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Pregnant women and midwives are not in tune with each other about dietary counseling: studies in Swedish antenatal care
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women.  IV) Describe women’s food habits during pregnancy and up to six months postpartum.

Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics.

Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling.

Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2015. , 114 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1745
Keyword [en]
Pregnancy, food habits, dietary counseling, counseling strategies, woman-centred care, antenatal care, qualitative methods, longitudinal studies, food frequency questionnaire.
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-107691ISBN: 978-91-7601-294-9 (print)OAI: oai:DiVA.org:umu-107691DiVA: diva2:849039
Public defence
2015-09-18, Aulan, Vårdvetarhuset, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Note

Felaktigt ISSN angivet i avhandlingen och på spikbladet.

Available from: 2015-08-28 Created: 2015-08-27 Last updated: 2015-08-27Bibliographically approved
List of papers
1. Women's experiences of dietary advice and dietary changesduring pregnancy
Open this publication in new window or tab >>Women's experiences of dietary advice and dietary changesduring pregnancy
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2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, 1027-1034 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Pregnancy; Dietary advice; Dietary changes; Quality methods
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-66838 (URN)10.1016/j.midw.2012.09.005 (DOI)000321744500002 ()23427852 (PubMedID)
Available from: 2013-03-05 Created: 2013-03-05 Last updated: 2017-12-06Bibliographically approved
2. Midwives' strategies in challenging dietary and weight counselling situations
Open this publication in new window or tab >>Midwives' strategies in challenging dietary and weight counselling situations
2014 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 3, 107-112 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Dietary counselling, Pregnancy, Midwives, Qualitative, Non-adherence, Empowerment
National Category
Public Health, Global Health, Social Medicine and Epidemiology Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-95871 (URN)10.1016/j.srhc.2014.07.001 (DOI)000342889200004 ()
External cooperation:
Available from: 2014-12-03 Created: 2014-11-06 Last updated: 2017-12-05Bibliographically approved
3. A questioned authority meets well-informed pregnant women: a qualitative study examining how midwives perceive their role in dietary counselling
Open this publication in new window or tab >>A questioned authority meets well-informed pregnant women: a qualitative study examining how midwives perceive their role in dietary counselling
2015 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1, 88Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Antenatal care, Midwifery, Dietary counselling, Role change, Qualitative content analysis
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-102826 (URN)10.1186/s12884-015-0523-2 (DOI)000353103400001 ()25879462 (PubMedID)
External cooperation:
Available from: 2015-05-11 Created: 2015-05-07 Last updated: 2017-12-04Bibliographically approved
4. Swedish women's food habits during pregnancy up to six months post-partum: a longitudinal study
Open this publication in new window or tab >>Swedish women's food habits during pregnancy up to six months post-partum: a longitudinal study
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(English)In: Perspectives on sexual and reproductive health, ISSN 1538-6341, E-ISSN 1931-2393Article in journal (Other academic) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-107690 (URN)
Available from: 2015-08-27 Created: 2015-08-27 Last updated: 2017-12-04

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