The meaning of caring in prenatal care from Swedish women's perspectives

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The purpose of maternity health care is to assist women who are at a life stage characterised by major changes. Pregnant women do not primarily turn to prenatal care because of illness but to get advice and support at a time of their lives, when great expectations but also fears and worries are present. The mission of Swedish maternity health care is to provide preventative measures and to work to minimise risks and morbidity during pregnancy in both the woman and the expected child. Although prenatal care is organised in a different way internationally, its purpose is similar and the focus is on risk reduction 1. Swedish prenatal health care is free of charge and consists of a basic care programme that includes 8–9 visits to the midwife before the birth and one visit after birth. It also includes an ultrasound screening with anatomical assessment at weeks 18–20 of pregnancy. The visits include medical checks, psychosocial evaluations and health information. In the Swedish model, there is an intension to work for a positive birth experience and a good start to parenthood. When a woman is expecting her first child, the parents are offered childbirth preparation classes. The care programme is continuously updated as new research is published. In an uncomplicated pregnancy, no doctor visits are included, but obstetricians or general practitioners can be consulted if problems arise. It is also possible to transfer to a specialist unit if necessary 3.
There is great satisfaction from the women's side of view with this kind of care, which means an almost 99% attendance. In particular, there is much confidence in medical science, and dissatisfaction with the care generally relates to shortcomings in terms of continuity and support from the midwife. Women sometimes feel they receive too little information and explanation about the content of prenatal care. There is also dissatisfaction if the expectant father or partner is not involved and there are comments that the number of visits is too few or has too long intervals between them 4.
The midwife in maternity care has the normal pregnancy as her goal and is supposed to have an overall perspective; however, the focus tends to be on medical content. Olsson says that despite knowing the importance of psychosocial care, midwives still focus to a great extent on medical–biological problems 7. Vos et al. 8 argue that it is important to pay attention to nonmedical risk factors and Waldenström 9 points out that despite the healthcare problem‐solving ability and increased medical safety, the experience of childbirth has not improved and there is a questioning of the separation of psychosocial and medical programmes; a more holistic approach would be preferable. Pregnant women need to share their story in the context of a safe relationship where professionalism and continuity are prominent 10. Research shows that providing support and individualised care means building relations and this promotes both physical and mental health in pregnant women 1.
Caring science research on pregnancy primarily focuses on deepening the knowledge of women's own experiences, which does not imply an opposition to a medical perspective. Women meet the physical challenges and risks of pregnancy in their own ways and women define their pregnancy in a different way than the externally applied diagnosis of disease and also negotiate the risk to normality 13. The caring relationship is often crucial when it comes to the experience of childbirth and a negative experience of encounter in care could mean lifelong disempowering 5.

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