The limitations of the study

The limitations of this study included the lack of variation regarding ethnicity of research participants at two case study sites, the unknown effects of women being observed in labour, the lack of organisational data from the management team and lack of observations outside the birth environment at case study site two and lastly, the challenge rather than limitation regarding the quantity of research data.

3.3.10.1 Ethnicity

All the female research participants in this study were British Caucasian at case study sites one and two. There was ethnic diversity within case study site three. The stipulation for English speaking may have influenced the ethnic diversity of women in this study. The reasoning for choosing English-speaking participants has been previously discussed in this chapter (Section 3.3.2).

3.3.10.2 The unknown effects of women being observed in labour

A further potential limitation of this study concerned the methods used. I cannot be absolutely certain that my presence as an observer inside and outside the birth environment, did not affect the actions and conversations that transpired. The risk would have been minimised if a video camera was used in my place as recommended by the Maternity Services Liaison Committee. As an ethnographic researcher however, I quickly learned that observations are not only visual. Feeling the atmosphere was a crucial part of my observations including

emotions, reactions as they happen, room temperature, the texture of furnishing, smells and even the occasional eye contact with midwives and women gave a sense of a moment. All these elements were absorbed by me to translate. Much of this would have been lost using a video footage.

125 There was also evidence that women, birthing partners and maternity staff did forget that I was present as I occasionally made them jump when they came out of a moment focused on each other. In addition I was surprised by the frankness of conversations and body language which was particularly present outside the birth environment where offstage performances (Goffman 1990) where observed. This consistently reinforced that my presence became increasing invisible as the study progressed at all three case study sites.

3.3.10.3 Lack of organisational data from management

Another limitation in this study was not conducting interviews with NHS organisation managers and the senior midwives on labour ward. This study provides the real life working context and perspectives of midwives and women when one-to-one support in labour occurred, but organisational knowledge is limited. More information could have been gained primarily by concerning the priorities of the three NHS organisations and how midwifery one-to-one support in labour fits into these priorities. Furthermore, the themes regarding activities outside the birth environment including surveillance and territorial behaviours could have been investigated from a management perspective. This would be in order to gain knowledge of whether strategies were being used to improve inter- professional relations. Such knowledge would have built on the work of McCourt et al. (2011, 2014).

3.3.10.4 No observations outside the birth environment at case study site two

The observations completed at case study site two were restricted to the ten labour observations inside the birth environment and the short introductions with the community midwives within the midwife-led unit and labour ward in the hospital. This meant that knowledge regarding organisational systems were limited to the perspectives of midwives and women rather than including

observations. Observations were achieved outside the birth environment at case study sites one and three, because I could complete observations in the staff office. To achieve the equivalent at case study site two, would have required me to accompany the community midwives as they completed their antenatal clinics/visits and postnatal visits. Accompanying the community midwives was not deemed feasible or applicable to this study. It was not feasible due to the large numbers of community midwives that I would need to accompany and not applicable as the study was focusing on labour. In hindsight focus groups with

126 community midwives may have helped to further explore the themes that

emerged from the interviews regarding organisational issues.

3.3.10.5 The quantity of research data

One major challenge was the amount of data produced from the fieldwork from the three case study sites. The amount of data did not have an impact on the method of data analysis, the issue was the amount of time getting familiar and coding the large volumes of data. The process of systemically organising the data was helped by using NVivo 10, because the software made it easy to locate categories and audit trails were created for all data transferred and coded. I have questioned if less observations would have provided similar findings. I feel that the findings would have been similar with five observations at each case study site, but the conviction concerning the associations within the data would have decreased.

3.4 Conclusion

Chapter three presented the methodology used for this study to address the research aim and objectives. The presentation started by justifying the decision to choose ethnography as the methodology. Explanations were provided reviewing previous research methodologies used in relation to midwifery one-to- one support in labour, the ethnographic methods used in this study, and how elements of symbolic interactionism were used to grasp and understand how to interpret the fieldwork. Reflexivity was also dissected acknowledging the insider (emic)/outsider (etic) status in relation to collecting and translating data.The research protocol was subsequently explained starting with an understanding of what constituted a case, the methods used for sampling, the ethical

considerations, methods for collecting data and a description of the researcher’s experiences of interactions and challenges in the research field. The chapter closed with a description of the methods used for data analysis and the limitations of this study.

Chapter four, five and six present the findings of this study. Chapter four sets the scene by describing the three case study sites. Chapter five describes the first main theme associated with the activities that occurred inside the birth

environment. Chapter six describes the second main theme associated with the activities that occurred outside the birth environment.

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Chapter four

Setting the scene

4.1 Introduction

Chapter four is the first of three chapters (chapter 4, 5, and 6) to present the findings of this study. Chapter four begins by setting the scene. The first part of this chapter aims to provide contextual details encompassing the three case study sites. Descriptions include the scale of the NHS organisations, the birth environments, staffing, transfers and organisational changes that impacted on the midwives providing one-to-one support in labour at the AMU, home and FMU. Furthermore, the perspectives of midwives and women are discussed in relation to the impact of the midwife-woman ratio in regards to care in labour.

Throughout the findings, pseudonymous have been used to protect the

anonymity of all research participants. In addition, drawings have been used to help create a picture of the environment. Some abbreviations have been used due to limited space. The meanings of the abbreviations are shown in Appendix XIV.