Straddling Paradigms: an Interpretive Hermeneutic Exploration of Midwives Practising Homeopathy by Jean Ellen Duckworth

Straddling Paradigms: An interpretive hermeneutic exploration of midwives practising homeopathy by Jean Ellen Duckworth A thesis submitted in partial fulfilment for the requirements for the degree of PhD at the University of Central Lancashire April 2015 STUDENT DECLARATION FORM I declare that while registered as a candidate for the research degree, I have not been a registered candidate or enrolled student for another award of the University or other academic or professional institution I declare that no material contained in the thesis has been used in any other submission for an academic award and is solely my own work. Signature of Candidate: Type of Award: PhD School: Health 2 Abstract This study aimed to explore the experiences of midwives who were also homeopaths as they attempted to straddle the different philosophical and practice paradigms they encountered in each domain. It also explored the implications of their experience on their practice. Over recent decades the National Health Service (NHS) has moved towards a scientific-bureaucratic perspective, in which the emphasis is on the use of evidence-based frameworks. It has been argued that this development has moved the focus in healthcare away from ‘caring’. In parallel, there has been an increase in the demand for complementary and alternative medicines in the United Kingdom (UK), and elsewhere. In responding to this call a number of midwives have taken up training opportunities in massage, aromatherapy, hypnotherapy, acupuncture and homeopathy, amongst others. There are no studies however, that have examined the impact of training as a homeopath on midwives and their practice. After a comprehensive analysis of existing literature, this study used an interpretive hermeneutic framework to explore the experience of midwives who trained as homeopaths. In-depth interviews were conducted with seven midwife homeopaths. The findings were analysed using three different lenses. The first of these conceptualised and explored the midwives narratives as personal and professional metamorphoses, as they changed from midwife to homeopath or midwife homeopath. Secondly, the data were framed using a Heideggerian lens, which illuminated a process of transformation into being authentic practitioners. This demonstrates how authenticity allowed the participants to (re) engage with, and further value the therapeutic relationship as a fundamental element of their clinical practice. The final lens explored the impact engendered of being authentic on the therapeutic relationship that developed between midwife homeopath and the women in their care. The conclusion was drawn that the therapeutic relationship developed by an authentic practitioner via a 3 homeopathic consultation is transferable to other healthcare practitioners, and offers a challenge to practice based in notions of scientism and bureaucracy. Further exploration of these phenomenon’s could help to deliver on the drive to deliver compassionate personalised care across the NHS as a whole. 4 Table of Contents Student Declaration .................................................... Error! Bookmark not defined. Abstract ............................................................................................................................... 3 List of Tables and Figures ............................................................................................ 11 Acknowledgements ....................................................................................................... 13 For Dad (Two Ways of Looking at a Death) .......................................................... 14 Guide to abbreviations ................................................................................................. 15 Section One: Introduction, Background and Review of the Literature. ...... 17 Chapter One: Introduction .......................................................................................... 18 1.1 Introduction ....................................................................................................................... 18 1.2 Why this research? ........................................................................................................... 18 1.2.1 Personal motivations for the study ................................................................................. 19 1.2.2 Professional motivations for the study .......................................................................... 20 1.3 Framing the research: A crisis in healthcare .......................................................... 23 1.4 Research question ............................................................................................................ 28 1.5 Structure of the thesis ..................................................................................................... 28 Chapter Two: Background and key debates in the professions. .................. 31 2.1 Introduction ....................................................................................................................... 31 2.2 Historical development of midwifery ....................................................................... 31 2.3 Characteristics of late 20th and early 21st century UK midwives. .................... 42 2.4 The role of the midwife .................................................................................................. 44 2.5 Philosophies of maternity care in the 20th and 21st centuries ......................... 45 2.5.1 Technocratic philosophy of childbirth ........................................................................... 46 5 2.5.2 Social philosophy of childbirth ......................................................................................... 47 2.6 Influences on maternity care in the United Kingdom ......................................... 49 2.6.1 Risk ............................................................................................................................................... 51 2.6.2 Choice .......................................................................................................................................... 54 2.7 Introduction to homeopathy ........................................................................................ 56 2.7.1 Philosophy underpinning homeopathy ......................................................................... 57 2.8 A brief history of homeopathy ..................................................................................... 58 2.9 Types of homeopathy ...................................................................................................... 62 2.10 The homeopath ............................................................................................................... 66 2.11 Evidence-based medicine ........................................................................................... 67 2.11.1 Emergence of Evidence Based Practice ...................................................................... 69 2.11.2 Midwifery and evidence-based practice ..................................................................... 69 2.11.3 Critique of Evidence Based Medicine/Practice ....................................................... 71 2.11.4 Homeopathy and evidence-based medicine ............................................................. 76 2.12 Conclusion ........................................................................................................................ 85 Chapter Three: Focused review of studies of homeopathy and midwifery. .............................................................................................................................................. 87 3.1 Introduction ....................................................................................................................... 87 3.2 ‘Doing’ a mixed-methods systematic review in a phenomenological study? ........................................................................................................................................................ 87 3.3 The importance of the literature review ................................................................. 88 3.3.1 Locating relevant papers ..................................................................................................... 90 3.4 Results .................................................................................................................................. 93 3.4.1 Attitudes and use of homeopathy by midwives and women .............................. 101 3.4.2 Summary of the key points ............................................................................................... 118 3.4.3 Trials of homeopathy in maternity care ...................................................................... 120 3.5 Homeopathy: a complex intervention................................................................... 137 6 3.6 Conclusion ........................................................................................................................ 141 Section Two: Data Collection .................................................................................. 144 Chapter Four: Theoretical perspective and methodology ............................ 145 4.1 Introduction .................................................................................................................... 145 4.2 Aim of the study ............................................................................................................

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