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Paper short abstract

This paper examines how trust/mistrust operates differently within GDM care in Canadian and Danish hospitals, showing how national welfare cultures and infrastructures differentially shape whether (mis)trust becomes part of productive dialogue or an wearying burden for pregnant patients.

Paper long abstract

Research on gestational diabetes mellitus (GDM) has documented its rising prevalence and its psychosocial effects, yet less attention addresses how mistrust—as an affective and epistemic force distinct from mere lack of trust—shapes women's engagements with diagnosis and care. Drawing on ethnographic fieldwork in Canadian (Vancouver) and Danish (Copenhagen) hospitals, this paper examines how mistrust operates as a stratified force in pregnancy care, exploring how different 'regimes of (mis)trust' emerge from distinct welfare infrastructures and distribute burden differently across patient populations.

I argue that mistrust toward public institutions and medical expertise operates at multiple scales—from skepticism about screening and treatment protocols, to interpersonal doubt in clinical encounters, to everyday vigilance. In Denmark's universal healthcare system, patients exhibit "ambient trust" (Khanna 2018), producing more productive clinical encounters within a trusted framework. Conversely, Canada's fragmented landscape generates structural mistrust toward institutional access and continuity, transforming routine care into additional, exhausting labour.

The GDM diagnosis becomes a critical site where patients calibrate mistrust across biomedical authority, welfare institutions, and embodied experience. This calibration is not equally available to all. While some deploy mistrust to stimulate robust patient-practitioner dialogue, for others it signals profound relational issues that haunt entire clinical encounters.

By foregrounding mistrust as differentially productive, this paper illuminates how diagnostic moments crystallize broader patterns embedded in national welfare infrastructures, revealing uneven possibilities for patient agency and critique within polarized healthcare landscapes. Rather than treating mistrust as merely a barrier, I demonstrate its generative potential in shaping health futures.