Raphaël Hammer

Pregnancy is a time of rapid physical transformations. Medical and societal pressures regarding women's weight and body image throughout pregnancy may increase body dissatisfaction, which can negatively affect psychological health and health behaviors. Yet healthcare providers (HCPs) often feel uncomfortable addressing the topic. This study explored women's experiences of body changes during pregnancy, as well as the practices and challenges faced by midwives and dietitians in supporting them. A purposeful sample of 20 pregnant women (16-32 weeks of gestation) in Switzerland participated in face-to-face semi-structured interviews. In addition, four focus groups were conducted with six midwives and four dietitians. All narratives were transcribed verbatim and analyzed using thematic analysis. Three themes were identified in pregnant women's interviews: navigating body changes, managing the unmanageable, and experiencing lack of support around body image and weight gain. Women worried about weight gain, attempted to monitor their diet, and often felt unsupported by HCPs. Two themes were identified in HCP focus groups: reassuring and conveying information, and experiencing practical obstacles and societal challenges. HCPs acknowledged the sensitivity of the topic and described adopting a reassuring stance while conveying information and seeking ways to help women make peace with their bodies. Tailored support for body image during pregnancy is needed to promote maternal and fetal health. Midwives and dietitians are well placed to provide interdisciplinary consultations addressing gestational weight gain and body dissatisfaction. Training in positive body image could enhance their confidence in addressing these issues.

Les institutions de soins sont des terrains d’enquête essentiels pour analyser la complexité des systèmes de santé contemporains. Ce numéro réunit des analyses de différentes expériences de négociations d’entrée dans des institutions de soins, dont plusieurs ont échoué, afin d’éclairer les relations actuelles entre les sciences sociales et la médecine. Mener l’enquête dans ces contextes implique de composer avec des standards éthiques qui font débat, des hiérarchies de savoirs implicites et des politiques scientifiques néolibérales. En considérant les négociations d’accès comme des données de recherche à part entière, les auteur·rices proposent de nouvelles façons de gérer les désaccords et de promouvoir une réciprocité entre chercheur·es et institutions. Il importe en effet de construire des pratiques de recherche plus justes, dans lesquelles les contributions spécifiques des sciences sociales sont reconnues.

Background: Alcohol consumption during pregnancy and breastfeeding is associated with a risk for the child’s healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman’s perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period. Methods: The longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth. Results: In our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women’s perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling. Conclusion: Many women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.

Cet article s’intéresse aux récits d’expériences de (non-)consommation d’alcool de mères allaitantes. En suivant une approche pragmatique et féministe, les auteur·e·s décrivent ce qui importe pour elles et ce dont elles dépendent pour élaborer des « options vivantes » (James, [1897] 2005). Explorant les situations où la question de boire un verre se (re)pose, leur recherche rend compte des problèmes que rencontrent ces mères. L’article montre ainsi que leurs expériences de (non-)consommation d’alcool constituent des options à la fois distribuées, corporées et accountable . Au plus proche des préoccupations des femmes, l’analyse met en évidence l’accomplissement du genre et de la maternité dans leurs élaborations pratiques (West et Zimmerman, 2009) et ouvre la voie à des existences parentales alternatives.

Le problème du don d’organe est devenu un enjeu majeur, culturel, social et politique, de nos sociétés. Le présent ouvrage constitue une contribution cruciale à cette question. Il en éclaire l’émergence historique, analyse ses enjeux actuels en tenant compte d’une grande variété de matériaux (enquête sociologique auprès des associations et instances actives dans le domaine, archives hospitalières ou administratives, articles de presse, témoignages d’acteurs impliqués). Fondé sur la situation helvétique, il apporte une clé de lecture indispensable pour un débat d’une grande actualité à l’échelle internationale.