How am I, really? Perceptions of health and distress by women and their midwives

Abstract

Objective: This study examined agreement between ratings of health and emotional distress by women and their midwives.

Background: Physical complaints and medical complications during pregnancy can significantly impact a woman’s experience of pregnancy. Previous studies have found that women and their healthcare providers may have differing perceptions of their condition and how they are coping with the challenges of pregnancy.

Methods: This study used questionnaires completed by women and their midwives to assess perceptions of health and emotional distress in two contexts. Sixty-eight of the women were on an antenatal unit, hospitalised for complications of their pregnancy; 33 women were a comparison group in community maternity care.

Findings: Many women in the hospital experienced high levels of emotional distress and worry about their pregnancy; 45% scored in the clinical range on state anxiety, and 28% screened positive for depression. However, midwives rating emotional distress did not pick up on this consistently, and women and hospital midwives often viewed their health status differently. In the community, women’s ratings of their health were more consistent with the ratings of their midwives, and midwives were attuned to acute anxiety, but had more difficulty picking up on cues to depression.

Conclusion: It is challenging, particularly in the unfamiliar and stressful environment of the antenatal unit, for midwives to assess emotional distress and needs for health information. Deliberate screening for antenatal distress might provide the opening for midwives to empower women to identify their options, strengths, and strategies for self-care and emotional resilience.

Keywords:

• Pregnancy complications
• anxiety
• stress
• perceptions
• health communication

Acknowledgements

The authors would like to acknowledge the members of the University of Waikato Perinatal Mental Health Research Group for their camaraderie and collaboration on this project. We also thank the Waikato Hospital, the University of Waikato Faculty of Arts and Social Sciences for financial support, and, primarily, the mothers and midwives who gave their time and thought to participate in this study.

Notes

1. Lead Maternity Carers are publicly funded in New Zealand, and provide primary maternity care throughout the woman’s pregnancy and four to six weeks postnatally. They may be midwives, general practitioners, or obstetricians, but the large majority (about 81%) are midwives (Bartholomew, Morton, Atatoa Carr, Bandara, & Grant, 2015). In this report, LMCs will be referred to as ‘midwives’, because the large majority of LMCs are midwives. Conversely, not all midwives are LMCs; women on the antenatal inpatient unit were cared for by midwives who were staff at the hospital, who were not in an LMC role.