Skip to main content
Top
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research

General practitioners’ perceived indicators of vulnerability in pregnancy- A qualitative interview study

Authors: L Brygger Venø, DE. Jarbøl, LB. Pedersen, J Søndergaard, RK Ertmann

Published in: BMC Primary Care | Issue 1/2021

Login to get access

Abstract

Objective

To explore general practitioners’ (GPs’) perceived indicators of vulnerability among pregnant women in primary care.

Design

A qualitative study with semi-structured in-depth focus group interviews.

Setting

General practices located in a mixture of urban, semi-urban and rural practices throughout the Region of Southern Denmark

Subjects

Twenty GPs.

Main outcome measures

Through qualitative analysis with systematic text condensation of the interview data, the following themes emerged: (1) obvious indicators of vulnerability—i.e. somatic or psychological illnesses, or complex social problems and 2) intangible indicators of vulnerability – i.e. identification depended on the GPs’ gut-feeling.
From the GPs’ perspective, the concept of vulnerability in pregnancy were perceived as the net result of risk factors and available individual and social resources, with a psychosocial etiology as the dominant framework.

Conclusions

The GPs demonstrated a broad variety of perceived indicators of vulnerability in pregnancy; most importantly, the GPs were aware of a group of pregnant women with intangible vulnerability mainly representing low resilience. Despite not fitting into the GPs' perceived concept of vulnerability, the GPs had a strong gut feeling that these women might be vulnerable. Misjudging the resources of pregnant women due to their physical appearance could delay the GPs’ identification of vulnerability. Future studies should explore the challenges GPs experiences when assessing vulnerability among pregnant women.
Appendix
Available only for authorised users
Literature
1.
go back to reference Sundhedsstyrelsen. Danskernes sundhed - Den nationale sundhedsprofil 2017 [The health of the danes - The national profile of health 2017]. Copenhagen 2018. Sundhedsstyrelsen. Danskernes sundhed - Den nationale sundhedsprofil 2017 [The health of the danes - The national profile of health 2017]. Copenhagen 2018.
2.
go back to reference Sundhedsstyrelsen. Anbefalinger for svangreomsorgen [Recommendations for pregnancy care], Danish. 2 ed. Copenhagen2013. Sundhedsstyrelsen. Anbefalinger for svangreomsorgen [Recommendations for pregnancy care], Danish. 2 ed. Copenhagen2013.
3.
go back to reference Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.CrossRef Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.CrossRef
4.
go back to reference D Nielsen Forman, P Videbech, M Hedegaard, J DalbySalvig, Secher NJ. Postpartum depression: identification of women at risk. BJOG. 2000;107(10):1210–7.CrossRef D Nielsen Forman, P Videbech, M Hedegaard, J DalbySalvig, Secher NJ. Postpartum depression: identification of women at risk. BJOG. 2000;107(10):1210–7.CrossRef
5.
go back to reference O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12. O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12.
6.
go back to reference Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.CrossRef Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.CrossRef
7.
go back to reference Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Hofler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord. 2015;175:385–95.CrossRef Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Hofler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord. 2015;175:385–95.CrossRef
8.
go back to reference Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14.CrossRef Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14.CrossRef
9.
go back to reference Kettunen P, Hintikka J. Psychosocial risk factors and treatment of new onset and recurrent depression during the post-partum period. Nord J Psychiatry. 2017;71(5):355–61.CrossRef Kettunen P, Hintikka J. Psychosocial risk factors and treatment of new onset and recurrent depression during the post-partum period. Nord J Psychiatry. 2017;71(5):355–61.CrossRef
10.
go back to reference Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77.CrossRef Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77.CrossRef
11.
go back to reference Health] SDNBo. Narkotikasituationen i Danmark [The drug abuse situation in Denmark 2017 - National data]. Copenhagen; 2017 22. november 2017. Report No.: 978–87–7104–928–2. Health] SDNBo. Narkotikasituationen i Danmark [The drug abuse situation in Denmark 2017 - National data]. Copenhagen; 2017 22. november 2017. Report No.: 978–87–7104–928–2.
12.
go back to reference Walsh F. Family resilience: a developmental systems framework. E J Dev Psychol. 2016;13(3):313–24.CrossRef Walsh F. Family resilience: a developmental systems framework. E J Dev Psychol. 2016;13(3):313–24.CrossRef
13.
go back to reference Howard LM, Megnin-Viggars O, Symington I, Pilling S, Guideline DG. Antenatal and postnatal mental health: summary of updated NICE guidance. BMJ. 2014;349:g7394.CrossRef Howard LM, Megnin-Viggars O, Symington I, Pilling S, Guideline DG. Antenatal and postnatal mental health: summary of updated NICE guidance. BMJ. 2014;349:g7394.CrossRef
14.
go back to reference de Graaf JP, Steegers EA, Bonsel GJ. Inequalities in perinatal and maternal health. Curr Opin Obstet Gynecol. 2013;25(2):98–108.CrossRef de Graaf JP, Steegers EA, Bonsel GJ. Inequalities in perinatal and maternal health. Curr Opin Obstet Gynecol. 2013;25(2):98–108.CrossRef
15.
go back to reference Mongan D, Lynch J, Hanna D, Shannon C, Hamilton S, Potter C, et al. Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2019;19(1):412.CrossRef Mongan D, Lynch J, Hanna D, Shannon C, Hamilton S, Potter C, et al. Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2019;19(1):412.CrossRef
16.
go back to reference Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):25–35.CrossRef Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):25–35.CrossRef
17.
go back to reference Aabakke AJM, Mortensen LH, Krebs L. [Socioeconomic inequality affects pregnancy and birth outcomes in Denmark]. Ugeskr Laeger. 2019;181(13). Aabakke AJM, Mortensen LH, Krebs L. [Socioeconomic inequality affects pregnancy and birth outcomes in Denmark]. Ugeskr Laeger. 2019;181(13).
18.
go back to reference Sethi D, Bellis M, Hughes K, Gilbert R, Mitis F, Galea G. European report on preventing child maltreatment: World Health Organization. Regional Office for Europe; 2013. Sethi D, Bellis M, Hughes K, Gilbert R, Mitis F, Galea G. European report on preventing child maltreatment: World Health Organization. Regional Office for Europe; 2013.
19.
go back to reference Sundhedsstyrelsen. Evaluering af "styrket indsats i svangreomsorgen for udsatte gravide" [Evaluation of supportive efforts for vulnerable pregnant women] 2017. Sundhedsstyrelsen. Evaluering af "styrket indsats i svangreomsorgen for udsatte gravide" [Evaluation of supportive efforts for vulnerable pregnant women] 2017.
20.
go back to reference Health CfM. The costs of perinatal mental health problems. 2014. Health CfM. The costs of perinatal mental health problems. 2014.
21.
go back to reference Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323–31.CrossRef Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323–31.CrossRef
22.
go back to reference Sundhedsstyrelsen. Evaluering af etablering af Familieambulatorierne. Slutevaluering. [Evaluation of the estabilishment of the social-obstetrics outpatient clinics. End-evaluation.]. 2015. Sundhedsstyrelsen. Evaluering af etablering af Familieambulatorierne. Slutevaluering. [Evaluation of the estabilishment of the social-obstetrics outpatient clinics. End-evaluation.]. 2015.
23.
go back to reference Khan L. Falling Through the Gaps: Perinatal Mental Health and General Khan L. Falling Through the Gaps: Perinatal Mental Health and General
24.
go back to reference Practice. London, UK: Centre for Mental Health; 2015. Practice. London, UK: Centre for Mental Health; 2015.
25.
go back to reference Ford E, Lee S, Shakespeare J, Ayers S. Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. Br J Gen Pract. 2017;67(661):e538–46.CrossRef Ford E, Lee S, Shakespeare J, Ayers S. Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies. Br J Gen Pract. 2017;67(661):e538–46.CrossRef
26.
go back to reference Ford E, Shakespeare J, Elias F, Ayers S. Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Fam Pract. 2017;34(1):11–9.CrossRef Ford E, Shakespeare J, Elias F, Ayers S. Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Fam Pract. 2017;34(1):11–9.CrossRef
27.
go back to reference Noonan M, Doody O, Jomeen J, O’Regan A, Galvin R. Family physicians perceived role in perinatal mental health: an integrative review. BMC Fam Pract. 2018;19(1):154. Noonan M, Doody O, Jomeen J, O’Regan A, Galvin R. Family physicians perceived role in perinatal mental health: an integrative review. BMC Fam Pract. 2018;19(1):154.
28.
go back to reference Engel GL. The need for a new medical model: a challenge for biomedicine. Science (New York, NY). 1977;196(4286):129–36.CrossRef Engel GL. The need for a new medical model: a challenge for biomedicine. Science (New York, NY). 1977;196(4286):129–36.CrossRef
29.
go back to reference McWhinney IR. Being a general practitioner: what it means. Eur J Gen Pract. 2000;6(4):135–9.CrossRef McWhinney IR. Being a general practitioner: what it means. Eur J Gen Pract. 2000;6(4):135–9.CrossRef
30.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef
31.
go back to reference Pedersen KM, Andersen JS, Søndergaard J. General practice and primary health care in Denmark. J Am Board Fam Med : JABFM. 2012;25(Suppl 1):S34–8.CrossRef Pedersen KM, Andersen JS, Søndergaard J. General practice and primary health care in Denmark. J Am Board Fam Med : JABFM. 2012;25(Suppl 1):S34–8.CrossRef
32.
go back to reference Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805.CrossRef Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805.CrossRef
33.
go back to reference Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753–60.CrossRef Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753–60.CrossRef
34.
go back to reference Buist A, Bilszta J, Milgrom J, Barnett B, Hayes B, Austin MP. Health professional’s knowledge and awareness of perinatal depression: results of a national survey. Women Birth. 2006;19(1):11–6.CrossRef Buist A, Bilszta J, Milgrom J, Barnett B, Hayes B, Austin MP. Health professional’s knowledge and awareness of perinatal depression: results of a national survey. Women Birth. 2006;19(1):11–6.CrossRef
35.
go back to reference Noonan M, Doody O, O’Regan A, Jomeen J, Galvin R. Irish general practitioners’ view of perinatal mental health in general practice: a qualitative study. BMC Fam Pract. 2018;19(1):196.CrossRef Noonan M, Doody O, O’Regan A, Jomeen J, Galvin R. Irish general practitioners’ view of perinatal mental health in general practice: a qualitative study. BMC Fam Pract. 2018;19(1):196.CrossRef
36.
go back to reference Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. Health Soc Care Community. 2019;27(4):e389–405.CrossRef Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. Health Soc Care Community. 2019;27(4):e389–405.CrossRef
37.
go back to reference Sellman D. Towards an understanding of nursing as a response to human vulnerability. Nursing philosophy : an international journal for healthcare professionals. 2005;6(1):2–10.CrossRef Sellman D. Towards an understanding of nursing as a response to human vulnerability. Nursing philosophy : an international journal for healthcare professionals. 2005;6(1):2–10.CrossRef
38.
go back to reference Stolper E, van Bokhoven M, Houben P, Van Royen P, van de Wiel M, van der Weijden T, et al. The diagnostic role of gut feelings in general practice. A focus group study of the concept and its determinants. BMC Fam Pract. 2009;10:17. Stolper E, van Bokhoven M, Houben P, Van Royen P, van de Wiel M, van der Weijden T, et al. The diagnostic role of gut feelings in general practice. A focus group study of the concept and its determinants. BMC Fam Pract. 2009;10:17.
39.
go back to reference Stolper E, Van Royen P, Van de Wiel M, Van Bokhoven M, Houben P, Van der Weijden T, et al. Consensus on gut feelings in general practice. BMC Fam Pract. 2009;10:66.CrossRef Stolper E, Van Royen P, Van de Wiel M, Van Bokhoven M, Houben P, Van der Weijden T, et al. Consensus on gut feelings in general practice. BMC Fam Pract. 2009;10:66.CrossRef
40.
go back to reference Sundhedsloven. Bekendtgørelse om tolkebistand efter sundhedsloven [Ministrial order of translater assistance after the law of health] (Danish). 2018. Sundhedsloven. Bekendtgørelse om tolkebistand efter sundhedsloven [Ministrial order of translater assistance after the law of health] (Danish). 2018.
41.
go back to reference Hjertholm P, Moth G, Ingeman ML, Vedsted P. Predictive values of GPs’ suspicion of serious disease: a population-based follow-up study. Br J Gen Pract. 2014;64(623):e346–53.CrossRef Hjertholm P, Moth G, Ingeman ML, Vedsted P. Predictive values of GPs’ suspicion of serious disease: a population-based follow-up study. Br J Gen Pract. 2014;64(623):e346–53.CrossRef
Metadata
Title
General practitioners’ perceived indicators of vulnerability in pregnancy- A qualitative interview study
Authors
L Brygger Venø
DE. Jarbøl
LB. Pedersen
J Søndergaard
RK Ertmann
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01439-3

Other articles of this Issue 1/2021

BMC Primary Care 1/2021 Go to the issue