umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
'Dealing with ambiguity': the role of obstetricians in gestational diabetes mellitus
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Nursing.
Inst. för medicin, avd. för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
(English)Article in journal (Other academic) 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.

Keyword [en]
Gestational diabetes mellitus, experiences, counselling, obstetricians, qualitative study
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-27740OAI: oai:DiVA.org:umu-27740DiVA: diva2:277456
Available from: 2009-11-18 Created: 2009-11-18 Last updated: 2011-03-31Bibliographically approved
In thesis
1. Gestational diabetes mellitus: experiences of pregnant women, midwives, and obstetricians and the performance of screening
Open this publication in new window or tab >>Gestational diabetes mellitus: experiences of pregnant women, midwives, and obstetricians and the performance of screening
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2009. 112 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1316
Keyword
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
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-27761 (URN)978-91-7264-902-6 (ISBN)
Public defence
2009-12-11, Sal B, 9tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, 901 87 Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-23 Created: 2009-11-19 Last updated: 2011-04-07Bibliographically approved

Open Access in DiVA

No full text

Authority records BETA

Persson, MargaretaHörnsten, ÅsaMogren, Ingrid

Search in DiVA

By author/editor
Persson, MargaretaHörnsten, ÅsaMogren, Ingrid
By organisation
Obstetrics and GynaecologyDepartment of Nursing
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 164 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf