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. / <p>Felaktigt ISSN angivet i avhandlingen och på spikbladet.</p>

Yes / Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with “midwifery discourse” being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.

Bakgrund: Barnmorskan ska arbeta utefter evidens och beprövad erfarenhet. Föda Utan Rädsla är en metod som bygger på beprövad erfarenhet och har införts inom mödrahälsovården och förlossningskliniker i Sverige för att få kvinnan att känna sig trygg under förlossningen. Föda Utan Rädsla har införts i mödrahälsovården och på förlossningskliniker utan vetenskaplig utvärdering av metoden.Syfte: Syftet var att beskriva barnmorskors erfarenheter av metoden Föda Utan Rädsla under förlossningen.Metod: En kvalitativ design med induktiv ansats valdes. Tio barnmorskor intervjuades. Det manifesta innehållet analyserades med en kvalitativ innehållsanalys. Resultat: Analysen genererade fyra kategorier Att närvara, Att medverka, Att möjliggöra samt Att skapa trygghet. Att närvara handlade om att barnmorskorna ansåg att närvaro och tillgänglighet var viktigt men även att vara lyhörd inför parens förutsättningar. Att medverka bestod i att barnmorskan samverkade med paret och partnern blev delaktig. Att möjliggöra innebar att metoden medförde ett strukturerat arbetssätt. För att möjliggöra användandet behövdes regelbundna utbildningstillfällen och tillämpas vid rätt tidpunkt. Att skapa trygghet innebar att Föda Utan Rädsla var ett tryggt och naturligt arbetssätt. Metoden fungerade som ett tryggt bemötande och förhållningssätt som bidrog till helheten av förlossningen. Slutsats: Föda Utan Rädsla skulle kunna bidra till en positiv förlossningsupplevelse vilket är målet med förlossningsvården. Föda Utan Rädsla kan även bidra till ökad delaktighet hos partnern. Med Föda Utan Rädsla möjliggörs ökad närvaro på rummet. Barnmorskorna lade inte stor vikt vid alla verktygen i Föda Utan Rädsla, utan metoden sågs mer som ett förhållningssätt och inte som någon ny kunskap. / Background: The midwife must work according to evidence and experience. Confident Birth Method is a method built on experience, to make the woman feel safe during childbirth. Confident Birth Method has been introduced in maternal health care and in maternity wards, without scientifically evaluation of the method.Aim: The aim was to describe midwives' experiences of the Confident Birth Method during childbirth.Method: A qualitative design with an inductive approach was chosen. Ten midwives were interviewed. The manifest content was analyzed using a qualitative content analysis.Findings: The analysis generated four categories To be present, To participate, To enable and To create security. To be present meant that the midwives considered presence and availability to be important, but also being sensitive to the couples' circumstances. To Participate consisted of the midwife´s collaboration with the couple and the partner became more involved. To Enable meant that the method entailed a structured way of working. To enable its use, regular training sessions were needed and applying the method at the right time. Creating security meant that the Confident Birth Method was a safe and natural way of working. The method functioned as an approach that contributed to the entirety of the birth.Conclusion: The Confident Birth Method could contribute to a positive birth experience, which is the goal of maternity care. The Confident Birth Method can also contribute to increased participation by the partner. With The Confident Birth Method, increased presence in the room is enabled. The midwives did not attach great importance to all the tools in The Confident Birth Method, the method was seen more as an approach and not as any new knowledge