2024). Parents, professionals and a pandemic: An exploration of the influence of antenatal imaging on prenatal bonding. (Unpublished Doctoral thesis, City, University of London)


Background: Positive parental experiences of antenatal imaging are associated with enhanced prenatal bonding. However, this association is not well understood, particularly for expectant fathers, when advanced imaging techniques such as fetal magnetic resonance imaging (MRI) are utilised, or when there is a suspected prenatal fetal diagnosis.

Aim: This thesis aimed to gain a comparative insight into expectant parents’ experiences of imaging during pregnancy and how these experiences may help to enhance parent-fetal bonding. Additional aims were to understand the effect of the COVID-19 pandemic in the United Kingdom on obstetric sonographers (e.g., evaluating occupational burnout) and new and expectant parents (e.g., evaluating prenatal bonding and exploring imaging experiences).

Methods: A convergent, mixed-methods design was used. In addition to a systematic review of literature, three research studies were conducted; two studies utilised online questionnaires to capture data during the COVID-19 pandemic from: 1) UK obstetric sonographers (n=138); and 2) new and expectant parents (n=714). The third study used online questionnaires (n=76) and semi-structured telephone interviews (n=28) with first-time expectant parents who had imaging at a London hospital during pregnancy (including ultrasound and fetal MRI), and were following a routine antenatal care pathway, or receiving specialist care because of a diagnosed fetal condition.

Results and discussion: The systematic review (Article 1) suggested that interactive and parent-centred scan experiences may help to enhance parent-fetal bonding. The study of obstetric sonographers found that over 90% of respondents met thresholds for occupational burnout during the pandemic, which had potential implications for care provision and parental experiences of antenatal imaging (Article 2). Sonographer burnout during the pandemic was explained by experiences of moral injury and ineffective leadership (Article 3). The second study showed that bonding in fathers was significantly lower compared to mothers, which may be attributed to changes in the delivery of obstetric ultrasound services during the pandemic (Article 4). The final study found no differences in bonding between mothers and fathers, but significantly higher bonding in parents having fetal MRI compared to ultrasound (Article 5). Expectant parents valued experiences where HCPs balanced the medical and psychosocial aspects of fetal imaging, particularly when a fetal condition was present (Article 6).

Conclusion: This thesis highlights the integral role of HCPs in facilitating parent-centred experiences of care during fetal imaging to support parent-fetal bonding. However, tensions are identified due to HCP burnout, organisational culture, and the lack of a clear definition of parent-centred care in antenatal imaging.

Publication Type: Thesis (Doctoral)
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > RG Gynecology and obstetrics
R Medicine > RZ Other systems of medicine
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Skelton thesis 2024 redacted PDF-A.pdf]
Text - Accepted Version
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