Nucleobase Directors

discussion of sensitive topics, painful memories being stirred, disclosure of personal information, or other class members voicing strong or unwelcome opinions.

Risk of psychological discomfort or uncertainty is a ‘normal everyday’ risk in NCT classes, since discussion on sensitive topics is planned with the aim of increasing parents’ confidence and ability to make informed decisions by exploring personal values and beliefs within a safe group. NCT teachers routinely discuss difficult issues both antenatally and postnatally with individual parents in their classes. The skill and training of NCT teachers is to maximise benefits from such discussions whilst minimising risks of negative consequences. NCT teachers are trained to manage difficult and sensitive topics with both individuals and groups of parents. All the teachers were experienced in facilitating NCT classes and supporting the parents who attend them.

There is conflicting evidence on the effects of formal debriefing by health professionals (Selkirk et al., 2006; Phillips, 2003; Gamble et al., 2002) and its use is not recommended as part of standard care. However, the National Collaborating Centre for Primary Care (NCCPC) guidelines advise that a ‘listening visit intervention may reduce emotional distress’ (NCCPC, 2006). In addition, the NICE guidelines for Post-Traumatic Stress Disorder (PTSD) state that ‘support delivered in an empathetic manner is important in promoting recovery’ (Gaskell, 2005). The present study did not involve formal debriefing but, where necessary, the researcher used active listening skills to offer validation and witnessing of the women’s experience (Stern et al., 1998).

Difficult discussions were perhaps less likely to take place in NCT YfP classes than a traditional NCT couples class as there is less emphasis on discussion and more on physical preparation for birth. The aim of the videoing was to increase knowledge of

the purpose and content of YfP classes and there was no reason to expect upsetting discussions to take place. However, it was possible to predict that some women would choose to attend YfP classes having had a previously distressing experience of pregnancy, labour or birth and would want to talk about this experience during the class. Any increased risk would be due to the class being videoed, resulting in women wishing they had not disclosed sensitive information where it was being recorded and potentially stored. No sensitive issues were apparent in the videoed classes, but if they had occurred, the following strategy had been written as part of the ethics approval process:

 Emphasise at the outset that the videoing/interview is voluntary and participants may withdraw at any time

 If a participant becomes distressed, offer to take a break or stop the videoing/interview altogether

 During interviews, offer the possibility of having a friend or relative present

 Use active listening skills (unconditional positive regard, reflecting back, giving time and affirming statements, eye contact) whilst listening to the individual’s story

 Provide signposting as appropriate

 If the researcher is concerned about a participant, she will first discuss with the DoS, then recommend the participant contact her General Practitioner (GP) or midwife, or explore the possibility of contacting the participant's GP

on their behalf. If necessary, she will discuss the incident with NCT’s safeguarding lead.

During interviews with the women, particular care was taken where there were instances of strongly expressed opinions, personal disclosure or where participants had distinctive characteristics such as an unusual background or personal history. It was recognised that this was important in the study as participant numbers were small so identification more likely.

The researcher has over 20 years’ experience of facilitating antenatal groups and supporting parents. She has had specialist training in supervision, qualitative research interview methods and birth crisis counselling. She also worked regularly with a bereavement counsellor to train health professionals in supporting parents through loss. The researcher was aware of the potential for intrusion and the sensitivity with which the subject of previous traumatic birth experiences or current pregnancy anxieties needs to be handled and was capable of signposting where necessary.

Sensitive topics did arise in the interviews. Examples of these were women who had experienced close family bereavements which affected their feelings about their pregnancy and birth, previous miscarriages, and women who had negative feelings about previous births or very high anxiety about the imminent birth. In these cases, as soon as practically possible, the woman was asked if she would like the audio device switched off and the data deleted. In every instance the woman said she was happy for her words to be included as they may help other women in the future. In one case, the researcher took the decision to turn off the recording device while the woman spoke

as she felt the woman’s wellbeing might be affected by continuing. When it was possible to confirm, the woman asked for the recording to be restarted. Feminist literature (Reinharz & Davidman, 1992) explores the ‘closeness/distance’ dilemma, contrasting interviewers who aim for a nurturing relationship with participants versus those who maintain a ‘respectful distance’. The approach taken in the present study is explored further in the reflexivity chapter fourteen.

5. Risk that data analysis and reporting would be compromised by the researcher’s