Search

The aim of this study was to use the grounded theory method to discover the main concerns of midwives in relation to their practice with baby feeding, and to identify the processes that are involved in dealing with baby feeding in their day-to-day work. Data were generated from thirty in-depth interviews with midwives who worked in two maternity care Trusts in the North of England. Data were analysed using constant comparative techniques of the grounded theory method. A computer software program (Non-numerical Unstructured Data Indexing Searching and Theorising package) for qualitative data analysis was used to manage and store the analysis. The grounded theory that emerged suggests that baby feeding was not an easy part of these midwives’ work. These midwives were finding ways of dealing with the pressures that were around them, and which they felt, were affecting their practice. Examples of these pressures include the environment where feeding took place, the support and contributions of those around the woman and baby (particularly other midwives), and the beliefs and behaviour of the woman and baby themselves. ‘Surviving’ enabled midwives to feel that they had dealt with baby feeding in their practice and successfully managed their workload. Surviving consists of four main categories: altering proximities of baby feeding, emotionalising baby feeding, struggling with baby feeding, and directing baby feeding. Surviving is not a linear process that is sequential, but cyclical as these categories are inter-related to each other. However, these midwives’ actions created many of the problems that they experienced, therefore the process was perpetuated. The significance of this substantive theory has been explored within the literature related to baby feeding, workers’ functioning in other public service bureaucracies, and research methodology. Implications for midwifery research, practice and policy are discussed. It is suggested that this thesis could contribute to wider health service agendas such as clinical governance, multi-disciplinary working and public health.

Background: In Oman, 33.3% of women attended late for publicly funded antenatal care in 2015 and 24% did not attend for the recommended 4-6 visits during their pregnancy. This low attendance suggests a need to explore attendance for antenatal care for low-risk pregnant women in Oman. Methodology: An exploratory qualitative design informed by constructivist grounded theory methodology was used in this research. Methods: In-depth semi-structured interviews were conducted with an initial purposive sample of nine pregnant women. The initial analysis enabled theoretical sampling of thirteen non-participant observations during women's appointments, interviews with ten care providers, and six women who booked late after 12 weeks of gestation. A constructivist grounded theory analytical framework of initial, focused and theoretical coding was followed to analyse all the data collected. Findings: The core category consists of five interrelated sub-categories: perceived benefits and value of antenatal care; timing of the first antenatal visit; woman-carer interactions during antenatal care; experiences with antenatal care delivery; and supplementary use of private healthcare. The integral categories explain the social processes and issues surrounding antenatal care. The emergent core category, Navigating antenatal care, reflects the views of the women and their care providers. The women were unhappy with the organisation and physical environment of care but attended their appointments to ensure optimal pregnancy outcome and to alleviate their fears of developing complications. Thus, they used both private and public healthcare and sourced online information in response to their feelings of obligation to protect their fetus. Conclusion: The women appeared disempowered and to lack control over the care they received. Thus, they accepted conditions such as long waiting times in an uncomfortable environment and the disrespect they encountered during their visits. There was a discrepancy between what the women expected and needed from their antenatal care and the actual care and information they received, which did not satisfy their needs. This could be due to a lack of woman-centred care and limited involvement in the plan of care. Thus, women sought further reassurance by accessing private clinics, using online information, and networking with others, which also resulted in a late booking for public antenatal care.