"Who am I to say?" Dutch care providers' evaluation of psychosocial vulnerability in pregnant women.

Autor: van Blarikom E; Department of Anthropology, Amsterdam Institute of Social Science Research, Amsterdam, Netherlands; Wolfson Institute of Population Health, Centre for Primary Care, Queen Mary University of London, United Kingdom., de Kok B; Department of Anthropology, Amsterdam Institute of Social Science Research, Amsterdam, Netherlands. Electronic address: B.C.de.Kok@uva.nl., Bijma HH; Department of Obstetrics and Gynaecology, Division of Obstetrics & Foetal Medicine, Erasmus MC, Rotterdam, Rotterdam, Netherlands.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2022 Aug; Vol. 307, pp. 115181. Date of Electronic Publication: 2022 Jun 30.
DOI: 10.1016/j.socscimed.2022.115181
Abstrakt: Maternity care increasingly focuses on evaluating psychosocial vulnerability during pregnancy. Research and nationwide (public health) programs, both in the USA and Europe, led to the development of new protocols and screening instruments for care providers to systematically screen for psychosocial vulnerability in pregnant women. However, standardised screening for vulnerability is complex since it requires discussion of sensitive issues. Women may fear stigmatisation and may have limited trust in their care providers or the health system. Our study contributes to the growing field of client-facing risk work by exploring care providers' interpretations and evaluation of psychosocial vulnerability in pregnant women. Drawing on semi-structured interviews with Dutch maternity care providers, we explore how they conceptualise risk and vulnerability and identify 'vulnerable pregnant women' in their practices. We find that care providers conceptualise 'vulnerability' as primarily based on risk, which contributes to an imbalanced focus on individual mothers, rather than on both parents and the social context. Our findings highlight care providers' concerns around 'care avoidance', seen as a risk factor affecting 'vulnerability' during pregnancy and as a possible consequence of risk screening. The care providers we interviewed employ "in between-strategies" based on intuition, emotion, and trust to skillfully attend to the risk that comes with risk work, in terms of its potential impact on relationships of trust and open communication. We conclude that 'vulnerability' should be understood as a multi-layered, situated and relational concept rather than simply as an epidemiological category. Since a trusting relationship between pregnant women and care providers is crucial for the evaluation of vulnerability, we reflect critically on the risk of standardised perinatal psychosocial risk evaluations. Policy should recognise providers' "in between-strategies" to embed epidemiological understandings of risk in the context of everyday risk work.
(Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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