Midwives’ provision of health promotion in antenatal care: A qualitative explorative study

Published:January 25, 2021DOI:



      Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care.


      Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important.


      To explore how Danish midwives experienced antenatal care and practiced health promotion.


      Midwives undertaking antenatal care were interviewed individually (n = 8) and two focus groups (n = 10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper’s health promotion practice Framework for midwives were used to analyse the midwives’ health promotion approach.


      Two major themes were highlighted. Theme 1: ‘The antenatal care context for health promotion’ described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: ‘The health promotion approach in antenatal care’ described both midwife-focused and woman-focused approaches to pregnant women’s health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time.


      The midwives’ experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care.


      Midwives mainly had a midwife-focused approach. To further promote women’s health, midwives need to focus on a woman-focused approach.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kickbusch I.
        Health promotion: a global perspective.
        Can. J. Public Health. 1986; 77: 321-326
        • WHO (World Health Organization)
        Health Promotion. The Ottawa Charter for Health Promotion.
        2020 (Accessed September 2020)
        • RCM
        Stepping up to Public Health: a New Maternity Model for Women and Families, Midwives and Maternity Support Workers.
        Royal College of Midwives, London2017 ((Accessed June 2020)
        • Nutbeam D.
        • Harris E.
        • Wise M.
        Theory in a Nutshell – A Practical Guide to Health Promotion Theories.
        3rd edition. The McGraw-Hill companies, 2010
        • Schriven A.
        Promoting Health: A Practical Guide.
        Elsevier, London2010
        • Piper S.
        Health promotion: a practice framework for midwives.
        Br. J. Midwifery. 2005; 13
        • Obrochta C.A.
        • Chambers C.
        • Bandoli G.
        Psychological distress in pregnancy and postpartum.
        Women Birth. 2020; 33: 583-591
        • Devlieger R.
        • Benhalima K.
        • Damm P.
        • van Assche A.
        • Mathieu C.
        • Mahmood T.
        • Dunne F.
        • Bogaerts A.
        Maternal obesity in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG).
        Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 201: 203-208
        • Naughton F.
        • Hopewell S.
        • Sinclair L.
        • McCaughan D.
        • McKell J.
        • Bauld L.
        Barriers and facilitators to smoking cessation in pregnancy and in the post-partum period: the health care professionals’ perspective.
        Br. J. Health Psychol. 2018;
        • Smith D.M.
        • Cooke A.
        • Lavender T.
        Maternal obesity is the new challenge; a qualitative study of health professionals’ views towards suitable care for pregnant women with a Body Mass Index (BMI) ≥30 kg/m2.
        BMC Pregnancy Childbirth. 2012; 12: 157
        • Wennberg A.L.
        • Hamberg K.
        • Hörnsten Å
        Midwives’ strategies in challenging dietary and weight counselling situations.
        Sex. Reprod. Healthc. 2014; 5: 107-112
        • McLellan M.J.
        • O’Carroll R.E.
        • Cheyne H.
        • Dombrowski S.U.
        Investigating midwives’ barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework.
        Implement. Sci. 2019;
        • Hildingsson I.
        • Thomas J.E.
        Women’s perspectives on maternity services in Sweden: processes, problems, and solutions.
        Am. Coll. Nurs. Midwives. 2007; 52: 126-133
        • Baas C.I.
        • Erwich J.J.
        • Wiegers T.A.
        • Cock P.
        • Hutton E.K.
        Women’s suggestions for improving midwifery care in the Netherlands.
        Birth. 2015; 42: 369-378
        • Boyle S.
        • Thomas H.
        • Brooks F.
        Women’s views on partnership working with midwives during pregnancy and childbirth.
        Midwifery. 2016; 32: 21-29
        • Baron R.
        • Heesterbeek Q.
        • Manniën J.
        • Hutton E.K.
        • Brug J.
        • Westerman M.J.
        Exploring health education with midwives, as perceived by pregnant women in primary care: a qualitative study in the Netherlands.
        Midwifery. 2017; 46: 37-44
        • Jepsen I.
        • Mark E.
        • Nøhr E.A.
        • Foureur M.
        • Sørensen E.E.
        A qualitative study of how caseload midwifery is constituted.
        Midwifery. 2016; 36: 61-69
        • Johnsen H.
        • Clausen J.A.
        • Hvidtjørn D.
        • Juhl M.
        • Hegaard H.K.
        Women’s experiences of self-reporting health online prior to their first midwifery visit: a qualitative study.
        Women Birth. 2018; 31: e105-e114
        • Nyström M.
        • Dahlberg K.
        Pre-understanding and openness - a relationship without hope?.
        Nord. Coll. Caring Sci. 2001; 15: 339-346
        • Cohen M.Z.
        • Steeves R.H.
        • Kahn D.L.
        Hermeneutic phenomenological research: a practical guide for nurse researchers.
        Methods Nurs. Res. 2000; (Chapter 7): 71-83
        • Kvale S.
        • Brinkmann S.
        3rd edition. Interview: Det Kvalitative Forskningsinterview Som Håndværk. 3. 2018
        • Halkier B.
        (Samfundslitteratur)3rd edition. 2016
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101
        • NVK
        The Danish National Committee on Health Research Ethic.
        2020 (Accessed September 2020)
        • Collins C.T.
        • Fereday J.
        • Pincombe J.
        • Oster C.
        • Turnbull D.
        An evaluation of the satisfaction of midwives’ working in midwifery group practice.
        Midwifery. 2010; 26: 435-441
        • Downe S.
        • Finlayson K.
        • Tunçalp Ö
        • Gülmezoglu A.M.
        Provision and uptake of routine antenatal services: a qualitative evidence synthesis.
        Cochrane Database Syst. Rev. 2019; (Art. No.: CD012392): 529-539
        • Hunter A.
        • Devane D.
        • Houghton C.
        • Grealish A.
        • Tully A.
        • Smith V.
        Woman-centred care during pregnancy and birth in Ireland: thematic analysis of women’s and clinicians’ experiences.
        BMC Pregnancy Childbirth. 2017; 17: 322
        • WHO
        WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience.
        2016 (Accessed September 2020)
        • Wright D.
        • Pincombe J.
        • McKellar L.
        Exploring routine hospital antenatal care consultations — an ethnographic study.
        Women Birth. 2018; 31: e162-e169
        • Murphy P.A.
        Effective Communication Is Essential to Being With Woman: Midwifery Strategies to Strengthen Health Education and Promotion. Editorial.
        The American College of Nurse-Midwives, 2013
        • Deveugele M.
        Communication training: skills and beyond.
        Patient Educ. Couns. 2015; 98: 1287-1291
        • Silverman J.
        • Kurtz S.M.
        • Draper J.
        Skills for Communicating With Patients.
        3rd edition. 2013
        • Stephenson J.
        • Heslehurst N.
        • Hall J.
        • Schoenaker D.A.J.M.
        • Hutchinson J.
        • Cade J.E.
        • et al.
        Preconception health 1. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.
        Lancet. 2018; 391: 1830-1841
        • Navarro P.
        • Mehegan J.
        • Murrin C.M.
        • Kelleher C.C.
        • Phillips C.M.
        Associations between a maternal healthy lifestyle score and adverse offspring birth outcomes and childhood obesity in the Lifeways Cross-Generation Cohort Study.
        Int. J. Obes. (Lond). 2020; 44: 2213-2224
        • Coar L.
        • Sim J.
        Interviewing one’s peers: methodological issues in a study of health professionals.
        Scand. J. Prim. Health Care. 2006; 24: 251-256
        • Malterud K.
        • Siersma V.D.
        • Guassora A.D.
        Sample size in qualitative interview studies: guided by information power.
        Qual. Health Res. 2016; 26: 1753-1760