Discovering midwives’ role and perceptions of hyperemesis gravidarum in antenatal care units in Sweden

PROBLEM: Support for women with hyperemesis gravidarum is crucial yet insufficient, with research indicating harmful normalisation and dismissiveness towards affected women and their partners. BACKGROUND: Hyperemesis gravidarum is one of the leading causes of early pregnancy hospitalisation, affecting an estimated 0.3%-3.6% of pregnancies worldwide. The condition imposes substantial physical, psychological, and psychosocial burdens, yet it frequently remains underrecognised and inadequately managed. As a result, many women experience prolonged suffering and a considerably reduced quality of life. AIM: To explore midwives' subject positioning in the context of hyperemesis gravidarum. METHODS: This study used focus group discussions guided by a semi-structured interview guide and analysed using discourse psychology. Six focus group discussions with 28 midwives across four Swedish regions were conducted in antenatal care units. FINDINGS: Midwives positioned themselves as decision-makers, signposts and facilitators, and reassurers. They played a key role in identifying when symptoms go beyond normality and in striving to provide stability within a fragmented healthcare system. DISCUSSION: Midwives' positioning reflects an independent workforce that promotes women's well-being and emphasises the normality of pregnancy and childbirth. The latter can be perceived both as support, but it can also complicate women's access to care. Midwives navigate diagnostic uncertainty and a lack of clear management guidelines, contributing to a troubled subject positioning. CONCLUSION: This study highlights the role of midwives in supporting women with hyperemesis gravidarum. Grounded in a commitment to women's well-being and normal pregnancy, the midwives demonstrate strong decisiveness and a role as safe midpoint within a fragmented healthcare system.