Table 5 Free-text answers presented in three categories, including category content description and illustrative quotes

I. Reactions to the questions, and survey topic

Critical comments:

Some respondents viewed the statements as condescending both to people with obesity or to health care staff, and others found the topic irrelevant, or questions difficult to answer. Some thought that body weight should not be brought up as it may make the pregnant woman unhappy.

”This topic belongs to the 90’s. We have come further.” Obstetrician no 11.

“I find it hard to answer such categorical questions, as I do not see patients with obesity as a homogeneous group, but instead they are as diverse as normal weight patients.” Midwife no 6.

Positive or confirmative comments:

Respondents confirmed the relevance of the topic of obesity, and the sensitivity around weight and described how participants are working dedicatedly with this patient group.

“It is a huge problem and I believe it is increasing. We now perceive normal weight patients as underweight.” Midwife no 3,

“It feels like this questionnaire was a good reminder of how I relate to obese people and to myself. Thank you!” Midwife no 39.

“We must strive towards a goal where obese patients are met with respect. It is deeply rooted among my colleagues, that obesity can be treated with diet and exercise.” Obstetrician no 14

“Since a pregnant woman is considered a risk -pregnancy, it is my obligation to make sure the pregnant women and her child will have an as safe pregnancy as possible. At the same time, I must consider that this may be a sensitive subject for the pregnant woman. It is a balancing act and it can be very difficult”. Midwife no 57.

II. Clarifications to quantitative answers

Explanations to why respondents had answered that they found pregnant women with obesity difficult, or preferred treating non-obese women. Reasons provided were that higher perinatal risks and practical matters (e.g. more difficult ultrasounds, harder to operate on, and more oral glucose tolerance tests), rather than the personality of women with obesity affected respondents answers.

“… and as obstetrician I am responsible for lives when a woman with severe obesity is giving birth. It is not because I have a condescending view on the person but because there is a factual medical risk.” Obstetrician no 2.

“My reluctance to treat patients with a high BMI, depends solely on that it is so much more difficult to do a good job / … / because the patient’s BMI is associated with an incredible amount of medical risks” Obstetrician no 16.

III. Suggested areas for weight management improvement

Stories from respondents own experiences reflected empathy and concern for women with obesity, as well as displayed areas where improvements of gestational weight gain management could be made. Factors mentioned were: lack of time, lack of access to dieticians, psychological support, or obesity treatment teams, a wish for written material about weight, access to water aerobics, walking groups, training in communication skills, and obesity education in general.

”I think maternity care should have access to a dietician who can see the overweight, and especially the obese patients. We midwives can support/motivate overweight women up to a certain point, but then something more is needed. Above all, I am a midwife, not a dietician” Midwife no 4

“Most women know how they should eat, but because of anxiety or other hinders, they are unable to. Unless they have anorexia, there is no one we can refer them to who can take their eating problems seriously. This is a forgotten patient group, and we [midwives] lack education to help them. It feels rather stupid to just talk about the right diet, when there is so much more behind it.” Midwife no 37

“It is a challenge to talk about body weight with overweight women. However, It is not the knowledge I’m lacking, but the communication skills” Midwife no 10.

“Give midwives more time to perform professional conversations. The medical duties take up 90% of the work time” Midwife no 62.