Navigating insider research as a pregnant midwife researching maternity care: an autoethnography to explore challenges and opportunities in qualitative research

In the world of healthcare, the people who study a system are often the same people who work inside it. This is known as insider research. Imagine a teacher studying how students learn in their own classroom, or a doctor investigating how patients feel about their treatment in their own hospital. In the field of midwifery, where professionals guide women through pregnancy and birth, this approach is becoming increasingly common. There is a strong push for midwives to lead their own research because they understand the daily realities of their work better than anyone else. However, when a researcher is also a member of the group they are studying, and perhaps even a user of the services they are observing, the line between observer and participant can become blurry. This creates a unique set of challenges and opportunities that can shape the quality and honesty of the findings.

Hannah M. Brennan, a midwife and researcher at the University of Manchester, explored this complex territory by examining her own experience. She conducted a study to understand how midwives talk to pregnant women about changing their health habits, such as diet or exercise. During the three months she spent observing these conversations in a large hospital and in community clinics, Brennan was not just a researcher; she was also a pregnant woman and a practicing midwife working at the same hospital trust. She kept a detailed journal of her thoughts and feelings throughout the process, using a method called autoethnography. This approach treats her personal story as the primary data, allowing her to analyze how her dual identity influenced the research. She observed twenty-one appointments involving thirty-three participants, recording the interactions to see how health advice was actually delivered.

The journey was not without its internal struggles. Brennan found that holding two roles at once—midwife and researcher—sometimes created a conflict of interest. For instance, during one observation, a midwife she was watching struggled to draw blood from a patient and asked for help. As a midwife, her instinct was to step in and assist, but as a researcher, she had to remain an observer to keep the study ethical. She had to politely decline, explaining that her role was strictly to watch and record, not to practice medicine. This moment left her feeling guilty, as she wanted to help her colleague, yet she knew that breaking her research boundaries would compromise the study. She also had to think carefully about what to wear. While she could not wear her full midwifery uniform because of her pregnancy, she chose to wear medical scrubs and a hospital lanyard. This helped her look like a healthcare professional, which built trust with the staff and patients, but she had to be very clear when introducing herself that she was there as a researcher, not as a colleague on duty.

Another significant hurdle was managing her own assumptions. Because she had worked as a midwife and had been a pregnant woman herself, she entered the study with strong ideas about how conversations should go. She assumed that midwives would be too rushed to give detailed advice and would rely on a generic script. However, she realized that if she let these beliefs take over, she might miss the real stories the data was telling. To prevent this, she made a conscious effort to set her expectations aside and let the actual conversations guide her analysis. She also faced ethical concerns regarding trust. Because she was a known midwife at the hospital, some staff members might have felt pressured to participate in her study, fearing that saying no could affect their job. To solve this, she worked with the ethics committee to change her recruitment strategy, ensuring that an administrative team member, rather than Brennan herself, approached potential participants to ask for their help. This removed any sense of coercion and protected the voluntary nature of the study.

Despite these challenges, being an insider offered powerful advantages that an outsider could not easily replicate. Her deep knowledge of how the maternity system works allowed her to plan the study more effectively. She knew that the booking appointment, where a woman first meets her midwife, was the best time to observe discussions about health habits because it was the longest routine visit. This insight helped her gather rich, detailed data. Furthermore, her identity as a midwife and a pregnant woman helped build immediate rapport. When she spoke to the midwives, they understood her perspective on the stress of the job. When she spoke to the pregnant women, they felt comfortable sharing their feelings because she was going through the same experience. These shared moments of connection, such as chatting about their pregnancies during breaks, created a safe space where participants were more open and honest.

The process also brought personal satisfaction and professional growth. Brennan found that engaging in research allowed her to see her profession in a new light. She witnessed moments of exceptional care, such as a midwife showing deep compassion to a woman struggling with substance use. These observations served as a learning opportunity, reminding her of the kind of care she wanted to provide in her own practice. She realized that research could be a way to honor the history of midwifery, which began with women supporting each other through birth. By studying her own field, she felt she was contributing to the profession in a meaningful way, finding joy in the work and a renewed sense of purpose.

The study concludes that while insider research in midwifery presents real difficulties, such as navigating conflicting roles and managing personal biases, it is a valuable approach. The key to success lies in reflexivity, which is the practice of constantly thinking about one's own influence on the research. By being honest about their position, clearly defining their boundaries, and using their unique knowledge to deepen their understanding, midwife researchers can produce work that is both credible and deeply insightful. This approach does not eliminate the challenges, but it provides a framework for managing them, ensuring that the research remains ethical and that the findings truly reflect the experiences of those involved. As more midwives take on the role of researchers, understanding these dynamics will be essential for creating transparent and high-quality studies that improve care for mothers and babies.