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The previous section highlighted that feminist pragmatism extended the ontological and epistemological arguments of pragmatism to explicitly include issues of gender oppression. Many feminist pragmatists draw upon Dewey’s pragmatism to apply his theories to their philosophical arguments (Radin, 1990; Rooney, 1993; Seigfried, 1996; Shuford, 2010; Thayer-Bacon, 2010; McHugh, 2015). As such, Dewey’s theories of experience and inquiry are discussed in the following sub-sections.

Dewey’s theory of experience

Dewey’s (1925a) theory of experience considers experience as a philosophical concept, as ‘a notation of the inexpressible (p.325)’. This is likened to Kant’s ‘thing-in-itself’, an idea that is necessary for a coherent theory of knowledge, but that is fundamentally unrepresentable (Clandinin & Rosiek, 2007). For Dewey, experience is a changing stream that is characterised by continuous interaction of human thought with our personal, social and physical environment (Dewey, 1925a). Dewey conceptualises this

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as ‘continuity’, wherein experiences give rise to other experiences, that give rise to more experiences that influence further experiences, thus encompassing the past and the unseen future (Clandinin & Rosiek, 2007). Therefore, he views experience as ongoing and cumulative where experience requires the active participation of person to their environment. How a person engages with their environment ultimately determines the sense-making of their experiences. Therefore, Dewey (1925a) perceives experience as interactional - the result of an interaction between a person and aspects of the world (s)he lives in:

‘in an experience, things and events belonging to the world, physical and social, are transformed by the human context they enter, while the live creature is changed and

developed through intercourse with things previously external to it’ (p.251). As such, for Dewey, meaning can only be determined through their relationship to specific situations, history’s, social conditions etc. Alexander (1987) describes Dewey’s assertion as the idea that an organism (person) is already dynamically involved with the world in which it inhabits. As such, Dewey’s pragmatism treats all experience as both historically and culturally located that is open to the changing nature of circumstances (Morgan, 2014). Therefore, to inquire into ‘experience’ is to inquire into the relations between the person and environment; life, community, culture, world (Clandinin & Rosiek, 2007). When applied to my study, by inquiring into the experiences of the midwives (who self-define as facilitative of alternative birth choices) the nature of their ‘interactions’ i.e. with the women, their colleagues, wider teams, Trusts, personal histories and cultural discourses can be explored. Through such an exploration, complex and nuanced intrapersonal, interpersonal and cultural insights can be illuminated that may generate complex and multi-faceted heuristic knowledge.

Dewey’s concept of inquiry

For Dewey (1925a), experiences create meaning from bringing into contact two inseparable questions; What are the sources of our beliefs? And what are the meanings of our actions? As such, experiences are asserted to always involve interpretation (Morgan, 2014). Often, our experiences require little thought, which Dewey refers to as a ‘habit’ (Dewey, 1882). However, when self-conscious attention

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(reflection) is brought to an experience, Dewey refers to this as ‘inquiry19_{’ (Dewey,}

1910). As such, Dewey’s concept of inquiry can be applied to research endeavours, where Morgan (2014) asserts that inquiry is a specific kind of experience, and research is a specific form of inquiry. Additionally, Dewey argues that experiences always have an emotional, embodied element whereby feelings provide an essential link between action and beliefs (Dewey, 1925a; Dewey, 1931). Both James (1975) and Dewey (1929) acknowledge that the start of any inquiry usually begins with a sense of discord, unrest or a feeling of something not being right. Rooney, a feminist pragmatist, (1993) expands upon Dewey’s notion of ‘qualitative thought’ (feelings) to argue that feelings indicate the presence of a dominating quality in a situation, one that calls for action. Arguably, the acknowledgement of the role of feelings and emotions is a strength of Dewey’s (and James’) pragmatism exemplifying the mind-body connection, embodied knowledge, thus dissolving traditional dichotomies (Radin, 1990). When applied to my study, this inquiry began as a feeling and embodied knowing of the challenges in which women and midwives face in order to access/deliver care that is deemed alternative. Where I have positioned myself in Chapter 1 (section 1.5), it follows that my ‘discord’ has given rise to the line of inquiry within this thesis.

4.5 Methodology

The previous sections situated this study in a feminist pragmatist theoretical positioning. This section will justify the use of narrative inquiry. In addition, I will outline an overview of the different epistemological positions of the three main narrative methodologies, through which, I will demonstrate how this research has overcome incompatibilities within the approaches. Finally, I will demonstrate an alignment between feminist pragmatism and narrative inquiry that collectively forms the theoretical and methodological basis for the study.

Finding a path- beginning with the research problem

As previously stated, feminist pragmatism opts for a methodology that will answer the research question(s), a ‘bottom up’ approach. My aims and objectives (see Chapter 1/1.4), were the result of a number of iterations, where I explored different angles of the possible research questions. During several early reflective sessions, I recognised that my research questions related primarily to capturing how midwives

19 _{It was Dewey’s concept of inquiry that was felt to be a significant shift from the philosophers} of his time- whereby, his move away from metaphysical concerns to a starting point of human experiences was thought to be a radical act (Morgan, 2007).

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facilitated women’s alternative choices. As stated in Chapter 1 (section 1.5), as a practicing midwife I knew (some) midwives working in the NHS were working this way. I also knew very little published literature had captured this. Therefore, from the outset, I was looking to capture midwives’ processes of facilitation to generate

practical knowledge that could be used as a learning tool for other midwives. In addition, I also felt that such data could not be separated from the midwives’ experience of facilitation, nor could it be separated from the sociocultural-political context of the midwives working environments. Early on I recognised that qualitative approaches were suited to meet the aims of the research, where they have the

capacity to provide rich and in-depth insights.

Prior to making a final decision on my methodological approach, two other options were considered. First, a mixed methods prospective observational cohort study to follow mother-midwife dyads throughout the childbirth continuum (from antenatal decision-making to post-birth). The study would generate qualitative insights from women and the midwives caring for them, and to record obstetric outcomes. The benefit of such a study was to capture both women’s and midwives’ ‘real time’ views of the processes and experiences and to assess the impact of such on birth outcome data. Viewing the mother-midwife within a relational dyad would generate rich holistic insights, generating specific knowledge to the mechanisms of relational care/receiving. However, the scale of such a study was far beyond a single researcher within a three-year time frame, thus excluded.

Second, as I became immersed in the literature I came to consider that the midwives’ juxtaposition between women and their employing institution as particularly

problematic. Moreover, given the dearth of literature from the perspectives of midwives, I felt that focusing upon the midwives’ perspectives would be particularly beneficial. Therefore, I decided to limit the study to midwives only. I considered a mixed method methodology using survey and interview data. I felt that a national survey (with follow up interviews) would be beneficial to capture a ‘snapshot’

(Denscombe, 1998) of NHS midwives’ views and experiences as well as rich, in-depth data. At this point, I had not refined the subgroup of midwives to gather data from and was considering recruiting midwives who had any experience of facilitating alternative births, not just those who willingly did so. However, limitations of survey designs such as the oversimplification of social reality (Pederson, 1992), questionable validity of knowledge claims (Pederson, 1992), and poor response rates (Kelley, Clark,

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Brown, & Sitzia, 2003; Cook, Dickinson, & Eccles, 2009) meant that a survey was unlikely to yield the rich data pertaining to the research questions (Kelley et al., 2003). Therefore, a mixed methods research design with surveys was excluded.

Returning to the exploratory research questions with a greater understanding of other methodologies, the study foci was decided to only include qualitative data from the midwives’ perspective. At this stage, my view of answering the research questions would entail eliciting in-depth responses from midwives by exploring a particular and specific episode of care where they facilitated a woman’s alternative birthing choices. My thinking related to attempting to get as close to a real clinical situation as possible to generate rich data. I wanted to avoid generic questions of attitudes, beliefs that pertained to midwives’ generalised perspectives as I felt this may limit the data generated. Therefore, the use of professional stories of practice was considered to meet the overall aim of the research, the initial research questions, and would be achievable to complete within a three-year period. As such, an exploration of methodologies related to collecting stories led me to consider a narrative inquiry methodology as a suitable research design.

Narrative inquiry overview

During the early conceptualisations of the empirical study, the decision to elicit professional stories of practice guided me to a narrative inquiry methodology. However, narrative as a method and narrative as a methodology are different points to consider. Whilst many qualitative research designs include data based upon stories of personal experiences, a narrative inquiry study has unique epistemological and methodological approaches that must be considered (Squire, Andrews, &

Tamboukou, 2013; Loots, Coppens, & Sermijn, 2013; Patterson, 2013). Narrative as method relates to the collection of stories during qualitative data collection, whereby the researcher may be theoretically guided by other methodologies with their

associated ontological and epistemological commitments (Dykes, 2004). However, narrative as a methodology, views narratives as knowledge devices (Squire, 2005; Fraser, 2004; Squire et al., 2013), that involve particular ontological and

epistemological commitments. Broadly, narrative methodologies agree that human beings use storying as a way of understanding ourselves, our lives, and the worlds in which we inhabit (Plummer, 2001; Bruner, 2004; Clandinin & Rosiek, 2007; Squire et al., 2013). For some, narratives are seen an essential part of being human (Ricoeur,

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1991; Bruner, 2004; Clandinin & Rosiek, 2007), a way of interpreting experiences to achieve making-sense of our lives (Ricoeur, 1991; Crossley, 2002; Bruner, 2004) Narrative methodologies encompass a broad umbrella of definitions and

understandings which can be contradictory and conflicting (Squire et al., 2013; Squire, 2013; Patterson, 2013; Loots et al., 2013)20_{. Such differences are related to ontological}

and epistemological issues, discussed in the next section. Stories typically have a beginning, middle and end or a resolution (Bamberg, 2010). This view of stories can be traced back to Aristotle (Ricoeur, 1991; Bruner, 2004), and is often associated with archetypal stories such as the hero’s tale or quest, tragedy, romantic etc. (Bruner, 2004). Broadly, stories or narratives suggest a constitutive temporality or sequencing, which is generally how stories and narratives are perceived (Squire, 2005). However, a number of narrative turns over the last century has resulted in contemporary

narrative research that has moved beyond the typical story, to a more complex and diverse view of storying (Georgakopoulou, 2006; Squire, 2013; Loots et al., 2013). Such diversity relates to whether narrators are perceived as agentic beings, where their stories offer an internal representation of their experience and are broadly seen as ‘fixed’ (Ricoeur, 1991; Crossley, 2002; Squire, 2013). Whereas others perceive narrators and the act of narration as socially constructed where the stories are cultural

representations rather than internal representations, therefore, not fixed (Sermijn, Devlieger, & Loots, 2008; Timboukou, 2010; Loots et al., 2013). Additionally, other researchers have challenged the notion that stories require sequencing, and have worked with fragmented, unfinished or partial utterings (Schneider, 2003;

Georgakopoulou, 2006). Other researchers work visually, with photos, art, sculptures which they argue can be viewed narratively (Keats, 2009; Tamboukou, 2010; Jackson, Richter, & Caine, 2013; Mattern, Jeng, He, Lyon, & Brenner, 2015). Thus, challenging the notion of the classical story structure.

Accordingly, within narrative research methodologies a number of disagreements exist that include conflicting accounts of what a story actually is, or what constitutes a story, and whether or not story and narrative mean the same thing (Andrews, Day, Squire, & Treacher, 2000; Riessman, 2002; Clandinin & Rosiek, 2007; Sermijn et al., 2008; Squire, 2013). Often, story and narrative are used interchangeably but can

20 _{There is some disagreement whether narratives and stories are the same thing (Squire, 2005;} Hyvärinen, 2008; Bamberg, 2010) however, I personally use them interchangeably.

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create confusion as many researchers deploy them differently (Andrews et al., 2000; Squire, 2005). Arguably, the creative and disruptive nature of the narrative turns has diversified the field to facilitate radical new ways of thinking and doing narrative. Conversely, the lack of shared understandings between researchers is arguably a messy and confusing endeavour (Squire, 2005), particularly for the novice narrative researcher (Daiute & Lightfoot, 2002). However, many researchers perceive stories and narratives as devices that illuminate human meaning-making and so, can be captured, understood and/or interpreted to generate knowledge (Bruner, 2004; Hyvärinen, 2008; Squire, 2013; Esin, Fathi, & Squire, 2013). Regardless of perspective, narratives are broadly perceived as a means to theoretically explore human

experiences, with stories seen as rich sources of data (Riessman, 2002; Greenhalgh & Wengraf, 2008; Squire, 2013; Esin et al., 2013; Patterson, 2013; Loots et al., 2013; Jackson et al., 2013).

Reconciling conflicts within narrative epistemologies

The previous section outlined an overview of the conflicts within narrative methodologies21_{. Such conflicts are broadly associated with the differing}

epistemological positioning of different narrative methodologies22_{. There are three}

broad narrative approaches; event, experience, and culturally-centred. Key theoretical differences between the different narrative methodologies relate to assumptions of representation, identity, agency, subjectivity, language, and the social (Squire, 2013):

‘…relating stories to events, personal identities and cultural representations are theoretically different endeavours. Analysing clauses, searching out an intertextual

hermeneutics and decoding cultural meanings are epistemologically distinct programmes.’ (Squire, 2013, p.16)

Event-centred narrative is a structural approach to examining stories that assumes a direct relationship between experience, cognition and representation (Labov, 1972;

21 _{My early reading and understanding of narrative inquiry was mostly influenced by Clandinin and}

Connelly (Connelly & Clandinin, 1990; Clandinin & Connelly, 2004; Clandinin, 2006; Clandinin & Rosiek, 2007; Connelly & Clandinin, 2006). Those early readings did not highlight the varied epistemological perspectives within narrative inquiry, for they have pioneered their own conceptualisations,

methodology and methods. It was half way through my first year that I enrolled on a postgraduate course with the University of East London with Prof Corinne Squire, Prof Molly Andrews, and Dr Cigdem Esin that I learned of these complexities. By this point, I had my research questions and was committed to them. Through successful completion of the course, I learned how to navigate the epistemological differences.

22 _{There are also many different epistemological perspectives within the three broad categories, which is}

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Patterson, 2013). Labov (1972), a sociolinguist and pioneer of event-centred narrative approaches, developed a method that that recapitulates past experiences through a series of clauses within a temporal order. Event-centred narrative views stories as an objective and external expression of a person’s past experiences, but unlike other approaches, it assumes that this expression remains relatively constant (Squire et al., 2013). Event-centred narrative is characterised by a micro-structuralist approach to analysing stories with particular attention to language itself, not just it’s content or meanings (Labov, 1972; Squire, 2005; Patterson, 2013). Labov’s (1972) work was viewed as seminal, for his approach demonstrated the sophistication and subtlety of African American English, at a time when language was the object of fierce and political debate. However, the rigid framework of an event-narrative provides a narrow

conceptualisation of what constitutes a story - one that is linear with clear boundaries of a beginning, middle and end (Patterson, 2013). This is viewed as problematic when considering complex narratives such as when the narrator jumps from past to future, back to the present again (Georgakopoulou, 2006), or in fragmented, unfinished stories (Schneider, 2003). Moreover, critics argue that the lack of attention to subjective meaning-making or sociocultural context is also problematic (Patterson, 2013; Squire, 2013).

Experience-centred narrative relates stories to personal identities and experience, that theoretically view narratives as internal representations of life experiences (Ricoeur, 1991; Riessman, 2002; Squire, 2013). Squire (2013) situates experience- centred approaches as a ‘conceptual technology’ rather than the methodological technology within the event-centred approach. An experience centred approach is largely based upon the work of Ricoeur (1991) and Bruner (2004). For Ricoeur (1991), a hermeneutist, he perceived lives to have a time-based relationship with narrative. This assumes the perspective that the sequential temporal orderings of human experience into narrative, is what makes us human (Bruner, 2004; Ricoeur, 1991). Therefore, experience-centred narrative is described as a time inflected

phenomenology which places creating and maintaining meaning at the centre of human activity (Andrews et al., 2000; Squire, 2013). Experience-centred narrative has four key perspectives; narrative is perceived as sequentially ordered, often in relation to temporality (past, present, future) (Ricoeur, 1991; Bruner, 2004; Squire, 2013); is a means for sense-making (Bruner, 2004); involves the re-presenting and reconstituting of experience whilst attending to the context of the narrator and/or the narrative

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itself (Ricoeur, 1991; Squire, 2013); and assumes that narratives represent personal (positive) transformations (Bruner, 2004; Squire, 2013). Within this approach, narrative is viewed from the lens of ‘emplotment’, where heterogeneous elements (events or incidents) come together to form a synthesised and coherent whole or plot (Ricoeur, 1991). Therefore, this narrative methodology is viewed within traditional notions of a story and employs hermeneutics as a theory and methodology for analysis (Ricoeur, 1991).

The benefits of an experience-based approach are the attendance to the meaning- making and constructions of human experience, offering unique insights to a range of human experiences (Squire, 2013). This is particularly useful in social science

research, as it can offer unique insights into otherwise marginalised or invisible groups of people (Riessman, 2002; Squire, 2005). For some, the flexibility of the approach to explore nuances within a phenomenon is advantageous (Squire, 2013). However, for some researchers, the lack of specific methodological guidelines as to how to undertake the analysis can be a disadvantage (Squire, 2013). Additional difficulties highlighted with this approach relate to a tendency to make strong, prescriptive assumptions, and risk over interpretations (Squire, 2013). Furthermore, Squire (2013) argues that tendencies to only search for, or examine the ‘good’ story can occur - wherein transformations are assumed to be present and implied to be ‘good’. Therefore, value judgements can be inferred within this approach (Andrews et al., 2000; Squire, 2013). Conceivably, some human experiences do not result in

positive transformations, and some stories are partial or fragmented (Radley & Billig, 1996; Sermijn et al., 2008; Proudfoot, 2014), which this approach may not account for. Another ‘conceptual technology’ (Squire, 2013) of narrative inquiry is the culturally- centred approach. Its approach inspired by a postmodern, poststructuralist and linguist turn, challenges the notion that narrative offers a window to the experiential world of a single subject (Loots et al., 2013; Sermijn et al., 2008). It broadly perceives traditional story characteristics as socio-cultural constructs (Sermijn et al., 2008), that may shift over time in relation to these constructs (Plummer, 2001; Tamboukou, 2015). So rather than a representation of life as in experience-centred narrative, here, narrative may be viewed as an event told in response to life (Tamboukou, 2010). It views narrative as not completely closed and as a performance within its micro- context e.g. what was said, how it was said and the audience observing the narration (Loots et al., 2013). Here, the role of the researcher is positioned within the study as

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jointly participatory, co-constructing the narration (Loots et al., 2013; Riessman, 2002). In addition, culturally-centred approaches situate narrative within a macro- context of social, cultural, political and historical discourses (Loots et al., 2013;

Plummer, 2001; Tamboukou, 2015). Notably, it holds the space for fragmented stories, disruptions and multiple ambiguities (Loots et al., 2013; Sermijn et al., 2008; Squire, 2013).

The benefits of a culturally-centred approach include that it is less prescriptive and less fixated upon temporality (Squire, 2013) whereby the perspective of human subjectivity is no longer subjected to a need for coherency and recognises the