Susan Crowther

Crafting Stories in Hermeneutic Phenomenology Research A Methodological Device

Hermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.

Kairos time at the moment of birth.

BACKGROUND there is something extraordinary in the lived experience of being there at the time of birth. Yet the meaning and significance of this special time, named Kairos time in this paper, have received little attention. AIM to describe the lived-experience of Kairos time at birth and surface its meaning. METHODOLOGY this is an interpretive hermeneutic phenomenology study informed by the writings of Heidegger and Gadamer. 14 in-depth interviews with mothers, birth partners, midwives and obstetricians were transcribed and stories from the data were hermeneutically analysed. FINDINGS there is a time, like no other, at the moment of birth that is widely known and valued. This paper reveals and names this phenomenon Kairos time. This is a felt-time that is lineal, process and cyclic time and more. Kairos time describes an existential temporal experience that is rich in significant sacred meaning; a time of emergent insight rarely spoken about in practice yet touches everyone present. The notion of Kairos time in relation to the moment of birth is introduced as a reminder of something significant that matters. KEY CONCLUSIONS Kairos time is revealed as a moment in and beyond time. It has a temporal enigmatic mystery involving spiritual connectedness. Kairos time is a time of knowing and remembrance of our shared natality. In this time life is disclosed as extraordinary and beyond everyday personal and professional concerns. It is all this and more. IMPLICATIONS Kairos time at birth is precious and powerful yet vulnerable. It needs to be safeguarded to ensure its presence continues to emerge. This means maternity care providers and others at birth need to shelter and protect Kairos time from the sometimes harsh realities of birth and the potentially insensitive ways of being there at the moments of birth. Those who find themselves at birth need to pause and allow the profundity of its meaning to surface and inspire their actions.

Open, trusting relationships underpin safety in rural maternity a hermeneutic phenomenology study.

BackgroundThere are interwoven personal, professional and organisational relationships to be navigated in maternity in all regions. In rural regions relationships are integral to safe maternity care. Yet there is a paucity of research on how relationships influence safety and nurture satisfying experiences for rural maternity care providers and mothers and families in these regions. This paper draws attention to how these relationships matter.MethodsThis research is informed by hermeneutic phenomenology drawing on Heidegger and Gadamer. Thirteen participants were recruited via purposeful sampling and asked to share their experiences of rural maternity care in recorded unstructured in-depth interviews. Participants were women and health care providers living and working in rural regions. Recordings were transcribed and data interpretively analysed until a plausible and trustworthy thematic pattern emerged.ResultsThroughout the data the relational nature of rural living surfaced as an interweaving tapestry of connectivity. Relationships in rural maternity are revealed in myriad ways: for some optimal relationships, for others feeling isolated, living with discord and professional disharmony. Professional misunderstandings undermine relationships. Rural maternity can become unsustainable and unsettling when relationships break down leading to unsafeness.ConclusionsThis study reveals how relationships are an important and vital aspect to the lived-experience of rural maternity care. Relationships are founded on mutual understanding and attuned to trust matter. These relationships are forged over time and keep childbirth safe and enable maternity care providers to work sustainably. Yet hidden unspoken pre-understandings of individuals and groups build tension in relationships leading to discord. Trust builds healthy rural communities of practice within which everyone can flourish, feel accepted, supported and safe. This is facilitated by collaborative learning activities and open respectful communication founded on what matters most (safe positive childbirth) whilst appreciating and acknowledging professional and personal differences.

Joys and challenges of relationships in Scotland and New Zealand rural midwifery: A multicentre study

BACKGROUND Globally there are challenges meeting the recruitment and retention needs for rural midwifery. Rural practice is not usually recognised as important and feelings of marginalisation amongst this workforce are apparent. Relationships are interwoven throughout midwifery and are particularly evident in rural settings. However, how these relationships are developed and sustained in rural areas is unclear. AIM To study the significance of relationships in rural midwifery and provide insights to inform midwifery education. METHODS/DESIGN Multi-centre study using online surveys and discussion groups across New Zealand and Scotland. Descriptive and template analysis were used to organise, examine and analyse the qualitative data. FINDINGS Rural midwives highlighted how relationships with health organisations, each other and women and their families were both a joy and a challenge. Social capital was a principal theme. Subthemes were (a) working relationships, (b) respectful communication, (c) partnerships, (d) interface tensions, (e) gift of time facilitates relationships. CONCLUSIONS To meet the challenges of rural practice the importance of relationship needs acknowledging. Relationships are created, built and sustained at a distance with others who have little appreciation of the rural context. Social capital for rural midwives is thus characterised by social trust, community solidarity, shared values and working together for mutual benefit. Rural communities generally exhibit high levels of social capital and this is key to sustainable rural midwifery practice. IMPLICATIONS Midwives, educationalists and researchers need to address the skills required for building social capital in rural midwifery practice. These skills are important in midwifery pre- and post-registration curricula.

The significance of interfamilial relationships on birth preparedness and complication readiness in Pakistan.

BACKGROUND In the interests of improving maternal health care and survival, the issue of birth preparedness and complication readiness has been much debated and has remained a priority for the international health community. The provision of birth preparedness and complications readiness is determined by a range of different factors. AIM The main aim of this study is to identify and measure the influence of husbands and other family relationships on birth preparedness and complications readiness in the Khyber Pakhtunkhwa province of Pakistan. METHODS This study is a cross-sectional exploratory study. Data was collected through a survey questionnaire. Logistic regression and descriptive analysis was used. FINDINGS Analysis indicated that the mother-in-laws role, mens and womens level of education and interfamilial relationships are still the most significant factors influencing birth preparedness and complications readiness. Of the respondents, 86% were receiving antenatal care and 76.5% were planning for the birth to take place in state-run hospitals or private obstetric and gynae clinics. CONCLUSION The tendency to take up antenatal care in Khyber Pakhtunkhwa can mainly be credited to a mutual understanding between husband and wife and a good relationship between the woman and her mother-in-law. Highlighting the significance of these relationships has implications for ensuring birth preparedness and complications readiness.

Service evaluation of relaxation workshops for pregnant women.

This article reports a service evaluation of “antenatal education on physiology of childbirth and relaxation.” A service evaluation was carried out during group class discussion, immediately after the workshops, and following birth. Identified themes in the collected data were (a) my own relaxation, (b) confident, and not afraid, (c) proud of myself, (d) unexpected and feeling in control, and (e) support. Overall, women creatively customized the learned skills and reported feelings of pride and confidence. They reported feeling able to apply relaxation techniques when unexpected situations arise. Support and encouragement from partners and midwives were also valued by women. The evaluation demonstrates the efficacy of designing antenatal education that includes education on physiology of normal birth and relaxation training.