title: Normalizing birth in England: a qualitative study.
abstract: BACKGROUND
  This study examined factors that foster or hinder the support of normal birth in two English National Health Service Trusts identified for public recognition of their work to normalize birth.
  
  
  METHODS
  This interpretative qualitative study was guided by institutional ethnographic and narrative methods. Purposive sampling was conducted to achieve maximal variation across social, demographic, cultural and ethnic groups. In-depth interviews explored clinician's and women's views and experiences of normal birth. Ethnographic observations of practice, clinical and administrative meetings, educational sessions, and informal discussions were conducted over 6 months at one of the maternity settings. Antenatal and intrapartum clinical guidelines were reviewed and analyzed.
  
  
  RESULTS
  Three key strategies supported the normalization of birth: 1) an "ethos" of normality; 2) "working" the evidence; and 3) "trusting" women to make informed choices best for them. Inappropriate use of technology, disregarding risk status when assigning women to units, lack of physician preparation in normal birth, and poor staffing levels were cited as barriers.
  
  
  CONCLUSIONS
  These strategies should be carefully examined for translation to the United States and future research.
authors.affiliation: Yale University School of Nursing, 100 Church Street South, New Haven, CT 06536-0740, USA. holly.kennedy@yale.edu
authors.forename: Holly Powell
authors.initials: HP
authors.lastname: Kennedy
authors.forename: Jane
authors.initials: J
authors.lastname: Grant
authors.forename: Cathy
authors.initials: C
authors.lastname: Walton
authors.forename: Jenna
authors.initials: J
authors.lastname: Shaw-Battista
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
mesh_terms: D002755:Choice Behavior; D003657:Decision Making; D004739:England; D055318:Evidence-Based Nursing; D005260:Female; D006291:Health Policy; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009723:Nurse-Patient Relations; D036801:Parturition; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D035502:Trust