Reflexivity in midwifery research: the insider/outsider debate.
OBJECTIVE
To explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings.


BACKGROUND
Participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of 'identity' and 'insider' knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis.


METHODS
A qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers.


METHODS
Two maternity units in New South Wales, Australia.


METHODS
Participants included 40 midwives and 78 breast-feeding women.


RESULTS
Possessing 'insider' midwifery knowledge was advantageous in the 'getting in' and 'fitting in' phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this 'insider' knowledge and status. Prolonged periods of observation challenged the midwife researcher's preconceived ideas and early decisions about the advantages and disadvantages of being an 'insider' or an 'outsider' in the research setting.


CONCLUSIONS
Reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the 'midwife' observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectations.


CONCLUSIONS
Midwifery observation of clinical practice, for research, or practice development purposes, requires a degree of juggling of insider knowledge to facilitate observation and analysis. Prior to conducting observations midwives should consider how best to occupy the middle ground between insider and outsider. Within the middle ground the midwife can draw on those aspects of 'self' required to negotiate respectful relationships with colleagues, whilst also ensuring the maintenance of an analytical degree of distancing.
School of Nursing & Midwifery, College of Health & Science, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. e.burns@uws.edu.au
Elaine
E
Burns
Jennifer
J
Fenwick
Virginia
V
Schmied
Athena
A
Sheehan
D000328:Adult; D001942:Breast Feeding; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D007587:Job Description; D009517:New South Wales; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D018802:Patient-Centered Care / Q000379:methods; D011181:Postnatal Care / Q000379:methods; D036301:Qualitative Research; D055815:Young Adult