pains and gains of birth clinic owners

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BIRTHPAINS AND BIRTHGAINS OF BIRTHING CLINIC OWNERS

______________

A Dissertation Proposal

Presented to the Faculty

of the Graduate School

Baguio Central University

Baguio City

______________

In Partial Fulfillment

of the Requirements for the Degree

Doctor of Philosophy in Administration and Supervision

_____________

Lolita Itliong-Dicang

September 2014


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APPROVAL SHEET

This dissertation proposal entitled, BIRTHPAINS AND BIRTHGAINS OF

BIRTHING CLINIC OWNERS, prepared and submitted by LOLITA ITLIONG-

DICANG, in partial fulfillment of the requirements for the degree, DOCTOR OF

PHILOSOPHY IN ADMINSTRATION AND SUPERVISION (PHAS), has been

reviewed and examined and is hereby endorsed for acceptance and approval for proposal

defense.

CARLOS P. LUMA-ANG, Ed.D

Professor

PROPOSAL EXAMINATION COMMITTEE

ESTRELLA V. BISQUERA, Ph.D.

Chairman

LOUELLA M. BROWN, Ed.D. EVANGELINE B. FUENTES, Ed.D

Member Member


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ACKNOWLEDGMENT

The researcher wishes to thank the following for their assistance in the completion

of this dissertation proposal:

The Good Lord, for giving the researcher sufficient encouragement so she may

pursue this challenging endeavor;

Her family, for all the support, understanding and unconditional love;

Members of the proposal committee, Dr. Estrella V. Bisquera, Dr. Louella M.

Brown, and Dr. Evangeline B. Fuentes, for their critiques and helpful suggestions;

Her other relatives and friends who provided spiritual, moral and financial

support;

To the librarians of BCU for providing some of the reference materials;

And to all those who, in one way or another, contributed in the completion of this

manuscript.

To God be the glory!

Lolita


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TABLE OF CONTENTS

Page No.

TITLE PAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

APPROVAL SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

ACKNOWLEDGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

LIST OF FIGURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

CHAPTER

1 THE PROBLEM

Background of the Study . . . . . . . . . . . . . . . . . . . . 1

Philosophy of Sef-actualization . . . . . . . . . . . . . . . . . . . 4

Conceptual Framework . . . . . . . . . . . . . . . . . . . . 7

Statement of the Problem . . . . . . . . . . . . . . . . . . . . 9

Scope and Delimitation of the Study . . . . . . . . . . . . . . 10

Definition of Terms . . . . . . . . . . . . . . . . . . . . . . 11

Significance of the Study . . . . . . . . . . . . . . . . . . . . . 11

2 DESIGN AND METHODOLOGY

Research Design . . . . . . . . . . . . . . . . . . . . . . . 13

Locale and Population . . . . . . . . . . . . . . . . . . . . . . 14

Data Collection Procedure . . . . . . . . . . . . . . . . . . . . 14

Data Gathering Tool . . . . . . . . . . . . . . . . . . . . . . . . 16

Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Establishing Trustworthiness of Data . . . . . . . . . . . . . . . 20


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REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

APPENDICES

A. Letter to the Respondents . . . . . . . . . . . . . . . . . . . . 24

B. The Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . 25

CURRICULUM VITAE . . . . . . . . . . . . . . . . . . . . . . . . . . 26


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FIGURE USED

Figure Page No.

1 Phenomenological Data Analysis .. 17


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Chapter 1

The Problem

Background of the Study

The news about woman's pregnancy always brings happiness to all families.

Nevertheless, this happiness is connected with number of possible difficulties and

questions. One of the most important is the right choice of birthing. Today most families

prefer one of the three possible variants; hospital, birthing centers or home facilities.

Each variant has its both advantages and disadvantages. But majority of doctors

recommend birthing centers as the best choice.

Maternity care aims to ensure that every expectant and nursing mother maintain

good health, learns the art of child care, has normal delivery and bears healthy children.

Maternal health care begins from the time of conception of the child, thus, the prenatal

and postnatal care of the mother is included in the health system. The prenatal care

ensures that the nutritional status of the expectant mother is safeguarded and

complications of pregnancy prevented or treated before they give birth. The natal care

also includes the care rendered to the mother during labor and delivery by health care

workers.

The care of a mother before, during and after delivery is important and needs the

focused attention of the staff nurse. Putting the mother at ease and providing her the

much-needed nursing care encourages the mother to be relaxed and assured that her

giving birth will be properly attended to by both the attending physicians and the nurse.

Furthermore, a common Filipino saying about pregnancy states that one foot of the

mother is in the grave during childbirth. It is a fact that there are risks in pregnancy as


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complications may arise during or immediately after delivery. The presence of skilled

health professionals is very important to minimize the risks.

Birth centers are a place where women can fully experience the midwifery model

of care. Pregnancy and birth are viewed as normal, healthy, yet important life events. The

peaceful, home-like atmosphere allows for woman centered care.

A birth center presents a more home-like environment than ahospital labor ward,

typically with more options during labor: food/drink, music, and the attendance of family

and friends if desired. Other characteristics can also include non-institutional furniture

such as queen-sized beds, large enough for both mother and father and perhaps birthing

tubs or showers forwater births.The decor is meant to emphasize the normality of birth.

In a birth center, women are free to act more spontaneously during their birth, such as

squatting, walking or performing other postures that assist in labor. Active birth is

encouraged. The length of stay after a birth is shorter at a birth center; sometimes just 6

hours after birth the mother and infant can go home.

The following are some of what clients can expect from birthing clinics:

(a) Relaxed and warm atmosphere; (b) The option of returning home shortly after the

birth; (c) A team of health care providers that can include nurse-midwives, direct-entry

midwives, or nurses working with an obstetrician; and (d) The facility may be free-

standing, on hospital grounds or inside a hospital.

On the other hand, the following are considered acceptable in birthing clinics: (a)

No Induction or No augmentation of labor with Pitocin (oxytocin); (b) No electronic fetal

monitoring except Doppler ultrasound; (c) No drugs for pain relief except local analgesic

to suture tears in the perineum; (d) Very few episiotomies; (e) No operative deliveries;
http://en.wikipedia.org/wiki/Hospital_labor_wardhttp://en.wikipedia.org/wiki/Water_birthhttp://en.wikipedia.org/wiki/Water_birthhttp://en.wikipedia.org/wiki/Hospital_labor_ward


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and (f) In many birth centers, the only equipment is oxygen and catheters used to clear a

babys airways if necessary.If the birth center is connected to a hospital, medical

intervention can be a routine part of their care. When choosing a birth center connected to

a hospital, ask if it has its own staff or is staffed by hospital personnel. One might also

want to know when and how often the birthing center would rely on the assistance of

hospital personnel.

Women are designed to give birth. Consequently, some women prefer not to view

labor and birth as a medical condition, but rather as the culmination of a beautiful and

natural nine-month process. Birthing centers are typically committed to providing

prenatal care and educating women in order to optimize their personal birth experience.

In 2002, before the end of the USAid-assisted project, the Well-Family Midwife

Clinic Partnership Foundation Incorporated (WPFI) was established as mechanism to

sustain and continue the successful work of the project. There are currently 300 maternal

clinics in the country established under WPFI.

This is part of the The Maternal and child health (MCH) care in response to

fulfilling three out of the eight important Millennium Development Goals (MDG) of the

United Nations, namely: MDG 3, Promote Gender Equality and Empower Women; MDG

4, Reduce Child Mortality; and MDG 5, Reduce Maternal Mortality. According to the

Department of Health, the Philippines is at greater risk of dying than children born in

other South Eastern Asian countries, according to the latest results from 2003 National

Demographic and Health Surveys (NDHS) conducted by the National Statistics Office.

Furthermore, In the Philippines, for every 1,000 births, 29 children will die before their


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first birthday (infant mortality rate), and 40 will die before age five (under-five mortality

rate).

Although the infant mortality rate in the country has decreased slightly since

1998, it is still high compared to other countries in the region: Vietnam, Brunei,

Singapore, Thailand, and Malaysia.

Today, the cost of establishing one clinic varies between P300,000 to P640,000

per clinic depending on the location/region and equity contribution of the midwife. The

cost of P640,000 includes the cost of equipment (180,000), renovation (250,000), initial

training/organizing costs (100,000), franchise fees (60,000), and feasibility study.

Philosophy of Self-Actualization

This study will lean on the humanistic philosophy of self-actualization or self-

fulfillment according to Abraham Maslow.

Self-actualization implies the attainment of the basic needs of physiological,

safety/security, love/belongingness, and self-esteem. If people think of life as a series of

choices, then self-actualization is the process of making each decision a choice for

growth.

According to the philosophy, in the process of self-actualizing one become more

aware of his/her inner nature and act in accordance with it. The philosophy operates on

the premise that man is naturally good and he is operating in his natural capacity by being

self-actualized. Maslow argues that a human being has within him a pressure toward

unity of personality, toward spontaneous expressiveness, toward full individuality and

identity, toward seeing the truth rather than being blind, toward being creative, toward

being good, and a lot else. That is, the human being is so constructed that he presses


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toward what most people would call good values, toward serenity, kindness, courage,

honesty, love, unselfishness, and goodness.

Abraham Maslow described several characteristics of self-actualized people.

Maslows theory conceptualizing behavioral was defined in terms of a hierarchy, which

the self-actualization needs is the highest of the human needs, involves the active use of

all our qualities and abilities, the development and fulfillment of our potential. Self-

actualized people are those who have achieved this goal. They are characterized by their

giving, calm and practical natures.

Self-actualized people share certain characteristics and Maslow concluded which

is objective perception of reality. Self-actualized people perceive their world and other

people with clarity, logic and in an unbiased view. The self-actualized people have

comfortable relations with more efficient perception of reality. This is extended to all

areas of life. Self-actualized people are not frightened, they are not frightened by the

unknown and they have greater ability to reason and to see the truth. They are able to

detect the dishonest and the fake.

Secondly, characteristic of self-actualized person has full acceptance of their own

nature. They accept their strengths and weaknesses. They do not try to distort or falsify

their self-image and they do not feel guilty or shame about their failing. They enjoy

themselves without regret or apology, they have no unnecessary inhibitions. They also

accept the weaknesses of other people and of society in general. They accept natural

events, even disasters, as a part of life.

Thirdly, a self-actualized person is committed and dedicated to a kind of work.

They focus on problems outside themselves. Self-actualized people have a sense of


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mission in life which they require energy. Their mission is their reason for living in the

world. This dedication to a cause or vocation is a requirement for self-actualization. They

are serene, characterized by a lack of worry, and are devoted to duty. Self-actualized

people find pleasure and excitement in their hard work.

Fourth, the behavior of a self-actualizer is composed of simplicity, honesty and

being natural. The behavior of self-actualized people is open, direct, and natural. They

rarely hide their feelings, emotions or play a role to satisfy the society, they may do so

only to avoid hurting other people. Self-actualized people are individualistic in their ideas

and ideals but not necessarily standard in their behavior. They feel secure enough to be

themselves without being aggressive. They are so spontaneous in their inner life, thoughts

and impulses and they are not hampered by agreement. Their ethics is independent. They

are individuals and motivated to keep growing.

Besides that, a self-actualized person craves for autonomy, privacy, and

independence. Self-actualizers can experience isolation without harmful effects and seem

to need loneliness more than persons who are not self-actualizing. They are alone but not

lonely and unflappable. They retain dignity amid confusion and personal misfortunes and

are objective. They do not go in for fads and they prefer to follow their self-determined

interests. This independence may make them seem aloof or unfriendly, but that is not

their intent. They are simply more autonomous than more people and do not crave social

support.

Furthermore, self-actualizers possess intense peak experience. A peak experience

is a momentary feeling of extreme wonder, awe, and vision, the loss of placement in time

and space with, finally, the conviction that something extremely important and valuable


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had happened, so that the subject was to some extent transformed and strengthened even

in his daily life by such experiences. Self-actualized people know moments of intense

ecstasy, not unlike deep religious experiences, that can occur with virtually any activity.

They are special experiences that appear to be very meaningful to the person who has

one.

In addition, self-actualized people abundantly exercise empathy and affection for

all humanity. All self-actualizers tend to have a deep and sincere caring for their fellow

humans. Although often irritated by the behavior of other people, self-actualizers feel a

kinship with an understanding of others as well as desire to help them. Identification,

sympathy, and affection for mankind, kinship with the good, the bad and the ugly, and

older-brother attitude. Truth is clear to them and often see things others cannot see.

Most of the people would like to describe self-actualization to be positive in many

ways , but Maslow wanted to make it clear that it was not easy to achieve self-

actualization. The hierarchy of needs which proposed by Abraham Maslow shows that

the lower the needs in the hierarchy, the more basic they are. However , everyone have to

achieve the lowest needs before they can deal with the highest need. The highest need,

which is self-actualization, meant they reaching their full potential, figuring out who they

are and the meaning of their life.

Conceptual Framework

The researcher will utilize the process of data analysis developed by Colaizzi

(1978). It is a seven step data analysis technique which is designed and congruent with

descriptive research studies in the hope of producing a descriptive, comprehensive

summary of the experiences of birthing center clinic owners.


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Collaizis methodological framework, a qualitative design using descriptive

phenomenology guided this study. The framework offered a unified view of objective

and subjective realities and more effectively described the complexity of the birthing

clinic owners. Therefore, the goal of this study is to bring to written and verbal

descriptions, distinct, critical components of the phenomenon.

Rigorous analysis of data constitutes the second component of the descriptive

phenomenological investigation. Collaizi method may be used to guide the analysis. The

following steps represent Collaizi process for phenomenological data analysis which are

as follows:

1. Each transcript should be read and re-read in order to obtain a general about

the whole content.

2. Extracting significant statement that pertains directly to the phenomenon. For

Each transcript, significant statements that pertain to the phenomenon under study should

be extracted. These statement must be recorded on a separate sheet noting their pages and

lines numbers.

3. Formulating meaning for these significant statements. The formulations must

discover and illuminate meanings hidden in the various contexts of the investigated

phenomenon. Meanings should be formulated from these significant statements.

4. The formulated meanings should be sorted into categories, clusters of themes,

and themes. Categorizing the formulated meanings into clusters of themes that are

common to all participants; referring these clusters to the original transcriptions for

validation and confirming consistency between the investigators emerging conclusions

and the participants original stories; not giving into the temptation to ignore data which


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do not fit prematurely generating a theory which conceptually eliminates the discordance

in the findings thus far.

5. Integrating the findings into exhaustive description of the phenomenon being

studied. Employing a self-imposed discipline and structure to bridge the gaps between

data collection, intuition and description of concepts. Describing includes coding

segments of text for topics, comparing topics for consistent themes, and bridging themes

for their conceptual meanings. Based on this description a prototype of a theoretical

model about the phenomenon under investigation is formulated.

6.

The fundamental structure of the phenomenon should be described. Validating

the findings by returning to some participants to ask how it compares with their

experiences.

7. Finally, validation of the findings should be sought from the research

participants to compare the researchers descriptive results with their experiences or final

description of the essence of the phenomenon.

Statement of the Problem

The study aims to explore the experiences of birth clinics owners in selected

provinces in Luzon. Specifically, it aims to answer the following questions:

1. What is the demographic profile of the respondents in terms of age, civil status,

highest educational attainment, and years in practice?

2. What inspired the participants to establish a birthing clinic?

3. How long did it take for the participants to formally establish the birthing clinic?

4. What are the challenges or difficulties experienced by the participants in the

establishment of the birthing clinic?


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5. What are the gains experienced by the participants in the establishment of the

birthing clinic?

6. What is the present status of the participants birthing clinics?

7. What pieces of advice or lessons do the participants wish to impart to others who

want to establish a birthing clinic?

Scope and Delimitation of the Study

The scope and delimitation of this study are the narration of the pains and gains of

the birthing clinic owners in their experiences to establish their own clinics. Their

responses will reflect how they went through the steps of establishing and maintaining

their birthing clinics. Most of the interviews will be conducted through interviews at their

desired time and venues.

Because the researcher is the primary instrument of analysis and interpretation, it

is important to state not only her role in the study, but also self-evaluate and clearly state

not only her own biases that may affect analysis and interpretation of the data. The intent

of this study was to provide a full and rich description of the phenomenon experienced by

the participants. The main focus is on biases related to their experiences as owner of

birthing clinics. Likewise, the study will only be conducted in selected provinces in

Luzon. Translation of the interviews threatens the richness and depth of the experiences

as to the experiences as to the significance of the whole study. The researcher will be

aware that the biases can impede the interview process as sometimes the interviewer can

unknowingly lead the participants to answer the questions.


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Definition of Terms

Birthing clinic.It refers to a healthcare facility, staffed by nurses or midwives

and/or obstetricians, solely for laboring mothers. They serve to assess the stages of labor,

and to monitor the well-being of the mother and fetus during birthing to determine

whether hospital-based backup due to complications, is needed.

Birthgains.These pertains to the rewarding experiences of the birthing clinic

owners when establishing or maintaining their clinics. It includes all those benefits they

gained personally or professionally.

Birthpains.These refers to the challenges that the birthing clinic owners

experienced both in their personal and professional lives when establishing or

maintaining their clinics.

Birthing clinic owners.They refer to those individuals who underwent the

process of establishing and maintaining birthing clinics in selected areas of Luzon.

Midwives. They refer to professionals who practicesobstetrics as a health

science. In addition to providing care to women during pregnancy and birth, midwives

may also provideprimary care to women, well-woman care related to reproductive

health, annualgynecological exams,family planning,andmenopausal care.

Participants. They refer to those individuals who met the criteria endorsed by

this study. Particularly, they are those who graduated Midwifery; previous or current

birthing clinics

Significance of the Study

The significance of the study is for people to understand the pains and gains of

birthing clinic owners. It is hoped that the findings of the study will benefit the following:
http://en.wikipedia.org/wiki/Obstetricshttp://en.wikipedia.org/wiki/Primary_carehttp://en.wikipedia.org/wiki/Gynecologyhttp://en.wikipedia.org/wiki/Family_planninghttp://en.wikipedia.org/wiki/Menopausalhttp://en.wikipedia.org/wiki/Menopausalhttp://en.wikipedia.org/wiki/Family_planninghttp://en.wikipedia.org/wiki/Gynecologyhttp://en.wikipedia.org/wiki/Primary_carehttp://en.wikipedia.org/wiki/Obstetrics


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To the researcher herself, that she might gain better perspective and understanding

of the experiences of other birthing clinic owners and use them to improve the services

offered to her clients as she endeavors to participate in the goal of diminishing the rate of

mortality among birthing mothers and their infants.

To the participants themselves, that the information to be provided by this study

will serve as inspiration to further enhance their services in terms of facilities and human

interaction. In addition, this study will also give them opportunities to reflect upon their

life experiences and interact with the other owners.

To the mothers, the information about birthing clinic may provide awareness so

they may be able to avail of their services and give birth successfully in those birthing

clinics.

For future researchers, to look beyond this research project to gain new inputs and

critically examine and focus on the experiences of the clients which are the main

beneficiaries of the birthing clinics.


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Chapter 2

DESIGN AND METHODOLOGY

This chapter deals with the methods and procedure that utilized in the study, the

research design, location and participants, and the data gathering procedure.

Research Design

The study will utilize a qualitative interpretative phenomenological approach

which consists of investigation that seeks to answer questions. It systematically uses a

predefined set of procedures to answer questions, collect evidences, and produce findings

that are applicable beyond the immediate boundaries of the study (Groke, 2010).

As cited by Cavaneyro (2013), Shuttleworth mentioned that qualitative research is

a method used specifically for studying behaviors and habits as well as perception and

beliefs of people.it focused on the subjective meaning of an experience to an individual

who previously or currently owned birth clinics.

According to Clark (2005) as cited by Malia (2013), subjective experience is

perception on which one creates their own state of reality; a reality that is based on ones

interactions with their environment and it is based on ones ability to process, store and

internalized data.

A descriptive phenomenological approach was used when little is known about an

issue and the aim of the study is to make clear and understand the most essential meaning

of a phenomenon of interest from the perspective of those directly involved in it. In view

of the aims underlying each of the major approaches, the use of phenomenological

approach was better suited to examine the experiences of the participants.


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Locale and Population of the Study

The researcher will conduct the study in selected provinces of Region 1, Region

3, and CAR. There will be 10 respondents for this study who are previous or current

owners of birthing clinics.

The following criteria were observed is choosing the participants in this study.

1. Midwifery graduates;

2. Previous or current owners of birthing clinics;

3. BCHS

Byrne (2001) as cited by Malia (2013) reported that qualitative researchers must

determine how many participants are necessary. Unlike in quantitative studies where

large numbers are necessary for statistical analysis, qualitative sample size are related to

the researchers time, budget, and geographic location. It is often helpful in a qualitative

study to perform data analysis concurrently with data collection. Creswell (2008)

suggested that often the sample size in a qualitative study is determine by data saturation.

Once the researcher had reached the point where participants report the same

information, data saturation has occurred and the researcher no longer needs to pursue

other participants.

Data Collection Procedure

In conducting the study, the researcher will adhere to the ethical principles of the

Code of Ethics to protect and safeguard the participants. The ethical principles to be

observed in the study were informed consent, self-determination, anonymity and

confidentiality.


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Informed consent is known as prerequisite for conducting any research. Any

dialogue referencing informed consent must be grounded in ethical principle of autonomy

which encompasses the notion of being a self-governing person with decision-making

capacity. It also means that the participants in the study received adequate information

regarding the research and voluntarily consented to participate in the research or even

decline participation.

In the study, the researcher will approach the participants and inquire about the

level of willingness to participate. To make the inquiry informal, a letter requesting

voluntary participation in the study will be given to them. Attached in the letter are the

documents to the study.

The participants of the study have the right to expect strict confidentiality where

any data provided for the participants will be kept confidential. Anonymity is the most

secure means of protecting confidentiality. There is anonymity when even the researcher

cannot link participants to the data. Confidentiality is a pledge that any information that

the participants would provide will not be publicly reported in a manner that identifies

them and will not be made accessible to others.

The researcher will assure the participants that all data obtained will be kept

confidential. Their names will not be revealed in the study to protect their identities.

Instead, their names will be replaced with code names which will be names of

phenomenological researchers. All data to be collected will be used for the purpose of the

study only. All data to be gathered from them will be handled with security to abide by

rules of confidentiality of data.


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In addition, researcher will treat the participants fairly and equally. They will be

chosen based on the eligibility criteria that the researcher formulated to avoid

discrimination or bias. Their values and beliefs will be deeply appreciated and respected.

Those who want to refuse and opted to withdraw in the study will be treated justly as

well.

Data Gathering Tool

In this study an interview guide questions will be used to collect data. The guide

questions will reflect the experiences of birthing clinic owners. Participants will answer

the question through interview aided by audio-video recording to ensure that all needed

data will be collected.

Data Analysis

In analyzing the data, the researcher will utilize Collaizzis method. This method

sets forth a procedural modification to unveil the meaning of participants experiences

through their responses to research questions relating to the phenomenon under the study.

Figure 2 illustrates the process of descriptive phenomenological data analysis.

1. Each transcript should be read and re-read in order to obtain a general sense about

the whole content.

Interviews to be conducted with each patient will be transcribed verbatim and read to

gain an understanding of their personal experiences. The interviews will be read multiple

times to immerse the researcher in each participants text and achieve a collective

impression. During this stage, any thoughts, feelings, and ideas that may arose from the

researcher due to her experience were added to the bracketing diary. This helped to

explore the phenomenon as experienced by the participants themselves.


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Transcript

Identify Significant Effects

Formulation of Meanings

Clusters, Themes

Description of the Phenomena

Fundamental Structure

Validation of Findings with the Experiences

Figure 1

Phenomenological Data Analysis


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2. For each transcript, significant statements that pertain to the phenomenon under

study should be extracted. These statements must be recorded on a separate sheet noting

their pages and line numbers.

After reviewing the transcripts, significant statements/phrases relating to the

experiences under research will be extracted. Significant statements and phrases

pertaining to body image changes and coping strategies will be extracted from each

transcript, the statements will be written in separate sheets and coded based on their

transcripts.

3.

Meanings should be formulated from theses significant statements.

For every significant statement extracted, meanings will be formulated and

original meanings maintaining the consistency of descriptions. Then similarities and

differences will be synthesized from the statements.

4. The formulated meanings should be sorted into categories, clusters of themes, and

themes.

Meanings will be organized into cluster or themes. Theme will be used to describe

a structural meaning unit of data that is essential in presenting qualitative findings. All

meanings will be considered. After having an agreement toward all formulated meanings,

the process of grouping all these formulated meanings into categories that reflect a

unique structure of clusters of themes was initiated. Each cluster of theme coded will

include all formulated meanings related to that group of meanings. After that, groups of

clusters of themes that reflect a particular vision issue will be incorporated together to

form a distinctive construct of theme. Indeed, all these themes are internally convergent


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and externally divergent; meaning that each formulated meaning falls only in one

theme cluster that is distinguished in meaning from other structures.

5. The findings of the study should be integrated into a exhaustive description of the

phenomenon under study.

The findings of the study will be integrated into an exhaustive description of the

phenomenon under study. At this stage of analysis, all emergent themes will be defined

into an exhaustive description. After merging all study themes, the whole structure of the

phenomenon experiences of birthing clinic owners will beextracted. This state is

where the data saturation will emerge.

6. The fundamental structure of the phenomenon should be described. This step is a

bit similar to the previous step, but no exhaustive meaning will be sought.

In this step a reduction of findings will be done in which redundant, misused or

overestimated descriptions will be eradicated from the overall structure. It seems that

such attempt will be made to emphasize on the fundamental structure. Some amendments

will be applied to generate clear relationship between clusters of theme and their

extracted themes, which will included eliminating some ambiguous structures that

weaken the whole description.

7. Finally, validation of the findings should be sought from the research participants

to compare the researchers description results with their experiences.

Finally, validation of the findings will be sought from the research participants to

compare the researchers descriptive results with their experiences. This step aims to

validate study findings using members checking technique. It will be undertaken by

returning the research findings to the participants and discussing the results with them.


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During this process, bracketing will be made to minimize interference with the

pure and clear transfer of the phenomenon into the researchers consciousness as

described by Drew (2001). This attempt is necessary to prevent assumptions from

shaping the data collection process, to discover any possible bias, to prevent interposing

the researchers understanding and construction of the data. This will allow discovery of

phenomenon through experiential perspectives of the midwives thus alleviating any

researcher imposed impressions and recollections. To facilitate this process, the

researcher will maintain a reflective diary which will be initiated preceding any

interviews. There will be a continuous reflection and self-questioning to bring personal

perceptions, presuppositions, and biases to the surfaces of consciousness.

Establishing Trustworthiness of Data

To enhance the trustworthiness of the study, a criterion validity will be integrated

in the procedure. The four factors to be included includes credibility, dependability,

conformability, and transferability (Polit and Beck, 2008).

Credibility as described by Polit and Beck (2010) is the overall goal of qualitative

research. If refers to confidence / truth within the results found and the interpretations of

those results. The researcher strived to establish confidence in the truth of results of the

research. Moreover, there are two important aspects to credibility. First, carrying out the

research study in such a way that makes the finding most believable. Second, the

researcher must be able to demonstrate his/her credibility to readers. The researcher plans

to demonstrate credibility by posting a copy of each individual interview transcript to

each respondent that will participate in an interview. This will allow them to give

feedback on the accuracy of the transcript. By doing this, the researcher will establish


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whether the experiences of the birthing owners has been truthfully presented while also

offering the researcher a chance to modify any transcripts. This is known as member

validation where the researcher will conduct two to three times interview to the

participants within thirty minutes to one hour in the their preferred venue and time.

On the other hand, dependability is described as the reliability of the data in a

different but similar time and condition. In order for the researcher to attain credibility,

they must attain dependability or generalizability. The researcher is aware, that due to the

nature of qualitative research, generalizability will be difficult to achieve and was not the

aim of this type of research.

Confirmability is concerned with ensuring that all data presented is an accurate

and factual representation of the information provided by participants. In other words, the

data presented must not be figments of the inquiries imagination. The researcher will

be aware that if confirmability is to be achieved, strict neutrality must be present so that

biases or preconceptions can be introduced in to the data. The researcher intends to use a

decision trail when interpreting the data. A decision trail will allow the researcher to trace

back how they came to a conclusion about certain interpretations and themes in the

findings. The researcher made a copy of the decision trail that will include; a written

record of notes that will be taken by the researcher with a typed version will also be

prepared. The decision trail copy will be made available upon request.

Lastly, transferability is described as the extent to which the findings of a

qualitative study can be applicable in other groups or settings. The researcher intends to

provide sufficient descriptive data so that the reader can determine this for themselves.

According to Holloway and Wheeler (2010) as cited as Malia (2013), since the


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researcher/interviewer is the main inquiry tool within a qualitative study, replication

cannot be entirely achieved when conducting interviews.

The researcher will consider the reliability and validity of the study to determine

whether this research truly measure how truthful the results are. Asking chain of

questions was a way to validate the respondents answers. Also the researcher will sought

advice from people who have knowledge on qualitative researcher who reviewed the

findings in terms of richness and completeness to provide sufficient description reflecting

the pains and gains of birthing clinics owners. Finally, a validation to this exhaustive

description will confirmed with the researchers adviser.


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References

Castillo, R. B. (2013).Lived experiences of women who had underwent intentional

abortion. Unpublished Thesis. Baguio Central University.

Cavaneyro, L.L. (2013).Lived experiences of spousal caregivers of patients undergoing

hemodialysis.Unpublished Thesis. The Philippines Women University.

Collaizzi, P. (1978).Existential phenomenological alternatives for psychology.

http://www.amazon.com/Paul-Francis-Colaizzi/e/B001KICGB2

Cresswell, J.W. (2008).Research designs: Qualitative, quantitative, and mixed methods

approaches (2

nd

Edition). Thousand Oaks, C.A.:Sage.

Direja, A.H.S. (2012).Lived experiences of family members with children with

maladaptive behavior: Inputs to mental health awareness. Unpublished Thesis.

Indonesia.

Malia, J.P. (2013).Lived experiences of cancer patients.Unpublished Thesis. Baguio

Central University.

Polit, D.F. & Beck, C.T. (2008).Nursing research: Generating and Assessing evidence

for nursing practice. Philadelphia: Wolters Kluwer. Lippincott, Williams

and Wilkins.

Polit, D.F. & Beck, C.T. (2010).Essentials of nursing research appraising evidence for

nursing practice 7th

edition. Lippincott Williams and Wilkins, Philadelphia, PA.


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Appendix A

Letter to the Participants

Greetings!

I am a graduate student of Baguio Central University, taking up Doctor of

Philosophy. I am presently gathering data for my research work entitled Pains and

Gains of Birthing Clinic Owner.This study intends to illuminate the experiences of

birthing clinics owners as they went through the process of establishing and maintaining

birthing clinics. In this regard, may I ask your permission to answer questions related to

this study. With your consent, an audio recording will be used during the interview. You

are asked then to validate your answer after the interview. Rest assured that all

information that is shared during the interview will be strictly confidential.

Thank you for your participation. You may decline to answer any questions

during the interview. You may withdraw from the study at any time. An abbreviated copy

of the research findings will be sent to you at the end of the study.

Respectfully Yours,

Lolita Itliong-Dicang

Researcher


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Appendix B

Questionnaire to Participants

Part I. Demographic Profile

Age: _______

Civil Status: __________

Highest Educational Attainment: _______________________________

Years in Practice: __________________

Name of Birthing Clinic: ______________________

Part II.1. Would you like share or talk about yourself and family?

2. What motivated you to establish a birthing clinic?

3.

To aid the achievement of the DOH goal of lowering maternal mortality byproviding avenues where mothers can safely deliver.

4. To provide alternative facility-based sites for mothers to give birth aside from the

hospitals and health centers.

5. To augment financial income of the participant.6. To provide employment opportunities.

Others, please specify: _______________________________

7. When did you start to plan or conceive the establishment of a birthing clinic?8. When did it formally operate?

9. Please describe the process you underwent to formally operate your birthing

clinic?

10.What are challenges or difficulties did you experience in the establishment of thebirthing clinic personally, professionally and as an owner?

11.What are the rewards and gains did you experience in the establishment of your

birthing clinic personally, professionally and as an owner?12.What are your advices and lessons learned that you would like to impart to those

who also want to establish a birthing clinic?


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CURRICULUM VITAE

PERSONAL DATA:

Name: LOLITA ALCARAZ ITLION-DICANGDate of Birth: January 7, 1945Place of Birth: Manaoag, Pangasinan

Civil Status: Married

Religion: Roman CatholicChildren: Bernard I. Dicang

Cherrilynn Dicang-Rillera

Anthony I. Dicang

Simelyn Dicang-Ostrea

EDUCATIONAL BACKGROUND:

Post-Graduate : Baguio Central UniversityBaguio City

Doctor of Philosophy in Administration and

AdministrationIn Progress

18 Bonifacio St., Baguio City

Pamantasan ng Lungsod ng Maynila

Intramuros, Manila

Master of Community Health Services2007

University of PhilippinesBaguio City

Master in Management

Major in Health Services Management

2001

College: Baguio Central University

Baguio City

Bachelor of Science in Public Administration1995

San Juan Hospital School of MidwiferySan Juan, Metro Manila

1963


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WORK EXPERIENCE

Board Examiner

Professional Regulation Commission (PRC)Board of Midwifery

Sampaloc, Manila2006 to Present

Midwife Supervisor

Baguio Health Department (Health Services Office)Baguio City

2001 to 2010

Senior MidwifeBaguio Health Department

Baguio City

1987 to 2000

Staff Midwife

Baguio Health Department

Baguio City1970 to 1987

Casual MidwifeBaguio Health Department

Baguio City

1969 to 1970

Rural Health MidwifeMankayan Rural Health Unit

Mankayan, Benguet1964 to 1966

pains and gains of birth clinic owners

Documents