Midwives' strategies in challenging dietary and weight counselling situations

- In conclusion, weight-related counselling and counselling of women on special diets, non-adherent women, and immigrants or women from different cultures were described as particularly challenging.
- Midwives may need cooperation with dieticians to manage such challenges.
- Midwives also need improved education and training to develop counselling skills such as motivational interviewing for person-centred care during pregnancy.
- Despite their education, Swedish midwives may benefit from opportunities to train, reflect and be observed when counselling.
- This study indicates that Swedish midwives' counselling strategies' can be ambiguous, controlling and coercive although also can be person-centred and that midwives struggle providing care to vulnerable pregnant women.

ObjectiveBy 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.MethodsSeventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis.ResultsChallenges 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 “correctly”; Controlling and mastering; and Resigning responsibility.ConclusionsThe 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.