Nutritional counseling in midwifery and obstetric practice

It is generally acknowledged that pregnant women require healthy diets. However, the cultural idea of "eating for two" and what constitutes an "appropriate" diet during pregnancy have been contested grounds of research as guidelines have changed over the decades. Using a grounded theory approach, we examine how research on pregnancy nutrition is incorporated into practice and translated to patients by obstetricians and 2 categories of midwives--certified nurse midwives (CNMs) and direct-entry midwives (DEMs). Five themes emerged from interviews: (1) food and exercise as "two sides of the same coin"; (2) "good food" and "food that harms" dichotomies; (3) nutrition as holistic prevention; (4) institutionalized barriers to nutritional counseling; and (5) food and the obesity epidemic. An exploration of the conceptual connections between these themes by provider type suggests mechanisms that we argue may be functioning to produce, reproduce, and perpetuate midwifery and medical models of care and associated provider-effects on nutrition-related complications.