“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

Published:December 31, 2021DOI:



      Experiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.


      This study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.


      This was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.


      Women had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.


      To improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.


      GDM (Gestational Diabetes Mellitus), GP (General Practitioner)


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        • Jolving L.R.
        • Nielsen J.
        • Kesmodel U.S.
        • Nielsen R.G.
        • Beck-Nielsen S.S.
        • Norgard B.M.
        Prevalence of maternal chronic diseases during pregnancy — a nationwide population based study from 1989 to 2013.
        Acta Obstet. Gynecol. Scand. 2016; 95: 1295-1304
        • Carolan M.
        Women’s experiences of gestational diabetes self-management: a qualitative study.
        Midwifery. 2013; 29: 637-645
        • Titapant V.
        • Chuenwattana P.
        Psychological effects of fetal diagnoses of non-lethal congenital anomalies on the experience of pregnant women during the remainder of their pregnancy.
        J. Obstet. Gynaecol. 2014; 41: 77-83
        • McCoyd J.
        • Curran L.
        • Munch S.
        They say, “If you don’t relax…you’re going to make something bad happen”: women’s emotion management during medically high-risk pregnancy.
        Psychol. Women Q. 2019; 44: 117-129
        • Christian L.M.
        Physiological reactivity to psychological stress in human pregnancy: current knowledge and future directions.
        Prog. Neurobiol. 2012; 99: 106-116
        • Rowlands S.
        High-risk pregnancy [Internet]. East Melbourne (AU): East Melbourne.
        Obstetr. Gynaecol. 2020; ([cited 2020 Mar 25]. Available from:)
        • BMJ Publishing Group
        Overview of pregnancy complications 2021.
        BMJ Best Practice [Internet]. BMJ Best Practice, London2021 ([updated 2021 Sep; cited 2021 Nov 5]. Available from: BMJ Best Practice)
        • Bick D.
        • Beake S.
        • Chappell L.
        • Ismail K.M.
        • McCance D.R.
        • Green J.S.A.
        • Taylor C.
        Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: a systematic review.
        BMC Pregnancy Childbirth. 2014; 14
        • Munch S.
        • McCoyd J.L.M.
        • Curran L.
        • Harmon C.
        Medically high-risk pregnancy: women’s perceptions of their relationships with health care providers.
        Soc. Work Health Care. 2020; 59: 20-45
        • Guerra F.A.
        • Mirlesse V.
        • Baião A.E.
        Breaking bad news during antenatal care: a challenge to be tackled.
        Ciên Saúde Colet. 2011; 16: 2361-2367
        • Nicoloro-SantaBarbara J.
        • Rosenthal L.
        • Auerbach M.V.
        • Kocis C.
        • Busso C.
        • Lobel M.
        Patient-provider communication, maternal anxiety, and self-care in pregnancy.
        Soc. Sci. Med. 2017; 190: 133-140
        • Atienza-Carrasco J.
        • Linares-Abad M.
        • Padilla-Ruiz M.
        • Morales-Gil I.M.
        Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study.
        Reprod. Health. 2018; 15: 11
        • Baile Wf
        • Buckman R.
        • Lenzi R.
        • Glober G.
        • Beale Ea
        • Kudelka Ap.
        SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer.
        Oncologist. 2000; 5: 302-311
        • Hunt M.R.
        Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work.
        Qual. Health Res. 2009; 19: 1284-1292
        • Thorne S.
        Interpretive Description: Qualitative Research for Applied Practice.
        2nd ed. Routledge, New York (USA)2016
        • NSW Ministry of Health (AU)
        Health Stats NSW: South Western Sydney LHD [Internet].
        ([cited 2021 Nov 5]. Available from:) State of NSW, NSW Ministry of Health, place unknown]2020
        • Eastwood J.G.
        • Jalaludin B.B.
        • Kemp L.A.
        • Phung H.N.
        • Adusumilli S.K.
        Clusters of maternal depressive symptoms in South Western Sydney, Australia.
        Spat. Spatiotemporal Epidemiol. 2013; 4: 25-31
        • Australian College of Midwives
        National Midwifery Guidelines for Consultation and Referral.
        (Available from:)4th ed. ACM, Canberra (AU)2021
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101
        • COAG Health Council (AU)
        Woman-centred Care: Strategic Directions for Australian Maternity Services [Internet].
        ([cited 2021 Nov 5]. Available from:) Australian Government, Department of Health, Canberra2019
        • Grimes H.
        • Forster D.
        • Newton M.
        Sources of information used by women during pregnancy to meet their information needs.
        Midwifery. 2014; 30: e26-e33
        • Svensson L.
        • Nielsen K.
        • Maindal H.
        What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration.
        Scand. J. Caring Sci. 2017; 32: 756-764
        • Pozzo M.
        • Brusati V.
        • Cetin I.
        Clinical relationship and psychological experience of hospitalization in “high-risk” pregnancy.
        Eur. J. Obstet. Gynecol. Reprod. Biol. 2010; 149: 136-142
        • Cheng E.R.
        • Carroll A.E.
        • Iverson R.E.
        • Declercq E.R.
        Communications between pregnant women and maternity care clinicians.
        JAMA Netw. Open. 2020; 3 (e206636-e)
        • Wyles K.
        • Miller Y.D.
        Does it get better with age? Women’s experience of communication in maternity care.
        Women Birth. 2019; 32: e366-e375
        • Heys S.
        • Thomson G.
        • Downe S.J.M.
        ‘I know my place’; a meta-ethnographic synthesis of disadvantaged and vulnerable women’s negative experiences of maternity care in high-income countries.
        Midwifery. 2021; 103103123
      1. Iedema R. Piper D. Manidis M. Communicating Quality and Safety in Health Care. Cambridge University Press, Port Melbourne (AU)2015
        • Davis-Floyd R.
        The technocratic, humanistic, and holistic paradigms of childbirth.
        Int. J. Gynaecol. Obstet. 2001; 75: S5-S23
        • Altman M.R.
        • Oseguera T.
        • McLemore M.R.
        • Kantrowitz-Gordon I.
        • Franck L.S.
        • Lyndon A.
        Information and power: women of color’s experiences interacting with health care providers in pregnancy and birth.
        Soc. Sci. Med. 2019; 238112491
        • Keedle H.
        • Peters L.
        • Schmied V.
        • Burns E.
        • Keedle W.
        • Dahlen H.G.
        Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia.
        BMC Pregnancy Childbirth. 2020; 20: 1-15
        • Furskog Risa C.
        • Friberg F.
        • Lidén E.
        Experts’ encounters in antenatal diabetes care: a descriptive study of verbal communication in midwife-led consultations.
        Nurs. Res. Pract. 2012; 2012
        • Naughton S.L.
        • Harvey C.
        Providing woman-centred care in complex pregnancy situations.
        Midwifery. 2021; 103060
        • Gordon S.
        • Aydam J.
        • Hamm K.
        • Rocha M.
        • Northcut A.
        • Roberson B.
        • Shook M.
        Improving communication and coordination of complex perinatal patients.
        MCN Am. J. Matern. Child Nurs. 2015; 40: 167-173
        • Thomas M.
        • Hutchison M.
        • Castro G.
        • Nau M.
        • Shumway M.
        • Stotland N.
        • Spielvogel A.
        Meeting women where they are: integration of care as the foundation of treatment for at-risk pregnant and postpartum women.
        Matern. Child Health J. 2017; 21: 452-457
        • Lapolla A.
        • Scibetta D.
        • Gallina P.
        • Iorizzo G.
        • Dalfrà M.G.
        • Visentin S.
        • Nardelli G.B.
        • Vettor R.
        Innovative clinical pathways for obese pregnant women: design and feasibility of the Padua project (North-Eastern Italy).
        J. Endocrinol. Invest. 2017; 41: 647-653
        • Harris R.
        • Fries M.
        • Boyle A.
        • Adeniji-Adele H.
        • Cherian Z.
        • Klein N.
        • John A.S.
        Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care.
        Congenit. Heart Dis. 2014; 9: E204-E211
        • Reid R.
        • Haggerty J.
        • McKendry R.
        Defusing the Confusion: Concepts and Measures of Continuity of Healthcare [Internet].
        ([cited 2020 Mar 20]. Available from:) Canadian Health Services Research Foundation, Montreal2002
        • Murfet G.
        • Allen P.
        • Hingston T.
        Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy.
        Aust. J. Adv. Nurs. 2013; 70: 1150-1163
        • Byerley B.M.
        • Haas D.M.
        A systematic overview of the literature regarding group antenatal care for high-risk pregnant women.
        BMC Pregnancy Childbirth. 2017; 17: 329
        • Adams H.P.
        • Picardo C.
        Centering pregnancy: a novel approach to antenatal care.
        Physician Assist. Clin. 2018; 3: 433-444
        • Baldwin A.
        • Harvey C.
        • Willis E.
        • Ferguson B.
        • Capper T.
        Transitioning across professional boundaries in midwifery models of care: a literature review.
        Women Birth. 2019; 32: 195-203