Vietnamese health professionals' views on the status of the fetus and maternal and fetal health interests: A regional, cross-sectional study from the Hanoi area

Abstract

Obstetric ultrasound is an important tool in managing pregnancies and its use is increasing globally. However, the status of the pregnant woman and the fetus may vary in terms of clinical management, views in the community and legislation. To investigate the views and experiences of Vietnamese health professionals on maternal and fetal health interests, priority setting and potential conflicts, we conducted a cross-sectional study using a structured questionnaire. Obstetricians/gynecologists, midwives and sonographers who manage pregnant women in maternity wards were invited to participate. We purposively chose public health facilities in the Hanoi region of Vietnam to obtain a representative sample. The final sample included 882 health professionals, of which 32.7% (n = 289) were obstetricians/gynecologists, 60.7% (n = 535) midwives and 6.6% (n = 58) sonographers. The majority of participants (60.3%) agreed that "The fetus is a person from the time of conception" and that maternal health interests should always be prioritised over fetal health interests in care provided (54.4%). 19.7% agreed that the fetus is never a patient, only the pregnant woman can be the patient, while 60.5% disagreed. Participants who performed ultrasounds were more likely to agree that fetal health interests are being given more weight in decision-making the further the gestation advances compared to those who did not perform ultrasounds (cOR 2.47, CI 1.27-4.79: n = 811). A significant proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. While the fetus is often considered a patient with its own health interests, a majority of participants did give priority to maternal health interests. Health professionals appear to favour increased legal protection of the fetus. Strengthening the legal status of the fetus might have adverse implications for maternal autonomy. Measures to restrict maternal autonomy might require close observation to ensure that maternal reproductive rights are protected.

Fig 1. Separated and accumulated agreements for statements 1–3.

Separated and accumulated agreements (%) for statement 1 (“The fetus is a person from the time of conception”; n = 872), statement 2 (“The fetus is a person from the time heartbeats are detected”; n = 877), and statement 3 (“The fetus is a person from the time the pregnant woman experiences fetal movements”; n = 877).

Fig 2. Venn diagram presenting the numbers and proportions of all that agreed/strongly agreed with the two statements.

“Maternal health interests should always be prioritised over fetal health interests in care provided; A: blue area), “Fetal health interests should be better protected by law; B: apricot area).

Fig 3. Venn diagram presenting the numbers and proportions of all participants that agreed/strongly agreed or disagreed/strongly disagreed (specified) with the following three statements.

“Fetal health interests should be better protected by law (agreement); A: blue area), “The fetus is never a patient, only the pregnant woman can be the patient (disagreement); B: apricot area), and “The delivery sometimes has to be postponed in order to improve fetal outcome, although the pregnant woman may be at risk (agreement); C: green area).