Bev Jervis, PhD Student
At the moment I feel I have many midwifery hats……. Most of my time is spent doing my PhD, I am now in my third year of a full time course at the University of Salford. I am looking at knowledge acquisition around movement in labour from women’s, midwives and obstetricians perspectives and from this I am hoping to change the midwifery world!!! (Wish me luck, I am thinking it is going to be a long road!) I am also teaching midwifery at Salford on a graduate teaching studentship, a whole other learning journey about teaching and learning. I absolutely love it! I am also involved in a national midwifery charity. Sadly I haven’t done any clinical midwifery since 2014 due to time pressures but I had the opportunity to be a doula last summer which was truly amazing.
For my PhD I am looking at movement during labour. For the literature review, I wanted to look at how this knowledge was put together. I did a critical review of literature reviews on movement and positioning during the first stage of labour and looked at how knowledge around movement and positioning was viewed, validated and put together from other sources.
From my perspective women’s movement and positioning during labour was a natural and normal part of normal birth, it was something available to most women who experienced labour, yet the reviews termed movement and positioning as an intervention. These reviews took a cause and effect approach, they aimed to quantify movement and the effect it had on reducing the length of time in labour. They failed to take into account other factors which impacted on the process of labour, did not justify why length of time in labour mattered and had maternal comfort as a minor outcome that movement had on the labour process. These were all from a very medical perspective yet these reviews and other which were similar in methodology were the main source of evidence and research which inform the NICE intrapartum guidelines.
This led me to question why quantitative, positivist, obstetric knowledge formed the basis of midwifery practice for normal birth and what sources of knowledge did women, midwives and obstetricians use in practice.
I then went on to review the midwifery knowledge around movement in labour. What I found was very different from the medical cause and effect perspective. From a historical perspective, the literature looked at how women had moved during birth in their homes supported by other women. As midwifery knowledge was documented, the physical process of birth is explored in the context of the woman and the fetus. Movement is something that women do during birth as part of the process and can be used antenatally and during labour to aid fetal alignment.
This was the information I was looking for to help women in clinical practice, I questioned if this was being used. Movement doesn’t have to have an outcome according to some of this literature but it is what women do spontaneously. But I questioned why this knowledge is absent from guidelines and good practice within many hospital labour wards.
Knowledge of physiology is deemed as expert opinion and therefore of low quality. Physiology is the basis for most midwifery knowledge. How can an understanding of how the body works, and using that knowledge be ‘low quality’ evidence? Does this mean that midwifery knowledge is not as worthy as RCT’s, systematic reviews, meta- analysis? Knowledge that is gained from working with women, observing birth and the moves that women make, knowledge of the physiology of birth which few obstetricians learn.
Midwives and women
I have now collected the data for my research from midwives and women and I am in the process of transcribing and analysing. I am beginning to identify how the midwives in the study gain knowledge around movement during birth and what barriers there are to implementing this knowledge.
From the data gained from the women I have interviewed I am finding how women gain knowledge around movement during birth. Unsurprisingly, despite the huge amount of information available to women, midwives continue to be the main source of knowledge.
The 3rd year; the end is insight
I am loving my PhD journey, I love to study and I am really grateful that I have the opportunity to teach within the midwifery department. The biggest struggles for me have been the diminished contact with the outside world whilst cocooned in the library and the financial pressure going back to full time study has meant. But as 2016 emerges, so do my hopes and expectations for the fruition of my research, study, self-development and new opportunities this course has given me.
School of Nursing, Midwifery, and Social Work & Social Sciences, University of Salford.