DATA GENERATION AND ANALYSIS
This chapter outlines the operational details of the research beginning with
recruitment, following with data collection and data preparation, and concluding with the methods used for interpreting the data.
Data Collection Recruitment
As discussed in Chapter 3, much of the research on the topic of childbirth-related distress excludes many participants whose life experiences may contribute to distress. Thus, it was important for me to have broad inclusion criteria in my recruitment. I recruited participants who had given birth within the last year, were at least 16 years of age at the time of conception, spoke English, and were able to provide their own consent. This time frame allowed participants to reflect on their recent experiences with relatively fresh recollections, while permitting comparisons to be made between narratives
occurring within a specific time frame. As the focus of the project was not the
people/participants, but the experience of distress in childbirth, purposive selection was used to seek out participants who could provide details of a variety of experiences in childbirth15 (Polkinghorne, 2005). While the criteria for inclusion in this study was that the participant had given birth in the last year, once they began telling their stories many women included previous pregnancy and birth experiences as well. A feminist narrative
15 The recruitment methods used were not specific to feminist narrative inquiry and analysis, but are common methods for finding participants for various qualitative approaches (Polkinghorne, 2005).
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approach minimizes the constraints placed on the stories the participants choose to tell as the participants are trusted to decide for themselves what is important to be included or excluded from the interview (Barbour, 2008; Hydén, 2013; Riessman, 2002; Squire, 2013). Thus these stories are also included in the data and analysis.
I sought out various experiences across social locations, as well as various types of birth (types of birth includes such conditions as hospital birth, home birth, midwife assisted, physician assisted, vaginal, caesarean, and other factors that affect the birth experience). As I wanted to obtain in-depth stories about each person’s childbirth
experience, it was important that I recruited participants who were comfortable engaging in in-depth conversational processes and who were motivated and interested in the project (Hole, 2004).
I began with recruitment through one particular family resource centre and then expanded recruitment sites to broaden representation among participants with no
expectation that my sample would be representative of the population individuals birthing in Atlantic Canada. Participants were recruited from various sites including community organizations such as health care services, family resource centres, and doula
organizations; community groups representing specific racial and ethnic communities, including four agencies that provide services to Indigenous women; local informal parent and infant play groups; and through word of mouth referrals among participants and among those who became aware of my research through other means. Representatives from these organizations (and those who made informal word of mouth referrals) were given an “Invitation to Participate” letter regarding the project that included my contact information (Appendix B). Personnel at the partnering agencies provided this information
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to all potential participants. Potential participants were then able to contact me directly regarding their interest in becoming involved as participants in this project. The staff at partner organizations did not know who may or may not have decided to participate unless the participants themselves disclosed this information. I also attended several gatherings of potential participants (such as a new parents group) in order to describe this study and answer questions of potential participants. When I attended these gatherings I left behind the Invitation to Participate letter so that individuals could contact me directly.
Participants were provided with my cell phone number, which was password protected and had password protected voice mail, as well as my email addresses. My cell phone had an answering message asking potential participants to leave their contact information and a convenient time for me to contact them. I returned potential participants calls and responses to email inquiries. I provided a brief overview of the research via email (Appendix D), which I asked the potential participant to review. I then called back or emailed within a few days to see if they remained interested in the
research. One potential participant decided she did not meet the criteria of the study and two potential participants did not respond to my follow up email. All other potential participants who were contacted continued to express interest, and so a mutually agreed upon time and location was arranged for the interviews.
Fifteen people participated this study. This number of participants allowed for a balance between a number of participants that was neither too large nor too small. The selection represented a diversity of experiences and allowed a thick and rich exploration of various influences on childbirth experiences, while at the same time it was small enough for detailed microanalysis required in narrative approaches, and accommodated
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the pragmatic considerations of the research (such as time, expense, and travel) (Creswell, Hanson, Plano, & Morales, 2007; Polkinghorne, 2005; Riessman, 2002; Sandelowski, 1995; Squire, 2013).
Organizational Consent
Ethics approval was obtained through the Memorial University Interdisciplinary Committee on Ethics in Human Research (ICEHR). The ICEHR process required that I obtain specific and additional ethics approval from any agency that required its own ethics approval in order to take part in research with their organization (Memorial University of Newfoundland [MUN], 2015). Thus I also sought and received approval from the Nova Scotia Health Authority Research Ethics Board (in order to partner with Nova Scotia Health for recruitment). Additionally I sought and received informal
approval of the directors and/or organizers from the other agencies and organizations who were involved in recruitment.
Participant Informed Consent
During the face-to-face interviews, prior to the commencement of the interview, and before the turning on the audio recorder, I once again explained the intent and expectations of the project to the potential participants. At that time they were reminded that participation was voluntary and confidential. All participants had read Information Letter previously sent to them. I read aloud the Informed Consent Form (Appendix E) and answered all participants’ questions.
Privacy and Confidentiality
Discussions regarding privacy were part of the consent process. Steps were taken to ensure that the privacy and confidentiality of participants was maximized through
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secure data storage, use of pseudonyms, changing or excluding potentially identifying data, and meeting with participants in locations which were private, such as their own home (Josselson, 2007). Legal limits to confidentiality were also discussed at the outset of the interviews, such as my status as a mandated reporter of suspected abuse of children, and my commitment to take steps to ensure safety of anyone who may be expressing intention of lethal self-injury (Josselson, 2007).
Interviews
Interviews were carried out in the participant’s home with the following exceptions: one participant wanted to meet at her local family resources centre where private space was provided, one participant met at my home, another met at her workplace in a private office, and one participant met with me at my workplace in my private office as she had requested. When we met at participants’ homes there were either no other adults or older children present or we met in a room apart from others who were home. Due to the nature of the topic, participants’ babies were often with them during the interviews, either nursing, eating, napping, or quietly playing while the interview
unfolded. Interruptions to address the babies’ needs were frequent, and the recorder was left running through these interruptions. Participants continued to tell their stories while attending to their babies. Each interview was recorded and transcribed. All participants chose a unique pseudonym for me to use in representing their interviews.
Interviews and their resultant transcripts served as the data for this research study. In this feminist narrative research the questions asked and the direction of the narratives were left open, with the goal of discovery and to allow unanticipated topics and
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Hydén, 2013; Riessman, 2002; Squire, 2013).16 However, in order to support a reasonable level of focus during the interviews, I made use of a self-created interview guide
(Appendix F) which was used to investigate what messages and assumptions people had entering childbirth; to understand what these messages and assumptions reflected about dominant understandings of childbirth; to explore how participants’ own experiences agreed with and challenged these assumptions; as well as to elicit what subjugated knowledges participants expressed and saw as important additions to knowledge about childbirth (Arvay, 2003).
Each interview began with the prompt, “Please tell me your birth story” and follow-up questions were used (if the topic did not emerge unprompted) to probe for further detail and deeper understanding. For example, the following prompts and questions were often used to explore ideas that were raised or were absent in the participants’ childbirth stories:
What was giving birth like for you—consider physical, emotional, social, spiritual aspects of childbirth?
How was childbirth like you expected? How was childbirth different than you expected it to be?
Describe some of your family traditions, cultural traditions, and/or religious beliefs about birth and how they influenced your expectations.
In what ways, if any, did you feel good, positive, or satisfied about your birth
16 Very specific, predetermined questions run the risk of closing off areas of inquiry that may emerge, as the researcher may become more focused on answering her question rather than discovering a subjective truth (Barbour, 2008).
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experience? In what ways, if any, did you feel poorly, negatively, or distressed by your birth experience?
Do you have any advice or messages you would give to those who are going to experience labour and delivery?
The interviews also served as the beginning of analysis (Riessman & Quinney, 2005). In the feminist narrative approach, interviewing is about more than asking
questions and gathering information. It requires the researcher to be aware and conscious of her role in the construction of the narrative as all narratives are seen as co-
constructions where the shape and content of the narrative involves the teller, the listener, and the interaction between the two (Clandinin, 2013; Clandinin & Connelly, 2000; Davis, 2002; Guba & Lincoln, 2004; Hole, 2004; Huisman, 2008; Hydén, 2013; Pinnegar & Daynes, 2007; Riessman, 2008; Riessman & Quinney, 2005; Squire, 2013). Thus, telling and hearing the story was the first step in the co-construction and interpretation of the narrative.
Feminist narrative researchers believe that storytelling is a process of co- construction, where stories are woven within the interaction of telling, listening, and conversation, rather than a representation of truth through the recounting of a specific time or event (Hydén, 2013; Patterson, 2013; Pinnegar & Daynes, 2007) and it is essential to be aware that the researcher, to a large extent, structures the interview. There is a risk that the researcher will structure the interview in such a way as to have the participants tell a particular story and so a commitment to reflexivity as a researcher was also essential. I have chosen to discuss my process as one of reflexivity rather than using the common qualitative terminology and process of bracketing.
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While the idea of bracketing originated within phenomenology, where researchers were called upon to put aside and look beyond their preconceived notions, it has more recently become a term open to various interpretations and applications across a variety of qualitative methodologies17 (Tufford & Newman, 2012). One of the controversies regarding bracketing is premised on the question of whether researchers can ever truly set aside their own preconceptions (Tufford & Newman, 2012) and this is a premise for which I too have some skepticism. Thus, I feel it is more in line with my own ideas of subjectivity and bias to be clear in my research that I have reflected deeply and frequently on the research process—to question how I might be influencing the interviews (not to deny that I have an influence) and to do my best to be fair in my analysis—without leading the reader to believe that I have removed myself from the research process. This reflexive stance is in line with the feminist narrative methodology that views stories as co-constructions of events and understandings, rather than as one-sided tellings of events (H. Fraser, 2004; Riessman, 2008).
In keeping this reflexive stance, I needed to be aware of my own assumptions, values, beliefs, and experiences and be mindful of how my own history and interests might influence the questions I asked and how I interpreted the responses (Burck, 2005; Tufford & Newman, 2012). Thus, how I asked questions, listened for responses, and interacted with the participants was of central importance (Burck, 2005; Polkinghorne,
17 This includes disagreement regarding what bracketing should include (beliefs, values, assumptions), when bracketing should occur (before interacting with participants, during the interview and/or analysis phases), who is included in the bracketing (researcher, participant, or both), and the methods of bracketing (memo writing, interviews with colleagues, reflexive journaling) (Tufford & Newman, 2012).
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2007). One way I reduced the shaping as the researcher, was to ask probing questions that searched for deeper meanings behind words that might have reflected taken-for-granted ideas and prevailing theories (K. Anderson et al., 2004; Brown, 2012) rather than seeking a particular truth (Burck, 2005), or assuming an understanding that fit with my own experience. For example, ideas about being “hormonal” or “too emotional”, and the phrase “power struggles” were ideas and concepts that entered into various participants’ telling of their stories, and that I explored in greater depth during the interviews.
Additionally, if I wanted to explore a topic raised by the participant that may have touched on some preconceived ideas I had (either through my own experience, reading, or interviews with the participants) I would preface the question with a disclosure regarding why I was following up. For example, at times I would say, “this is an idea that keeps coming up with other women (or in the childbirth literature) and I’m wondering what you have to say about this idea.” Similarly, if a topic was of particular interest to me, given my own philosophical and theoretical position, I would make this overt as well, before asking follow-up questions. Both silence and questions act to shape what is discussed in the interview. No decision is neutral and so I chose to act on the principle of transparency and reflexivity with the participants and in the analysis.
Emotion and curiosity work together in the co-construction of narratives.
Accordingly the listening should occur not only on a cognitive level, but on an emotional level as well. Thus, I attended to my own internal emotional experience and my thoughts about what the participants were saying during the interviews (Davis, 2002; H. Fraser, 2004; Harrison, MacGibbon, & Morton, 2001; Hole, 2004; Josselson, 2007). The
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as important sources of embodied knowledge which pointed to areas of information and possible future conversation and analysis (K. Anderson et al., 2004; Bold, 2012; H. Fraser, 2004). It was important that I paid attention to not only what happened in the narrative, but also to how the participants felt about it—what emotions they experienced at a particular time, and the emotions that were elicited in the telling (K. Anderson et al., 2004).
In addition to paying attention to what participants said, it was also important that I paid attention to what participants did not say—what they left out, or expressed
difficulty articulating (Alvesson & Sköldberg, 2009; Best, 2003; Brown, 2012; Hydén, 2013; Squire, 2013). Participants’ questions such as, “You know what I mean?”
frequently occurred, and I treated these not only as seeking validation of understanding, but also as a signal of things that were difficult to articulate due to the inability of
language to reflect subtleties of experiences (Devault, 1990). Hesitations and confirming questions also served as a sign that what was being said was important—the fact that participants made the concerted effort to ensure understanding meant something important was being communicated (Best, 2003).
Field notes and a journal were kept during all stages of the research project. In this journal I made notes during the interview, as I was listening to participants’ stories, noting ideas and statements for further discussion. Often times, sometimes quite some time after the interview, I would think of how a particular idea or moment in the
interview was linked to the existing literature on childbirth (either agreeing or contesting it), linked to other participants’ experiences (again through both similarities and
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these moments of insight in the field journal and referred back to them frequently during the interview and analysis phase of the research. These journal notes and reflections also informed my analysis and the findings of this research.
Preparing the Data for Analysis Transcripts and Member Checking
Interview recordings were given to a hired transcriber who transferred the interviews from an audio file into a word processing document. These new documents were returned to me as unedited, unformatted text, consisting of large blocks of text with only basic punctuation. I proceeded to edit these documents in order to create the final transcripts.
Transcribing is in itself a form of interpretation as the researcher makes decisions about what to select and omit from the transcript, and this is also the point where the researcher may start to notice themes emerging or ideas becoming clearer (H. Fraser, 2004; Hole, 2004; McCance et al., 2001; Polkinghorne, 2005; Riessman, 2002, 2013; C. P. Smith, 2000). Transcription includes not only what is spoken, but also how it is spoken (for example, using italics to indicate emphasis, and including symbols representing pauses and breaks in conversation)(Hole, 2004). Therefore, due to the importance of the nuances of the interview that may be included or excluded based on the decisions of the researcher, I worked to refine the transcriptions by editing the transcripts while listening to the original interviews, and made the final decision regarding what to include and exclude from the transcript. At this stage attention was paid to the nuances of the
narrative, including paraverbal utterances and sounds, pauses, and incomplete sentences (H. Fraser, 2004; Riessman, 2002, 2013).
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The transcript was formatted to reflect the flow of speech, where each phrase or clause was given its own line, so that the final transcript looked more like a poem rather than prose (H. Fraser, 2004; Riessman, 2013). Sentences did not always end neatly, instead often merging into new ideas. The punctuation I used in the final transcripts reflects this manner of speaking, where it might seem as if a period is missing, but to add a period (or other grammatically correct punctuation) would not reflect the style of speech the participant demonstrated. At this stage, any names that were included in the
interviews were removed and replaced with the participants’ chosen pseudonyms or with generic titles (for example, husbands’ names were replaced with [husband]).
Participants were offered the opportunity to assess the accuracy of the
transcriptions and provide feedback (Borland, 2004; H. Fraser, 2004; Polkinghorne, 2007; Riessman, 2002). Seven participants provided feedback on the transcripts, and the
remaining eight did not respond to my offer. The feedback provided indicated that the participants were satisfied with the decisions made during the transcription process as no significant changes were requested. Any minor changes requested by the participants were incorporated in my endeavor to have the written narratives reflect the stories the participants desired to tell. The participants who did not provide feedback on the