Aim. We regard consultations as cocreated communicatively by the parties involved. In this paper on verbal communication in midwife-led consultations, we consequently focus on the actual conversation taking place between the midwife and the pregnant woman with diabetes, especially on those sequences where the pregnant woman initiated a topic of concern in the conversation. Methods. This paper was undertaken in four hospital outpatient clinics in Norway. Ten antenatal consultations between midwives and pregnant women were audiotaped, transcribed to text, and analyzed using theme-oriented discourse analysis. Two communicative patterns were revealed: an expert's frame and a shared experts' frame. Within each frame, different communicative variations are presented. The topics women initiated in the conversations were (i) delivery, time and mode; (ii) previous birth experience; (iii) labor pain; and (iv) breast feeding, diabetes management, and fetal weight. Conclusion. Different ways of communicating seem to create different opportunities for the parties to share each other's perspectives. Adequate responses and a listening attitude as well as an ambiguous way of talking seem to open up for the pregnant women's perspectives. Further studies are needed to investigate the obstacles to, and premises for, providing midwifery care in a specialist outpatient setting. 1. Introduction In line with the global increase in prediabetes and diabetes, a significant rise in the proportion of diabetes during pregnancy has been reported. Women with diabetes are regarded as a high-risk group with respect to maternal, fetal, and neonatal outcomes [1]. According to the Medical Birth Registry in Norway [2] reporting for the year 2008, diabetes was reported in 2.1% of all pregnancies. Diabetes type I (T1DM) and type II (T2DM) were diagnosed in 0.4% and 0.3%, respectively, of the pregnancies in 2009. Gestational diabetes mellitus (GDM) was recorded in 1.4% of pregnancies, a number that has doubled during the last decade. In Norway, antenatal care for diabetes pregnancies is delivered in hospital outpatient clinics by multidisciplinary diabetes teams, in line with national guidelines for diabetes in pregnancy [3]. In this team, the midwife is responsible for continuity of follow-ups of the developing pregnancy. In addition, the midwife provides information and advice related to the consequences of living with diabetes and the expressed needs of the woman. Several studies point to the fact that midwifery consultations are perceived as valuable for the women [4, 5], but there is
References
[1]
M. Balsells, A. García-Patterson, I. Gich, and R. Corcoy, “Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis,” Journal of Clinical Endocrinology and Metabolism, vol. 94, no. 11, pp. 4284–4291, 2009.
[2]
The Norwegian Institute of Public Health, The Medical Birth Registry of Norway; Diabetes in pregancy 2008( Medisinsk f？dselsregister), 2008.
[3]
T. Henriksen, H. Thordarson, and T. Clausen, Veileder i f？dselshjelp kapitel 8 [Clinical guidelines in obstetrics 2008, The Norwegian Medical Association, Norwegian gynecologic association]. 1998, http://www.legeforeningen.no/id/131704.0.
[4]
M. J. Harrison, K. E. Kushner, K. Benzies, G. Rempel, and C. Kimak, “Women's satisfaction with their involvement in health care decisions during a high-risk pregnancy,” Birth, vol. 30, no. 2, pp. 109–115, 2003.
[5]
E. Anderberg, K. Berntorp, and E. Crang-Svalenius, “Diabetes and pregnancy: women's opinions about the care provided during the childbearing year,” Scandinavian Journal of Caring Sciences, vol. 23, no. 1, pp. 161–170, 2009.
[6]
J. M. Lawrence, “Women with diabetes in pregnancy: different perceptions and expectations,” Best Practice and Research, vol. 25, no. 1, pp. 15–24, 2011.
[7]
K. Lambert and S. Germain, “Pre-existing type I and type II diabetes in pregnancy,” Obstetrics, Gynaecology and Reproductive Medicine, vol. 20, no. 12, pp. 353–358, 2010.
[8]
A. Gupton, M. Heaman, and L. W. Cheung, “Complicated and uncomplicated pregnancies: women's perception of risk,” Journal of Obstetric, Gynecologic, and Neonatal Nursing, vol. 30, no. 2, pp. 192–201, 2001.
[9]
M. Berg, “Pregnancy and diabetes: how women handle the challenges,” Journal of Perinatal Education, vol. 14, no. 3, pp. 23–32, 2005.
[10]
M. Berg and C. Sparud-Lundin, “Experiences of professional support during pregnancy and childbirth—a qualitative study of women with type 1 diabetes,” BMC Pregnancy and Childbirth, vol. 9, article 27, 2009.
[11]
T. Lavender, M. J. Platt, E. Tsekiri et al., “Women's perceptions of being pregnant and having pregestational diabetes,” Midwifery, vol. 26, no. 6, pp. 589–595, 2010.
[12]
C. Sparud-Lundin, A. Ranerup, and M. Berg, “Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes,” BMC Medical Informatics and Decision Making, vol. 11, no. 1, article 49, 2011.
[13]
B. Sj？gren, N. Robeus, and U. Hansson, “Gestational diabetes: a case-control study of women's experience of pregnancy, health and the child,” Journal of Psychosomatic Research, vol. 38, no. 8, pp. 815–822, 1994.
[14]
M. Persson, A. Winkvist, and I. Mogren, “‘From stun to gradual balance’—women's experiences of living with gestational diabetes mellitus,” Scandinavian Journal of Caring Sciences, vol. 24, no. 3, pp. 454–462, 2010.
[15]
F. Griffiths, P. Lowe, F. Boardman, C. Ayre, and R. Gadsby, “Becoming pregnant: exploring the perspectives of women living with diabetes,” British Journal of General Practice, vol. 58, no. 548, pp. 184–190, 2008.
[16]
M. Persson, M. Norman, and U. Hanson, “Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study,” Diabetes Care, vol. 32, no. 11, pp. 2005–2009, 2009.
[17]
H. E. Fadl, I. K. M. ？stlund, A. F. K. Magnuson, and U. S. B. Hanson, “Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003,” Diabetic Medicine, vol. 27, no. 4, pp. 436–441, 2010.
[18]
M. Berg and K. Dahlberg, “Swedish midwives'care of women who are at high obstetric risk or who have obstetric complications,” Midwifery, vol. 17, no. 4, pp. 259–266, 2001.
[19]
M. Persson, ？ H？rnsten, A. Winkvist, and I. Mogren, “‘Mission Impossible’? Midwives' experiences counseling pregnant women with gestational diabetes mellitus,” Patient Education and Counseling, vol. 84, no. 1, pp. 78–83, 2011.
[20]
P. Linell and M. Bredmar, “Reconstructing topical sensitivity: aspects of face-work in talks between midwives and expectant mothers,” Research on Language and Social Interaction, vol. 29, no. 4, pp. 347–379, 1996.
[21]
C. Sparud-Lundin and M. Berg, “Extraordinary exposed in early motherhood—a qualitative study exploring experiences of mothers with type 1 diabetes,” BMC Women's Health, vol. 11, article 10, 2011.
[22]
Legislation, for, Care H, Personnel, “The Norwegian Health Personnel Act and its regulations,” Lovom helsepersonelloven 1999, Sosial-og Helsedepartementet 2000.
[23]
Directorate for Health and Social Affairs Norway, “A national clinical guideline for antenatal care short version,” Oslo, Norway, 2005.
[24]
C. Risa, E Lidèn, and F. Friberg, “Communation patterns in antenatal diabetes care: an explorative and descriptive study of midwive-led consultation,” Journal of Clinical Nursing, vol. 20, no. 13-14, pp. 2053–2063, 2011.
[25]
J. Potter and M. Wetherell, Discourse and Social Psychology: Beyond Attitudes and Behaviour, Sage, London, UK, 1987.
[26]
C. Roberts and S. Sarangi, Talk, Work, and Institutional Order: Discourse in Medical, Mediation, and Management Settings, Mouton de Gruyter, Berlin, Germany, 1999.
[27]
R. White, “Discourse analysis and social constructionism.,” Nurse researcher, vol. 12, no. 2, pp. 7–16, 2004.
[28]
A. Lock and T. Strong, Social Constructionism: Sources and Stirrings in Theory and Practice, Cambridge University Press, Cambridge, UK, 2010.
[29]
C. Roberts and S. Sarangi, “Theme-oriented discourse analysis of medical encounters,” Medical Education, vol. 39, no. 6, pp. 632–640, 2005.
[30]
World Medical Organization, “Declaration of Helsinki,” British Medical Journal, pp. 1448–1449, 2006.
[31]
M. Sandelowski, “Qualitative analysis: what it is and how to begin,” Research in nursing & health, vol. 18, no. 4, pp. 371–375, 1995.
[32]
A. Bleakley, “Stories as data, data as stories: making sense of narrative inquiry in clinical education,” Medical Education, vol. 39, no. 5, pp. 534–540, 2005.
[33]
E. Goffman, Frame Analysis: An Essay on the Organization of Experience, Harper & Row, New York, NY, USA, 1974.
[34]
E. Goffman, Forms of Talk, University of Pennsylvania Press, Philadelphia, Pa, USA, 1981.
[35]
P. Brown and S. C. Levinson, Politeness: Some Universals in Language Usage, Cambridge University Press, Cambridge, UK, 1987.
[36]
S. J. Knaak, “Contextualising risk, constructing choice: breastfeeding and good mothering in risk society,” Health, Risk and Society, vol. 12, no. 4, pp. 345–355, 2010.
[37]
P. Olsson and L. Jansson, “Patterns in midwives' and expectant/new parents' ways of relating to each other in ante- and postnatal consultations,” Scandinavian Journal of Caring Sciences, vol. 15, no. 2, pp. 113–122, 2001.
[38]
I. Hildingsson and I. R？destad, “Swedish women's satisfaction with medical and emotional aspects of antenatal care,” Journal of Advanced Nursing, vol. 52, no. 3, pp. 239–249, 2005.
[39]
B. Hunter, “Conflicting ideologies as a source of emotion work in midwifery,” Midwifery, vol. 20, no. 3, pp. 261–272, 2004.
[40]
A. L. Suchman, K. Markakis, H. B. Beckman, and R. Frankel, “A model of empathic communication in the medical interview,” Journal of the American Medical Association, vol. 277, no. 8, pp. 678–682, 1997.
[41]
D. Silverman and A. Per？kyl？, “AIDS counselling: the interactional organisation of talk about ‘delicate’ issues,” Sociology of Health and Illness, vol. 12, no. 3, pp. 293–318, 1990.
[42]
M. Bergstrand, H？lsor？dgivande samtal [Health dialogues], Studentlitteratur, Lund, Sweden, 2004.
[43]
P. Olsson, L. Jansson, and A. Norberg, “A qualitative study of childbirth as spoken about in midwives' ante- and postnatal consultations,” Midwifery, vol. 16, no. 2, pp. 123–134, 2000.
[44]
S. M. Kogan and J. E. Gale, “Decentering therapy: textual analysis of a narrative therapy session,” Family Process, vol. 36, no. 2, pp. 101–126, 1997.
[45]
S. M. Kurtz, “Doctor-patient communication: principles and practices,” Canadian Journal of Neurological Sciences, vol. 29, no. 2, pp. S23–S29, 2002.
[46]
J. C. Lapadat, “Problematizing transcription: purpose, paradigm and quality,” International Journal of Social Research Methodology, vol. 3, no. 3, pp. 203–219, 2000.
[47]
D. R. Rhoades, K. F. McFarland, W. H. Finch, and A. O. Johnson, “Speaking and interruptions during primary care office visits,” Family Medicine, vol. 33, no. 7, pp. 528–532, 2001.
[48]
B. Hedberg and U. S？tterlund Larsson, “Environmental elements affecting the decision-making process in nursing practice,” Journal of Clinical Nursing, vol. 13, no. 3, pp. 316–324, 2004.
