Midwives' provision of health promotion in antenatal care: A qualitative explorative study

Abstract

Problem: Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care.

Background: Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important.

Aim: To explore how Danish midwives experienced antenatal care and practiced health promotion.

Methods: Midwives undertaking antenatal care were interviewed individually (n=8) and two focus groups (n=10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper's health promotion practice Framework for midwives were used to analyse the midwives' health promotion approach.

Findings: Two major themes were highlighted. Theme 1: 'The antenatal care context for health promotion' described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: 'The health promotion approach in antenatal care' described both midwife-focused and woman-focused approaches to pregnant women's health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time.

Discussion: The midwives' experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care.

Conclusion: Midwives mainly had a midwife-focused approach. To further promote women's health, midwives need to focus on a woman-focused approach.

Keywords: Antenatal care; Health promotion; Midwifery; Pregnancy; Qualitative research; Woman-centeredness; Woman-focused approach.