Preparation for entering the field coincided with the actions of WP2 as detailed in Table 2 (section 2.8) I had the opportunity to attend and observe focus group interviews, in May 2013, that were conducted to ascertain possible barriers that prevent the promotion of VBAC, as well as the views of women and clinicians on VBAC.
This gave me the opportunity to visit my study‟s field-site, as a member of the OptiBIRTH research team rather than as an ethnographer at this time (my study was introduced at a later time when the intervention was developed), and make first contact with the hospital clinicians. By observing the focus groups, I got an initial sense of staff feelings toward VBAC, the opinions that clinical staff currently held and their thoughts on how and what OptiBIRTH should incorporate as a legitimate package of care. Although I had yet to achieve specific ethical approval for the ethnography (I was covered to attend the focus groups as a member of the OptiBIRTH team under Trinity College ethical approval), and locate a gatekeeper for my study, attending the focus groups gave me a real flavour of the clinical atmosphere and where VBAC was situated in it.
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Around the same time as the focus groups, I was applying for ethical approval for my ethnography from TCD. The Committee, with my first application, raised some concerns related to observations in the antenatal clinic and informed consent in the field-site and the fact that I was not a healthcare professional. After discussing the concerns with my supervisors, I made an amendment to my study design whereby women would now be informed of my presence and the ethnography in the overall main trial OptiBIRTH information leaflet that they received when they first booked for maternity care at the field-site and prior to consenting to participate in the OptiBIRTH study. Following this, I would only observe interactions between women who had consented to and were participating in OptiBIRTH, and their clinicians. Information pertaining to myself, including that I am not a healthcare professional and the reason for and design of the embedded ethnography were detailed in booklets that I had created specifically for the ethnography. Furthermore, details of observing (as part of the ethnography) were added to the consent form (tick-box format) and highlighted in red writing. This ensured that women who were consenting to OptiBIRTH in this site would also be aware that a researcher would be present in the field-site observing as part of the study (see Appendix 5 for consent form). Separate information and consent forms for interviews, etc, were developed and distributed at a later time (see section 4.5.1 and 4.5.2 for details). These amendments were taken back to the Faculty of Health Sciences Research Ethics Committee (REC) in TCD and formal ethical approval was granted on 8th July 2013 (see Appendix 6).
A separate ethical application was submitted to the Health Services Executive (HSE) REC for site specific ethical approval. The process for this application included visiting
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the field-site with my supervisor to meet the obstetric OL (OOL) for the intervention, who was also the obstetric clinical lead in the hospital, in July 2013. We provided him with the information on the embedded ethnography and requested that he might act as the clinical sponsor for the study as was required on the ethics application. The OOL was, at this time, already aware, in brief, of the ethnography through information provided by the post-doctoral researcher for OptiBIRTH. Following my supervisor and myself providing further information on my study, the OOL was happy to support my study and signed the form for submitting to the Ethics Committee indicating his support.
After this meeting, I submitted the application to the HSE REC on the 27th August 2013. I was invited to attend a meeting with the REC to discuss my ethnography on the 11th September 2013. The REC, to my relief, had absolutely no concerns about the ethnography and I was granted ethical approval, without a need for amendments, on the 12th October 2013 (see Appendix 7for letter of approval).
During the time I was preparing and submitting my ethics applications, I also embarked on a period of training and knowledge gain to prepare myself for data collection, as this was my first foray into the world of ethnography and my first experience of conducting research in a hospital. In July 2013, I participated in a workshop in Queen Mary, University of London, which focused on anthropological methods in clinical practice. This gave me the opportunity to examine the field of medical anthropology and the use and practice of ethnography in this field. It also provided networking opportunities with other students similar to myself who were embarking on their studies and an
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opportunity to ask questions from people who have conducted ethnographic research in a variety of cultures and places.
In January 2014 I attended an ethnography winter school held in the University of Maynooth, which is the only Department of Anthropology in Ireland. This was also a very insightful workshop that gave me an understanding of what field-work was actually like and to listen to other people who were at the same stage as I in their research studies. The workshop further prepared me with the tools to enter the field and to generate field-notes that were both descriptive and reflexive.