3.3.1.1 Setting the boundaries
In this research identifying the ‘case’ means to define the ‘unit of analysis’ (Yin 2003; Miles and Huberman 1994) and is not referring to the case study method. This is one of the most important stages of the research design as it portrays what is to be analysed in the study. Without it, the everyday life being
investigated would have boundaries of observation and analysis almost endless (Coffey 1999). The literature review exposed conceptual and geographical boundaries resulting in more than one case of interest. The conceptual
boundary of the cases reflecting midwifery one-to-one support in labour included a labouring woman who was under midwife-led care and being supported by a midwife; began in established labour (DH 2004; NICE 2014) and ended one hour after the birth (Rosen 2004). This conceptual boundary was expected in all birth environments to enable a comparative analysis of all geographical sites.
A definition regarding midwifery presence was not used within the description of the conceptual boundary as there are variations in the literature (Gagnon et al. 1997; DH 2004; Hodnett 2002; Hodnett et al. 2013) and part of the research aimed to investigate how NHS organisations translated this concept into practice. It was acknowledged that birthing partners and other health professionals would enter the birth environment, but the focus remained with the experiences and perceptions of midwives and women. At the broadest level the geographical boundary was confined to the UK. The literature review identified three
geographical sites in which the concept of midwifery one-to-one support in labour took place:
92 1. Case one: Ten labouring women each receiving one-to-one support
by a midwife in a labour room within an alongside midwife-led unit 2. Case two: Ten labouring women each receiving one-to-one support
by a midwife at home
3. Case three: Ten labouring women each receiving one-to-one support by a midwife in a labour room within a freestanding midwife- led unit
The boundaries did not end here. Although the second and third cases were not geographically within a NHS hospital, the midwives were affiliated with a NHS organisation. This meant that in the event of a deviation from the normal physiology of labour or an emergency occurred during labour or following birth, the woman was transferred to the consultant-led obstetric unit within a NHS organisation. When planning the research strategy it was envisaged that resources such as the allocated budget, staffing and equipment for all three cases would be influenced by the associated NHS organisation which may impact on midwifery one-to-one support in labour.
3.3.1.2 Multiple case study sites
Once the boundaries of the cases had been determined I referred to them as case study sites one, two and three to reinforce a geographical connection. Using more than one case study site provided the opportunity to achieve a broader knowledge of the complexities concerning midwifery one-to-one support in labour and an ability to compare the culture and activities across the three geographical sites (Marcus 1995; Falzon 2009). It has been suggested that social phenomena cannot be defined when focusing on one site (Marcus 1995). This argument was applicable to this study as the findings will later show in this thesis how the activities inside the birth environment were very similar at all three case study sites, the differences were more apparent outside the birth
environment.
3.3.1.3 Deciding how many labour observations make a case
Calculating the number of labour observations required was difficult as there is limited guidance regarding sample sizes in qualitative research. Marshall et al. (2013) reinforced the latter point in their research which found that out of eighty- three qualitative studies, none cited qualitative methodologies regarding
93 appropriate sample size. Such difficulty arises due to flexibility being advised concerning sample sizes for qualitative studies, since the aim is to reach a point when new categories, themes and explanations stop emerging from the data which means data saturation is accomplished (Marshall 1996). Morse (1994:225) has published guidance concerning sample sizes in relation to interviews and recommended 30-50 interviews when using ethnography. Morse (2000) has also recommended that these numbers are dependent on the quality of the data collected resulting in the amount of data that is usable for the research. The greater the amount of useable data, the less research participants required.
In this study it was thought during the planning stage that as the data produced from the interviews was focused on labour observations, the quality of usable data should be high. This meant that the number of observations had an impact on the numbers of interviews so this had to be taken into consideration. The calculation of the sample size was also based upon what I believed was achievable within the timing of the research protocol, and to accomplish comparative analysis and data saturation. During the fieldwork the amount of labour observations could be reduced if required. However there was not the same flexibility to increase the labour observations as permission from the ethics committee, NHS Research and Development departments representing the NHS organisations and heads of midwifery (HOM) and Consultant midwife would have had to be achieved. The final decision was made to include ten labours
observations for each of the three case study sites which meant that
approximately thirty interviews involving midwives, and thirty interviews involving women were anticipated. This estimation was accurate in hindsight.