MUMMIEBODIES Eating Disorders, Pregnancy and Postpartum. A Qualitative Study of Women With Eating Disorders in Pregnancy and Post Partum Period.
Conditions: Mental Health Disorder, Eating Disorders, Pregnancy Related, Post Partum
Sponsor: Bente Sommerfeldt

 
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MUMMIBODIES.  
EATING DISORDERS, PREGNANCY AND POSTPARTUM 
1st of May 2020. VERSION 3.  
Revised with SAP  
 
 
STUDY PROTOCOL 
 
 
 
Approved by REGINAL COMITTEES FOR MEDICAL AND HEALTH RESEARCH 
ETHICS (REC) 20th of May 2020, Reference 92665 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Mummibodies 
Eating disorders, pregnancy and postpartum period 
A qualitative Study of Women With eating Disorders in Pregnancy and Post-Partum Period 
 
Background 
The purpose of this study is to gain better knowledge about how pregnancy and postpartum 
are experienced by women with eating disorders. There are well-known risks in people with 
eating disorders both during and after pregnancy (1, 2) and an increased risk of relapse (2). 
The strength of the study is the inclusion of users' own experience. It is necessary that health 
professionals understand the experiences of pregnant and new mothers with an eating 
disorder. This knowledge will form the basis for later development of adapted help and 
follow-up. The study will identify the course and experiences when women with eating 
disorders encounter pregnancy and childbirth. We will study three areas: 1) pregnant women 
and mothers' subjective experiences of the course and change in relation to food, body and 
weight during pregnancy and postpartum; 2) women's subjective experiences of emotional, 
cognitive and relational core experiences during and after pregnancy; and 3) women's own 
perceptions of what is the best help through pregnancy and childbirth. 
 
Pregnancy and childbirth represent a major challenge for women with eating disorders. The 
body's shape, scope and functions change. Strange appetites can occur. The woman is often 
presented with a number of advices on diet and exercise. Eventually, breastfeeding will begin 
where the baby sucks nutrients out of the woman's own body. The woman's experience of her 
own body and the way she handles these changes can affect her care and be a risk factor for 
the newborn's development both physically and mentally. Studies show that low weight and 
poor nutrition during pregnancy can lead to premature birth (3-5), low birth weight (3-7) or 
cardiovascular malformations in the baby (4-7). Other studies show that mothers with eating 
disorders have difficulty breastfeeding and challenges related to the transition to solid foods 
(5,8,9,10,11). Several studies describe that postpartum depression occurs more frequently in 
women who have or have had an eating disorder (1, 5, 11, 12). 
 
The risk of getting worse appears to be high after birth (1, 2, 12-15). Eight to ten 
months after birth, a Swedish study found an eating disorder in 11 percent of mothers (13). 
Another Swedish study found 5.2 percent in 10-12. week in pregnancy, which then increased 
to 12.8 percent 8-10 months after birth (15). The incidence of eating disorders among 
pregnant women is significantly higher than previously thought and increases throughout 
childbirth. 
 
We know too little about how women with eating disorders relate to their body and food 
during and after pregnancy. What is the woman's relationship with the body in the "fourth 
trimester"? It has been documented those women with a previous eating disorder experience 
great difficulty with the physical changes during both pregnancy and childbirth (1, 2). Body 
dissatisfaction plays a crucial role in both the development and maintenance of eating 
disorders (16). Results from existing research are somewhat varied, but give a strong 
indication that pregnancy is associated with increased body dissatisfaction and recurrence of 
symptoms in those who have previously had an eating disorder (2, 14, 17, 18). Probably the 
eating problems take several paths through pregnancy and childbirth. Clinical experience and 
some studies suggest that in some cases, eating problems will decrease during pregnancy (15). 
For many, these positive changes seem to be temporary. Scientifically, we know far too little 
about these processes and whether the positive change with better help could have been 
lasting. 

 
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There is a great need for research that promotes expertise on how to understand and help 
women with eating disorders during pregnancy and in childbirth. Vestre Aker Health station 
contacted the Department of Eating Disorders because they experience increased concern and 
dangerous practices related to body image and self-image in pregnant and new mothers. 
Nurses and midwives believe they lack expertise in the field. They say they do not address 
this. They are afraid of making mistakes and hurt worse (personal communication, Leader at 
Vestre Aker health station). 
 
Measures that ensure high motivation and good follow-up should preferably be based on the 
woman's own motivated motivation (19-22), be individually adapted (19, 23) and preferably 
harmonize with - at least not come into conflict with - what the woman herself thinks will be 
the best help for himself and the child. This presupposes in-depth knowledge of how the 
eating problems through pregnancy and childbirth look from the woman's point of view. We 
need to know how she perceives the process. We need to know how she experiences and 
reacts to the changes in her body, appetite and weight. And we need to know what the woman 
herself thinks would have helped her and the baby best through these periods. Today we lack 
scientific knowledge on all these topics. Both clinicians and researchers therefore recommend 
that health authorities pay greater attention to the importance of eating problems during 
pregnancy and childbirth (24). 
 
Aim 
To promote understanding of how pregnancy and childbirth are experienced by women with 
eating disorders in order to prevent relapse and develop measures for this vulnerable group. 
 
Research questions 
We have formulated three key research questions. 
1. Can characteristic processes be identified in relation to their own body, food and 
weight when women with eating disorders encounter pregnancy and childbirth? Here 
we will try to identify and describe different prototypical processes, any common 
features, characteristic separators and drivers. 
Delivery: Empirically based hypothetical model for prototypical processes. 
2. Can it be identified that clinically or preventively important cognitive, emotional, 
behavioral and relational core experiences that the woman herself believes have been 
central in determining the course? believes has been critical of the course of the eating 
problems during pregnancy and during childbirth. 
Delivery: Categorization, characterization, identification of possible dimensions and 
experiential descriptions of assumed critical, typical and atypical experiences. 
 
3. Can measures be identified that the woman herself believes have or would have led to 
her eating disorder having a less negative, possibly more positive, development during 
pregnancy and childbirth? Here we will describe what the women themselves as 
reflected as possible believe have helped and would have helped them.  
Delivery: Linked to the various identified processes and critical experiences, a list of 
potential measures that women themselves believe will contribute to better 
development for women, infants and immediate family. 
 
 
 

 
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Method 
Design 
The epistemological approach is empirical realism (not constructivist) where we assume that 
experiences are real and that the woman is an expert on her own experience. The strategy is to 
utilize the woman's experience as a source of knowledge. The point of view is the woman's, 
where we try to formulate, categorize, characterize and analyze dimensions in eating 
problems in the face of pregnancy and childbirth as the woman sees it. 
There are three reasons for this choice: (1) The woman's experience is an underused source of 
knowledge in this area. (2) Therapeutic and indicated preventive measures are dependent on 
an alliance with the woman. Alliance formation is normally based on the woman's experience. 
(3) The woman's subjective presentation of the course may deviate from what an external 
observer would have reported. The measures the women themselves launch may run counter 
to what research and experienced clinicians recommend. But objective measures that neglect 
the user's own experience are unlikely to have a particularly lasting effect. 
This longitudinal, prospective qualitative study involves a sample of 24 women with a history 
of severe EDs, assessed during pregnancy and six months postpartum. The Eating Disorder 
Examination Questionnaire (EDE-Q) and the Eating Disorder Examination (EDE) were 
employed to evaluate current diagnoses at both time points. Ideal types, Grounded Theory, 
and Interpretative Phenomenological Analysis were utilised to refine user experiences and 
develop perceived models based on these experiences. The study protocol received approval 
from the Norwegian Regional Ethics Committee (REK) (project ID 92655/2020). 
Data analysis 
To achieve the project aims, a prospective, longitudinal, in-depth design was employed across 
all three sub-studies. Twenty-four women with a history of severe EDs were interviewed 
twice: the first interview occurred during pregnancy (between weeks 9 and 40), and the 
second approximately four to six months postpartum. Semi-structured interviews explored the 
participants' perspectives, perceptions, and meanings attributed to their experiences related to 
food and body image. Supplementary data, including standardised diagnostic interviews (e.g. 
the EDE and EDE-Q), were gathered at both time points to establish diagnostic accuracy 
using DSM-5 criteria. 
 
A semi-structured, participant-centred 'experience interview' was employed to gather data for 
all three sub-studies. A total of 24 women were interviewed at two time points, resulting in 48 
interviews. Each participant engaged in two meetings, during which they received 
introductory information, participated in a semi-structured interview, and completed the EDE-
Q (Fairburn & Beglin, 2008) and the EDE interview (Fairburn et al., 2008). The total duration 
for these sessions ranged from four to five hours, culminating in 206 hours of recorded 
material across all interviews.  
 
Given the distinct nature of the questions posed in the three sub-studies, three different data 
analysis methods were employed (Masoodi, 2017). These methods facilitate the identification 
of patterns within and across participants’ experiences and perspectives to address the 
research project’s aims. Significant differences exist between Ideal Type (IT) analysis, 
Interpretative Phenomenological Analysis (IPA), and Grounded Theory (GT) in terms of 
selection, analysis, and reporting methods (e.g. constructed ITs and trajectories versus actual 

 
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experiences). These differences proved beneficial given the varied research focus of the 
studies.  
Study 1: Bodies out of control: Relapse and worsening of eating disorders in pregnancy. 
Methods: Semi-structured interview/standardised inteviews for diagnostic evaluation for 
DSM-5 diagnosis. Participant selection: 23 of 24 pregnant women with a history of Eds. 23. 
Interviews. Analysis: Ideal type (IT) analysis.  
Study 2: IVF-induced prgnancy and early motherhood among women with a history of severe 
eating disorders. Methods: Semi-structured interview/standardised interviews for diagnostic 
evaluation for DSM-5 diagnosis. Participant selection: Seven of the 24 women with a history 
of Eds and IVF backgrounds interviews from pregnancy to postpartum. 14 interviews.  
Study 3: Trajectories of severe eating disroders through pregnancy and early motherhood. 
Methods: Semi-structured interview/standardised interviews for diagnostic evaluation for 
DSM-5 diagnosis. Participant selection: All 24 women woth a history of Eds. Interviews from 
pregnancy to postpartum. 48 interviews. Analysis: Elements of Strauss´grounded theory (GT) 
analysis.  
Study I: Ideal type analysis 
IT analysis provides a structured approach for examining and comparing various aspects of 
experiences by simplifying them into distinct categories and concepts (Stapley et al., 2021). 
For this analysis, data from all participants at time point 1 (pregnancy) were utilised. Of the 
24 participants, 23 reported either a worsening of or a relapse in EDs during pregnancy. 
Consequently, the experiences related to this worsening and/or relapse were further explored 
among these 23 participants. 
The research questions for Study I (Sommerfeldt et al., 2022) were: 1. How do women 
with a history of EDs experience pregnancy? 2. How do they understand and describe the 
worsening, relapse, and perceived triggers of these changes? 
IT analysis (Weber, 1978) was selected to address these questions, as it allows for the 
identification of patterns among a group of women exhibiting considerable variation. This 
choice was informed by the limited empirical knowledge concerning how women with a 
history of EDs experience pregnancy and ED pathology. A heterogeneous sample was 
employed, not solely based on diagnoses but also considering background factors such as 
length of illness, whether participants were first-time mothers or had previous pregnancies, 
and experiences related to abortion, IVF, and trauma. IT analysis was thus used to encapsulate 
the most relevant experiences through ITs. 
Study I sought to uncover similarities and differences within and across the dataset 
regarding the participants’ views and experiences (Ayres et al., 2003). Through IT analysis, 
the women’s accounts were described within their contexts, while also highlighting the 
variations and patterns that may exist across their experiences (Ayres et al., 2003). Thus, IT 
analysis was employed to compare each participant’s experiences of worsening or relapse, 
serving as a tool for interpretation and understanding of these occurrences, and for generating 
new insights regarding pregnancy in the context of EDs. 
Key features of IT analysis include in-depth descriptions of participant groups, 
comparisons among groups and individuals through material deconstruction, hypothesis 
formation regarding thoughts and behaviours, and subsequent reconstruction of the material 
into qualitative cluster analyses.  
 
Steps of the analysis in study 1 

 
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Five steps were inspired by IT analysis (Stapley et al., 2021):  
1. Following the bottom-up principle (Richard, 2015; Seidel & Kelle, 1995), all text from 
time point one was transcribed and re-read. This process involved examining each line of 
the transcripts to capture meaning, compare data for similarities and differences, and list 
elements pertinent to the research questions. Active coding facilitated engagement with 
the data, encouraging questions, interpretations, and comparisons of experiences. Detailed 
notes from the interview experiences, including reflections on the significance of 
participants' accounts, were summarised. Of the 24 participants, 23 identified bodily 
changes as a challenge, noting significant deterioration or the re-emergence of EDs. 
Consequently, further analysis focused solely on experiences and perspectives related to 
the worsening or relapse of eating pathology.  
2. Each of the 23 participants' experiences of worsening or relapse was summarised. These 
summaries were deconstructed to identify key issues in their experiences and perspectives 
regarding ED worsening or relapse, incorporating the researcher’s viewpoints. Themes 
related to relapse and the exacerbation of EDs emerged. Experiences concerning bodily 
changes during pregnancy became crucial elements for the ITs. Participants identified 
perceived triggers, with significant categories emerging that influenced experiences 
during pregnancy (e.g. in vivo mothers, first pregnancy compared with subsequent 
pregnancies, abortions, and pregnancy as a high-risk period for relapse).  
3. Third, a reconstruction of the material via clusters of similar experiences was formed 
using summaries to combine the experiences of several women to construct ITs. Each 
summary was compared with others to discern differences and similarities, with the aim 
of identifying patterns across the dataset. ITs were conceptualised based on essential 
features that emerged from initial coding, such as perfectionism (‘I have never been 
satisfied with something halfway, and I want to be the perfect mother’), rigidity (‘I have 
always been a person who has plans and rules for everything’), guilt (‘I know I should be 
doing all this while pregnant; I am hurting the baby inside me’), shame (‘I am a terrible 
person doing all this while pregnant’), impulsivity (‘I have always been described as 
inpatient and someone who makes decisions without thinking’), anxiousness (‘I have 
always been described as a very worried type through my childhood’), and insecurity (‘I 
have always been concerned about what others think of me’). Following a thorough 
analysis, 11 clusters informed the development of tentative ITs: ´the chaotic mother´, ´the 
outer directed mother´, ´the rigid mother´, ´the furious mother´, ´the shameful mother´, 
´the guilty in vitro mother´, ´the competitive mother´, ´the self-lossed mother´, ´the 
ambivalent mother´, ´an aliened body´, and ´a liquid body´. See Table 2 for the clusters of 
experiences and associated quotes. 
4. The simplest solutions were sought to ensure an optimal qualitative balance between 
managing variations, maintaining conceptual clarity, and minimising overlaps. The 
clusters were re-named and included overlapping experiences: ´the outer directed mother´ 
type was included in the re-named cluster ´ the perfect mother-to-be´ type; ´the rigid 
mother´ and a ´liquid body´ types were included in the re-named cluster ´the worried 
mother´ type; ´the furious mother´ type was included in the ´shameful mother´ type; ´the 
guilty in vitro mother´ type was included in the re-named cluster ´the worried mother´ 
type; and ´the rigid mother´, ´the outer directed mother´, and ´the competitive mother´ 
types were included in ´the perfect mother-to-be´ type. Some clusters were re-named to 
better reflect their characteristics (e.g. ´the ambivalent mother´ was re-named ´the mother 
who fears motherhood´). This reorganisation yielded seven ITs: the chaotic mother, the 
rigid mother, the perfect mother-to-be, the worried mother, the shameful mother, and the 
mother who fears motherhood. These types were labelled according to the most relevant 
personal features characterising worsening conditions or a relapse. For example, ´ an 

 
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alienated body´ and ´the furious mother´ were more related to experiences than IT 
characteristics and, thus, were discussed and reorganised into ´the shameful mother´.  
5. Descriptions of the ITs were constructed using the summaries that best represented each 
theme. Each summary was refined to remove experiences not aligned with the relevant 
cluster and to replace them with appropriate experiences. Ongoing discussions ensured 
that the ITs accurately represented the data. Ultimately, this process yielded coherent ITs.  
 
Study II: Interpretative phenomenological analysis  
IPA investigates how individuals derive meaning from their life experiences. In this study, 
seven out of 24 participants underwent IVF. This group of women was selected due to their 
clear similarities. Data analysis for these participants encompassed two time points: 
pregnancy and postpartum. 
The research question for Study II (Sommerfeldt et al., 2023) was: How do women 
with a history of EDs who have undergone IVF experience the process of becoming mothers 
through IVF, pregnancy, and the postpartum period? IPA (Smith et al., 2022) was employed 
to address this question and to explore the experiences of this homogeneous group of IVF 
mothers with a history of EDs. This approach allows for a more nuanced understanding of 
IVF experiences, particularly focusing on differences among participants who share a 
significant common denominator rather than among those who are already markedly different. 
A targeted selection strategy was employed concerning IVF, including participants 
who had experienced the phenomenon under study (Creswell & Poth, 2018; Patton, 2015; 
Smith et al., 2022; van Manen, 2014). IPA is especially pertinent for smaller, homogeneous 
data sets (Smith, 2015; Smith et al., 2022). It captures and conveys key individual experiences 
that are vital for both clinicians and participants in understanding a given phenomenon. 
Consequently, IPA does not construct meanings but rather elucidates the individual 
phenomena and experiences relevant to each context, facilitating clinicians’ comprehension of 
the described experiences. Ideography is concerned with deriving meaning from participants’ 
unique experiences (Smith, 2015; Smith et al., 2022). The analysis and systematisation of 
participants’ experiences related to pregnancy and childbirth were thus comprehended 
phenomenologically, allowing for in-depth descriptions of IVF experiences in the context of 
pregnancy and postpartum. 
The application of IPA in this study was grounded in hermeneutics (Smith et al., 
2022). Hermeneutics emphasises the interpretation of people’s experiences through in-depth 
exploration (Thagaard, 2018). The interpretation of meaning, along with the concepts of 
conversation and text, is central to this approach (Kvale, 1996). The interpretive process is 
characterised by the 'hermeneutical circle' (Giddens, 1987; Kvale, 1996), where understanding 
a text develops through a cycle wherein the meaning of its parts emerges from a grasp of the 
overall meaning. A critical methodological step involves generating an overarching 
understanding before moving from the general to the specific. This interpretive process 
consistently oscillates between the whole (e.g. the interview) and the parts (e.g. a quote). 
While participants’ experiences remain distinct from those of the researcher, a conducive 
interview environment can facilitate partial insight into the participants’ lives (Smith et al., 
2022). Thus, a circular process emerges, in which participants’ experiences contribute to the 
researcher’s evolving understanding of the phenomena under investigation (Stiles, 1999). 
This interaction creates a two-stage interpretation process in which participants 
simultaneously attempt to understand their world while the researcher endeavours to 
comprehend what the participants seek to understand about their environment (Kvale, 1996; 
see Section 6.2.3 Reflexivity). 
Key features of IPA include in-depth descriptions of a homogeneous group to 
elucidate the participants’ lived experiences and the implications of these experiences within 

 
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their context (Smith & Osborn, 2007). The hermeneutical circle plays a pivotal role in this 
analysis, assisting in the interpretation of participants’ experiences.  
 
Steps of the analysis in study II 
IPA was conducted in six steps, following Dallos and Vetere (2005) and Smith et al. (2022):  
1. All 14 transcripts from both time points were read and re-read to capture the overall 
meaning of the content. Detailed notes from the interviews provided insights into the 
participants' expressions, revealing similarities and potential differences among the seven 
IVF mothers. This information was organised into a table for clarity (see Table 3 for 
descriptions of IVF mothers). The interview notes and transcripts facilitated an 
understanding of how the women articulated their experiences. These notes also 
encompassed thoughts and reflections, aiding in recognising preconceptions and their 
possible impact on the thematising process. For instance, one note remarked, ‘She sounds 
worried and anxious when talking about the baby inside her. I am wondering if I asked 
her a too direct question and if that made her feel ashamed´. 
2. The descriptions of the participants’ experiences with IVF were examined. Summaries 
were crafted from the experiences of all seven participants, spanning pregnancy to 
postpartum. The semantic content—the language and words used by participants—was 
thoroughly analysed (Smith et al., 2022). The focus was on how participants articulated, 
understood, and conceptualised their IVF journeys. For example, one participant stated, 
‘The woman expresses that shame and guilt, and consequences of ED pathology, are 
crucial throughout the process and result in denial and prevent her from telling 
healthcare professionals about it’. Detailed notes and comments on the transcripts and 
summaries facilitated the identification of meaningful units. Some reflections were 
interrogative, such as, ‘I wonder about the woman´s relation to her body and how she 
reacts to IVF might be in connection with her earlier trauma experiences?’ This depth 
contributed to the analytic process. Certain interview segments elicited more detailed 
comments, particularly those closely tied to the participants’ expressed meanings, such as, 
‘ED pathology was hidden throughout the whole process’. Other segments prompted 
more interpretative insights (hermeneutics), for instance, ‘She did not tell anyone because 
of shame and guilt. Is she afraid of being a terrible mother?’ These notes were 
instrumental in understanding the participants’ experiences and identifying patterns in 
their expressed meanings (Smith et al., 2022). In this step, potential quotes from the 
transcripts that reflected participants’ experiences relevant to the research aim were 
identified. One poignant example included, ‘I'm an adult, and I'm ashamed that I still 
struggle with it. Everyone thinks I have recovered and am just happy to exercise. If I 
maintain my weight, people think I'm not struggling with this. After all, I managed to get 
pregnant’. This stage also included reflections from the researcher, such as, ‘I get a 
feeling of a switch in themes when talking about the body, or concreteness of symptoms 
such as amount of food, bingeing, purging. I recognise that I have become more careful 
and hesitate to ask follow-up questions’. According to Smith et al. (2022), this interaction 
can be conceptualised as a Gadamerian dialogue between the researcher’s preconceptions 
and an evolving understanding of the participant’s life. The researcher’s experiences 
during the interviews were used to deepen the understanding of participants, particularly 
regarding feelings of shame. Continuous discussions of comments and reflections with the 
research team and reference group enhanced awareness of potential preconceptions, 
clarifying both negative and positive experiences of the IVF process.  
3. Overall meaningful themes were identified. Based on the summaries, this step was 
implemented earlier than Smith et al. (2022) recommend, as each participant’s experience 
was explored in-depth prior to examining common themes. The transcripts, notes, and 

 
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summaries facilitated an exploration of subtle distinctions, variations, and dimensions 
within the participants’ experiences. Steps 1 to 3 were conducted for one participant at a 
time.  
4. Participant-based comments grounded in phenomenological, hermeneutic, and semantic 
insights from Steps 2 and 3 were developed. This process entailed refining the summaries 
from Step 2 to concentrate on key details while reducing the number of comments. 
Unmodified quotes encapsulating IVF experiences were included, such as: ‘The body 
changes faster due to the hormone treatment. This time I got a belly and got very fat very 
early on. I didn't want to tell anyone, for fear of failure. I thought I would go two months 
without anyone seeing it, without feeling big. But this time I got a belly just weeks after I 
got pregnant’. The roles of the 'I' (interpretation) and 'P' (phenomenology) were central to 
further analysis. Comments from Step 2 were interpreted with less analytic depth, 
focusing on descriptive rather than interpretative insights, while retaining the essence of 
participants’ experiences. These insights were subsequently coded for further analysis. 
Ideas from previous transcriptions, categorisation, and thematisation were discussed with 
the research team and reference group to prevent the replication of themes from one 
participant to another.  
5. Patterns and themes were identified concerning how a specific phenomenon, such as IVF, 
was experienced by a group of women with a history of EDs in the contexts of pregnancy 
and postpartum (Smith et al., 2022). The categorisation process was completed 
analogously, with codes selected for further analysis marked and summarised for all seven 
participants, organised into themes related to managing uncertainties from both time 
points (see Table 4 for examples of themes with quotes). This summary provided an 
overview of the varied experiences of all participants. The summaries from different time 
points enriched, illuminated, and intersected with one another, revealing several 
similarities in the described experiences. 
6. Four phenomena were identified: ´anxiousness and fear´, ´shame and guilt´, ´sexual 
maladjustment´, and ´non-disclosure of eating problems´ (see Section 5.3). These 
phenomena were named based on the content of the participants' experiences. The 
emerging themes were organised according to three phases: ‘IVF’, ‘Pregnancy’, and 
‘Motherhood’.  
 
Study III: Grounded theory  
GT emphasises the development of theory through systematic analysis of qualitative data 
(Charmaz, 2014; Corbin & Strauss, 2008; Glaser & Strauss, 1967). It identifies common 
themes regarding change across individuals and captures how participants' experiences evolve 
over time. A key feature of GT is its interpretative and systematic approach to data analysis 
(McCann & Polacsek, 2018; Strauss & Corbin, 1998). All 24 participants from both time 
points were included in this analysis. 
The research questions for Study III (Sommerfeldt et al., 2024) were: 1. How do 
women with a history of severe EDs experience their eating pathology during the process 
from pregnancy to postpartum? 2. Is it possible to identify different trajectories through 
pregnancy and early motherhood based on these experiences? 
 
 
To address these questions, elements of GT, as inspired by Strauss (Corbin & Strauss, 
2008), were employed to construct a model depicting the trajectories of ED pathology among 
all participants from pregnancy to postpartum. The aim was to uncover processes and 
structures related to experiences of ED pathology during these periods. Coherence and 
internal consistency patterns were sought, alongside consideration of differences in 
experiences across multiple cases. GT is an inductive methodology that seeks to bridge the 
gap between research and theory (Glaser & Strauss, 1967). Selected elements of GT provide a 

 
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theoretical framework for understanding a complex phenomenon, with emphasis placed on 
individual perspectives that yield valuable data for developing a theoretical sample (Strauss & 
Corbin, 1998). 
This approach generated a theory grounded in the experiences and perspectives of the 
women (Corbin & Strauss, 2008). GT offers a conceptual framework that can inform tailored 
support and guide further quantitative research, such as the trajectories of EDs from 
pregnancy to postpartum. It aimed to identify themes across participants and segment them 
into distinct units of meaning. Informed by Strauss, GT underscores the importance of 
reflexivity, or the researcher’s awareness of their prejudices, assumptions, and values (Glaser 
& Strauss, 1967).  
 
 
 
 
 
Steps of the analysis in study III 
Elements of the GT analysis in this study were conducted in nine steps, following Corbin and 
Strauss (2008): 
1. Research questions were formulated through the transcription and repeated review of all 
interviews, alongside discussions with the research team and reference group. Each 
transcript was examined line by line, and open codes were assigned to identify themes 
based on the ‘bottom-up principle’ (Richards, 2015; Seidel & Kelle, 1995) across the 48 
interviews. For instance, codes related to the experience of ED pathology during 
pregnancy and postpartum were generated through open coding, including terms such as 
‘worsening’: ‘I cannot stop this bingeing, I am vomiting everyday again’, ‘relapse’: ‘I did 
not think that I was going to be this restrictive again, all the rules around food are getting 
worse’, ‘improvement’: ‘Finally, I have found another meaning and focus. I really 
embrace this time’, or ‘put on pause’: ‘I am making plans for the time after childbirth. I 
am holding on now, knowing that I can do whatever I need to do after childbirth’. Notes 
and summaries highlighted central themes and categories throughout the analysis process, 
such as: ‘23.06.22. She describes how she failed in her plans during pregnancy. She gives 
examples of feelings of insecurity. During the interview, she asked for confirmation 
several times if she was doing things right’. By listening to interview recordings and 
reviewing transcripts, possible interpretations were discussed with the research team and 
reference group. This process generated numerous concepts around the experiences of ED 
pathology, which were then categorised based on commonalities.  
2. Data were systematically and iteratively analysed using axial coding to identify key 
themes and concepts (Sbaraini et al., 2011). The complexity of each case was deliberated 
upon before achieving consensus on central themes and categories that encapsulated the 
participants’ narratives rather than isolated factors (Corbin & Strauss, 2008). 
Corresponding to the main research questions in this study, all text excerpts addressing 
experiences and challenges related to ED pathology from pregnancy to postpartum were 
coded, based on contextual analysis rather than solely on participants’ words. Themes and 
categories of trajectories emerged by defining meanings and making analytic 
interpretations of specific statements. For example, the statements ‘I am disgusting’, ‘I am 
fat’, and ‘I feel like an alien’ were interpreted as differing aspects of the trajectory labelled 
‘overwhelmed mother’.  
3. Summaries for each participant were created to integrate data from various sources across 
two time points. These summaries captured the progression from pregnancy to 
postpartum, detailing participants’ experiences regarding their journeys in and out of ED 
pathology. They facilitated the development of nuanced descriptions within and across 
cases, offering in-depth insights into how participants’ thoughts, feelings, and behaviours 
related to body image, weight, and food evolved. Through the selective coding process, 
trajectories detailing movements in and out of ED pathology emerged. 

 
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4. Constant comparison through the collection, transcription, analysis, and comparison of 
summaries facilitated the identification of patterns, themes, and categories (Charmaz, 
2014; Corbin & Strauss, 2008). The examination of how women experienced ED 
pathology during pregnancy and postpartum, along with the interrelation of different 
themes, was addressed. The constant comparative method, initially proposed by Glaser 
and Strauss (1967) and later refined by Strauss (Corbin & Strauss, 2008), emphasises that 
the researcher should oscillate between the open coding (steps 1 and 2) and axial coding 
(step 3) processes multiple times before progressing to selective coding (steps 4 and 6) 
(Strauss & Corbin, 1998). This active coding process engaged the data, prompting 
questions, interpretations, and comparisons of experiences. The interplay between these 
steps facilitated the emergence of robust statements or concepts and verified the 
significance of a potentially crucial core trajectory (Corbin & Strauss, 2008). New data 
were continuously compared with previously collected information, including 
transcriptions and notes, to refine and adjust the emerging trajectories (Glaser & Strauss, 
1967). This comparison process ensured that the modelled trajectories were grounded in 
the data and accurately represented the participants’ experiences (Glaser & Strauss, 1967). 
Different categories emerged based on factors such as diagnosis, whether the mothers 
were undergoing IVF and distinctions between first-time and subsequent mothers.  
5. The experiences related to different trajectories were validated against the original texts 
through confirmatory and selective coding (Corbin & Strauss, 2008). Three structural 
components were identified: precursors, triggers, and protective factors. Refer to Table 5 
for details on these components and related quotations. Precursors were factors present 
before the women became pregnant, which they deemed salient in navigating pregnancy 
and early motherhood. Participants described various precursors (e.g. personality 
characteristics, body-related precursors, precursors related to role-model affinities, 
familial transmission, attitudes towards pregnancy, the number of births, and earlier 
history of EDs).  
Triggers were specific events associated with participants' experiences of relapse or 
exacerbation of EDs. For instance, a participant stated, ‘Issues about weight had not been 
bothering me for the last few years (precursor), but when I got pregnant so quickly, I lost 
control’ (trigger), ‘Ì want to be the perfect mother’ (precursor), and ‘When I got pregnant, 
nothing went as I planned it’ (trigger). External triggers were identified (e.g. negative 
comments on body or weight and lack of support). Others were events that originated from 
within the participants (e.g. changes in apparency, the body being an alien, feelings of 
lack of success, intensified exercising).  
Protective factors encompassed experiences and events that women associated with 
positive coping strategies during pregnancy and early motherhood, as well as 
improvements in their eating pathology over time.  
6. The interrelations between the higher-order constructs (precursors, triggers, and 
protective factors) were examined to capture the complexity of participants' narratives. 
Experiences were described longitudinally, spanning from before pregnancy through 
pregnancy, childbirth, and the postpartum period. These experiences were organised into 
five trajectory constructs, representing the minimum necessary constructs to describe 
women's perceptions of their ED trajectories into motherhood.  
7. Constructs closely reflecting participants’ descriptions of their experiences were 
developed within an atheoretical framework, utilising elements from GT. The trajectory 
constructs were labelled based on their content, leading to the identification of short 
descriptions: the mastering mother, in which an ED pathology seems to be absent through 
pregnancy and early motherhood; the succeeding mother, in which an ED worsens during 
pregnancy, but reduces during early motherhood; the inadequate mother, in which ED 

 
12 
pathology worsens before pregnancy, through pregnancy, and during early motherhood; 
the depressed mother, in which the ED subsides during pregnancy, but worsens during 
early motherhood; and the overwhelmed mother, in which the ED worsens during 
pregnancy and early motherhood. Based on variations within these constructs, three 
overarching constructs representing five types of trajectories were extracted, with 
participants potentially belonging to one or two different trajectories.  
8. Condensed quotations from all interviews were utilised to illustrate the complexity of 
participants’ experiences as grouped into a subjective trajectory. The three components 
(precursors, triggers, and protective factors) were addressed across all trajectories but 
exhibited significant variation among participants. These concepts were grounded in the 
data pertaining to the labels assigned to their experiences (e.g. mastering, succeeding, 
inadequacy, depressed, and overwhelmed). Through this process, the trajectories were 
tested and refined via further data collection and analysis (Glaser, 1978; Strauss & Corbin, 
1998). Subsequently, these concepts were integrated into an empirical model elucidating 
the individual variation of ED pathology trajectories from pregnancy to postpartum 
concerning precursors, triggers, and protective factors. 
Reference group: User representatives as co-researchers 
In the pre-project phase, we will establish a reference group with relevant personal 
experience. In collaboration with the user organizations Counseling on Eating Disorders and 
the Eating Disorders Association, we have recruited a group of mothers who have had or have 
an eating disorder. The focus will be on experiences they themselves have had during and 
after pregnancy. The purpose is to get input to the interview guide and help to later validate 
the results. Research questions, analyzes and results will be discussed with the group during 
and finally during the project period. 
 
Informants 
We will use a heterogeneous sample. This has several causes. We currently know too little 
scientific to identify one scientifically and clinically interesting homogeneous group. Our 
clinical experience indicates that there can be great variation between different women in this 
life situation. In this round, we seek to identify different experiences one may have. Varied 
diagnoses have been chosen because we want to describe different courses, because these 
diagnoses are often unstable, and because we want to identify possible measures with 
different experiences and courses. Such diversity has great clinical relevance and has not been 
previously described scientifically. In practice, it facilitates the recruitment of informants. A 
disadvantage of using a heterogeneous sample is that each individual informant becomes 
relatively important. This is a small problem as long as the purpose is to identify different 
experiences. The limitation lies in the cases where a supposedly important experience is 
described in only one or very few informants and at the same time there is basically little 
depth and nuance in the descriptions. This is compensated to some extent by very high 
demands on the quality of the way we interview the informants.We know that some of those 
who have an eating disorder during childbirth may not have shown a symptomatic level 
during pregnancy. There can be many, and maybe even mean a different problem. Therefore, 
we have defined two groups of informants. We define one group of informants in pregnancy 
and follow longitudinally with two measurement times: in pregnancy and after birth. Another 
group of informants is defined after birth and interviewed about current and past experiences. 
The number of informants for problem 1 will be determined on the basis of a saturation 
criterion where we include informants until after at least ten interviews, three subsequent 
interviews follow which do not add anything significantly new to the answer to the problems 
(30). Based on previous experience with similar surveys, the number of informants for each 

 
13 
issue is expected to be somewhere around 20 informants, ie about 40 informants. From these, 
a strategic choice will be made on issues 2 and 3. Strategic choice can mean looking for 
differences in order to obtain different prototype experiences. Recruitment of informants will 
take place continuously from the start of the project via a network.The project period has been 
extended to four years to get a sufficient number of informants. 
Before further inclusion in the study, eating disorders are mapped with a revised version of 
the Eating Disorders Examination Questionnaire, EDE-Q adapted to pregnant women and 
women immediately after birth (16). The form is scored by the research fellow before further 
inclusion. EDE-Q is a self-completion form based on the "Eating Disorder Examination" 
(EDE) interview. EDE-Q measures the core symptoms of eating disorders. EDE-Q adapted to 
pregnant women and women immediately after birth is based on factor analysis. If the 
informant satisfies diagnostic criteria for a cut-off equivalent to ≥ 2.8 for an eating disorder, 
we will conduct a researcher-based interview, Eating Disorder Examination (EDE), for 
diagnosing the informant, and obtain standard background information. EDE is designed to 
assess the current condition, as well as to generate an operationalized defined eating disorder 
diagnosis. The interview is conducted after the experience interview. 
The informants' background will be thoroughly documented. Background information will 
include data on age, gender, diagnosis, type of eating disorder, weight before, during and after 
pregnancy, onset of illness, first contact with the support system, relationships, first-time or 
multiple births. Background information is filled in by interviews after the experience 
interview. 
Inclusion criteria will be that the woman is aged 20-40 and satisfies diagnostic criteria for 
anorexia nervosa, bulimia nervosa, overeating disorder or unspecified eating disorder (DSM-
5). Exclusion Criteria will be people with additional problems related to ongoing psychosis, 
drug addiction or organic brain damage / disease because this will make it difficult to answer 
the research questions in this study. 
 
Data collections 
Information about the project will be disseminated, both orally and in writing via the network 
(see below). Before further inclusion in the study, eating disorders are mapped with a revised 
version of the Eating Disorders Examination Questionnaire, EDE-Q (28, 29) adapted to 
pregnant women and women immediately after birth (16). The questionnaire is completed by 
the informant with a representative from the network. The form is scored by the research 
fellow before further inclusion. EDE-Q is a self-completion form based on the interview 
"Eating Disorder Examination" (EDE). EDE-Q measures the core symptoms of eating 
disorders. EDE-Q adapted to pregnant women and women immediately after birth is based on 
factor analysis (15). If the informant satisfies diagnostic criteria for a cut-off equivalent to ≥ 
2.8 for an eating disorder, we will conduct a researcher-based interview, Eating Disorder 
Examination (EDE), for diagnosing the informant, and obtain standard background 
information. EDE is designed to assess the current condition, as well as to generate an 
operationalized defined eating disorder diagnosis. The interview is conducted after the 
experience interview. 
The informants' background will be thoroughly documented. Background information will 
include data on age, gender, diagnosis, type of eating disorder, weight before, during and after 
pregnancy, onset of illness, first contact with the support system, relationships, first-time or 

 
14 
multiple births. Background information is filled in by interviews after the experience 
interview. 
Information about the issues is collected through a semi-structured, interactive face-to-face 
interview. The aim of the interviews is to get descriptions as precise and close to the 
participants' own experiences as possible. A semi-structured interview guide is designed in 
advance. The Interview Guide is developed in close collaboration with user representatives in 
the reference group and ensures that relevant input from the reference group is covered in the 
interview. The interview guide contains all the topics we want the interview to cover in 
advance. The interview guide is primarily a thematic guide and aims to prepare interviews as 
an instrument. It is also used as a summary and checklist for interviews at the end of the 
interview to ensure that all relevant topics are touched upon. The informants are thoroughly 
informed in advance about what the interview will be about and why, and how it will proceed. 
The better informed the informant is in advance, the better founded the voluntary 
participation. The actual interview takes the form of improvisation on the topics as it is 
natural from the dynamics that develop in the conversation. The informant can introduce their 
own relevant topics independently of the interview guide. The supervisors have published a 
double-digit number of scientific articles and trained thousands of clinicians and researchers 
with this method, which is informally called the "Experience Interview" developed by Arne 
Holte (19, 21-23). The interviews are quality assured by a professional who is not directly 
involved, continuously listening through randomly selected sections of randomly selected 
interviews and providing guiding comments. The purpose of this is to ensure that consistency 
and validity in the interview format is maintained. 
Data-analyze 
All interviews are transcribed verbatim, stored, organized, coded and analyzed in the 
electronic software NVivo version 11. Data for problem 1 will be analyzed according to the 
Grounded Theory method (25, 26). The analysis involves eight phases such as categories, 
theoretical sampling, identification of similarities and differences between categories, open 
coding, focused coding, negative case analysis, theoretical sensitivity, theoretical sampling, 
theoretical saturation, memo writing. The analysis will be regularly discussed in the research 
group and continuously monitored by the main supervisor to ensure reliability and credibility. 
Data for issues 2 and 3 will be analyzed according to the IPA method (27). Repeated listening 
and reading of each interview is carried out to get an overview and context. Each text is then 
explored using open thematic coding according to the "bottom-up principle". Each interview 
is divided into text excerpts that are given a definition based on the content of meaning and 
distributed in a tree structure. The definitions of potential constructions are finally tested 
against the text by confirmation and selective coding according to the "top-down principle". 
Validation of the results will take place through focus group interviews with informants from 
the survey with varying stories. The number and selection of focus group participants depends 
on the results. The participants will be briefly presented in advance with the most important 
results in writing. The results will then be presented orally to the group. The group will be 
asked to comment on the presentations. The purpose is to investigate whether the informants 
recognize their experiences as they have been analyzed, presented and illustrated, and 
possibly adjust and correct this. We make audio recordings of the focus group interview so 
that a person who is not directly involved in the project will listen through and check the 
conclusions the research fellow makes from the focus group interview. 
Procedure 

 
15 
The informants will be asked orally and in writing for consent to participate as described 
above: EDE-Q, EDE interview, "Experience interview" with audio recording, summary check 
according to interview guide and background information. Based on previous experience, the 
experience interview is expected to take 90-120 minutes. Total time spent per informant is 
calculated for a total of 140-180 minutes of interview hours (EDE interview, experience 
interview and background interview). The text is printed verbatim and stored electronically in 
NVivo 11. Audio recordings are deleted immediately after electronic storage. The 
electronically stored text is deidentified so that names and other clear characteristics cannot 
be recognized. After the data has been analyzed and before the completion of articles, 
validation is carried out using focus group methodology. All data is deleted when the survey 
is completed in accordance with the agreement with REK. 
 
Organization –cooperations 
The project will have academic, professional and administrative roots at the non-profit 
foundation Department of Eating Disorders / Villa SULT (Sommerfeldt, Skårderud, Clinton). 
The project is also affiliated with the Department of Psychology, University of Oslo (Holte). 
Department of Eating Disorders / Villa SULT has strong clinical and academic expertise in 
the area. The choice of supervisors covers different aspects of the project. All three 
supervisors have cutting-edge expertise in qualitative research. If the main supervisor cannot 
complete the main supervisor role, Skårderud will take over as main supervisor. 
 
PhD candidate: Psychologist specialist Bente Sommerfeldt has broad health professional and 
clinical expertise and cutting-edge expertise in the treatment of eating disorders. Sommerfeldt 
currently works at the Department of Eating Disorders as a professional director and clinical 
psychologist. She is a co-author of several articles and textbooks. She has communication 
skills and has given a number of courses, educations, lectures and supervised a number of 
departments within child welfare, child and family services, psychiatry and intoxication on 
eating disorders, mentalization, parental mentalization and treatment, both nationally and 
internationally. See CV. 
 
Main supervisor: Professor of Health Psychology (UiO) Arne Holte is previously a full 
professor of Health Psychology (UiO), Clinical and Personality Psychology (UiT) and 
Medical Behavioral Sciences (Med. Fac. UiO). He is one of the country's foremost experts on 
prevention and on advanced qualitative research methods. He has more than 140 international 
publications, 10 of which are qualitative studies of eating disorders, H-rating 28. Holte has 
supervised 16 completed doctoral degrees, as well as one in progress, in Norway and the USA 
and a three-digit number of master's and master's degree candidates. Holte is still a very active 
researcher and research communicator. Holte's main role will be to guide on method in all 
stages of the process, as well as to guide scientific writing and ensure progress. 
 
Co-supervisor I: Professor, Ph.D. with Finn Skårderud is a psychiatrist, founder of Villa 
SULT and professor at the Norwegian Sports Academy. Skårderud has a doctorate in a series 
of qualitative studies of eating disorders. He is an internationally recognized expert on eating 
disorders with a large international network in both treatment and research in the field. He has 
supervised 11 completed doctoral degrees and has been an opponent in a number. He has 
supervised two completed PhD projects on mental illness and early parenthood. He is on the 
Editorial Board of the Journal of Eating Disorders. Skårderud's main role will be to guide on 
eating disorders, monitor the interview processes and interpretation of data. 
 

 
16 
Co-supervisor II: Psychologist specialist, Dr. psych Ingela Kvalem is a psychologist and 
researcher at Oslo University Hospital. 
 
We have established a network that will collaborate in the form of recruitment, 
implementation and dissemination throughout the project period. The network is a direct 
collaboration with the users themselves. The network includes: 
- Foundation Institute for Eating Disorders, Villa SULT (www.spiseforstyrrelser.no). The 
doctoral candidate Sommerfeldt and supervisor Skårderud are affiliated with Villa SULT. 
- The health station Vestre Aker has entered into a collaboration with Villa SULT because 
they want increased competence in the field. 
- Advice on eating disorders (ROS), www.nettros.no. 
- The Eating Disorders Association (SPISFO), www.spisfo.no. 
 
Time schedule 
Before project start (December 2019): The reference group is contacted. Literature search 
and review. Apply for funding. Develop and test data collection procedures and methods. 
Reference group meetings. 
By funding (2020): Apply for admission to a doctoral program at the Department of 
Psychology, UiO. Apply for approval REK. Register the study in clinicaltrials.gov. 
First period (Spring 2020): Updating literature. Include mothers. Data collection before 
birth. Data collection after birth to group 2. Processing and coding of data continuously. 
Reference group meetings. Write the first draft of the introduction and method section of 
articles. 
Second period (Autumn 2020 / Spring 2021): Follow literature. Further data collection 
before birth and start data collection after birth for group 1. Data processing, coding and 
analysis. Reference group meetings. Adjust article drafts. 
Third period (Autumn 2021 / Spring 2022): Complete data collection after birth to group 1. 
Continued data processing, coding and analysis. Reference group meetings. Article draft 
adjustment. 
Fourth period (Autumn 2022 / Spring 23): Reference group meetings. Focus group 
interview, final writing and publication of articles. 
Fifth period (Autumn 2023): After completing a doctorate: Academic and popular 
communication. 
 
 
 
Publishing 
Scientific. We will publish three scientific articles that are sent to "open access" journals 
registered with the Directory of open access journals (DOAJ) such as the Journal of Eating 
Disorders, the European Eating Disorder Review or equivalent international journals. 
 
Working titles:   
1. Trajectories of eating disorders through pregnancy, birth and early motherhood.  
2.   Eating disorder and emerging motherhood: Emotional, cognitive and relational 
experiences. 
3. Helping women with eating disorders during emerging motherhood: Perceptions and 
experiences of support. 
 
Other. The Department of Eating Disorders / Villa Sult will produce videos that are posted 
on websites, Facebook and distributed via the network described above. We will write an 

 
17 
article on the topic of the Norwegian Journal of Nursing Research and the Journal of 
Midwives, and an article in the Journal of the Norwegian Medical Association. We will try to 
get the most important results into Nordic textbooks in gynecology and obstetrics. We will 
offer lectures and courses on the topic of medical education at the University of Oslo and we 
will offer the Norwegian Directorate of Health text for a brochure that can be posted in GPs' 
waiting rooms and at health stations. Workshops, conferences and educations will be 
developed and implemented. 
 
Media. The videos will be open and accessible to everyone. We will inform about this in 
various Facebook groups and central channels such as Podcasts such as "Foreldrepodden", 
"Babyverden" ":.". Through these forums, we will reach both the general public and various 
relevant user groups. In addition, we will offer a column and interviews to the Norwegian 
media where some of the supervisors are well known. 
 
Etichs 
The study is approved by the Regional Committee for Medical and Health Research Ethics 
(REK). Ethical reflections permeate the entire research process. Participation is voluntary. A 
well-understood information letter is presented to the informants. For other advance 
information, see Data Collection above. We follow the usual rules for informed written 
consent, withdrawal, deletion of material, de-identification and assessment of the 
consequences of participation. 
 
Researching mothers' thoughts and experiences about their own health, body and self-image 
requires a high level of ethical awareness in the meeting with the informants themselves, as 
well as interview and text material. The theme of this project is occasionally sensitive. All 
participants in the project group are regulated by their respective professions' legislation on 
ethical conduct. The project group's clinical experience and experience with similar projects is 
as far as possible a guarantee for a safe and respectful situation where mothers can feel safe 
sharing personal information and talking about sensitive topics. Experiential conversations 
about difficult experiences in life can activate difficult thoughts and feelings. This requires 
professionalism from the researchers. This is taken care of by the fact that the interviewer is a 
specialist in clinical psychology with extensive experience in dealing with eating disorders 
and in that all the supervisors are very experienced with this type of conversation. Informants 
will not be their own patients. 
 
 
Audio recording involves significant amounts of potentially personally identifiable material. 
All audio files are transcribed immediately and deleted after transcription and electronic 
loading. Before electronic loading, we will change personal names and all other easily 
identifiable characteristics. Should there exceptionally occur delays between interview and 
transcription or transcription and electronic loading, the data material is stored in a locked 
burglar-proof safe in Villa Sult. All findings published are anonymised. Quotes in published 
text will not be able to be linked to a person. 
 
Budget and financial plan   
Due to the project's time frame, it is desired that the project funds be spread over four years 
from January 2020 to December 2023 to ensure a sufficient number of informants and time to 
conduct interviews six months after birth (measurement T2). We are mainly applying for 
salary for a three-year PhD position spread over four years (75% position) for psychologist 

 
18 
specialist Bente Sommerfeldt with a view to qualifying for the academic title PhD. See 
attached budget in application form. 
 
Scientific utility and practical utility values  
Scientific utility 
As described several times here, this is by far an unexplored field. The survey will be able to 
help fill knowledge gaps about birth and the body in the fourth trimester. Closing knowledge 
gaps and being an initiator and contributor to knowledge development and research on 
women's health is central to the strategic plan of the Norwegian Women's Health Association 
and this study could contribute to this. There is an obvious need for more knowledge, and not 
least knowledge based on the users' own experiences. Thus, this is typically demand-driven 
research. Research findings will not least clarify issues for further research projects. 
 
Practical utility values 
Prevention. The project is especially important because it promotes women's health and living 
conditions and provides an offer to women in a vulnerable phase of life. The project already 
complements the Sanitary Women's existing research on eating disorders, the body and the 
"beauty tyranny" and also pregnancy and postpartum depression (Mamma Mia). Increased 
knowledge of such phenomena, such as early clinical signs, and what is perceived as useful 
by the users themselves, opens up opportunities for information, information activities and 
campaigns. The study will also form an important basis and experience on what can help 
women to strengthen the bond with the child already from the fetal stage. This applies not 
least under the auspices of public health stations, user organizations and of organizations such 
as Sanitetskvinnene and Villa SULT. 
 
Competence-enhancing measures. Through research findings, the study will lay the 
foundation for establishing competence-enhancing measures for health personnel who work 
with pregnancy, childbirth and childbirth. By placing the user as an expert on their own 
experiences, the survey will be particularly relevant for competence development among 
users, relatives and health personnel. Specifically, this means courses and content in 
educations. An important focus will then be how to promote well-being and health in mother 
and child during pregnancy and after birth. 
 
Early intervention. Knowledge of risk factors and signs will promote security among health 
professionals to more actively and purposefully ask the woman more directly about the 
relationship to food, body and weight. Being asked will lead to a lower threshold for 
requesting and receiving help from the user himself. It will promote interventions at an earlier 
stage. 
 
Better interactions between actors and levels in the health care system. The pregnant, giving 
birth and maternity mother necessarily meet many actors in the health care system, such as 
health stations, midwives, GPs and maternity wards, and occasionally also mental health care. 
Increased competencies also promote the opportunities for better collaboration and more 
targeted communication between the various parties involved. This also applies to family 
members. 
 
Manualized programs and national guidelines. The results of the research project as well as 
experiences that accumulate in its wake will together form a competence basis for further 
development of these parts of our health care system. This can be expressed in the content of 

 
19 
health education and later establishments of local and national guidelines for how these 
women and their families meet. 
 
 
User participation 
We take care of the user perspective as follows: 
1. A reference group with eating disorders with children who do not participate in the study 
participates in the method development. The reference group has been established in 
collaboration with the user organizations. 
2. The very purpose of the survey is to bring out the users' experience. We interview face-to-
face, personally pregnant and mothers are interviewed about their subjective experiences. 
3. The experience interview is specially designed to cultivate in one's own words, as little as 
possible influenced by the researcher, precisely the users' own formulations of their feelings, 
thoughts and experiences. 
4. IPA and Grounded Theory are used to refine user experiences and develop models based on 
these. 
5. Focus group interviews are used to validate the findings among the informants before 
publication. 
6. The project is a direct and close collaboration with health stations in Norway (which are 
users of the results) and two central user organizations for eating disorders. Findings in the 
project will be discussed with the user organizations during the project period. 
 
Plan for continuation 
The study will form the basis for information, information and campaigns at health stations 
and user organizations of N.K.S and Villa SULT. Increasing the action skills of nurses and 
midwives is an important next step. Based on knowledge from the study, we will develop a 
training program for nurses and midwives. The training program can be used at all health 
stations in Norway via e-learning. Such a program will have a strong focus on how to 
understand and meet women with eating disorders in a vulnerable phase of life and what can 
help women to strengthen the bond with the child already from the fetal stage. Based on the 
results, we will also in collaboration with health stations and user organizations create a guide 
for health stations on how to meet women with strained relationships with food, body and 
weight during pregnancy and childbirth. This guide and the training will be an important 
supplement to the guidelines for maternity care in Norway. The new guidelines for maternity 
care that came in 2018 have a greater focus on living habits and diet. It is therefore the 
midwife's task to ask about these topics, but it is probably different from midwife to midwife 
how she asks. One thing is that health professionals ask how the woman is doing. But just as 
important is that they know what to do with the answer that comes. Increased competence is 
in demand. Leader of the midwives' association Kari Aarø has stated that midwives have not 
been good enough at detecting eating disorders. 
 
The results also form the basis for an intervention program for women with eating disorders 
who face pregnancy and childbirth. The intervention program will be a low-threshold offer for 
women with eating disorders during pregnancy and childbirth and a practical and simple tool 
to use at health stations in Norway. 
 
Relevant further studies after completing the PhD may be on the interaction between mother 
and child and the relationship. 
 
 

 
20 
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