umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
'Dealing with ambiguity': the role of obstetricians in gestational diabetes mellitus
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
Inst. för medicin, avd. för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
(Engelska)Artikel i tidskrift (Övrigt vetenskapligt) Submitted
Abstract [en]

Objective: As gestational diabetes mellitus (GDM) is a pregnancy-related complication, obstetricians provide these women with maternal health care and counselling during pregnancy. This study described obstetricians’ experiences providing maternal health care to pregnant women with GDM.

Methods: A consecutive purposive national sample of seventeen obstetricians providing maternal health care to pregnant women diagnosed with GDM on a regular basis participated in the interview study. The data were analyzed using qualitative content analysis.

Results: During the analysis, eight sub-categories, three categories and one theme were identified. The overall theme describing the experiences of the obstetricians was labelled ‘Dealing with ambiguity’. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organisation, the multifaceted maternal and foetal interests to balance and lack of consensus, recommendations and evidence-based knowledge.

Conclusions and Practice Implications: Dealing with ambiguity permeated all aspects of the role of the obstetrician in the maternal health care provided to pregnant women with GDM. This ambiguity comprised the role of the obstetrician and the context of organisation, the multifaceted interests the obstetricians had to balance and the lack of consensus, recommendations and evidence-based knowledge. The study indicates the need for national guidelines and standardised maternal health care services regarding GDM as to fulfil the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her foetus.

Nyckelord [en]
Gestational diabetes mellitus, experiences, counselling, obstetricians, qualitative study
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
obstetrik och gynekologi
Identifikatorer
URN: urn:nbn:se:umu:diva-27740OAI: oai:DiVA.org:umu-27740DiVA, id: diva2:277456
Tillgänglig från: 2009-11-18 Skapad: 2009-11-18 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Gestational diabetes mellitus: experiences of pregnant women, midwives, and obstetricians and the performance of screening
Öppna denna publikation i ny flik eller fönster >>Gestational diabetes mellitus: experiences of pregnant women, midwives, and obstetricians and the performance of screening
2009 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

In Sweden, there is currently no consensus addressing the screening, diagnostics and treatment of gestational diabetes mellitus (GDM). In addition, there is little knowledge on the impact of GDM on the daily life of pregnant women and the experiences of health care professionals providing maternal health care to women with GDM. Using different perspectives, this thesis examines the experiences of GDM and the performance of screening for GDM in a regional context in Sweden. The studies used qualitative and quantitative methods. In the qualitative studies, grounded theory was applied in two studies and qualitative content analysis in one study. In the quantitative study, a combination of questionnaire data and data from medical records of pregnancy and birth were processed.

Surprisingly, screening for GDM was reduced despite local clinical guidelines stipulating the risk factors indicating an OGTT. Furthermore, the prevalence of the risk factors for GDM in the population investigated was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors for GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. The experiences of pregnant women with GDM revealed that being diagnosed with and living with GDM during pregnancy might be understood as a process ‘from stun to gradual balance’. The experience comprised both negative and positive dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to an altered lifestyle and finding their balance in daily life was ‘the prize’ the women ‘were willing to pay’ to secure optimal maternal and foetal health. The experiences of midwives comprised managing conflicting demands providing antenatal care to pregnant women diagnosed with GDM. Most midwives felt the obligation to control and monitor the complicated pregnancy, to initiate and motivate the recommended changes in life style together with providing an empowering and caring relation with the women. These assignments disclosed complex conflicting situations and the midwives appeared to choose strategy for managing the situation depending on their perception of the circumstances. The experiences of the obstetricians were understood as ‘dealing with ambiguity’. The ambiguity permeated all aspects of working as an obstetrician within the maternal health care counselling women with GDM: the role of the obstetrician, the context of the organization, balancing the multifaceted interests of the maternal and foetal conditions and the lack of consensus, recommendations and evidence-based knowledge.  

The studies revealed the complexity of the situation for the affected pregnant women as well as for the health care professionals providing antenatal care to women diagnosed with GDM. Furthermore, the performance of screening of GDM in pregnant women with risk factors for GDM was insufficient in the investigated region. The findings in this thesis may be useful to increase knowledge of the experiences of pregnant women living with or managing GDM. The findings may also be useful when planning for improvements of maternal health care directed to pregnant women diagnosed with GDM during pregnancy.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå university, 2009. s. 112
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1316
Nyckelord
Gestational diabetes mellitus, pregnant women, midwife, obstetrician, grounded theory, qualitative content analysis, questionnaire, medical data, experiences, antenatal care, organization of antenatal care, maternal health care
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
obstetrik och gynekologi
Identifikatorer
urn:nbn:se:umu:diva-27761 (URN)978-91-7264-902-6 (ISBN)
Disputation
2009-12-11, Sal B, 9tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, 901 87 Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2009-11-23 Skapad: 2009-11-19 Senast uppdaterad: 2011-04-07Bibliografiskt granskad

Open Access i DiVA

Fulltext saknas i DiVA

Personposter BETA

Persson, MargaretaHörnsten, ÅsaMogren, Ingrid

Sök vidare i DiVA

Av författaren/redaktören
Persson, MargaretaHörnsten, ÅsaMogren, Ingrid
Av organisationen
Obstetrik och gynekologiInstitutionen för omvårdnad
Reproduktionsmedicin och gynekologi

Sök vidare utanför DiVA

GoogleGoogle Scholar

urn-nbn

Altmetricpoäng

urn-nbn
Totalt: 244 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf