Shame and avoidance as barriers in midwives' communication about body weight with pregnant women: A qualitative interview study.
INTRODUCTION
Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators.


METHODS
Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated.


RESULTS
The main theme identified in the latent part of the analysis was "midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women". Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives' professional identity (II) Perceived deficiencies in the working situation.


CONCLUSION
Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weight guidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices.
['Christenson|Anne|A|', 'Johansson|Eva|E|', 'Reynisdottir|Signy|S|', 'Torgerson|Jarl|J|', 'Hemmingsson|Erik|E|']
D000328:Adult D001291:Attitude of Health Personnel D015992:Body Mass Index D000068959:Body Weight Maintenance D003142:Communication D004035:Diet Therapy D005260:Female D000073599:Health Risk Behaviors D006801:Humans D007407:Interviews as Topic D009721:Nurse Midwives D018743:Perinatal Care D011247:Pregnancy D037841:Pregnant Women D036301:Qualitative Research D012752:Shame D013548:Sweden
Shame Obesity Communication barriers Stigma Midwife Pregnancy