Ethical considerations

The principles of Bournemouth University’s (2012) research code of ethical conduct have been adhered to in the design and execution of the study and an ethics committee submission was prepared for Bournemouth University’s Research Governance committee (RG2) which included the information sheet, (see appendix one, p.315) consent form (see appendix two, p.318) and the risk assessment (see appendix three, p.320) for external scrutiny. Ethical approval was subsequently granted (see appendix four, p.330). As the independent midwives are self-employed practitioners caring for women in a private capacity, and recruitment for this study was not through the NHS, it was not requisite to seek ethical approval from the National Health Service Ethics Committee (National Research Ethics Service 2009; Department of Health 2010b).

It has been argued that one of the primary concerns for research is justification of the study from an ethical perspective (Walker 2007). This entails ensuring the study does not needlessly duplicate other work or is not of sufficient quality to contribute something useful to existing knowledge. As the phenomenon under inquiry has lacked definition and exploration within the literature and the rigorous descriptive phenomenological process has been comprehensively researched and presented, it is asserted that this concern has been addressed. Other founding principles include beneficence (do positive good) and non-maleficence which includes the adage

“above all do no harm” (Walker 2007, p.39). Three issues which address this are consent, anonymity and confidentiality (Wertz et al. 2011a). These details are presented below.

Written consent was obtained from all seven participants (see appendix two, p. 318) who were fully informed of the study’s aims and methods (see appendix one, p.315). This included explicit instructions to omit or obscure any information which may identify clients and/or their families. This was emphasised as an acknowledgment that independent midwives do not come under the remit of the NHS ethical committee, therefore it is paramount both interviewees and their clients and families are afforded confidentiality. Confidentiality of interview material has been protected by pseudonyms this has included the independent midwives and any clients and/or their families or place names they have mentioned. All transcripts have been stored in a locked filing cabinet and will be destroyed within thirty-six months of the completion of the research. Interview recordings will also been destroyed (Bournemouth University 2012, Data Protection Act 1998). It is proposed that the general structure and subsequent embodied interpretation will be formulated from a number of analysed transcripts, anonymity will therefore be maintained. Explicit permission has been obtained for using direct quotes in the analysis section and in any future published or presented projects. One midwife however wanted to see any of her personal quotes that are to be used specifically in any publication. This will be undertaken and she will be contacted with the exact quotes to be utilised.

One of the most important ethical considerations for the qualitative researcher is to describe the experiences of others in the most faithful way possible (Munhall 1988). I have an obligation to therefore describe and report my findings in the most

authentic way, even if it is contrary to my aims for the study (Streubert and Carpenter 1995). It is anticipated that returning to the participants for coherence will achieve this. All transcripts have been returned to the participants and agreed as a faithful representation of their words and to ensure confidentiality is maintained.

It is suggested that the means of listening to the participants is a means of recognising and respecting their knowledge and experience. This is particularly important as it is acknowledged that due to their independent status the midwives have given their own time. This may also ensure the ethical principle of beneficence is adhered to (Bournemouth University 2012). Redwood and Todres (2006, p.26) call for “ethical imagination” in their dialogue concerning ethics and qualitative research. They assert that as interviewing is a dynamic process that cannot always be predicted where disclosure of life events occur, an ongoing checking procedure is necessary. During the course of the interviews on several occasions interviewees were reminded to not give too much detail of specific incidents that could compromise their own or their clients’ confidentiality to uphold this concern. Despite this during transcription it was noted that some details of experiences could possibly identify individuals, to address this when all scripts were returned for checking by the participants these details were highlighted for the participants and they were assured these details would not be used or anonymised. An example of this is included in appendix four which contains a transcript and details of an occasion when too many possibly identifying features of a client’s history were discussed during an interview (see p. 355).

Any ethical framework for interviewing must commence with the responsibility of the researcher (Smith 1992). This includes giving due consideration to the sensitivity of the material disclosed and the effect on the individual of self-disclosure (Walker

2007).The emergence of supervisory issues within interviews was acknowledged as a possibility and it was proposed that this could have entailed midwives divulging experiences that cause emotional distress. On a number of occasions as the midwives recounted experiences that were very meaningful to them, they visibly became upset and shed tears. On all occasions I stopped the interview and established whether they wanted to continue. On each occasion the participants wanted to continue and did so. They were reminded at the cessation of the interview that they may wish to speak to their Supervisor of Midwives to talk through and reflect on the experience of being interviewed, however none of the midwives chose to pursue this. It was also acknowledged that there was the possibility that interviews could also elucidate areas of unsafe practice. To support participants in this matter I intended to suggest midwives once again seek the support of their Supervisor of Midwives; this was also detailed on the information sheet and discussed prior to interviews commencing (see appendix one, p. 315). This however did not occur during any of the interviews. I also appointed a Supervisor of Midwives in Bournemouth University who was a senior lecture in research to be available for any supervisory issues that may have occurred, however no events ensued that required her assistance.

Coyle and Right (1996) stress that it is ethically questionable for a researcher to be interviewing on potentially sensitive topics without being able to cope with the resultant distress. As a midwife, educationalist and Supervisor of Midwives I consider myself to have advanced communication skills and was able to anticipate immediately if the participant was becoming upset which was aided by the embodied approach to my interviewing (Finlay 2011). I was however fully aware that my role within this research is that of researcher, not practitioner, educationalist or Supervisor of Midwives (Geanellos1998).

It is also acknowledged that immersion in lived experiences of others may also render the researcher vulnerable (Walker 2007), whilst I felt empathy for the participants if they became upset I did not feel vulnerable and this issue was discussed with my research supervisors.

The risk, health and safety issues of the study were considered and documented within a general risk assessment and a lone interviewing risk assessment and were agreed by the university’s internal research approval system (see appendix three, p.320).

Having presented and analysed the ethical considerations of the study and before the introduction of the findings chapter the timescale of the study is presented in the following table (figure 3:2, p.119) to provide context for the reader:

Timescale of the study

December 2010 Registration

December 2011 Submission to Bournemouth University’s RG2 Ethics Committee

December 19th 2011 Approval granted

January 2012-December 2012 Recruitment and Data Collection

January-May 2013 Transcribing and commencement of Data Analysis

June 2013 Transfer from MPhil to PhD

June 2013 -December 2015 Completion of Data Analysis

December 2015-September 2016 Writing- up

September 2016 Submission

Figure 3:2: Time line of research

The methodology and methods of the study have been presented utilising examples to provide context and enable transparency and rigour for the study. This has served to demonstrate an audit trail of maintaining a phenomenological reflexive attitude throughout the study and an upholding of ethical principles. In the next chapter the findings of the study will be presented. This will present a composite description, based on all of the interviewees’ experiences, the constituents, general structure and an embodied interpretation.