Sonographers can help enhance parents' emotional connection to the unborn baby during pregnancy

A systematic review of twenty-three studies suggests that, during pregnancy, expectant parents' feelings towards their unborn baby (fetus) can be positively enhanced by sonographers (specialist healthcare professionals who are trained to perform pregnancy ultrasound scans) making imaging examinations a truly parent-centered experience.

Such an experience can allay feelings of anxiety and stress in the parents, helping them to feel more informed about the health and well-being of their unborn baby, and reassured of their emotional investment in the ongoing pregnancy.

Conducted by the Centre for Maternal and Child Health Research at City, University of London, the review provides a holistic interpretation of the current evidence on the effect of antenatal (before birth) imaging on expectant parents' feelings towards their unborn baby.

To date, whilst the provision of ultrasound scans during pregnancy has been generally regarded as a positive experience for parents, and may predict the quality of the parent-child relationship after birth, there is evidence to suggest that the experience may also lead to increased anxiety and stress in parents, particularly those who are unable to interpret the scan images.

Seventeen of the studies analyzed in the review related to the mother's experience only, five included both parents and one study recruited fathers only. Six central themes were developed from analysis of the included studies:

• the scan experience begins before the scan appointment; including parents looking forward to the scan, but being simultaneously apprehensive of the potential to receive unexpected news about their baby
• the scan as a pregnancy ritual; parents regarded scans as a milestone event, which they expected, and wanted
• feeling actively involved in the scan; with the presence of fathers at scans important, not only for maternal support, but also as attending fathers felt closer to their unborn baby than those who were not
• parents' priorities for knowledge and understanding of the scan change during pregnancy; at earlier stages of pregnancy, parents prioritized knowing that their pregnancy was viable, at later stages it was important for parents to know about the presence of fetal anomalies
• the importance of the parent–sonographer partnership during scanning; parents' confidence in their sonographer was linked with narration of the scan, and limiting the use of non-medical terminology humanized the fetus, and implied to parents that the sonographer recognized their unborn baby as an individual rather than a medical entity
• scans help to create a social identity for the unborn baby; many parents centered their news about pregnancies around a scan, with some waiting until their first scan to tell friends and family about their pregnancies, and sharing their scan pictures or videos so that their support circle had a sense of knowing the baby even before birth

The review also identified a lack of published research studies exploring the impact of fetal MRI (magnetic resonance imaging) on expectant parents' emotional connection to their unborn baby. Fetal MRI is becoming more commonly used to complement ultrasound imaging when a fetal anomaly is suspected. Hence, the authors stress that more research needs to be undertaken in this area to help understand the acceptability of this type of scan to parents and its potential effect on their feelings towards their unborn child.

Lead author, Emily Skelton, is a sonographer, lecturer and College of Radiographers Doctoral Fellow within the Department of Radiography and Midwifery at City, University of London.

We know how important scans during pregnancy are to provide clinical information about fetal growth and development, but there are additional benefits for expectant parents, who, in their transition to parenthood, may feel closer to their unborn babies after "seeing" them on scan. This review highlights the integral role of the sonographer in facilitating the developing connection between expectant parents and their unborn babies, through an informative, supportive and inclusive parent-centred approach to care that parents feel actively involved in."

Emily Skelton, Lead Author

The review is published online in the Journal of Reproductive and Infant Psychology.