Knowledge, experiences and attitudes of midwives in maternity care in encounters with pregnant women with obesity - are adverse childhood experiences understood and explored as a contributing factor?

Abstract

ObjectiveTo explore knowledge, experiences and attitudes of midwives in maternity care in encounters with pregnant women with obesity, and whether they investigate adverse childhood experiences as a contributing factor to the weight challenges. DesignSemi-structured interviews were undertaken to explore midwives’ experiences of providing maternity care for women with obesity. For data analysis, Malterud's systematic text condensation was used, a method for thematic cross-case analysis of qualitative data with an inductive approach. Participants and settingNine midwives working in maternity care in Central Norway. The interviews were conducted online or at the midwives’ workplace. FindingsThe midwives routinely investigated pregnant women's childhood, but few saw a link between adverse childhood experiences and obesity. Pregnant women with obesity were perceived by the midwives as particularly vulnerable, which led to a sensitive, individualised approach focusing on trust and relationship building. This approach, in addition to pointing out complications that can occur with obesity, was described as a balancing act. The midwives described preventative healthcare as a natural task, but hectic days with many competing tasks were seen as an obstacle. The women's motivation for lifestyle change was experienced differently by the midwives; some described strong motivation while others mentioned poor motivation. The midwives found it reassuring to have experience to draw on in broaching difficult topics. Key conclusions and implications for practiceMidwives’ many years of experience enable them to approach obese pregnant women in an individual and careful way. Their mission in public health could be better utilised if they explored negative childhood experiences in relation to pregnant women's weight challenges.