An exploration of midwifery practice viewed through a social constructionism lens in order to gain an understanding of how midwives provide care to pregnant women who are obese

To enter pregnancy whilst obese carries risk for both mother and baby but obesity rates continue to rise. Community midwives are now the lead carers for all pregnant women and will inevitably encounter women whose health is at risk due to being obese. This qualitative study has explored how midwives construct their practice when delivering care and advice to women who live with a raised BMI≥30kg/m2 and what it means for them to do so. Thirteen in-depth interviews were conducted with practicing community midwives in South East Scotland. Participants were invited to complete reflective diaries. Interviews took place between January and May 2018. Interviews were audio recorded and then transcribed verbatim. Data were analysed thematically using a stepwise approach, the software package NVivo 10 was used to assist in this process. Three main themes emerged – ‘The situational context of practice’, ‘Constructing relationships and partnerships with women’ and ‘Midwives as public health agents’. Findings suggest that both the situational context and the role of community midwives is complex. Midwives appear to construct a unique approach to antenatal care as they provide care to women structures that do not appear to be flexible. They appear to ‘move’ between the paradigms of traditional midwifery practice and that of obstetric medicine and simultaneously promote normality and manage risk, in so doing they construct a unique pattern of practice. The public health agenda competes for time during appointments with midwives being expected to deliver voluminous information to women leaving little time to develop woman-focused care. Midwives rely on clinical protocols to open dialogue pertaining to obesity and its risks. Midwives could develop more personalised care schedules in partnership with women, ensuring that the woman’s voice is heard and that her needs are met. Practice may be strengthened by equipping midwives with enhanced consultation skills, enabling them to raise sensitive issues. Exploring alternative ways to address public health components may also facilitate better use of time, allowing midwives to ensure the antenatal appointment is woman-focused.