• normal birth;
  • childbirth;
  • evidence-based practice;
  • midwifery-led care;
  • institutional ethnography;
  • qualitative research

Introduction: This study examined factors that foster or hinder the support of normal birth in two English National Health Service Trusts identified for public recognition of their work to normalize birth.

Methods: This interpretative qualitative study was guided by institutional ethnographic and narrative methods. Purposive sampling was conducted to achieve maximal variation across social, demographic, cultural and ethnic groups. In-depth interviews explored clinician's and women's views and experiences of normal birth. Ethnographic observations of practice, clinical and administrative meetings, educational sessions, and informal discussions were conducted over 6 months at one of the maternity settings. Antenatal and intrapartum clinical guidelines were reviewed and analyzed.

Results: Three key strategies supported the normalization of birth: 1) an “ethos” of normality; 2) “working” the evidence; and 3) “trusting” women to make informed choices best for them. Inappropriate use of technology, disregarding risk status when assigning women to units, lack of physician preparation in normal birth, and poor staffing levels were cited as barriers.

Discussion: These strategies should be carefully examined for translation to the United States and future research.

J Midwifery Womens Health 2010;55:262–269 c̊ 2010 by the American College of Nurse-Midwives.