Table 2 Midwives’ perspectives on key study procedures – qualitative responses

What are your thoughts on the study specifically approaching women in the booking clinic to participate, who have been identified as at risk for GDM?

Acceptable

• Recruitment strategy is ‘good’, ‘good idea’ or ‘fantastic idea’ (S: 7)

No concerns

• No concerns regarding the ethics of approaching this group (F: 3)

• Neutral or no concerns recruitment (S: 6)

Concerns

• Consent is an important issue, women should be aware of what their participation would involve e.g. blinding of results, potential withholding of treatment (F: 3, S: 1)

• Do not agree with the deliberate recruitment of an at risk population (S: 1)

What do you think about delaying treatment, if needed, to 24 to 28 weeks?

Acceptable

• Treatment timing is acceptable/appropriate (S: 8)

• Acceptable, as standard procedures used to be based on 28 weeks to detect GDM (S: 1, F: 1)

• More information/research needed on the outcomes of delayed treatment (S: 2)

Concerns

• Concern about the legal and ethical issues of providing adequate ‘duty of care’ to patients whose results were withheld due to research participation (F: 2)

• Concern that researchers could make a mistake in identifying at-risk patients and delaying treatment (S: 2)

• No issue unless GDM is detected earlier, then treatment should not be delayed (S: 3)

Not acceptable

• Not acceptable, testing and treatment should be made earlier to prevent risk to the mother and foetus e.g. could be too late to treat, to educate mother, prevent complications (S: 4)

• Detection and treatment should occur earlier only if risk factors are present (S: 2)

• Treatment delay could prevent mothers from experiencing unnecessary anxiety about their pregnancy (F:3)

• Unsure (S: 1)

How do you feel about the heel prick test for glucose at one hour old?

Acceptable

• Midwives were not concerned as it was not part of their workload (F: 2)

• Baby’s best interests and health the main priority (S: 1)

• Test is needed and therefore there should be no concerns (S: 5)

• Not necessary as already part of standard care (S: 4)

• Test okay if managed professionally (S: 1)

• Test should occur on the basis it will assist in health research (S: 1)

Importance of mothers’ consent

• Mothers’ consent/refusal must be respected (S: 7)

• Mothers’ should be educated and given opportunity to consent, prior to birth (S: 4)

• Issues with consent can only be dealt with if there is ‘medical indication’ that test must be done, and a subsequent “refusal of treatment” is put in clinical notes (S: 1)

• Concern that test may not be conducted due to mothers’ viewing it as unnecessary despite previously consenting (F: 2)

Concerns

• Test may not be undertaken due to staff being overworked/too busy (S: 1)

• Unnecessary for babies who do not have a diabetic mother (F: 1)