For me, curiosity and a desire to understand the world I live in began in my childhood. I grew up in a small suburb north of Chicago that was nestled between patches of forest, appropriately called Northbrook, since the north branch of the Chicago River flowed through town. My childhood home lay between two sets of train tracks, one to the east and one to the west of us. As I was drifting off to sleep at night, I could hear the horns of the freight trains and the clickety-clack of the wheels on the tracks off in the distance.

Both lines of these freight trains often disturbed our travel paths as we drove through town. My mother made a game out of waiting as we often had to wait upwards of 15 minutes for the trains to slowly pass. The freight trains of my childhood were colorful and varied from enclosed freight cars to cattle cars and milk tanks. I learned in those hours of waiting to think about the world from a positivist perspective. Everything could be counted, from the number of cars, to the number of blue, brown and black cars, to the types of cars. I especially liked to call out the colors of the cars and became bored when the cars were all the same, a seemingly endless procession of brown and rust.

We loved the thrill of finally seeing the caboose, the last train car – called the little red caboose because it was always painted red. The conductor, who had his office in the caboose, always rode there with the brakeman and waved as they passed by. There was a well-known children’s song about the little red caboose that we always sang loudly as we waved to the conductor or brakeman.

Most children in western countries begin early to learn to count, name objects, learn the colors, and learn causality. When we saw the red caboose, we knew that the barriers with the flashing lights would go up, and we would be able to continue on our way. We also never sang the caboose song until we saw the red of the caboose in the distance. We take all these things for granted because they are considered mundane and obvious. Counting, knowing colors, identifying types of objects (in this case, freight cars) and being able to count on the red caboose being at the end of the train are nothing that I remember learning. By the time we are all old enough to have conscious memories, this knowledge and these skills seem to have always been there and are like properties of the objects themselves.

Much more than numbers …

The lens through which I saw the world, especially the things I took for granted, changed dramatically while living as an exchange student in 1981 on the Navajo Nation. The Navajo Nation is the largest Native American reservation in the USA and spans three states, Arizona, New Mexico and Utah. My experiences there changed my perspective from positivistic to what I would later discover is social constructionism. My host father was one of the medicine men for the reservation. Although he didn’t speak any English, he often spoke to me either in Navajo with hand gestures, pointing to something and explaining, or with the help of one of his daughters who gladly translated. I asked one of his daughters one day to ask her father to explain to me why the number of goats and sheep that they owned was different than the number allowed on the permit that hung on the wall near the door. The explanation he gave me was given in language and sign language. His oldest daughter translated most of the conversation. It was lengthy and required a short walk to show me the corral or space within which the sheep and goats lived: this included explanations of how this should appear to him – crowded or spacious, for example. He then directed me to take in the expanse of the land around us, reminding me of the plants I had seen when I took the sheep and goats out to graze during the day, the density of plant growth, and the distance I had to go while sheep herding before the animals could easily forage.

It was clear to me that this all had nothing to do with numbers and was more than just a »feeling«. This was significant for me, since it seemed much more meaningful to think this way about sheep and goats, as opposed to counting them or knowing their age. Their age, for example, was dependent on their actual condition or health as opposed to knowing the birth year of the animal. In a magnificent way, the world finally began to make more sense to me.

Certainly, one of the menaces of colonialism is that the way indigenous people experience and live in the world is impinged upon. Culturally constructed traditions, techniques and meanings are disregarded, perhaps even believed to be irrational, while the definitions of situations and understandings of the ruling people are forced onto a vulnerable folk and enforced through permits and regulations, as in the case of my Navajo family. Sheep and goats become numbers, while other ways of judging a herd become secondary, and, at worst, lead to illegality when the number of sheep and goats exceed that allowed in the permit. However, from the perspective of my host father, the herd could not be quantified. Many factors affected the size of the herd, including the environment, the season of the year, the size of the family, and the number of ceremonies in any particular season. Sheep are slaughtered for ceremonies and family gatherings.

The shattering of values

I am not in any way an expert on Navajo culture and way of life. These descriptions are solely meant to serve as an example of the horizon that opened up for me when I was kindly taken in by my guest family. The rather sudden experience of the shattering of my values and the then newly won perspective has accompanied me throughout my vocational and academic development. When it came time for me to choose a topic for my PhD research, these previous experiences were key. My life is full of numbers and regulations, from speed limits to the number of hours of my practical and theoretical training in my midwifery education. Disconnecting from this way of thinking and living in the world is an impossibility, and I am impressed by people who can explain the world from a quantitative perspective.

Nevertheless, my search for answers is less numerically based. I truly enjoy just sitting back and observing people as they go about doing whatever it is they’re doing, even observing a colleague lighting up a cigarette after a long shift. The exhaled smoke plumes hang differently in the air compared to a cigarette smoked by someone lighting up during their afternoon coffee break. I observe with curiosity how people in hospitals negotiate entering elevators, especially since the Covid-19 outbreak. One of the most interesting things I observed during my doctoral research was how midwives used the Leopold maneuvers to palpate a woman’s uterus and deepen the bond between the woman and her unborn baby. I can find something interesting or inspiring in just about everything I observe.

Because of this, when I chose my doctoral research topic, I knew I wanted to conduct a qualitative study. I also knew that I wanted to return to a birth centre or several birth centres to conduct research. After a short search in Germany for a doctoral supervisor, I ended up meeting Professor Soo Downe from the University of Central Lancashire (UCLan) at a conference on human rights in childbirth. Soo initiated the normal birth movement in the UK, and I had read much of what she had published up until that date. I had a moment at the conference to speak with her about my ideas for a doctoral thesis. She asked me to send her a writing sample (an article I had published, as well as excerpts from my masters thesis). After reading these, she invited me to UCLan for an interview. I had prepared several research proposals and felt a bit like a marketer pitching my wares to her. After almost an hour of discussion, we settled on a topic, and I got down to the business of officially applying to UCLan as a doctoral student.

Actual interactions

I have never had any issues with finding research topics. However, making the decision to spend years on one research question is daunting. I eventually settled on the topic of risk and safety in birth centres. My research aim was to explore and describe how birth centre midwives and the women registered to give birth at the birth centre construct risk and safety. My PhD supervisor was thrilled with this topic since notions of safety at births in birth centres hadn’t yet been investigated. The next part of the process for me, even before I would create the study design, was to choose my epistemology and the theoretical perspective that would inform my chosen methodology. This seems to be a typical question at the first meeting with doctoral supervisors in the UK. It’s actually a very simple question to ask oneself: How do I believe meaning and knowledge are constructed? Do I believe that there is a »truth out there« lying in wait to be discovered or do I believe that we »construct reality« in each and every interaction, whereby this reality feels as if it is a »truth out there« that has always been there?

Some research questions lead the researcher to choosing what seems like the most obvious or maybe even the only study design possible to answer the research question. Of course, if I want to know the average number of days that women post C-section remain in the hospital along with their breastfeeding rate when they are released, then I don’t need to conduct any interviews with the women or the nurses/midwives. However, if I want to know what influences the number of days that women stay in the hospital after a C-section and their experience of breastfeeding after a C-section then I have to conduct some interviews and even spend time in maternity wards observing practice.

For my topic, I didn’t believe that I could gather enough information solely from interviews with midwives and pregnant women to interpret how they construct meaning and understanding in their interactions. These mechanisms, I believe, can better be seen during actual interactions with each other. Therefore, I decided that an ethnographic approach with supporting interviews would be best. This would allow me to watch everything that goes on at the birth centre in order to eventually focus on specific work domains. My experiences with the Navajos taught me that context is as significant as words and actions, so watching the midwives at work (as opposed to just asking them questions about their work) allowed me to observe key moments during antenatal appointments and at births. These observations and real-time conversations continually informed the data collection and data analysis process.

I had a remarkable advantage while spending time collecting data at the birth centre in that I was accepted by the midwives and pregnant women there. I looked forward to every visit and made sure to be helpful when necessary or when I saw something, some task, that I could easily do. I wasn’t just an observer, but a participant observer. I was often included in conversations amongst the midwives and at antenatal appointments. This helped me to better understand the »taken-for-granted« concepts of risk and safety and how these played out in interactions at births. I did my best to set aside what my own beliefs were up until that time in order to learn their ways. This is the typical goal of an ethnographer and perhaps a more obvious task when conducting research in a foreign country where one has never been before. Conducting an ethnography in a familiar environment requires regular reflection, letting go of personal beliefs and work preferences, and quieting the mind, which is always judging. One way to keep track of judgements as an ethnographer is to write down every judgement as it arises, reflect on these, and contemplate all the different ways that any particular task can be accomplished. For people who thrive on criticizing others and often see only one way to do things, participant observation is almost certainly not the right data collection method.

It is worth it

Writing my dissertation spilled over into every other area of my life. At some point, I couldn’t bear to sit at my desk anymore, so I moved my laptop into the kitchen and wrote at the kitchen table. It might not be the right place for anyone else, but, for me, it offered the change of scenery that I so desperately needed. I had days where I was satisfied to have written 3–4 pages. I had imagined that it would be easy to write 10 pages a day, but this turned out to be an impossibility. I had to lower my expectations concerning my progress and get accustomed to the slow pace of writing. There is an internal transformation that some people experience during thesis writing. I found it to be a predominantly positive experience, but even positive experiences can be laced with stress. I felt so alone with this stress that I did a simple google search of »doctoral research AND stress« and discovered countless articles exploring this phenomenon. I breathed a sigh of relief, knowing that what I was experiencing was normal.

My typical British graduation ceremony at the University of Central Lancashire was a highpoint. My 24-year-old, who had just received their bachelor’s degree a few months earlier, watched proudly from the crowded auditorium. I finished my bachelor’s degree while pregnant with them, and the culmination of two graduations within a few months touched me deeply. Several months after graduation, I applied for a grant to continue conducting research in birth centres. From all of the possible topics that could be investigated, I have always wanted to identify and describe the skills and knowledge that midwives acquire as they learn to care for women and people birthing in free-standing birth centres. Each environment requires different skills – women at high risk for complications during labour and birth require skills and knowledge different than women at low risk for complications who wish to birth without interventions.

It is my belief, that, if we are to lower cesarean section rates and offer individualized care at every birth, we have to begin by learning from the experts who offer birth assistance at physiological births. Putting a labouring woman in a home-like environment in a hospital while offering the same intrapartum care as usual is not enough. The study I’m conducting until April 2024, funded by the German Federal Ministry of Education and Research (BMBF), called ASK a Midwife, will add to the knowledge base in the midwifery sciences of care at physiological birth and hopefully motivate more midwives to work in birth centres.

My wish is for everyone, every midwife who is deeply curious about her/his profession, to pursue research. Midwives possess extensive knowledge not just about pregnancy, birth and breastfeeding – for which they are without a doubt the experts – but also about human nature, behaviour, relationships, newborn behaviour, and countless other mysteries and yet-to-be-spoken-of secrets of what it is to be human and to be born. It is of utmost importance that midwifery skills and knowledge be researched for the betterment of maternal and infant health care.