References

Association of Radical Midwives. About us - Why Radical?. 2018. https://www.midwifery.org.uk/about-us/ (accessed 20 July 2018)

Bernhard C, Zielinski R, Ackerson K, English J. Home birth after hospital birth: women's choices and reflections. J Midwifery Womens Health. 2014; 59:(2)160-166 https://doi.org/10.1111/jmwh.12113

Up close and personal: The role of the bracketing interview in interpretative phenomenological analysis and its impact on the researcher. 2017. https://www.keele.ac.uk/media/keeleuniversity/facnatsci/schpsych/documents/counselling/conference/4thannual/Up%20Close%20and%20Personal.pdf (accessed 3 March 2018)

Eatough V, Smith J. Interpretative Phenomenological Analysis. In: Willing C, Stainton Rogers, W. (eds). London: SAGE; 2008

Feeley C, Thomson G, Downe S. Caring for women making unconventional birth choices: A meta-ethnography exploring the views, attitudes, and experiences of midwives. Midwifery. 2019; 72:50-59 https://doi.org/10.1016/j.midw.2019.02

Giorgi A. The phenomenological movement and research in the human sciences. Nurs Sci Q. 2005; 18:(1)75-82

Hinton L, Dumelow C, Rowe R, Hollowell J. Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups. BMC Pregnancy Childbirth. 2018; 18:(1)

Hollander M, de Miranda E, van Dillen J, de Graaf I, Vandenbussche F, Holten L. Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis. BMC Pregnancy Childbirth. 2017; 17:(1) https://doi.org/10.1186/s12884-017-1621–0

Jenkinson B, Kruske S, Kildea S. The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis. Midwifery. 2017; 52:1-10

JiscMail. Midwifery Research JiscMail. 2018. https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=MIDWIFERY-RESEARCH (accessed 28 May 2018)

Keedle H, Schmied V, Burns E, Dahlen HG. Women's reasons for, and experiences of, choosing a homebirth following a caesarean section. BMC Pregnancy Childbirth. 2015; 15:(1) https://doi.org/10.1186/s12884-015-0639-4

Larkin M, Watts S, Clifton E. Giving voice and making sense in interpretative phenomenological analysis. Qual Res Psychol. 2006; 3:(2)102-120 https://doi.org/10.1191/1478088706qp062oa

Lee S, Ayers S, Holden D. Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study. Midwifery. 2016; 38:49-54

National Maternity Review. Better Births. Improving outcomes of maternity services in England. A Five Year Forward View for maternity care. 2016. https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf (accessed 27 August 2019)

Pezaro S, Clyne W, Turner A, Fulton E, Gerada C. Midwives Overboard! Inside their hearts are breaking, their makeup may be flaking but their smile stays on. Women Birth. 2015; 29:(3)e59-66 https://doi.org/10.1016/j.wombi.2015.10.006

Pezaro S, Clyne W, Fulton EA. A systematic mixed-methods review of interventions, outcomes and experiences for midwives and student midwives in work-related psychological distress. Midwifery. 2017; 50:163-173

Pietkiewicz I, Smith J. A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. Czasopismo Psychologiczne. 2012; 18:(2)361-369

Rolls L, Relf M. Bracketing interviews: addressing methodological challenges in qualitative interviewing in bereavement and palliative care. Mortality. 2006; 11:(3)286-305

Smith B. Generalizability in qualitative research: misunderstandings, opportunities and recommendations for the sport and exercise sciences. Qual Res Sport Exerc Health. 2018; 10:(1)137-149

Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: Theory, method and research.London: Sage; 2009

Symon A, Winter C, Donnan PT, Kirkham M. Examining autonomy's boundaries: a follow-up review of perinatal mortality cases in UK independent midwifery. Birth. 2010; 37:(4)280-287

The Midwifery Hub. Request for Research Volunteers: 23rd February 2018. 2018. https://www.facebook.com/groups/1591562177523734/ (accessed 23 May 2018)

van Manen M. Researching Lived Experience. Human Science for an Action Sensitive Pedagogy, 2nd Ed. Canada: Althouse Press; 1997

van Manen M. Phenomenology of Practice; Meaning-Giving Methods in Phenomenological Research and Writing.California: Left Coast Press Inc.; 2014

Yardley L. Dilemmas in qualitative health research. Psychol Health. 2000; 15:(2)215-228 https://doi.org/10.1080/08870440008400302

An interpretative phenomenological study of midwives supporting home birth for women with complex needs

02 October 2019
19 min read
Volume 27 · Issue 10

Abstract

Background

As the landscape of women presenting for maternity care changes, so do the challenges associated with providing quality, informed and compassionate care, particularly for women with complex needs.

Aim

To explore the lived experience of midwives in facilitating care for women with complex needs who choose to birth at home.

Method

A qualitative design is employed, using an interpretative phenomenological analysis informed by hermeneutic principles. Purposive sampling is used to recruit midwives through social media and JiscMail. Data are collected via semi-structured interviews.

Findings

Two interpretative themes arose. A ‘radical midwife’ embraces the phrase ‘radical’ by positioning midwives between traditional beliefs and practices, physiological processes, midwife knowledge and skill set by applying current evidence and professional context. A ‘conflicted midwife’ arises out of this dichotomy and exposes the realities of striving for radicality while the negotiating ‘the system’.

Conclusions

It is no longer acceptable to assume that home birth for women with complex needs is exceptional. This must be the catalyst to move towards a constructive discourse with midwives, women and the wider team to address and expand the evidence base and pathways to support those who are already facilitating this care and those who will inevitably continue to provide care ‘outside of current guidelines’.

The landscape of women presenting for care in pregnancy now compared to the 1970s is vastly different thanks in part to the development of technologies which support women with comorbidities, significant and complex mental health, obstetric, social and physical needs. Women who present with complex needs remain well informed and with the rise of social media, are finding that their voice is strong - as individuals and as a collective. Better Births (National Maternity Review, 2016) expounded a vision for maternity care which firmly places the woman and her family at the centre of care, supporting choice, control and autonomy, and ensuring that midwives deliver responsive care, allow informed decision making and choices, and exemplify these as a fundamentally embedded concept and cornerstone in modern maternity service provision.

An evidence base exploring women's reasons for birth choices outside of conventional advice is growing, with a view to contributing not only a deeper understanding of these motivations, but also informing how health care professionals can support such women. What is less understood is the experiences of midwives who support women with complex needs who choose to birth at home.

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