title: Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking.
abstract: OBJECTIVE
  to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.
  
  
  METHODS
  the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.
  
  
  METHODS
  public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.
  in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.
  
  
  RESULTS
  the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.
  
  
  CONCLUSIONS
  culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting.
authors.affiliation: Medical Research Council of South Africa, Tygerberg 7505, Cape Town, South Africa. zaino.petersen@mrc.ac.za
authors.forename: Zaino
authors.initials: Z
authors.lastname: Petersen
authors.forename: Maria
authors.initials: M
authors.lastname: Nilsson
authors.forename: Katherine
authors.initials: K
authors.lastname: Everett
authors.forename: Maria
authors.initials: M
authors.lastname: Emmelin
mesh_terms: D003142:Communication; D030881:Disclosure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008880:Midwifery / Q000379:methods*; D016294:Models, Nursing; D010353:Patient Education as Topic / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control* / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology; D000074606:Smoking Prevention; D013019:South Africa; D035502:Trust