62 research outputs found
Freebirthing: A case for using interpretative hermeneutic phenomenology in midwifery research for knowledge generation, dissemination and impact
This study explored womenâs reasons for and their experiences of decision-making that related to the phenomenon of freebirthing within the UK. Freebirthing is the active choice to birth without a health professional present, even where there is access to maternity care. Ten women were recruited to participate in an interpretative hermeneutic phenomenological
study. Data was collected via written narratives and follow up interviews. The findings revealed direct implications for midwifery practice, namely that the complex and nuanced reasons to freebirth were often related to a previous birth trauma or negative interactions with maternity professionals. Additional findings revealed that women faced distressing opposition and conflict from midwives in relation to their decision to freebirth, despite its current legality in the UK. These findings have been published elsewhere. However, the purpose of this paper is twofold; firstly, using my research into freebirthing as a case study, I will demonstrate the use and benefits of interpretative hermeneutic phenomenology to midwifery and nursing research to generate knowledge for the benefit of service users, healthcare professionals, researchers and policy-makers. Secondly, I will discuss the activities I carried out to enhance dissemination and impact for the benefit of service users and clinicians
Giving birth and 'going it alone': choosing to freebirth in the UK
BMC Pregnancy and Childbirth recently published a research article investigating the reasons behind why women choose to âgo it aloneâ when giving birth in the UK. Co-author Claire Feeley explains more about their findings in this guest blog
Tensions and conflicts in âchoiceâ: Womenâs experiences of freebirthing in the UK
Background
the concept of choice is a central tenet of modern maternity care. However, in reality womenâs choice of birth is constrained by a paucity of resources and dominant medical and risk adverse discourses. In this paper we add to this debate through highlighting the tensions and conflicts that women faced when enacting a freebirthing choice.
Methods
secondary analysis of data collected to explore why women choose to freebirth in the UK was undertaken. Ten women were recruited from diverse areas of the UK via invitations on freebirthing websites. Women provided a narrative and/or participated in an in-depth interview. A thematic analysis approach was used.
Findings
we present three key themes. First âviolation of rightsâ highlights the conflicts women faced from maternity care systems who were unaware of womenâs legal rights to freebirth, conflating this choice with issues of child protection. âTactical planningâ describes some of the strategies women used in their attempts to achieve the birth they desired and to circumnavigate any interference or reprisals. The third theme, âunfit to be a motherâ describes distressing accounts of women who were reported to social services.
Conclusion and implications for practice
women who choose to freebirth face opposition and conflict from maternity providers, and often negative and distressing repercussions through statutory referrals. These insights raise important implications for raising awareness among health professionals about womenâs legal rights. They also emphasise a need to develop guidelines and care pathways that accurately and sensitively support the midwives professional scope of practice and womenâs choices for birth
Caring for women making unconventional birth choices: A meta-ethnography exploring the views, attitudes, and experiences of midwives
Introduction: Women can face opposition when exerting autonomous decision-making regarding their birth choices, particularly when the decisions involve going against medical advice and/or outside of national guidelines. Termed âunconventional birth choicesâ, some research has explored womenâs reasons and experiences of making such choices, but less is known about the midwives caring for them.
Objectives: To synthesize existing qualitative literature on the views, attitudes, and experiences of midwives caring for women who make unconventional birth choices.
Methods: A systematic search and meta-ethnography informed by Noblit and Hare and Schutz was undertaken. Eight databases were searched using predetermined search terms, alongside author, reference, citation chasing, and hand searching. Searches were conducted in July 2016 and updated in October 2017. Qualitative studies published since 1993 in English were included. Included studies were subjected to quality appraisal, conducted independently by two reviewers. Analysis was informed by the interpretative meta-ethnography methods.
Main results: Five studies met the inclusion criteria. Eight subthemes emerged. These resulted in three higher level interpretative themes emerged: perceptions of womenâs decision making, conflicting tensions as caregivers, ways of working with-woman.
Conclusions: Midwives can play a pivotal role in ensuring that respectful maternity care includes supporting women in their birthing decisions. Whilst limited research has been undertaken in this area, available insights suggest that midwivesâ views in this area are situated along a spectrum from âwillingly facilitativeâ to âreluctantly acceptingâ. Views were influenced by context, as well as prior philosophies and values. While further research is needed, this study offers insights into the challenges women can face in seeking unconventional birth choices if they require support from midwives to do so
Understanding how midwives employed by the National Health Service facilitate womenâs alternative birthing choices: Findings from a feminist pragmatist study
UK legislation and government policy favour womenâs rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated womenâs alternative physiological birthing choicesâdefined in this study as âbirth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birthâ. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwivesâ processes of facilitating womenâs alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the womenâs needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study
âPractising outside of the box, whilst within the systemâ: A feminist narrative inquiry of NHS midwives supporting and facilitating womenâs alternative physiological birthing choices.
This thesis presents the findings of an original study that explored NHS midwives practice of facilitating womenâs alternative physiological birthing choices - defined in this study as âbirth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birthâ. The premise for this research relates to dominant sociocultural-political discourses of medicalisation, technocratic, risk-averse and institutionalisation that has shaped childbirth practices in the UK. For midwives working in the NHS, sociocultural-political and institutional constraints can negatively impact their ability to provide care to women making alternative birth choices. A meta-ethnography was carried out, highlighting a paucity of literature in this area. Therefore, the aim of this study was to generate practice-based knowledge to answer the broad research question: âwhat are the processes, experiences, and sociocultural-political influences upon NHS midwivesâ who self-define as facilitative of womenâs alternative birthing choicesâ.
Underpinned by a feminist pragmatist theoretical framework, a narrative methodology was used to conduct this study. Professional stories of practice were collected via self-written narratives and interviews to understand the processes of facilitation (the what, how, why), their experiences of carrying out facilitative actions (subjective sense-making), and what sociocultural-political factors influenced their practice. Through purposive and snowball sampling, a diverse sample of 45 NHS midwives from across the UK was recruited. A sequential, pluralistic narrative approach to data analysis was carried out, and a theoretical model was developed using the whole dataset.
The findings were subjected to three levels of analysis. First, âNarratives of Doingâ highlight how and what midwives did to facilitate womenâs alternative choices. The sub-themes reflect the temporal nature of a wide range of actions/activities involved when caring for women making alternative birthing decisions. The second analysis; âNarratives of Experienceâ - highlighted the midwives polarised experiences captured as âstories of distressâ, âstories of transition,â and âstories of fulfilmentâ. For the third level of analysis, a theoretical model of âstigmatised to normalised practiceâ was developed using notions of stigma/normal, deviance/positive deviance. A six-domain model was developed that accounted for the midwives sociocultural-political working contexts; micro, meso, and macro.
The implications of this research related to a number of identified constraints, protective factors, and enabling factors for midwifery practice. Key barriers included negative organisational cultures that restricted both midwivesâ and womenâs autonomy. Disparities between the midwivesâ philosophy and their workplace culture were highlighted as a key stressor and barrier to delivering woman-centred care. Protective factors related to the benefits of working in supportive, like-minded teams that mitigated against their wider stressful working environments. Facilitating factors included positive organisational cultures characterised by strong leadership where midwives were trusted and womenâs autonomy was supported. Therefore, this study has captured what has been achieved, and what can be achieved within NHS institutional settings. Through the identification of both challenges and facilitators, the findings can be used to provide maternity professionals and services with insights of how they too can facilitate womenâs alternative birthing choices
Making sense of childbirth choices; exploring the decision to freebirth in the UK
Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity risks for mother and baby. To date there have been no UK based studies. The aim of this study was to explore the decision making experience of women who chose to freebirth in a UK context.
An interpretative phenomenological study was carried out. A purposive sampling method combined with a âsnowballâ technique was used to recruit women to the study (n=10). Inclusion and exclusion criteria were applied. Data collection comprised of women completing a narrative account. This was followed up with an in-depth interview. Data analysis was carried out using interpretative methods informed by Heidegger and Gadamerâs hermeneutic-phenomenological concepts.
Three main themes emerged from the data: âcontextualising herstoryâ; âdiverging paths of decision makingâ and âthe converging path of decision makingâ. With the exception of one participant, the women were making an active choice based upon their previous birth experiences. For some the decision was borne out of a negative experience which was then compounded by a further poor experience with maternity services. Namely obstructive practices by maternity professionals that limited their choice to book a homebirth. Therefore, in order to feel safe they opted to freebirth. For others this was borne out of a positive experience in which their decision evolved in trying to further improve their birthing experience, therefore a midwife became redundant.
The findings mirror that of the metasynthesis carried out by Feeley et al. (2015), but unique to this study is that it is based in a UK setting. This is an important finding as the UK has a strong midwifery culture which is philosophically embedded in woman-centred care. The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices. Further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision
Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: a mixed-methods systematic review
Aims: To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives. Design: A systematic integrated mixed methods review was conducted. Data sources: MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches. Review methods: Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes. Results: Thirty seven articles (29 studies) were includedâquantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and Itâs your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia. Conclusion: The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the âswingâ within these factors directly affected whether birthing pool use was facilitated or inhibited
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