Reflexivity in midwifery research: The insider/outsider debate

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Journal Article
Midwifery, 2012, 28 pp. 52 - 60
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Objective: to explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings. Background: participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of `identity and `insider knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis. Design: a qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers. Setting: two maternity units in New South Wales, Australia. Participants: participants included 40 midwives and 78 breast-feeding women. Findings: possessing `insider midwifery knowledge was advantageous in the `getting in and `fitting in phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this `insider knowledge and status. Prolonged periods of observation challenged the midwife researchers preconceived ideas and early decisions about the advantages and disadvantages of being an `insider or an `outsider in the research setting. Key conclusions: reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the `midwife observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectation.
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