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The paper I have decided to critique is “Why do some women choose to free birth in the UK? An interpretive phenomenological study Critical Appraisal” (Feeley and Thomson 2016).

The Critical Appraisal Skills Programme (CASP tool) will be used to carry out the critical appraisal for the qualitative study surrounding why women choose to freebirth in the UK (CASP, 2017). This tool will be used due to its validity as it ensures that studies are assessed and critically appraised in a standardised way (Baker, 2014). Evidence-based information on CASP tools from hundreds of trustworthy sources for health and social care state that the CASP tool helps to make better, quicker, evidence based decisions. Evidence search provides access to selected and authoritative evidence in health, social care and public health (NICE Evidence, 2017).

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Was there a clear statement of the aims of the research?

The goal of this research study was to identify what influenced women’s decision to freebirth in the UK. This was important because it will help maternity services to support women, improve care and understand why some women choose to freebirth. It is relevant for midwives to work with the women to restore relationships and co-create birth plans that are informed and safe. It is also important to take into consideration any previous experiences that may leave the women feeling disillusioned. Briefly, yes; there was a clear statement of the aims of the research.


Is a qualitative methodology appropriate?

Qualitative research is the development of concepts which help us to understand social phenomena in natural (rather than experimental) setting, giving due emphasis to the meanings, experiences and views of the participants (Pope & Mays, 1995). This methodology was the most appropriate for this research. It seeks to interpret the individual experiences of the participants i.e. the experiences and views of the women who decided to free birth and what influenced those choices. This method allowed the women to give their view informally and in their own words. Interviews are commonly used for data collection followed by data analysis. Sample sizes are often small and are selected purposively. The researchers adopted phenomenology. The phenomenological approach describes a person’s lived experience in relation to what is being studied (Denzin & Lincoln, 2005). In short, the answer is “Yes”, this methodology was appropriate.


Was the research design appropriate to address the aims of the research?

The research design was appropriate and the most efficient way to gather the information required for this study. The method was identified in the abstract then further discussed in detail. An interpretive phenomenological approach underpinned the study design. Phenomenology seeks to illuminate the lived experience of a shared phenomenon (Van Manen, 2014). This meant that the emphasis was placed on the subjective experience of the woman and the meanings that attributed to their experiences. This allowed the researcher to gain an insight into the reasons behind the women’s actions. Women all interpret things differently so this would help in reaching a wide source of opinions from all different experiences and outlooks on how the world works. So, the answer is “Yes”



Was the recruitment strategy appropriate to the aims of the research?

The recruitment strategy involved purpose sampling which was used via social media freebirth support groups. Permission was obtained prior to this and once granted, an advertisement was posted. A snowball sampling technique was then adopted. Snowball sampling is where one subject gives the researcher the name of another subject, who in turn provides the name of a third, and so on (Vogt, 1999). Using social media could be both a strength and a weakness to this study. Some women may not use social media sites so a wider audience could have been reached had more effort gone into advertisement i.e. physical signs in shop windows. The women recruited had to meet criteria that said they were over 18 years old, had intentionally carried out freebirthing and spoke English. To achieve the aims of the research, the women shared their stories voluntarily and provided detailed descriptions. The recruitment phase took place over a two week period. This recruitment phase was very short. Had the recruitment phase lasted longer, the researchers may have found a wider range of participants for the study. Women who were interested in the study were invited to make initial contact via email. However, some of the women who were interested may not have seen the email; i.e. the email could have gone to junk mail. This could have prevented women who were interested in participating in the study and losing great insight to freebirthing experiences. Additionally, the researcher did not provide an explanation as to why the participants they selected were the most appropriate to provide access to the type of knowledge sought by the study. In short, “yes”, the recruitment strategy was appropriate however there could have been some small changes to recruit the most suitable participants.


Was the data collected in a way that addressed the research issue?

There were two primary methods of data collection; narratives and telephone interviews. Although interviewing is the most widely used source of data collection, Bamberg (Bamberg, 2010) discusses how the narrative approach can provide a portal into the participants realm of experience. Furthermore, using the narrative method can help participants with making sense of a personal experience (Smith, Flowers and Larkin, 2010). This justifies the methods used to collect the data. The researcher made the methods explicit and indicated how the interviews were conducted i.e. semi structured interview style. The form of data collection was also clear. The majority of interviews were carried out over the phone or on skype. This is a very informal way to conduct an interview and feel that face to face interviews would have been more sufficient. Doing the interviews face to face may have allowed the researcher to engage better with the participant and therefore obtain more successful and useful data. The method was slightly modified during the study as one person used an encrypted online chat room. This gave the researcher no ability to pick up on behavior that can be observed on skype. However, it was explained how and why this was done. The researcher has also discussed saturation of data. In brief, the answer to this question is yes.


Has the relationship between researcher and participants been adequately considered?

To fulfil reflexivity, the lead author (Claire Feeley) was interviewed by the second author (Gill Thomson) prior to data collection. The interview was listened to several times to rule out potential bias and influences during the formulation of research questions, data collection and choice of location. There is an assumption among researchers that bias or skewedness in a research study is undesirable.  As Malterud (2001) writes: “Preconceptions are not the same as bias, unless the researcher fails to mention them” (p. 484). The interview highlighted that Feeley is a midwife with a firm philosophy of care embedded within a woman centered approach. Due to the limitations of current maternity practices, she recognised that this ethos of care is not always realistic or attainable. This exploitations of pre-understandings and potential biases was used to foster an open and authentic basis that was referred back to throughout the study. This relationship had been adequately considered by the researcher. It was recognised that being a midwife could be a potential barrier for the participants to engage in discussing their motivations without fear of judgement. To overcome this barrier, Feeley’s philosophy of care was shared with the participants prior to data collection. In short, the answer to this question is yes.


Have ethical issues been taken into consideration?

Consent was an issue considered during this study. Consent is an essential part of the research process, and as such entails more than obtaining a signature on a form (Donovan et al. 2002; Langston et al. 2005). Research personnel must inform potential participants what the study entails to ensure that they can reach an informed decision about whether or not to participate in the research. Consent must be given freely and with no coercion as well as based on a clear understanding of what participation in the study involves. This was done by the researchers for this study as they provided an information sheet with the email that contained explicit information regarding the study aims, participatory requirements, voluntary nature of participation and confidentiality. In this study, ethical approval was obtained from the Science, Technology, Engineering, Medicine and Health (STEMH) Ethics Committee at The University of Central Lancashire prior to this study. Briefly, the answer to this question is yes.

Was the data analysis sufficiently rigorous?

An In-depth description of the analysis process was shown in this study. The authors described each phase elaborately and clearly step by step. The data for this study was analysed using Heidegger’s and Gadamer’s interpretive phenomenological concepts; whereby the hermeneutic circle offers a theory and methodology for analysis (Lester, 1999). Thematic analysis was employed by the researchers. This focuses on identifiable themes and the data is analysed by theme. This method of analysis is highly inductive, that is, the themes emerge from the data and are not imposed upon it by the research personnel (Denzin & Lincoln, 2005). There were three key themes that arose from this study: contextualizing herstory; diverging paths of decision making and the converging path of decision making. These themes describe how these underlying factors led to a decision to freebirth. They were clearly categorised and explained using the women’s interviews as evidence to support these findings. This demonstrated the analysis process. The data was and further analysed to break down and understand it further. This helped to contextualise the themes presented and gain understanding of why previous experiences in their life influenced their decision to free birth. This included themes such as previous traumatic births, negative maternity care experiences, feeling in control and trusting their bodies. Contradictory data was taken into account and briefly mentioned however, it wasn’t discussed extensively. Although the researcher’s role was critically examined prior to the data collection, potential bias and influences could affect the analysis of the data. In short, “yes” the data analysis was rigorous however, it cannot be said if this was sufficient or not due to the researcher’s medical influence.


Is there a clear statement of findings?

It is extremely clear that there were several core qualities found by the researchers. Each quality was described in-detail in relation to the original research question with concrete examples of the original words from the women’s’ interviews. The findings were highly related to the research question. There is also an adequate discussion of the strengths and limitations of the study. The researcher has discussed the credibility of the findings. Triangulation has been acknowledged as a strength of this study explaining that a range of methods were used to confirm and authenticate the findings. It was also recognised that the sample size although adequate for this study (Smith, Flowers and Larkin, 2010), it would be beneficial to capture more participants views from different socio-economic and cultural backgrounds. In short, “yes” there is definitely a clear statement of the findings from this study.




How valuable is the research?

The researcher discusses the contribution the study makes to existing knowledge and understanding that many complex and varied factors that encompass previous life events and birth experiences lead to women wanting to free birth. It is noticed that in practice it is important for the midwives to work together with the women to consider their thoughts and feelings. This aims to improve maternity services for all. They have been able to identify that to better the research further; a future study should use several independent researchers to add strength to the interpretations and to reduce potential bias.



To summarise, I think that the main strengths of this study are that it has taken into account the unique perspectives of the women who uses maternity services and will provide important insight into why and how maternity services can influence women’s birthing decisions. Also, that the interview process has allowed the women to feel empowered and talk freely about their experiences. This will help to prevent recurrences of their traumatic experiences in future practice. The main limitation of this study was the sampling. I feel it required more time to gather participants and to take on a wider range of people from all different backgrounds. This would have possibly provided the researcher with contrasting themes.


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