How am I, really? Perceptions of health and distress by women and their midwives.

Objective: This study examined agreement between ratings of health and emotional distress by women and their midwives.

Background: Physical complaints and medical complications during pregnancy can significantly impact a woman's experience of pregnancy. Previous studies have found that women and their healthcare providers may have differing perceptions of their condition and how they are coping with the challenges of pregnancy.

Methods: This study used questionnaires completed by women and their midwives to assess perceptions of health and emotional distress in two contexts. Sixty-eight of the women were on an antenatal unit, hospitalised for complications of their pregnancy; 33 women were a comparison group in community maternity care.

Findings: Many women in the hospital experienced high levels of emotional distress and worry about their pregnancy; 45% scored in the clinical range on state anxiety, and 28% screened positive for depression. However, midwives rating emotional distress did not pick up on this consistently, and women and hospital midwives often viewed their health status differently. In the community, women's ratings of their health were more consistent with the ratings of their midwives, and midwives were attuned to acute anxiety, but had more difficulty picking up on cues to depression.

Conclusion: It is challenging, particularly in the unfamiliar and stressful environment of the antenatal unit, for midwives to assess emotional distress and needs for health information. Deliberate screening for antenatal distress might provide the opening for midwives to empower women to identify their options, strengths, and strategies for self-care and emotional resilience.