Alison

Age at interview: 45

Brief Outline:

Alison has been a research midwife for five years. She also works clinically on a labour ward and is an NIHR research champion. She feels there is a need for research to be recognised as “part-and-parcel of the clinical pathway, not some bolt-on”.

Background:

Alison is a research midwife. She is married and has children. Her ethnic background is White Other (Canadian).

More about me...

Alison has been a research midwife for five years, and currently works in three main roles. Primarily, she is a research midwife and has been in this role for five years. She also works clinically on a labour ward two days a week. For the past three years, Alison has also taken on a role as an NIHR research champion for reproductive health and childbearing. Alison enjoys the balance of her roles and feels they can off-set the limitations of one another; for example, she feels that working clinically, “it’s possible to miss the bigger picture”. Alison is on a fixed-term contract and, although she has been reassured that research funding is fairly consistent, she describes this as a “source of anxiety” for staff. The fixed-term contract is one reason why Alison continues to do clinical work alongside research. Alison’s desire to do research was reinforced through doing a Master’s degree, where she really enjoyed the experience of conducting a qualitative study. After doing her Master’s, Alison was offered a place on a paediatric study. From there, she took on more research projects. 

Alison found there were new things to learn when she moved into a research position, such as the roles of others on the team. She received training in various skills, such as lab skills and processing samples. Whilst Alison is “proud” of these skills, the activities that are focused on in the role clashed with her initial expectations of research midwifery: “perhaps at the outset of becoming a research midwife, you're actually thinking what all the-, burning ideas that you’ve been harbouring […] I won't say that it's disappointment, but […] it's a little bit removed from the ideas”. Nonetheless, being part of a research team has exposed Alison to different aspects of the research process – from the practical side of things to issues around regulatory ethics. She feels more aware of opportunities around research. For example, she has carried out a placement abroad to develop the research capacity of local midwives. 

Alison has worked on “a real mix” of projects. The tasks involved have included recruitment, explaining studies to potential participants and taking consent, and collecting samples and follow-up data. Alison currently works in the area of early pregnancy and sees each participant up to eight times in some studies. She tries to convey research as a collaborative opportunity to potential participants, and suggests that research staff need to move past the idea that they are inconveniencing people. Alison emphasises the benefits that research holds for participants by giving them knowledge of their bodies, which can be an empowering experience. Indeed, she has found that women are often happy to contribute to improving maternity experiences in the future, even if there is no direct benefit for them. She mentions one study on the psychological impact of concerning events in early pregnancy (such as pain and bleeding), which led to a miscarriage support group being set up. Similarly, she has enjoyed working on the intervention phase of a study about reducing anxiety in pregnancy: “that was fantastic ‘cos you're seeing people not only work with issues and challenges but be given the tools to develop ways of developing resilience”. 

Whilst Alison feels that the value of research is widely recognised, especially amongst patients, she emphasises that change is needed around how it fits within NHS settings, “it needs to be part-and-parcel of the clinical pathway, not some bolt-on that’s a favour. It's not a favour, it's how the whole healthcare system works”. An aspect of this is access to space, as Alison finds this is a challenge when research midwives want to talk to potential participants. Whilst knowledge of the clinical environment can help navigate this challenge, she feels there is fundamentally a “need to redesign all the buildings of clinical spaces to assume participation in research”. Recruitment can also be an issue for certain studies and Alison suggests “logistics” problems could be minimised with input from research midwives, as they are well-placed to “really identify and […] circumvent those issues”.

Alison feels research midwifery would suit “someone who's really good at the small picture, the details, and also has an eye for the big picture and the change that it's standing to effect”. In the future, Alison hopes to do a PhD and would like to take on a larger role in designing research studies as she feels: “there aren't enough midwifery studies, so I'd like to be part of that change […] I'd like to be co-designing research with women […] for women”.

Alison’s motivation to practice midwifery and carry out research went hand-in-hand.

What led you to do a Masters?

Well, I suppose it begins before that because really I think it was always programmed to work in research or change. So, the whole drive for me to become a midwife was to contribute to the improvement of women's health globally, which sounds lofty and whatever, a huge sort of task. But my way of doing that was through becoming a midwife because I wanted to have a practical skill, but it wouldn’t end there for me. Before being a midwife I'd done a history degree and I was always interested in contributing some improvement globally.

So, I wanted to match that sort of ideological pursuit with having a hands-on skill, and midwifery's the window through which I've done that.

So, it was always sort of a presumption that I would go into midwifery and want to take part at another level.

Alison thought there was often an “extraction” process as a midwife or nurse re-negotiated their role in research. However, she felt there can also be a lot of “continuity” in terms of values and relationships with patients.

Yeah, so it's interesting when you see people become a research midwife or nurse, there's this sort of extraction thing that happens and they're used to doing all the struggling, and then they perhaps join a study team and the role's quite different; it sort of floats above, but it's everywhere. You need to know who's who, you need to -, how to get involved in different pathways and get behind the scenes. So, that’s -, that’s kind of taking yourself out of the clinical role, but then as you ease into whatever study you're working in you realise you're very much still connected to the patient facing world in a distinct and different role. But as I mentioned, like the [trial name] study there's huge continuity, and I'm really hot on that cos I -, when I became a midwife I directly went into what's called case loading, which is where you know your midwife and you have your midwife throughout your pregnancy and then hopefully she or her partner, or someone that you’ve already met, attends your birth, and that’s how I thought midwifery should be, and there's just such value in that.

And, and even the Department of Health recognises that; there's massive initiatives in building continuity for women. It's always going to be a hot topic and we're just spending life times figuring out how to provide it for women. But anyway, my point was that, sometimes in research studies you see that little continuity package happening and that’s so cool. So, in [trial name] it was like, gosh, we're giving this whole additional continuity thing where the women, the participants, have really good access to a midwife and a doctor by email, by phone, by visits; set visits or even some last minute visits. What an addition to the maternity care that perhaps doesn’t feature the continuity. So, I'd like to -, I think it's really complimentary.

Yeah

And as a midwife it's not just this nice thing that women maybe get by joining the study, it's also really rewarding for the clinician.

When she first went into a research midwife role, Alison expected to be more involved in study design.

The actual practical tasks of the role can be sort of, maybe not a surprise, but there's a lot of practical skills, so lab skills, becoming trained in basic processing of samples and centrifuges. And sometimes that’s a surprise because perhaps at the outset of becoming a research midwife, you're actually thinking what all the -, burning ideas that you’ve been harbouring and wanting to get on to. So, there is a little bit of a dance and a readjustment I think, and I won't say that it's -, I won't say that it's disappointment, but it's a regrouping of how perhaps I, or other people I can see, think of being of research midwife, cos sometimes it's a little bit removed from the ideas. But it also affords you many, many, many opportunities and perhap -, like for example, working in a clinical research team that’s doing interesting things round early pregnancy or early embryology; it affords you a huge, rich window into that particular speciality.

That wouldn’t have been there had you continued in a -, a sort of clinic -, purely clinical role.

So, so, it's interesting because it's very task based.

And the practical side of things, and also it's a bit like being in project management because understanding the process of how somebody in your team, or somewhere else, got an idea and how you actually -, how you actually get something out of the idea – a question, a research question; how does that happen? And I actually kind of enjoy that sort of process thing. It maybe is the micro-manager in me; I like thinking about how it will run on the shop floor.

But sometimes I think that’s the difference between a well planned and well executed study or not; one that’s actually thought about – 'Well, how's this going to sit in the setting? How's that going to work with the antenatal clinic midwives who aren't directly involved in the project?' And I think you have to have a real sort of business almost mind for that.

Alison would like to do a PhD one day, but wasn’t sure how to “do that without stepping off the earning treadmill”.

I would like to be someone doing my own research. And so that’s-, I'm kind of banging on my drum about that because I-, I've always felt that, but then I've been sort of stumbled by how difficult that could be in practical terms, because as I said, I can't-, I can't just do a PhD because I fancy it and I'm independently wealthy and that’s what I'm going to do for five years. I need it to be through an awarded really well supported process. So, there are those amazing awards, like the NIHR [National Institute for Health Research] doctorate one. But the doctorate application probably takes a year to do the application and to have a really good supportive team around you. But then, just a few months ago there was the announcement of a new award, which is a pre-doctorate award, which is investing in people's time to get to be able to submit a competitive PhD application. So, it essentially buys out your time and sets you-, and you-, you submit an application where you’ve set up some supervisory relationships and a bespoke training package for yourself. And then if the lucky people who are awarded this would have a couple of day-, perhaps a couple of days a week, or 50% of their working time, to devote to the development of their own research pathway as a clinical academic.

And that’s what I want to do.

As a research midwife ‘champion’, Alison had insight at both local and national levels. She saw it as positive that there seemed to be less need to ‘reward’ clinical staff for supporting research activities in some places.

So, in the champion role I should say I'm also -, have a national input in that I meet four times a year with all of the champions from the whole country. So, that’s really good to hear about different research midwives' experiences.

And it is very different. And some of the -, you know it's still -, it's still the case that so and so's trying to do a study, but the nurses or midwives there are, you know, don’t want it and you're a pain. So, you can see that on the one side and I definitely see it as a labour ward midwife. The last thing I need is something else to do, but we need to move beyond that. So, there has been a whole period, and I guess we're still in it, of favours and sort of roadshows or championing, or role modelling, how these things don’t have to be an imposition and they can even help you as a clinician; it might even make something simpler. So, there's a lot of baking. When I worked in [trial name], you know the, the team was often bringing cookies or brownies into staff rooms, and just relations, it always comes down to relations – individual, one-on-one relations. So, you find someone who has a bit of an eye; you can see a twinkle in the eye of a certain clinician and you know she's going to be helpful, not obstructive. Latch onto that and go from there and yeh, there's always this element of-, or reward systems or vouchers or draws for having helped identify a recruit to a study. I think I see a little bit less of it, so maybe that’s a good sign that we're actually embedding it, cos it needs to be part and parcel of the clinical pathway, not some bolt-on that’s a favour. It's not a favour, it's how the whole healthcare system works.