title: Midwives' strategies in challenging dietary and weight counselling situations.
abstract: OBJECTIVE
  By 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.
  
  
  METHODS
  Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis.
  
  
  RESULTS
  Challenges 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden; Department of Nursing, Umeå University, Umeå, Sweden. Electronic address: annalena.wennberg@umu.se.
authors.forename: Anna Lena
authors.initials: AL
authors.lastname: Wennberg
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Hamberg
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Hörnsten
mesh_terms: D001835:Body Weight; D003142:Communication; D003376:Counseling; D004032:Diet; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000150:complications; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery; D009042:Motivation; D009721:Nurse Midwives; D009723:Nurse-Patient Relations; D009752:Nutritional Status; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D036301:Qualitative Research; D012944:Social Support; D013548:Sweden
keywords: Dietary counselling; Empowerment; Midwives; Non-adherence; Pregnancy; Qualitative