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

Ingrid Mogren; Pham Thi Lan; Ho Dang Phuc; Sophia Holmlund; Rhonda Small; Joseph Ntaganira; Jean Paul Semasaka Sengoma; Hussein Lesio Kidanto; Matilda Ngarina; Cecilia Bergström

doi:10.1371/journal.pone.0310029

Peer Review History

Original SubmissionNovember 22, 2023
29 May 2024 Decision Letter - Patrick Ifeanyi Okonta, Editor PONE-D-23-37905Vietnamese health professionals’ views on the status of the fetus and maternal and fetal health interests: A regional, cross-sectional study from the Hanoi areaPLOS ONE Dear Dr. Bergström, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 13 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. Some grammatical errors noted. Go through the manuscript once more and may need to engage a language editor to make some of the sentences easily comprehensible by the reader. 2. The tables were not presented in a reader-friendly manner making it very difficult to appreciate. I suggest contents of the tables are reduced to bring out only more relevant data in a concise way. 3. Responses to the questions should have been mutually exclusive, where a YES answer to one negates the others. In its current form, it becomes very difficult to make distinctions e.g when does the fetus become a person - the question cannot be answered when responders select multiple answers to the same question. This should be corrected. 4. The discussion leaves much more to be desired. I believe there should be more of ethical discourse involved in defining the fetus's person, personhood and patient's status. Also a brief review of Vietnamese laws as they pertain to the subject of interest might also have been apt. Reviewer #2: Thank you for your interesting and well-researched original article. I have a few corrections to help improve clarity a. Page 3 line 35: should read purposively b. Page 6 line 104: ‘based on in Vietnam’—please clarify c. Page 29 lines 486-488: Please clarify--do you mean "her relatives after obtaining her consent" ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
14 Aug 2024 Author Response We appreciate the reviewers’ comments addressing limitations in the submitted manuscript. The following letter includes comments on the reviewers’ reports on the submitted manuscript to PLOS ONE. Reviewer #1: 1. Some grammatical errors noted. Go through the manuscript once more and may need to engage a language editor to make some of the sentences easily comprehensible by the reader. In our efforts to enhance readability, the manuscript underwent thorough language revision, aiming to improve its reader-friendliness. 2. The tables were not presented in a reader-friendly manner making it very difficult to appreciate. I suggest contents of the tables are reduced to bring out only more relevant data in a concise way. Thank you for your feedback on the presentation of our tables. We understand the importance of clear and accessible information. In response to your suggestions, we have revised the tables to enhance their readability. This involved presenting data in a more concise format. We believe these changes will make the information easier to comprehend and appreciate. We value your input and hope you find the updated tables more user-friendly. 3. Responses to the questions should have been mutually exclusive, where a YES answer to one negates the others. In its current form, it becomes very difficult to make distinctions e.g when does the fetus become a person - the question cannot be answered when responders select multiple answers to the same question. This should be corrected. Thank you for your comment. We appreciate your insights on the complexity surrounding the status of the embryo/fetus. In the section “Statements on views of the fetus” (Table 1), the views were analysed in ascending chronological order, assuming that if the fetus were considered a person at an earlier chronologic stage, then personhood was presumed to be continuous during the remaining course of the pregnancy and at birth. By recognising the diverse stages and situations where individuals may view the embryo/fetus as a person, we developed various statements to reflect the spectrum of beliefs, as detailed in Table 1 and shown for convenience below: • The fetus is a person from the time of conception • The fetus is a person from the time heartbeats are detected • The fetus is a person from the time the pregnant woman experiences fetal movements • The fetus is a person when it can survive outside the uterus • The fetus is a person when the pregnant woman considers it to be a person • The fetus is a not a person until it is born For clarity and consistency, we chose to use the term “fetus” throughout the questionnaire. Our aim was to capture the range of perspectives regarding the fetus as a person, acknowledging that these viewpoints are not mutually exclusive. These statements were included in the questionnaire that was piloted across six countries with health professionals who were also eligible participants in the qualitative part of the CROCUS Study. Pilot participants completed these items with no issues raised about their relevance or appropriateness. Therefore, they were included in the final questionnaire and were not reported as problematic by participants in the study. 4. The discussion leaves much more to be desired. I believe there should be more of ethical discourse involved in defining the fetus's person, personhood and patient's status. Also a brief review of Vietnamese laws as they pertain to the subject of interest might also have been apt. In response to the reviewer's feedback, we have revised the discussion section to incorporate a more comprehensive ethical discourse on the fetus's status as a person, personhood and patient. These revisions aim to provide a deeper exploration of these ethical concepts and their relevance to our study. Furthermore, we have included a brief review of Vietnamese laws regarding the fetus's legal status and rights. This contextual addition ensures that our discussion aligns with the ethical and legal frameworks relevant to our subject of interest. These revisions are intended to enhance the discussion section's overall coherence and relevance, thereby facilitating a better understanding of the study's implications in ethical and legal contexts. Reviewer #2: Thank you for your interesting and well-researched original article. I have a few corrections to help improve clarity a. Page 3 line 35: should read purposively This has been corrected. b. Page 6 line 104: ‘based on in Vietnam’—please clarify This must have been a typo. It now reads: …when providing maternity care in Vietnam. c. Page 29 lines 486-488: Please clarify--do you mean "her relatives after obtaining her consent" We agree that this sentence needs further clarification. For convenience, please see below. It has been proposed that intrapartum management counselling of the pregnant woman – and any individuals she chooses to involve – should adhere to two ethical principles: the fetus as a patient, deserving appropriate medical care, and the pregnant woman as the ultimate decision maker, holding primary authority over health decisions. By integrating these principles, healthcare providers can offer comprehensive and respectful counselling, aiding informed decision-making during labour and delivery. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0310029.r002
23 Aug 2024 Decision Letter - Patrick Ifeanyi Okonta, Editor 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 PONE-D-23-37905R1 Dear Dr. Bergström, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Patrick Ifeanyi Okonta, MBBCh, MPH, FWACS, FMCOG, MD, DRH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0310029.r003
Formally Accepted
2 Sep 2024 Acceptance Letter - Patrick Ifeanyi Okonta, Editor PONE-D-23-37905R1 PLOS ONE Dear Dr. Bergström, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Patrick Ifeanyi Okonta Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0310029.r004

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