Hermeneutic Phenomenology: Bridging Western and Japanese Perspectives and Languages

This article offers the reader methodological insights emerging from a hermeneutic phenomenological study that examined the meaning of the woman–midwife relationship in Japan. The methodology of hermeneutic phenomenology was chosen because it is well suited to reveal women’s and midwives’ lived experience that is often taken for granted in day-to-day maternity care settings. However, implementing the methodology was not without its challenges. These challenges included whether hermeneutic phenomenology, based on Western philosophy, could be appropriate for conducting a study involving a researcher and participants who identify as Japanese. Further, while the study required final write up in English, the interviews were conducted in Japanese. Utilizing hermeneutic phenomenology relies on language as the tool for accessing the phenomenon of enquiry. However, Japanese culture is less expressive and, relative to Western cultures, values non-verbal communication. Beyond verbal expression, language also conveys unique influences of each culture. Although it may be challenging to conduct research between different cultures, and their unique ways of thinking and languages, it is not an impossible situation and can be rewarding. The value of using hermeneutic phenomenology for a Japanese centered study helped to convey the meaning of the woman–midwife relationship in Japan. This article details the unique process of the study, in terms of the philosophical foundation and languages, to provide methodological insights and advances for future cross-cultural qualitative research

Health policy and its unintended consequences for midwife-woman partnerships: is normal pregnancy at risk when the BMI measure is used?

Background: Little attention has been paid to understanding the unintended consequences of health policy for midwife-woman partnerships. The measure of Body Mass Index (BMI) is one such policy example which has become established in contemporary midwifery practice as a tool for assessing pregnancy risk. The universal acceptance of BMI creates an unsettling paradox for midwives concerned with promoting woman-centred practice. The increasing focus on BMI is challenging for midwives as they navigate ethical tensions when directed to undertake practices which have potential unwonted consequences for the midwife-woman partnership. Aim: The aim of the study was to explore the use of an indicator, using BMI as an example, to provide an international perspective on obesity prevention policy and maternity care provision. Method: A comparative case study approach was taken, using descriptive cross-national comparative analysis of obesity prevention policy, weight management guidelines and midwifery models of care in New Zealand and Scotland. Discussion: Despite promoting healthy weight gain in pregnancy, New Zealand and Scottish health policies may be missing health promotion opportunities. Focusing on BMI in maternity, per se, should not prohibit other assessment of lifestyle issues or delivery of services based on individual needs, capacities, histories and sociological characteristics. Relying solely on pre-pregnancy BMI as a marker of health in all women has remained relatively unchallenged and, as such, constitutes a policy problem because it occludes the factoring in of other lifestyle issues that may significantly alter individual risk status. Further, such an assessment of risk status is ideally arrived at within a partnership model of maternity care, rather than reliance on an a priori medical test. Conclusion: Decontextualised policies are challenging for midwives where medical and midwifery values are in conflict. Policy which fails to consider the multiple and complex contexts of women's lives is confronting for midwives as they attempt to re-articulate the meaning of woman-centred practice. Furthermore, BMI as a tool may be ineffectual. The current focus on BMI in policy and practice requires re-consideration

Generosity of spirit sustains caseloading Lead Maternity Carer midwives in New Zealand.

Background: This article is the third in a series reporting on original research exploring the sustainability of Lead Maternity Carer (LMC) midwifery. Previous publications have described sustainable practice arrangements and the way that partnership and reciprocity with women sustain LMC midwives. Research about sustainable caseload practice is important because lessons can be learnt that ensure this model of care, with its excellent outcomes and high levels of maternal satisfaction, continues. Aim: The aim of this paper is to provide stand-alone data in relation to what sustains LMC midwives in midwifery practice over time. The final theme to emerge from our original research arose from data which support the strong relationship between the midwives' generosity of spirit alongside professional boundaries that is critical to sustaining caseloading practice. Method: A qualitative descriptive study was conducted in New Zealand. Eleven LMC midwives with between 8-20 years of practice experience were interviewed. Interviews were transcribed and the data thematically analysed. The researchers within the group undertook the analysis together in a reciprocal fashion between the individual interviews and all the data as a whole. Themes were clustered into groups and excerpts from the data used to illustrate the agreed themes. Ethics approval was obtained from Auckland University of Technology Ethics Committee. Conclusion: This paper draws attention to the significance of generosity of spirit in LMC practice and how this acts synergistically with personal and professional boundaries. Reciprocity and partnership work well when generosity of spirt is enabled to flourish, and this, in turn, supports joy of practice. This paper provides further insight into how LMC practice is sustained over time and provides direction for midwives in LMC practice, and those planning to enter LMC practice, in New Zealand and elsewhere

Midwifing the notion of a 'good' birth: a philosophical analysis.

Objective: to ponder afresh what makes a good birth experience in a listening manner. Design: a hermeneutic approach that first explores the nature of how to listen to a story that is already familiar to us and then draws on Heidegger's notion of the fourfold to seek to capture how the components of a'good birth' come together within experience. Setting: primary birthing centre, New Zealand Participants: the focus of this paper is the story of one participant. It was her second birth; her first birth involved a lot of medical intervention. She had planned to travel one hour to the tertiary birthing unit but in labour chose to stay at the Birth Centre. Her story seems to portray a 'very good birth'. Findings: in talking of birth, the nature of a research approach is commonly to focus on one aspect: the place, the care givers, or the mode of care. In contrast, we took on the challenge of first listening to all that was involved in one woman's story. We came to see that what made her experience 'good' was'everything' gathered together in a coherent and supportive oneness. Heidegger's notion of the fourfold helped reveal that one cannot talk about one thing without at the same time talking about all the other things as well. Confidence was the thread that held the story together. Key conclusions: there is value in putting aside the fragmented approach of explicating birth to recognise the coming together of place, care, situation, and the mystery beyond explanation. Women grow a confidence in place when peers and community encourage the choice based on their own experience. Confidence of caregiver comes in relationship. Feeling confident within 'self' is part of the mystery. When confidence in the different dimensions holds together, birth is 'good'. Implications or practice: one cannot simply build a new birthing unit and assume it will offer a good experience of birth. Experience is about so much more. Being mindful of the dimensions of confidence that need to be built up and sheltered is a quest for wise leaders. Protecting the pockets where we know 'good birth' already flourishes is essential

Gaining insight from future mothers : A survey of attitudes and perspectives of childbirth

Funding Information: We thank Dr. Caroline Stretton (AUT University, School of Public Health & Interdisciplinary Studies) and Dr. Jean Rankin (University of the West of Scotland, School of Health and Life Sciences) for their contribution to this article in its early inception. Not applicable. Publisher Copyright: © 2022Objective: To determine whether participant characteristics and/or birth preferences of future mothers are associated with a fear of birth. Design: A cross-sectional survey was used to determine if fear of birth could be profiled in specific participant characteristics and birth choices. Setting: Urban New Zealand university. Participants: A convenience sample of women (final n = 339) who were 20 (‘severe’) for depression on DASS-21 scale (n=11, mean CFPP=44.8, SE=1.7, p < 0.0001) were all positively associated with CFPP. Post-hoc analyses revealed that mean CFPP was higher for those that perceived birth technologies as easier, safer, necessary, and required. Conclusions: Women born outside of New Zealand and/or suffering ‘severe’ depression were more likely to have a fear of birth. Fear of birth was associated with the participants choices towards medicalised childbirth. Familiarising women with the provision of maternity care in New Zealand and identifying mental health status early could reduce fear of birth and possibly support the vaginal birth intentions of future parents.Peer reviewe

Sustainability and resilience in midwifery: A discussion paper

Background midwifery workforce issues are of international concern. Sustainable midwifery practice, and how resilience is a required quality for midwives, have begun to be researched. How these concepts are helpful to midwifery continues to be debated. It is important that such debates are framed so they can be empowering for midwives. Care is required not to conceptually label matters concerning the midwifery workforce without judicious scrutiny and diligence. Aim the aim of this discussion paper is to explore the concepts of sustainability and resilience now being suggested in midwifery workforce literature. Whether sustainability and resilience are concepts useful in midwifery workforce development is questioned. Method using published primary midwifery research from United Kingdom and New Zealand the concepts of sustainability and resilience are compared, contrasted and explored. Findings there are obvious differences in models of midwifery care in the United Kingdom and New Zealand. Despite these differences, the concepts of resilience and sustainability emerge as overlapping themes from the respective studies’ findings. Comparison between studies provides evidence of what is crucial in sustaining healthy resilient midwifery practice. Four common themes have been identified that traverse the different models of care; Self-determination, ability to self-care, cultivation of relationships both professionally and with women/families, and a passion, joy and love for midwifery. Conclusions the impact that midwifery models of care may have on sustainable practice and nurturing healthy resilient behaviors remains uncertain. The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives ‘to toughen up’ in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife. The findings invite further examination of contextual influences that affect the wellbeing of midwives across different models of care

A cross-country survey of attitudes toward childbirth technologies and interventions among university students

Problem & Aim: Cultural beliefs that equate birth technology with progress, safety and convenience contribute to widespread acceptance of childbirth technology and interventions. Little is known about attitudes towards childbirth technology and interventions among the next generation of maternity care users and whether attitudes vary by country, age, gender, childbirth fear, and other factors. Methods: Data were collected via online survey in eight countries. Students who had never had children, and who planned to have at least one child were eligible to participate. Findings: The majority of participants (n= 4569) were women (79.3%), and the median age was 22 years. More than half of students agreed that birth technology makes birth easier (55.8 %), protects babies from harm (49.1 %) and that women have a right to choose a medically non-indicated cesarean (50.8 %).Respondents who had greater acceptance of childbirth technology and interventions were from countries with higher national caesarean birth rates, reported higher levels of childbirth fear, and were more likely to report that visual media or school-based education shaped their attitudes toward birth. Positive attitudes toward childbirth technology and interventions were also associated with less confidence in knowledge of birth, and more common among younger and male respondents. Discussion/Conclusion: Educational strategies to teach university students about pregnancy and birth in ways that does not frighten them and promotes critical reflection about childbirth technology are needed. This is especially true in countries with high rates of interventions that reciprocally shape culture norms, attitudes, and expectations

A Survey of University Students’ Preferences for Midwifery Care and Community Birth Options in 8 High‐Income Countries

Background: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence- based recommendations and options available. Methods: A cross-sectional, web-based survey was completed in 2014-2015 by a convenience sample of university students in 8 high-income countries across 4 continents (n=4,569). In addition to describing preferences for midwifery care and community birth options across countries, socio-demographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students’ attitudes towards birth were examined in relation to preferences for midwifery care and community birth options. Results: Approximately half of the student respondents (48. 2%) preferred midwifery-led care for a healthy pregnancy, 9.5% would choose to birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in England. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, who learned about pregnancy and birth from friends (compared to other sources, e.g. the media) and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences Conclusions: It would be beneficial to integrate childbirth education into high school curricula, to promote knowledge of midwifery care, pregnancy and childbirth and reduce fear among prospective parents. Community birth options need to be expanded, to meet demand among the next generation of maternity service users

Using an Online Platform for Conducting Face-To-Face Interviews

Semi-structured interviews are useful for exploring participants experiences, understandings, and opinions on a particular issue. Traditionally, interviews have taken place in-person however, because of in-person restrictions with Covid-19, and with the changing landscape of online connection, opportunities have arisen for how to conduct interviews using an online platform. The purpose of this article is to highlight the first author’s experiences with using an online platform to conduct face-to-face interviews and the valuable contribution that online interviewing could offer as a valid research tool that differs to that of in-person face-to-face interviews. Online semi-structured interviews were conducted with fourteen midwives and five pregnant people from New Zealand using Microsoft Teams. Interviews were videorecorded and conducted as part of a larger mixed methods multiphase study to explore participants experiences with how they use communication technology to connect with one another. The interviews took place between September 2022 – May 2023. Two key areas which highlight the benefits and challenges with online interviews were identified. These were around the potential to ‘capture the essence of the person’ and through the flexibility of the technology in enabling FTF connections. Challenges were also noted around connectivity issues. Videorecording online interviews offered an ability to capture the ‘essence of the person’ through visual and auditory cues. These same cues were shown to assist with lipreading when transcribing inaudible words which can assist in the analysis of data. There were disruptions to some interviews due to interviewing taking place in the person’s home and connectivity issues, however, these were felt to be minimal. Online interviewing should not be considered a ‘poor relation’ to in-person face-to-face interviews, but instead, a valuable option that contributes towards the growing body of knowledge around online interviewing as a valid research tool that is different from face-to-face