Epistemology is the branch of metaphysics that deals “with ways of knowing and learning about the social world by asking questions such as how can we know about
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reality and what is the basis of our knowledge?” (Snape & Spencer, 2003, p.13). As a researcher, I believe that the knowledge that we create is influenced by the culture and society that we come to know. It is the social processes that individuals participate in through a form of society, be that a hospital or in a home, that influences the creation of knowledge and culture. In Chapter Two, I discussed CS and VBAC and the perceptions around these forms of birth in the maternity world. Arguably, understandings of these forms of birth are influenced in some way by society and the interactions that women have with clinicians and therefore, the experiences that these women have with clinicians are being influenced by a certain type of knowledge creation that, in part, is both a societal and cultural issue.
In keeping with the epistemological stance that informed the research paradigm for this study, it is the theory of social constructionism that underpins my methodology. Social constructionism is a branch of philosophy that focuses on meaning and power.
Constructionism believes that meaning is not a property of objects and events
themselves, but a construction of them. As Berger & Luckmann (1966) demonstrate, constructionism and knowledge pertains to the concepts that all individuals in society engage in knowledge production and the analysis of the social construction of reality. Constructionism can be defined as
“knowledge and truth as created not discovered by the mind (Schwandt 2003) and supports the view that being a realist is not inconsistent with being a constructionist. One can believe that concepts are constructed rather than discovered yet maintain that they correspond to something real in the world” (Andrews, 2012, p.40).
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Meaning is a product of the prevailing cultural frame of social, linguistic and symbolic practices that occur in a society; “The goings-on between people in the course of their everyday lives are seen as the practices during which our shared versions of knowledge are constructed” (Burr, 2015, p.3). These social processes and interactions in which people are constantly engaged are the product of different types of knowledge, which are constructed through subjective observations of our world. Social constructionism places the emphasis and construction of knowledge on the everyday interactions
between people and the language that people use as a form of social action. This type of theorising is largely related to G. H. Mead (1863-1931) and his theory of social
interactionism.
Mead believed that we are not born with the ability to engage in symbolic
communication and self-reflexivity but rather we learn and develop these capacities as children. He uses the term “socialisation” to refer to the process by which we learn what it means to be an adult human being in society. It is in these interactions with others, through the sharing of language, that we can anticipate the meanings other selves will attribute to our attempts at communicative actions. Through this, he sees every person as a social construction. As Crotty (1998) demonstrates: “Mead‟s social behaviourism embodies a thoroughly social point of view. In the Meadian analysis, human behaviour is social in origin, shaped by social forces, and permeated by the social even in its biological and physical aspects” (Crotty, 1998, p.62). Therefore, situations are not pre- defined, rather we creatively define reality and knowledge through interactions in particular situations.
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Social constructionism is thus suited to my ethnography as it allowed me to explore the generation of knowledge and the socialisation of the actors in the study (women and clinicians) through the interactions they have with each other and with the OptiBIRTH intervention. It allowed for greater insight into the reasons for their actions and
interactions through the examination of the language they use and how their knowledge of VBAC and CS is shaped during the trial. It also let me explore the social dependence of actors in the field-site and to see if they influenced each other‟s decisions and the knowledge informing those decisions. Social constructionism helped me to explore the acts of social practice that I observed as the main focus of enquiry for this ethnography. It also helped me investigate the knowledge construction behind these practices to explore if they changed over the course of the intervention when it came to making a decision about subsequent mode of birth after a previous CS.
With the social constructionist view, I can attempt to understand the experiences, values, beliefs, and perceptions that the women and clinicians have on mode of birth after CS and if their interactions with the OptiBIRTH intervention aided them in
constructing a new belief or perception of birth after CS. This meant that I could look at the meanings the participants constructed around information that they received through OptiBIRTH and knowledge integration in their interactions with each other. The social constructionist viewpoint allowed me, as the researcher, to emphasise the development of shared meanings of the OptiBIRTH intervention through the social processes
involving language and how the participants interacted with each other when it came to decision-making for mode of birth after CS.
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3.5
Ontology and Realism
Ontology is the branch of philosophy that concerns itself with the nature of being and reality. This philosophical stance deals with “the study of being. It is concerned with what kind of world we are investigating, the nature of existence, with the structure of reality as such” (Crotty, 1998, p.10). With these ontological assumptions we try to respond to the questions “„what is there that can be known?‟ or „what is the nature of reality?‟” (Guba & Lincoln, 1989, p.83).
With regards to the relationship that these ontological assumptions have with social constructionism, Guba & Lincoln (1994), believe that they have a relativist
amalgamation. This suggests that there are multiple realities that are socially based and shared amongst individuals and cultures. The constructions that are produced by individuals are alterable with the realities that they are associated with. This
constructionist relativism suggests that there are multiple yet conflicting social realities that are produced by humans that are changeable as humans become more informed and intelligent (Guba & Lincoln, 1994). Even with this, there are many forms that the ontological position could take, from critical realism associated with post-positivism to relativism that has been described above. Frazer & Lacey argue that
“even if one is a realist at the ontological level, one could be an epistemological interpretivist . . . our knowledge of the real world is inevitably interpretive and provisional rather than straightforwardly representational” (1993, p. 182).
Though epistemology and ontology give two contrasting philosophies of the social world, there can be an integration of both assumptions with Campbell (2002) suggesting
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that researchers can believe that the ideologies of ontology can play a valuable role in the construction of knowledge (Maxwell, 2012). Crotty (1998) believes that
epistemology and ontology are mutually dependent on each other and “to talk about the construction of meaning (epistemology) is to talk about the construction of a
meaningful reality (ontology)” (p.10).
Hammersley (1992) proposed that „subtle realism‟ can bridge the gap between
epistemology and ontology. He suggested that subtle realism can help us to accept that the social world can be independent of an individual‟s understanding but that this subjective understanding is only accessible through interpretation, from both the
individual and the researcher. He brings to light questions of validity and relevance that the ethnographer must consider. In terms of the validity question, Hammersley (1992) contests that instead of having to choose between naïve realism and relativism, subtle realism allows the ethnographer‟s representation and point of view to explore features of phenomena that can be seen as both valid and irrelevant. If we, as researchers, took the concept of realism at a first glance, we would be at odds with the theory surrounding the ethnographic approach: understanding the perspectives of culture and society. Realism sees beliefs and values as a product of reality and does not take into account interpretation or representation. „Subtle‟ realism alleviates this situation. It lets us realise that while we are allowed to investigate independent phenomena, we must “rely on cultural assumptions and reject(s) the idea that knowledge must be defined as beliefs whose validity is known with certainty” (Hammersley, 1992, p.52).
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A constructionist epistemology and ontology places “priority on the phenomena of study and seeing both data and analysis as created from shared experiences and
relationships with participants and other sources” (Charmaz, 2006, p.330). With this in mind and using the ethnographic approach, this study is capable of understanding women‟s and clinicians‟ beliefs on different methods of birth after a CS, instead of judging their actions, and also documenting different positions and perspectives when exploring the culture surrounding the OptiBIRTH intervention within the setting of the field-site. The participant experience and their interpretation of the knowledge that they are provided with are crucial for understanding the significance the OptiBIRTH study could have not only for the individual participants, but also for the field-site society.