Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands

Objective: to explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. Design: qualitative semi-structured interview study, using thematic analysis and constant comparison. Setting and participants: twenty-two pregnant women in midwife-led primary care, varying in sociodemographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013. Findings: women considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them. Key conclusions and implications for practice: health education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy, they should ideally emphasise their availability for questions between antenatal visits.