My recent travels have led to another build-up of my reading pile and, as I do a few times each year, I am sharing a few articles in one post so that I can clear the backlog and keep you more up-to-date. So I have picked five recent and interesting-looking studies that I think are worth looking at in more depth, and which you might like to discuss in a journal club, review for your own practice, critique with students or look out for your assignments.
1. At pains to consent: A narrative inquiry into women’s attempts of natural childbirth
Published in Women and Birth, the authors of this study set out “to understand and contextualise the childbirth experiences of first-time mothers who planned to have a natural childbirth (without medical intervention) in the Midsouthern United States” (Happel-Parkins and Azim 2016: 310). They interviewed just six women, which means that they were able to look at the women’s experiences in significant depth (as opposed to the breadth which comes from including more participants, but in less depth. Often researchers have to choose between those dimensions, as it’s difficult to have both).
The researchers found four recurring themes; “(1) benefits and limitations of pre-labour self-education; (2) labouring women’s experiences of relationality; (3) the importance of birth stories and expectations; and (4) the creation of false dilemmas and complexities of “informed choice.”” They conclude that, “The women’s stories suggest that U.S. medical establishments, the media, and society need to empower pregnant and birthing women by creating new narratives of labour and positive spaces of relationality. Furthermore, health care professionals need to critically examine their usage of the medical model of care while respecting women’s choices and agency.” (Happel-Parkins and Azim 2016: 310).
If you are relatively new to looking at how culture affects the childbirth arena or keen to understand the issues that birthing women face in the U.S., this article would be a great place to start. It also illustrates how it is possible to look at the experiences of a few people in depth rather than focusing only on research which includes the measurements of hundreds of women but tells us little about the depth of their experiences.
Happel-Parkins A and Azim KA (2016). At pains to consent: A narrative inquiry into women’s attempts of natural childbirth. Women and Birth 29(4): 310-20. http://dx.doi.org/10.1016/j.wombi.2015.11.004
2. North American Nurses’ and Doulas’ Views of Each Other
I know from my own workshops that there is huge value to be gained from supporting the development of relationships between the different groups of people who aim to support childbearing families, so I was excited to see this paper. This study was conducted in the North American context, so it needs to be read with caution by those in other settings, but I still think we can learn from it. The researchers used an online survey which, as with all research methods, brings advantages and challenges.
A few things were highlighted in this research. “For nurses, exposure to doulas in their primary hospitals was associated with more positive views, whereas working more hours, feeling overworked, and a preference for clinical tasks over labor support were associated with more negative views of doulas. For doulas, working primarily in one hospital and certification were associated with more positive views of nurses. Nurses with more positive attitudes toward common obstetric practices had more negative attitudes toward doulas, whereas doulas with more positive attitudes toward common obstetric practices had more positive attitudes toward nurses.” (Roth et al 2016).
The authors of this paper concluded that, “Our findings show factors that influence mutual understanding and appreciation of nurses and doulas for each other. These factors can be influenced by educational efforts to improve interprofessional collaboration between these maternity care support roles.” (Roth et al 2016). I have to say I agree, and frequently find that shared educational opportunities seasoned with tea, biscuits, chatting and chocolate go a long way towards helping different groups to better understand each other.
Roth L, Henley MM, Seacrist MJ et al (2016). North American Nurses’ and Doulas’ Views of Each Other. JOGNN, online ahead. DOI: http://dx.doi.org/10.1016/j.jogn.2016.06.011
3. Women’s experiences with giving birth before arrival
Another study of women’s experiences, this one focuses on ten Norwegian women who gave birth before their arrival on the labour ward (although I want to note that the abbreviation BBA, or born before arrival, can also be used to mean that the woman gives birth at home before the arrival of the midwife). The women were interviewed in their homes, and the findings were that, “Three themes were generated from the analysis. In the encounter with the healthcare services, the women described midwives as gatekeepers defining active labour. Giving birth before arrival was dramatic, but at some point fear of giving birth alone was replaced by feelings of coping, and in hindsight they felt empowered. The women described giving birth before arrival to be a special experience, but this was not always acknowledged by the midwives.” (Skirnisdottir et al 2016). The researchers concluded by questioning the cost-benefit of modern maternity care, emphasising the need for adequate capacity of midwives and good communication skills.
This is another good study to look at if you want to see how research which focuses on the breadth of women’s experiences can enhance our knowledge, often giving us detail, perspective and nuances that we might not otherwise know about. In contrast with the two studies mentioned above, this one used semi-structured interviews, and each of these research methods will give us access to a different kind of data.
Skirnisdottir Vik E, Haukeland GT, Dahl B (2016). Women’s experiences with giving birth before arrival. Midwifery 42: 10-15. DOI: http://dx.doi.org/10.1016/j.midw.2016.09.012
4. Respectful care in labor
Moving away from research which directly asks people about their experiences but which nonetheless takes an important stand in relation to women’s experiences, I want to highlight a paper that was published in Obstetrics, Gynaecology & Reproductive Medicine; Respectful care in labor. This is a discussion paper rather than a research study, but both kinds of writing are (at least in my view) equally important. This paper outlines some of the key issues which, again, may be useful for those new to this topic. It does not say everything that I might wish it to, but as an experienced journal editor I am well aware of the constraints of word limit and tone. What is important, I think, is that papers like this are getting published in medical journals and creating awareness and debate.
Stones W (2016). Respectful care in labour. Obstetrics, Gynaecology & Reproductive Medicine, in press. http://dx.doi.org/10.1016/j.ogrm.2016.08.005
5. Exploring Dutch midwives’ attitudes to promoting physiological childbirth: A Qualitative Study
Back to qualitative research, this study offers one final type of data collection method – focus groups – in looking at Dutch midwives’ “attitudes toward, and motivations for, the promotion of physiological childbirth and to identify factors associated with those attitudes and motivations” (Thompson et al 2016). The researchers in this study found that, “Four themes emerged: physiological birth as a continuum, navigating the settings, woman-centeredness and competence and confidence.”
“Midwives view the safeguarding and promotion of physiological childbirth as central to their role. They define physiological childbirth along a continuum that is related to the context of their practice. Hospital culture is seen as an inhibitor of practices that promote physiological birth. Midwives believe that woman-centered ways of working and challenging practices that are not evidence-based will promote physiological childbirth.” (Thompson et al 2016).
If I’m honest, one of the reasons that I like this study probably has to do with the fact that its authors agree with my own stance in finding that, “in order to become competent and confident practitioners of physiological childbirth midwives need to be aware of the factors that inhibit and encourage practices that support this way of giving birth.” (Thomson et al 2016). I spend a lot of time trying to help midwives and others become aware of this, as well as to develop their own confidence, so I’m probably biased. But I still think this study is really useful to look at if you’re interested in promoting normal birth, and (as is often the case on good-quality qualitative research) it contains some fascinating quotes from the midwives:
“Johanna (H-B): I never used to, but now I…I don’t believe everything that they say, whereas in the past, I would have been overwhelmed, but now I think: Is that true, what you say? And I say, it sounds interesting, but where did you find this?”
If you’re trying to figure out how hierarchies, different belief systems and cultures affect midwifery practice, I think this study will help you.
Thompson SM, Nieuwenhuijze MJ, Kane Low L et al (2016). Exploring Dutch midwives’ attitudes to promoting physiological childbirth: A Qualitative Study. Midwifery, in press. DOI: http://dx.doi.org/10.1016/j.midw.2016.09.019
If you’d like to chat with other midwives and birth folk about research on different topics, I’d love to see you at a workshop or welcome you to one of my online courses 😀 And you can keep up with my research postings via my free updates and monthly Birth Information Update.