JOY KEMP1 NORMAL BIRTH, MAGICAL BIRTH: THE 36 WEEK BIRTH TALK JOY KEMP Kemp, J. and Sandall, J. (2010) ‘Normal birth, magical birth; the role of the 36 week birth talk in caseload midwifery practice’. Midwifery, 26 (2),

JOY KEMP2 The Study What are Birth Talks and do they increase normal births? Midwives’, Women’s and Their Partner’s experiences of the 36 week birth talk London, 2 caseload midwifery practices

JOY KEMP3 METHODS/TOOLS Qualitative study Ethnography and IPA Participant Observation Semi-structured interviews

JOY KEMP4 SAMPLE (small in qualitative research) 5 Birth talks 5 Experienced Midwives 5 Women and partners

JOY KEMP5 FINDINGS Rich description of the birth talk Three master themes

JOY KEMP6 WHAT HAPPENS? Antenatal Check Setting Ground-rules Making the birth seem real What do they already know? Explaining Labour Processes Talking about pain Images of birth Home or hospital? Defining roles Practical Preparation Exploring Wants

JOY KEMP7 MASTER THEMES A New Philosophy For Birth: “Don’t forget the magic” Achieving A Sense of Coherence: “Making Sense Of The Birth” The Construction Of Authoritative Midwifery Knowledge: “They Make You Believe That You Can Have What You Want”

JOY KEMP8 1. Don’t forget the magic: a new philosophy for birth Birth is normal “if you’re a normal woman who’s had a normal pregnancy and you go into labour normally then that’s normal and you don’t need people rushing round with bits of machinery and equipment to check that everything’s still normal, and that’s fine” (A Midwife)

JOY KEMP9 Normal…but magical “It’s about going beyond the physical stuff and talking about the beauty of birth and the magic of birth and how incredible it is, and how fantastic it is, and about how lucky they are that they’re about to do that.. let’s celebrate it! What I would like to say … is “don’t forget the magic”. (A midwife)

JOY KEMP10 You can do it! “… it’s a normal physiological process, they can do it, we are there to support them and hopefully that will have an impact on their labour” (A midwife) “I can picture myself in labour … I think I’ll be alright, I don’t know what else to say, and if I’m not… well, we’ll have to (see), I just think I will be (OK)… (A woman)

JOY KEMP11 Beautifully designed, not defective Women in control of their bodies or women as victims of their reproductive systems? “It’s about empowering women and saying ‘you can do this!’… focusing on what the woman can do, the idea giving birth as opposed the idea of having a delivery. … (It’s about) the power of pain in labour … and how women use the pain and work with the pain” (A midwife)

JOY KEMP12 Making the birth seem real “I think it was really helpful in making things more real, you know… we’re actually going to have that baby quite soon” (A woman) The role of photos “You know we was quite surprised, but we could see that the people (in the photos) was very happy, they enjoy, you know, and the picture was very helpful for us… We can manage you know. … and not only me (but) all people should get through that fine” (Partner)

JOY KEMP13 Empowerment, not dependency “(It was about) … trying to achieve for them some sort of empowerment … there (has always been) quite a resistance to the development of a sort of dependent relationship on the midwife… this was seen as really important as they became mothers. And this would be… a transformational moment in their lives” (A midwife)

JOY KEMP14 Empowerment in Practice “(Now) I am very pleased … when I (was in) pain I feel it’s very terrible and I want everything to pass quickly. But Sally said ‘I’m not bring(ing) the baby to you… you must to do everything for the baby and you (will) feel very happy when you saw baby here….’ And when I saw baby you know I feel very confident and I feel I am very happy… actually I like Sally’s ways when she (said) I’m not bring the baby to you, you must to do everything…” (Woman)

JOY KEMP15 WHAT CAN WE LEARN FROM THIS STUDY? Birth talks: Serve a practical purpose for caseload midwifery Help make the birth seem real & manageable Help women & their partners feel in control & trust their midwives May increase homebirth & normal birth Help women and their partners cope with labour & pain Reflect the philosophy of the midwives - may have limited generic value

JOY KEMP16 Midwifery knowledge can be powerful and authoritative Midwives need peer support and shared philosophy and values to work in this way

JOY KEMP17 “They make you believe you can have what you want… at each of my appointments I always left feeling it was possible that the birth was going to be a good experience” “Claire” AN AUTHENTIC MIDWIFERY ENCOUNTER

JOY KEMP18 THANKS FOR LISTENING! Any questions? Correspondence to: Tel: