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"Mission Impossible"? Midwives' experiences counseling pregnant women with gestational diabetes mellitus.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. (Arcum)
Inst. för medicin, avd för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
2011 (Engelska)Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, nr 1, s. 78-83Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM). METHODS: Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis. RESULTS: The emerging core category was 'Balancing fear of failure'. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations. CONCLUSIONS AND PRACTICE IMPLICATIONS: The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.

Ort, förlag, år, upplaga, sidor
2011. Vol. 84, nr 1, s. 78-83
Nyckelord [en]
Gestatinal diabetes mellitus, counseling, support, midwives, qualitative study
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
obstetrik och gynekologi
Identifikatorer
URN: urn:nbn:se:umu:diva-36860DOI: 10.1016/j.pec.2010.06.008ISI: 000292674000013PubMedID: 20634024OAI: oai:DiVA.org:umu-36860DiVA, id: diva2:356468
Tillgänglig från: 2010-10-12 Skapad: 2010-10-12 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

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Persson, MargaretaHörnsten, ÅsaMogren, Ingrid

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