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OBJECTIVE: to describe women's experiences of dietary information and the change of dietary habits during pregnancy. DESIGN: a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions. SETTINGS: five rural and city antenatal clinics in northern Sweden were included PARTICIPANTS: twenty-three women in mid-pregnancy participated in groups of three to seven FINDINGS: three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'. KEY CONCLUSIONS: the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves. IMPLICATIONS FOR PRACTICE: sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

Objective: By enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations. Methods: Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis. Results: Challenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of "the problematic women" when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose "correttly"; Controlling and mastering; and Resigning responsibility. Conclusions: The results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills.

BACKGROUND: During pregnancy and afterward, a healthy diet is beneficial for the expecting mother and her foetus. Midwives in antenatal care have an ideal position for promoting healthy diets. Dietary counselling is however complex and recommendations can be controversial. While pregnant women struggle with dietary recommendations, midwives struggle with a lack of authority. The aim of the study was therefore to describe how midwives perceive their role and their significance in dietary counselling of pregnant women.

METHODS: An interview study was conducted that involved twenty-one (21) experienced midwives, who worked in the Swedish prenatal health care. A qualitative content analysis was conducted.

RESULTS: Pregnant women were perceived to be well informed, but they needed guidance to interpret information on the Internet. They were described as rigorous and eager information seekers who needed guidance to interpret information as they were worried and emotional. The midwives saw themselves as a questioned authority who lacked support. This meant being informative and directive though not always updated or listened to. Their impact was uncertain and they could also lack sufficient competence to counsel in delicate issues.

CONCLUSION: The midwives' directive role may obstruct the women's needs to manage the dietary recommendations and risk evaluation in a women-centred dialogue. Midwives need to acknowledge pregnant women as both well informed and skilled if they are going to develop woman-centred antenatal care. Ongoing training and self-reflection will be needed to make this change.

Objectives: Diet influences the health of the foetus and the woman during pregnancy and later in life. It is therefore important to investigate pregnant women's food habits. The aim of this study was to describe women's food habits during pregnancy and up to six months post-partum. 

Study design: A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on five occasions during and after pregnancy. Data were analysed using Friedman's ANOVA and a Bonferroni post-hoc test.

Main outcome measures: Food habits in relation to the National Food Agency's (NFA) food index.

Results: The pregnant women's diets were inadequate according to the NFA food index. A tendency towards an even poorer diet after delivery was identified, something which was related to an increased intake of discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable. The alcohol consumption was low throughout.

Conclusions: The food habits during pregnancy were inadequate compared to recommendations and these habits became unhealthier after delivery. These suggest that dietary counselling needs to be more effective and continued into the lactating period. An increased focus should be given to healthy eating from the life course perspective, not just focus on effects on the foetus and pregnancy outcomes.