Academic journal article International Journal of Doctoral Studies

Access or Egress? Questioning the "Ethics" of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

Academic journal article International Journal of Doctoral Studies

Access or Egress? Questioning the "Ethics" of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

Article excerpt


Ethics committees, whose role is to review proffered research proposals for potential ethical breaches, are commonly situated in institutions such as universities and hospitals. They are referred to in Australia and the UK as Research Ethics Committees (REC), in the US as Institutional Review Boards (IRB) and in Canada as Research Ethics Boards (REB). In this article, we discuss the challenges encountered in gaining Human Research Ethics Committee (HREC) approval for a doctoral research study in midwifery being undertaken by Elizabeth Newnham (principal researcher, midwife, PhD candidate), supervised by Jan Pincombe and Lois McKellar. First, we outline the effectiveness of ethnography and its relevance to midwifery as a research method that captures data not readily available with other research methods. Next, we address the challenges regarding ethical concerns in qualitative research, with reference to the growing disquiet among qualitative researchers regarding HREC barriers to qualitative research methods. The hospital HREC review process of the doctoral research proposal is then described, with particular attention to their concerns over "consent" and "bias". Finally, we highlight proposed adaptations to HREC processes and ethical models from the current literature and, using these and our own experience, suggest a move towards an understanding of ethics that is more fitting for qualitative research methods.

The aim of our research is to discover the personal, social, institutional and cultural influences on women in their choice to use or decline epidural analgesia in labour. Given the cultural influences on this decision, such as wider social perspectives on birth and pain, as well as the micro-culture of the hospital setting, an ethnographic approach was adopted. As the study of human society and culture, ethnographic research can provide rich data, though limitations include its lack of generalisability. Seventeen women were recruited for a series of three interviews and, with consent, the presence of Newnham in the labour room. In keeping with ethnographic method, a general period of observation in a large metropolitan hospital labour ward was undertaken by Newnham, including informal interviews with members of staff, the taking of field notes, and document analysis. By highlighting the problems encountered in the ethics approval process, which took eight months out of a three-year program of study, we hope that other doctoral students and researchers will gain some insight from our experience. We also seek to contribute to the continuing debate regarding ethics approval in qualitative research.

Cultural Influences on Birth

There is increasing understanding of the influence of cultural beliefs on women's experiences of labour and the birth process (Davis-Floyd & Sargent, 1997). Cultural norms and accepted understandings of childbirth, technology and medical expertise help to shape not only women's knowledge of the birth process, but also their attitudes towards their bodies, their babies, and their birth experiences (Davis-Floyd, 1994; Heinze & Sleigh, 2003; Jordan 1980). These understandings necessarily extend to the use of analgesia in labour; therefore, an exploration of these influences goes some way to increasing our knowledge in this area, and an appreciation of cultural assumptions would also appear necessary for articulating and implementing areas of change. Ethnographic research thus has a specific and important role in identifying change requirements in health care institutions:

Ethnographies have a key role to play in creating a more efficient, more effective, more equitable and more humane health care system, particularly in illuminating the organizational and interactional processes through which health care is delivered. They offer important information, to policy makers and practitioners, about factors that compromise or promote high quality care, particularly the ways in which well-intentioned actions may have unanticipated negative consequences (Murphy & Dingwall, 2007, p. …

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