Background: Vulnerability is universally present but experienced biopsychosocially on an individual level. Stigma develops when populations are labelled vulnerable. Individual vulnerability can be lessened by resources accessed to assist in developing resilience. A deeper analysis of vulnerability and resilience is required to inform policy, ethics, law and social life. Design: Qualitative, quantitative and mixed method approaches were used. Sample: Five papers represented the perspectives of 102 women, 21 clinicians and 13 student midwives. A further paper presented a concept analysis which included the perspectives of 10,067 women and 325 clinicians (total sample size women n=10,169; clinicians n=346; student midwives n=13). Methods: Gadamer’s ontological perspective of time, place and culture and was seen through Engel’s biopsychosocial lens. Epistemologically, truth originated from multiple realities. Methodologically, women’s experiences were captured via mixed methods. 7 Analysis: Thematic analysis and descriptive statistics were synthesised via framework analysis. Findings: A coherent theme of vulnerability in maternity care was apparent. Women’s concerns were trivialised. The professional’s style of communication determined the women’s experience of maternity care. Clinician control of care provision undermined women’s ability to choose. Women developed resilience in adverse circumstances via: accessing other supportive members of society, identifying their need for information, talking to others and developing accommodative coping strategies. Conclusion: The new conceptual model, in this thesis, should be evaluated via mixed methods. A biopsychosocial approach should underpin informed choice. Clinicians need raised awareness about how interaction can lower women’s self-esteem and build resilience in others. Higher education needs to challenge preconceived biases in safe environments via reflective processes. Research should explore women’s influential circle in decision making during maternity care. Women should be involved in the design of research to inform how best to capture their complex lived experience. Funders of research and ethics committees should request information about how implementation of evidence may be influenced by the current clinical environment. Impact should be measured post implementation. Social policy should be informed by a deeper, conceptual analysis of vulnerability and resilience.
|Date of Award||15 Jan 2018|