title: Open, trusting relationships underpin safety in rural maternity a hermeneutic phenomenology study.
abstract: There are interwoven personal, professional and organisational relationships to be navigated in maternity in all regions. In rural regions relationships are integral to safe maternity care. Yet there is a paucity of research on how relationships influence safety and nurture satisfying experiences for rural maternity care providers and mothers and families in these regions. This paper draws attention to how these relationships matter.
  
  
  
  This research is informed by hermeneutic phenomenology drawing on Heidegger and Gadamer. Thirteen participants were recruited via purposeful sampling and asked to share their experiences of rural maternity care in recorded unstructured in-depth interviews. Participants were women and health care providers living and working in rural regions. Recordings were transcribed and data interpretively analysed until a plausible and trustworthy thematic pattern emerged.
  
  
  
  Throughout the data the relational nature of rural living surfaced as an interweaving tapestry of connectivity. Relationships in rural maternity are revealed in myriad ways: for some optimal relationships, for others feeling isolated, living with discord and professional disharmony. Professional misunderstandings undermine relationships. Rural maternity can become unsustainable and unsettling when relationships break down leading to unsafeness.
  
  
  
  This study reveals how relationships are an important and vital aspect to the lived-experience of rural maternity care. Relationships are founded on mutual understanding and attuned to trust matter. These relationships are forged over time and keep childbirth safe and enable maternity care providers to work sustainably. Yet hidden unspoken pre-understandings of individuals and groups build tension in relationships leading to discord. Trust builds healthy rural communities of practice within which everyone can flourish, feel accepted, supported and safe. This is facilitated by collaborative learning activities and open respectful communication founded on what matters most (safe positive childbirth) whilst appreciating and acknowledging professional and personal differences.
authors.affiliation: School of Nursing and Midwifery, Robert Gordon University, Garthdee Road, Aberdeen, Scotland, UK. s.a.crowther@rgu.ac.uk.
authors.forename: Susan
authors.identifier: 0000-0002-4133-2189
authors.initials: S
authors.lastname: Crowther
authors.affiliation: Auckland University of Technology, Auckland, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Smythe
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D034462:Dissent and Disputes; D004632:Emergency Medical Services; D005260:Female; D058006:General Practice; D066297:Hermeneutics; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008427:Maternal Health Services; D008880:Midwifery; D009035:Mothers / Q000523:psychology; D009520:New Zealand; D036801:Parturition; D061214:Patient Safety; D017060:Patient Satisfaction; D011247:Pregnancy; D011369:Professional-Patient Relations; D019035:Rural Health Services; D012424:Rural Population; D035502:Trust
keywords: Discord; GPs; Midwives; New Zealand; Phenomenology; Relationships; Rural maternity; Safety