Challenges to the research protocol

Ethnography continually challenged me, to be adaptable, think quickly and be creative to situations that arose. This section analyses the challenges to the research protocol and discusses the actions implemented to resolve the situations.

3.3.7.1 Out of site, out of mind

The commitment of time to the fieldwork was associated to developing relationships, as well as being down to a phenomenon I referred to as ‘out of

site, out of mind.’ This involved the concept that maternity staff did not think

about the research when I was not present. The phenomenon was experienced at all three case study sites and resulted in two repercussions related to the research protocol. Firstly, midwives were not universally distributing the research literature to inform the pregnant women about the research. Secondly, not all midwives were checking the consent of women when they were assessed in labour. Both components were vital for the recruitment of women into the study.

Nurse researchers Leslie and McAllister (2002) found by continually making their presence felt, they gained trust amongst staff so that they could remind patients about their research. Lambert et al. (2011) also spent intensive time periods within the field as relationships were transitory. Commencing with case study site one, I ensured that fieldwork included presence accompanied by circulating to the labour ward, triage and antenatal ward before returning to the AMU. This allowed me to remind midwives about the study and increase rapport,

115 interactions and trust. This approach was adapted to the different environments, but continued at case study site two and three. These interactions continued until the labour observations were achieved for each case study site. The concerns in relation to the AMU at case study site one, started week four when women were not attending the AMU with a consent form in their maternity notes. In addition, a coincidental meeting the same week with a community midwife reinforced

concerns which the following fieldnotes portray:

A midwife … working in the community … said that she must admit that she has not been giving out the research literature to women. This midwife was so supportive to me when I was in the introduction weeks, so if this midwife forgot, I wonder what the chances are that others are not giving the literature out either (AMU Fieldnotes)

A midwife at case study site three also verified my concerns on week four:

A midwife said that it is only when I [researcher] am here that they remember about the research (FMU Fieldnotes)

Building rapport with midwives was more challenging for case study sites two and three. At case study site two the challenges were associated with restricted contact with the community midwives during the fieldwork. Daily contact with the community midwives by text and face-to-face contact at the night shift handovers did help towards building relationships with the community midwives. The longer time to achieve the ten labour observations at case study site two however serves as a reflection of the consequences of reduced rapport, when compared to the other two case study sites. As previously discussed, in relation to the FMU at case study site three, the amount of hours per week was increased to

accommodate the higher numbers of transient on-call midwives covering the FMU. Although the FMU team was small their supportive network was vast across two hospitals.

3.3.7.2 Midwives asking clinical questions

Due to my midwifery knowledge, I like other researchers experienced midwives sometimes asking me clinical questions, asking my opinion (Bonner and Tolhurst 2002; Burns et al. 2010) or sounding me out (Bonner and Tolhurst 2002). Some

116 questions were posed spontaneously, whereas at other times I sensed a

question was coming. I soon adopted a ‘vague face’ to communicate that I did not know, while at other times I reminded staff about my researcher status. As the fieldwork progressed, staff explained my research status on my behalf.

3.3.7.3 Triggering vulnerability for midwives

The fieldnotes indicated that maternity staff were more vulnerable and had an increased sense of my presence as an observer when an emergency occurred, or when events did not go to plan. During such events I kept a low profile and left the room to provide space if I sensed it was required. Overall, I had to balance safeguarding research participants by striving not to increase their vulnerability. This was while also appreciating that the information attained provided

knowledge concerning support networks and emotions felt during emergencies. This showed how the dynamics inside and outside the birth environment

changed in relation to the midwifery one-to-one support in labour. In addition, I was requested to leave the birth environment once when a FMU midwife at case study site three wanted privacy. The midwife wanted to discuss transfer to labour ward and the management of a perineal tear with a women. The midwife later explained that she felt apprehensive that the woman may blame her for the need to transfer. This again reinforced the increased sense of feeling observed by a researcher when events did not go to plan.

3.3.7.4 Triggering emotions during interviews

During the course of the interviews midwives and women shared emotions which for some included feeling very sad, frustrated and caused some to cry. I was not alone feeling a tremendous responsibility as a researcher for causing research participants to cry (Kleinman and Copp 1993). From the perspective of midwives, the tears were connected to working in environments where midwifery one-to- one support in labour was not achieved. Midwives recalled instances where they had cared for more than one woman in labour, and shared feelings of failure concerning the women in their care and the fear of litigation if an adverse event occurred. When women cried it was mostly associated with transfers to the labour ward in hospital. Most of the issues were related to the discontinuation of the midwifery one-to-one relationship and the changed dynamics within the hospital environment. The emotions expressed by midwives and women

117 to-one support in labour as the challenges exposed caused emotional distress which will be explored further within chapters four, five and six as part of the findings.

Lastly, for each midwife and woman that showed such emotions, I stayed and talked about positive topics following the interview. I also sent a text message later to the midwives and women when I thought it was appropriate to check whether further support was required.