Clinical trials and their tribulations: A midwife's perspective.

From the late 1970's, there was an increasing criticism of hospital maternity care. Conventional practices were challenged, including that of recumbency for birth. ofessionals responded to these criticisms in a variety of ways: more homelike decoration in labour wards, information for women through birth plans and new equipment to use in labour. Some obstetricians utilised the randomised controlled trial to evaluate new methods of management. Inevitably, midwives attending women in labour came into contact with these trials. This thesis utilises the experiences of one such clinical trial. A case study methodology was used to identify the impact of the trial on the work and experiences of midwives attending women in labour. The effects on midwives' work include changes of philosophy, changes to practice, increased work, exacerbation of existing inter-disciplinary tensions and difficulties with communication. The effect of the presence of a midwife research assistant has been explored. Midwives' contact with research at the time of the trial is also included. This programme of research has added to the body of knowledge by demonstrating the extent of the impact of clinical trials on the work and experiences of midwives attending women in labour. The appropriateness of the case study approach for use by midwifery researchers has also been demonstrated. Issues arising from the case study have been further reviewed in the light of contemporary midwifery practice, education and research and related to the wider research agenda. Recommendations are made for the conduct of clinical trials in the labour ward and for future avenues of enquiry.