Open, trusting relationships underpin safety in rural maternity a hermeneutic phenomenology study.

Susan Crowther,Elizabeth Smythe

doi:10.1186/s12884-016-1164-9

Susan Crowther, Elizabeth Smythe

Open Access

https://doi.org/10.1186/s12884-016-1164-9

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Abstract

BackgroundThere 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.MethodsThis 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.ResultsThroughout 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.ConclusionsThis 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.

Highlights

There are interwoven personal, professional and organisational relationships to be navigated in maternity in all regions
This paper reports on an aspect of a larger study examining rural maternity experiences from a variety of professional and user experiences in New Zealand [9]
Most care is provided by Lead Maternity Care providers (LMCs) who are mainly self-employed midwives with some GPs and obstetricians taking on this role

Summary

Introduction

There are interwoven personal, professional and organisational relationships to be navigated in maternity in all regions. Women choose from available LMCs in their region for pregnancy, birth and postnatal care; choice is often limited to one care provider in a rural situation. Such care is free to citizens and residents of New Zealand. LMCs are responsible for coordinating women’s maternity health care from early pregnancy until 6 weeks postnatally, this includes full intrapartum care [13]. They provide primary services as well as provide care to women in secondary services if they are booked with them

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