Antenatal Midwifery Consultations

The overall aim of this thesis is to gain a deeper understanding of antenatal care by disclosing aspects of topics, meanings and the participants' ways of relating in midwifery consultations in a Swedish primary care setting. To accomplish this video recordings were made of five antenatal midwives' consecutive consultations with one expectant/new mother/father from the initial 'booking' in early pregnancy, throughout the pregnancy and the follow-up consultation after the childbirth (n=58). The data was analysed using a quantitative content analysis, qualitative content analysis and phenomenological hermeneutic approach. The results show that physical aspects of pregnancy, childbirth and parenthood dominated the consultations (l-IV). Pregnancy was the most frequent topic discussed followed by childbirth while the topic of parenthood was mentioned comparatively seldom (IIIV). In the consultations the situation of the expectant/new mother is the main focus. The expectant/new fathers' relations and concerns regarding the period of pregnancy, childbirth and parenthood were only discussed occasionally. The midwives led the consultations by taking and keeping the initiative and by their ways of relating, with which the expectant/new parents, with a few exceptions, complied (l-V). The complexity of meanings connected with pregnancy (II), childbirth (III) and parenthood (IV) disclosed in the consultations shifts between understanding the processes of transition to parenthood as trustworthy or as unreliable. The understanding of the woman's physical processes as unreliable is predominant in the studied consultations. The hazards and the deficient capacity of the woman's body to meet the various demands are focused on. Risks of deviations from an optimal development are central. The unborn/new-born child appears to be endangered by the processes. When trustworthiness towards the transitional process dominates the consultations, the possibilities and strengths of the processes and the woman's, baby's and the family's ability to meet the physical changes and challenges are emphasised. There is openness to the uniqueness of the expectant/new parents' ways of resolving the varying demands of the process. The midwives' ways of relating in the consultations are understood as moving between 'distanced surveillance' of the expectant/new mother and 'caring about' the expectant/new parents (I, V). 'Caring about' is distinguished by the midwives' involvement in the unique life situation of the expectant/new parents. 'Distanced surveillance' is characterised by impersonal, generalised ways of relating where the uniqueness of the expectant/new parents and their life situation are disregarded. In summary this study indicates that within antenatal care transition to parenthood can be understood as a feminine bodily risk project. The transition could also be understood as a trustworthy physical, emotional, existential and social process involving the whole childbearing family. Midwives were found to relate to expectant/new parents both in a distanced and a caring way.