Experts' Encounters in Antenatal Diabetes Care: A Descriptive Study of Verbal Communication in Midwife-Led Consultations

Aim. We regard consultations as cocreated communicatively by the parties involved. In this paper on verbal communication in midwife-led consultations, we consequently focus on the actual conversation taking place between the midwife and the pregnant woman with diabetes, especially on those sequences where the pregnant woman initiated a topic of concern in the conversation. Methods. This paper was undertaken in four hospital outpatient clinics in Norway. Ten antenatal consultations between midwives and pregnant women were audiotaped, transcribed to text, and analyzed using theme-oriented discourse analysis. Two communicative patterns were revealed: an expert's frame and a shared experts' frame. Within each frame, different communicative variations are presented. The topics women initiated in the conversations were (i) delivery, time and mode; (ii) previous birth experience; (iii) labor pain; and (iv) breast feeding, diabetes management, and fetal weight. Conclusion. Different ways of communicating seem to create different opportunities for the parties to share each other's perspectives. Adequate responses and a listening attitude as well as an ambiguous way of talking seem to open up for the pregnant women's perspectives. Further studies are needed to investigate the obstacles to, and premises for, providing midwifery care in a specialist outpatient setting

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

Background Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up. Aim To elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Design & setting Qualitative study in primary care in the region of Stavanger, Norway. Method Semi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically. Results Most women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change. Conclusion Women experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.publishedVersio

Being in an oasis: a restorative and reassuring place - women’s experiences of a valuable antenatal diabetes midwifery consultation

The prevalence of diabetes in the childbearing population is increasing globally. Pregnant diabetic women are considered to be at high risk, and thus require specialized, multidisciplinary prenatal care in which midwives play an integral part. These women’s views and experiences of encounters with midwives during diabetes care have not yet been investigated. Our aim was to use an exploratory interpretive approach to investigate the experiences of pregnant women and their perceptions towards the meaning of prenatal consultation provided by midwives in the prenatal care team. A purposive sample was recruited from four hospital-based prenatal diabetes outpatient clinics in the urban areas of Norway: 10 pregnant women (5 primiparous, 5 multiparous) aged 28-45 and diagnosed with different types of diabetes. Data from semi-structured interviews were transcribed and subjected to thematic analysis. Three main themes emerged: being in an open atmosphere, being seen as a person, and being reassured. Together, these themes created a construct that we labeled being in an oasis-a restorative and reassuring place. The counterpoint of this view was a more negative perspective described as having insufficient time, feelings of being objectified and rushed, and diseaseoriented care. The women valued the focus on surveillance in the consultations, although at their best, the midwife-woman encounters complemented and counteracted the iatrogenic effect of the biomedical focus in specialist prenatal care. However, the organization of care may have contributed to and created feelings of suffering, as these women had limited scope for addressing their concerns in the consultation. We conclude that these consultations are complex co-created activities in which interpersonal aspects of the midwifewoman encounters, such as the midwives’ openness and responsiveness to the women, seem to be significant in developing a personal approach. Introduction The prevalence of diabetes is increasing within both the general and the childbearing population, in Norway and worldwide.1 Women with pre-existing diabetes as well as those with pregnancy-induced diabetes (gestational diabetes, GDM) are regarded as a high-risk group with concerns for maternal, fetal, and neonate outcomes.2 In order to optimize their pregnancy outcome, these women are provided with centralized specialist care organized as diabetes teams within the prenatal outpatient clinics at obstetrics and gynecology departments. Midwives are routinely included in these teams, because they can provide the usual prenatal education and care in addition to diabetes management.3 Nurse-midwives are supposed to focus on more than the illness; they also attend to the patient as a unique individual with specific personal health concerns and questions. In this study, we therefore asked how these women perceive the care provided by the midwives in the prenatal team

Factors that enhance midwifery students’ learning and development of self-efficacy in clinical placement: A systematic qualitative review

Aim To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students’ learning experiences and development of self-efficacy in clinical placement. Background Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one’s ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development. Design A qualitative systematic literature review. Method A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results. Results The analysis revealed two descriptive themes – ‘A nurturing relationship’ and ‘Predictability in the learning process, contextual factors. In addition, one analytic theme emerged – ‘Gaining access to and belonging in an enabling educational and working culture'. Conclusion The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.publishedVersio

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

Background Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up. Aim To elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Design & setting Qualitative study in primary care in the region of Stavanger, Norway. Method Semi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically. Results Most women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change. Conclusion Women experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

Background Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach, aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up. Aim To elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Design & setting Qualitative study in primary care in the region of Stavanger, Norway. Method Semi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically. Results Most women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change. Conclusion Women experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support