Scientific Papers

The role of the partner in the support of a pregnant woman’s healthy diet: an explorative qualitative study | BMC Pregnancy and Childbirth

The couples were relatively highly educated, seemed happy in their relationship, and felt excited about their pregnancy. The couples were talkative and sympathetic. The sphere of the interviews was open and intimate, which led couples to share personal details such as their health or bad experiences during previous pregnancies. Because the interviews were held with both the pregnant woman and her partner, the interaction between them could be observed, as couples often added to each other’s stories and started asking each other questions. Example of such conversation between two partners:

P9: People often tell stories about men opening a bottle of wine for the pregnant woman to be like: “What about me? I’m pregnant!” Fortunately, we don’t experience that.

PW9: That would not help me or feel as supported either.

P9: No, but if you felt like that, I would not have done that.

PW9: No? Then you would have just continued drinking?

P9: No, then I would not drink wine and stuff. Then I would have just stuck with beer.

PW9 [laughing]: Is that not alcohol as well?

P9: Yes, but I could also open a very nice bottle of white wine, making you feel something like: “I would also have liked that.” However, that is something that I would not do.

When discussing the pregnancy and their complaints, the pregnant women did most of the talking. Some women mentioned not having something to complain about, whereas others experienced complaints such as tiredness, nausea, and vomiting. Partners often indicated that pregnancy was an exciting but difficult time because they empathized with the experience of the pregnant woman. When couples were asked about a rating between 0 and 10 (0 = very unhealthy and 10 = very healthy), they would assign to the healthiness of their diet: they graded this at about 7 out of 10 on average, ranging from 5 to 8.5. Only one couple scored their diet as low as a 5/10.

P13: With all snacks I eat… I think I am at a 5.

PW13: I think I also score 5 because I keep eating all day because I am hungry all the time.

P13: Yes, you will then grab a cookie or some candy…

PW13: Yes, to stop nausea, I just need to eat.

Dietary changes since pregnancy differed between couples. Almost half of the couples mentioned being more occupied with being healthy during the pregnancy than before. Some pregnant women consume more vegetables and fruits, while others consume more unhealthy snacks, often caused by pregnancy cravings. All pregnant women changed their diet by withholding unsafe foods such as raw meat, soft cheese, and alcohol.

“I noticed that when I found out I was pregnant, a switch flipped [to eat healthier].” (PW16)

When discussing support, almost all couples agreed with one another regarding their provided dietary support. Sometimes it was difficult for couples to come up with examples of dietary support, but most of them would add to each other’s previously made suggestions. For some couples, the pregnant women primarily supported their partner with a healthier diet, whereas in other couples the partner mostly supported the pregnant woman.

Partner support

When the couples were asked what came to mind when talking about support during pregnancy, most of them started talking about non-dietary support. Partners were more involved in doing household chores since pregnancy by vacuuming, doing the laundry, or loading and unloading the dishwasher. In addition, partners expressed more empathy and encouragement towards pregnant women. These were either related to pregnancy complaints, such as being tired or feeling sick, or being interested in pregnancy itself.

Instrumental dietary support

The majority of pregnant women received a lot of instrumental dietary support, including the partner cooking, doing groceries, and withholding from foods that are unsafe during pregnancy. During pregnancy, partners cooked more often than before. This included preparing dinner together with the pregnant women or doing it more often by themselves. Partners also took more care of the pregnant women during the day, for example by preparing fruit, ensuring that she drank enough fluids, or bringing a cup of tea. Partners also went grocery shopping more during pregnancy. Some partners mentioned accompanying the pregnant women to the store to carry the heavy bags, whereas others said they took on the entire task of grocery shopping.

“You did a lot of cooking, you made sure that the groceries were done, that there was enough food in the house, and that there was plenty of vegetables and fruit.” (PW5).

Pregnancy-related complaints among pregnant women have caused their partners to increase instrumental dietary support (e.g., cooking or groceries). Complaints such as tiredness or nausea made it more difficult for pregnant women to cook or do groceries, so the partners felt that they needed to take on these tasks. Being available helped the partners provide support. Some partners, for example, mentioned that the COVID-19 regulations were beneficial for providing support since they were more at home to help around the house.

“You see, on days that she is really tired or that we did something, and we get home and she is out of energy, then I often cook.” (P12).

“There was also a phase when you couldn’t handle standing in the smell of cooking so during that phase I did it more often.” (P13).

All pregnant women withheld unsafe foods during their pregnancies. 15 of the 16 pregnant women used the Zwangerhap app of The Netherlands Nutrition Centre to determine what to eat during pregnancy. Partners supported pregnant women by also withholding themselves from unsafe foods and felt like it would not be solidary to eat them in the presence of pregnant women. Ten partners mentioned drinking no or significantly less alcohol in the presence of the pregnant women or withholding from eating unsafe foods, such as raw meats and unpasteurized cheeses because of pregnancy. Partners felt that it would make it easier for pregnant women to avoid certain foods if they withheld themselves as well, and felt that it was not fun to eat or drink these foods alone.

“I think it is the biggest support that you do not eat everything that I cannot eat right in front of me, for example ordering sushi while I cannot have that.” (PW9).

“He says: I am not going to drink wine alone. You are sitting next to me, and I am drinking a glass of red wine by myself. That’s just not as nice.” (PW14).

“I understand that people do not want the smell of salmon in their nose when they cannot eat it” (P5).

Appraisal dietary support

Appraisal support refers to providing support for self-evaluation, helping in decision making, and giving appropriate feedback. Over half of the partners gave appraisal dietary support to increase the pregnant women’s consciousness of their dietary intake. Partners made comments about the pregnant women eating unhealthy food or steered them to eat healthier foods. Some partners were concerned about the amount of food consumed in a day and made comments regarding this.

“I once said that I really wanted to go to a snack bar and then he said; we are not going to do that, you will be grateful later.” (PW3).

“I can’t drink too much coffee. Only two cups a day, and sometimes when I say I would like another one, he says: you know you don’t need to drink more than two cups of coffee per day” (PW14).

In addition to increasing awareness of dietary intake, five partners specifically provided appraisal support for unsafe foods. For example, while doing groceries, partners asked which foods the pregnant women were allowed to eat and thus could be taken home, or while preparing meals which foods could be eaten. Some partners also commented on which foods should be eaten by the pregnant women or made suggestions about what to eat while being nauseous.

“He always asks something like: I am making fresh mint tea; can you have that?” (PW11).

“I try to say to her: you need to eat something light, like yoghurt, which includes a lot of protein so that you gain some strength back” (P15).

The importance of a healthy diet and avoiding unsafe foods were reasons for the partners to provide appraisal support for the health of both the mother and the baby.

“Raw meat is just something we are not going to do […] why would you risk that?” (P4).

Informational dietary support

Most informational support provided by the partner concerned foods that were unsafe during pregnancy. Partners informed themselves about these food products, discussed them with the pregnant women, and checked on food labels what could and could not be eaten by pregnant women. Some partners downloaded pregnancy- and dietary-related apps on their phones to inform themselves.

PW13: He makes sure that I do not eat something that I cannot have because of my pregnancy.

P13: Yes, with salmon, steak, or something like that.

PW13: Yes, like can you have that? So, you do not look at what is healthy, but you do look at what can be harmful to the baby.

In one interview, informational support regarding additional nutrients during certain period of pregnancy was provided.

“The app said, for example, that in this week the bones are being developed, so calcium is important. So, then I say: you need a bit more yoghurt.” (P5).

Informational support was often provided because the partner felt nervous about the pregnancy. Many of the partners expecting their first child felt uncertain in the first few weeks of pregnancy, since it was a new experience for them. Some partners were worried about the pregnant woman feeling sick. Information was sought to feel more confident and know what to eat during pregnancy. Similar to appraisal support, the health of the mother and baby underlies the reasons for providing this type of support.

“Especially in the beginning I was quite nervous about how it would all go up until 12 weeks, so then I asked many times whether she feels good and whether it wasn’t too heavy carrying certain things and all those kinds of things.” (P5).

Emotional dietary support

Emotional dietary support was mentioned in four interviews and was thereby the least mentioned type of dietary support during pregnancy: partners supported pregnant women by expressing care and empathy regarding dietary difficulties.

“At moments that it gets difficult, I try to empathize even though it is difficult since you do not feel it yourself. And also, to talk about it helps a lot if she can just share her story.” (P15).

No support received by pregnant women

In some situations, dietary support was not received by the pregnant woman and was not provided by the partner. Examples of such situations were that the partners did not withhold themselves from eating pregnancy-unsafe foods, were not involved in the dietary intake of the pregnant women, or did not take on tasks such as doing groceries. The main reason for not providing dietary support was that it was not needed or appreciated by the pregnant woman, for example, because the pregnant woman was well aware of unsafe foods, was already eating healthy, or was not experiencing difficulties. Some partners did not feel comfortable telling the pregnant women what (not) to eat. Not consciously being occupied with pregnant women’s dietary intake is also a reason why partners did not provide dietary support. Some partners expressed a lack of knowledge about what is healthy and what are the important nutrients during pregnancy. Lastly, pregnancy complaints, such as nausea, made it difficult for partners to provide dietary support because they did not know which foods to advise during nauseous periods or felt that pregnant women were less approachable. Partners also expressed that pregnant women should be able to enjoy (unhealthy) food during pregnancy without receiving comments about it.

Support acceptance

In a minority of cases, the support provided by partners was not accepted by pregnant women. For all four types of support, there were examples of pregnant women accepting support and pregnant women not accepting support. For example, regarding instrumental dietary support, some pregnant women accepted that their partner did the groceries, while others did not want their partner to do so. Appraisal support was accepted by some pregnant women because they felt that it showed involvement. However, others did not like appraisal support as it felt like unwanted interference.

“He sometimes bought me brown bread and then I got irritated because I don’t want brown bread – I want white bread! […] The more people pay attention to things I should not do, the more I feel the urge to do them. [.] So I think; what are you meddling? As if I’m some dumbass who does not know how to take care of herself.” (PW6)

Reasons for acceptance of support by the pregnant woman

Appreciation was the main reason for accepting support from their partners. In eight interviews, pregnant women appreciated getting support, from their partners or relatives. Multiple reasons can be identified as to why the given support has been accepted. One example is that support was accepted because it was helpful for pregnant women to take away some of the burdens of household chores. Another reason for support acceptance was that the support showed involvement and was perceived as being caring.

P8: I try to pay attention to what I eat. Because if I would eat crisps, or when I would get McDonald’s, I know that she would want it too. It would not be fair to eat it alone, so I think that I would pull her into that unhealthy food if I did that.

PW8: Yes, I am happy about that because I cannot guarantee that I am strong enough to resist that.

“I think that’s so sweet, that he is so involved in my health in that way” (P6).

The origin of support is relevant to whether it is accepted. Pregnant women more readily accept support when given by an expert, such as a midwife or a dietician. Besides experts, support is also more willingly accepted by someone who is also pregnant or has been pregnant before. Two participants, for example, more readily accepted support from their mothers than from their partner.

I: What if you received a dietary tip from a midwife, would that be different?

PW8: Yes, I think it is different. You can tell that they received training on how to transmit information. […] With midwives, it is their occupation, they have studied for it, and they have experience. I accept this information more willingly.

In addition to the importance of the person who provides support, the way support is communicated is important. For example, support should not be communicated with a know-it-all attitude or coercively but rather as advice to be accepted. The provided support should be clearly explained and come from a reliable source. Some pregnant women would like support to be given directly, but others prefer it more subtly.

“I always prefer that you just communicate directly to me” (PW12).

“I do need to communicate it subtle otherwise it will come across as an attack” (P14).

Support was more likely to be accepted if it was requested, not repeated constantly, and when provided at the beginning of the pregnancy rather than later or during a second pregnancy. This is because couples have gathered more information and experience later in pregnancy, reducing the need for support at later time points.

P3: Yes, I think support leads to healthier choices.

PW3: I think so too. I have quite some knowledge, so I do not need it as much. However, I do think that if you would have asked this question during my first pregnancy, I think I would have answered differently. I searched for a lot of information about the types of fish, etc. I was like a walking Google during my first pregnancy.

Finally, the content of the support was important. Pregnant women would receive positive rather than negative feedback, and would therefore rather receive support about what is healthy than what is unhealthy. However, some support regarding what is unhealthy or what can be harmful to the baby is appreciated. Other dietary support provided by the partner was only accepted by the pregnant woman if they felt that it was relevant. For example, if the partner provided appraisal support regarding snack behaviour (e.g., eating too many biscuits), it was only accepted if the pregnant woman agreed that her snack behaviour was problematic. In addition, if the partner provides this kind of support, the partner should comply with the support they provide. Support regarding unhealthy snack behaviour will only be accepted by pregnant women if the partner has healthy snack behaviour.

I: So when he tells you ‘This is healthy and I know you would like it’, that would be nice and you will take the support into account, but if he says ‘you should not eat this’, it would be harder to accept?

PW15: It depends, if I would eat cookies all day, and he would say: maybe that is not clever to do, it would be different. However, if I just eat one cookie occasionally, I would just enjoy eating it.

Reasons for non-acceptance of support by pregnant women

In the few cases of non-acceptance of support by pregnant women, some reasons were mentioned by both the pregnant women and their partners. Some characteristic traits of pregnant women have been mentioned as reasons for non-acceptance, such as stubbornness, recalcitrance, and being bad at receiving support. Partners find it more difficult to give support to pregnant women when they know it will not be appreciated by them, due to their character or previous experiences of failed attempts to provide support.

“I have a hard time letting go. I often think I can do it better. […] Even if I should stop and lie down, I am stubborn. I usually only sit down if I am done doing everything around the house.” (PW3).

“If I am being honest, I am really bad at receiving criticism or unwanted advice.” (PW6).

Pregnant women may feel that their partners do not have the authority to decide what they can eat. Most pregnant women said they were able to decide for themselves what is good or not good to eat and indicated that they already had a healthy diet before pregnancy, so the involvement of the partner was not appreciated. Support was also not accepted because of acute urges such as pregnancy cravings. If pregnant women want to eat a certain thing, it does not matter how support is communicated: it would not be accepted by pregnant women anyway.

“I’m like, it is my life and my body, and I can decide what I eat or drink” (PW6).

Dietary support can also have negative outcomes. When partners, for example, gave appraisal support for improving snack behaviour, pregnant women felt more urged to eat snacks.

I: If your partner would say something like ‘Maybe you should not drink the glass of chocolate milk.’ What would you think?

PW14: I would then drink an extra glass of chocolate milk.

Support was not accepted when it felt as judgment or unwanted interference. Some pregnant women felt judged for their choices regarding unsafe foods. Trustworthiness and unclear advice were other reasons for not accepting support. Most couples indicated that it is important to follow dietary guidelines, and support is less likely to be accepted when it is not in line with these guidelines. In rare cases of someone providing advice that conflicts with these guidelines, such as ‘one sip of alcohol will not harm the baby,’ this was often not accepted and appreciated.

P5: My mother tried to give you alcohol, which was very weird. I was really confused because she is not a drinker at all. She usually feels disgusted with alcohol consumption.

PW5: But she did so because your dad made wine of its own.

P5: Yes, my dad made wine, but then I said: ‘You will not feed alcohol to my baby, right Mom?’

Pregnant women mentioned that they should be able to follow the provided support for it to be accepted. One participant mentioned that she did not listen to the appraisal support of their partner regarding the amount of food she eats because she was unable able to eat large amounts of food anyway because of her pregnancy. Support is also not accepted when it is about eating food products that they do not like. For example, if a partner advises a pregnant woman to eat more vegetables, even if she does not like vegetables, the support would not be accepted.

“At the beginning when you are pregnant and everything is new, you get a lot of recommendations. In addition to supplements and vitamins. After a while, I stopped taking them because I never took them in my life, and I found it weird to do it now. Besides, those pills were gross.” (PW1).

Satisfaction with dietary support

Of the 16 couples, 11 were satisfied with the dietary support between the two; in two couples the pregnant woman and her partner were both not satisfied, and in three couples the pregnant women were satisfied but the partner was not satisfied with the support they provided. PW2 mentioned that they stimulated each other into an unhealthy diet at times. When asked whether her partner could support her in eating healthier, she said the following:

“We are quickly inclined to pull each other into an unhealthy diet while in most cases we have plenty of time to cook and eat a healthy meal. […] When I think about dinner, I would find it nice if he would stop me more often from eating unhealthy food.” (PW2).

Between couple 13, the following conversation took place when talking about the dietary support provided by the partner:

P13: Our son eats fruit every day. I am more occupied with him eating fruit than you eating healthy

PW13: Yes, I think you forget at times that I need to live healthily because I am pregnant.

P13: Yes, our son doesn’t eat very well so I find it important that he eats fruit

PW13: And then you forget about me.

P13: Yes, I forget about you a bit, even though I am already busy preparing fruit, so I could also make you some. I may fall a bit short there.

PW8 stated that she was happy with the support she had received. However, while discussing support during the interview, she realized that she would have liked more informational support from her partner.

“We could have delved a little bit more in the information about what nutrients are good during the development of the baby in the womb.” (PW8).

When partners were asked whether they were satisfied with the support they provided, five made suggestions for improvement. Some partners mentioned that they did not consciously think about the dietary patterns of the pregnant woman before, and that they could be more interested in this. Others mentioned that they could improve the provision of healthy meals and snacks. P15 was unsure about providing support because he did not know what to advise and what was healthy during pregnancy, so he mentioned that he could improve on this matter.

“I am partly happy with the support I provide. It could be improved, but I am often unsure about what the best choice is. I could give a lot of healthy suggestions, but I don’t know if that is also healthy during pregnancy or in combination with nausea.” (P15).

“I encourage her to keep eating well, but sometimes in a bit of a snappy way. […] I could let go of that snapping a bit more… But at least I try to support her.” (P16).

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