Title: Negotiating the ambiguity of an (in)authentic working life – a grounded theory study into
severe perineal trauma
Version: 1 Date: 01 Nov 2022
Reviewer's report:
Thank you for the opportunity to read and comment on this manuscript. It is an important topic
with novelty and the results are of importance.
General comments:
Thank you for using the definition severe perineal trauma!
I do like the concept of using a feminist framework and I think that it might add value to
the article. However, the use of Simone de Beauvoir’s framework currently overshadows your
result, which is very important. Parts of the manuscript becomes very abstract. Subcategories
and quotes are easy to understand, and the result is, as said, very important.
However, to help the reader, the more abstract parts of the manuscript need further processing,
which can be done by clarifying and explaining but also shortening some parts of the manuscript
and really making sure that all parts connect to your study aims.
The following concepts that need clarification
• situated embodiment
• authentic life and authentic work life: What is an authentic life? This wording might even be
provocative to some if not well explained
• in(authentic working life)
The word count for this article without references is 6800. Even though, BMC women’s health
have no word limit for their manuscripts, it is long. Please look over your manuscript an see
what is really needed (particularly the introduction) to understand your results.
Furthermore, you sometimes use ibid and cf in your referencing. This is not common practice
when using the Vancouver system for referencing. Please revise.
Abstract
Well written and clear
Introduction
The introduction is clearly written but would benefit from being shortened and made more to
the point. For example, the two first paragraphs regarding prevalence and symptoms could be
shortened to one. This comment applies to the whole introduction. For increased readability,
please shorten and focus on what is important for the study. Prevalence and consequences of
SPT are well known and well researched and do not need to be described in detail. The paragraph
about Swedish research and what is missing is also long, what is needed for the understanding of
this study? Reference 40 – is this research aimed at the prevention of perineal trauma? References
39,41 refers to trial protocols. If results have been published and are of relevance to this study
- refer to them instead.
The introduction lacks more explicit problematization that leads to your aim. The paragraph on
working life is short. What is the Swedish context regarding work life?
In addition, I miss gender perspectives in introduction because it is also mentioned both in study
design, results, and discussion. For example, cis is mentioned without explanation.
Theoretical framework:
The paragraph regarding Simone de Beauvoir and her framework is extensive. It needs a stronger
connection to the aim of this study. There is also a lack of an explanation why her framework
was chosen, as there are many other feminists and feminist theories.
Line 119-102: immanence represents the body or nature where existence as an object is
maintained passively, such as pregnancy and childbirth
This sentence lacks substantiation as childbirth is by many not described as passive – it can
be seen as both passive and active. Furthermore, your study does not include pregnancy and
childbirth, rather morbidity after childbirth. I suggest removing childbirth from the sentence.
Line 121-122: On the other hand, transcendence symbolises the mind actively developing life
projects towards freedom, activities mainly pursued by men.
This sentence is unclear. Do you mean men or mankind? As this article is about women’s
experiences, the end of this sentence leads the reader in another direction.
Line 131-137. How this paragraph regarding to shame relates to the purpose of the study needs
to be clarified.
Even if all the paragraphs separately have a certain problematization, there are no summarizing
sentences that leads to the purpose of the study and its contribution of the field.
Method
Design: Please elaborate on the study design. Why did you choose GT? What does grounded
theory approach according to Charmaz mean?
Participants and procedure: How many women volunteered to take part in your study? If only
11 on this large social media platform, why is that? And how does that affect your results? This
should also be discussed in the limitation section.
P 9, line 188-203. This  paragraph is about the background of women participating in the study. I
suggest that the description of the participating women should be moved to results (line 193-201)
for better readability as it precedes the data collection. Alternatively: move the development of
study guide (line 204-208) to procedure - line 187.
Line 191: Participants, subsequently referred to as “the women”, defined themselves as cis
women and were married or cohabited with their partners. We have consciously chosen to use
the binary categories of “women” and “men” in this paper.
Since you want a gender perspective for this article, this needs to be described more clearly in
the introduction,  including definitions such as cis (see previous comment). It is also unclear
why you are talking about binary categories women/men based on the results. I can't see that
the study is connected to men rather than in a societal sense. Perhaps this is all due to the lack
of a paragraph with clarification on gender/gender process and how this connects to your study
in the introduction.
Data collection: Here you address gender, in this case with regard to the research team. A
recommendation is to gather all parts that concerns gender and gender construction in the
methods section under one heading.
Line 220: Recordings were transcribed verbatim and validated for accuracy.
How was this done? Please clarify.
Data analysis: Line 229: Following Charmaz (60), KT inductively coded the remaining
interviews naming lines or segments of data while using gerunds to convey action.
This sentence is unclear, please clarify what gerunds to convey action means.
Line 232: In our discussions on understanding the meaning of data, Beauvoir’s concepts of
immanence and transcendence emerged as applicable.
How did you arrive to that conclusion? It must have been a process? This needs some
clarification.
Line 238-240: Finally, the theoretical coding identified how our categories related to each other.
The emergent theoretical model….
Since grounded theory is not described in the study design, it becomes difficult to understand
how 10 interviews can result in a theoretical model. Please provide more information on this.
Ethical considerations
Line 249-250: The project homepage (hyperlink) and the information letter provided information
on available support options.
Please avoid linking to a homepage as this hyperlink will probably not always be available.
Results
What is an authentic or inauthentic working life? This is not described in the introduction and
there is a need for a definition.
English is not my native language but when I look at synonyms of covert – secretive comes up.
Is there any reason for using covet rather than secretive?
Line p. 12260-262:The women negotiated work immanence as “the silent covert object” by
objectification and detention at work due to SPT. This sentence is unclear.
What do you mean by detention in this context? Please clarify.
Table 2 is very helpful for understanding the results!
P 17, line 372:
Quote: “Well, partly I do not want it [the toilet] to smell when they [my colleagues] go after me
or notice that it [toilet visit] takes some time. Moreover, in no way do I want to push, and when
I’m stressed, I may push. So, I have to make the body feel calm to relax fully, because then it
[faeces] comes easier by itself.” (Interview 10)
This quote is a bit difficult to understand by itself without the context (what are her problems,
why does she not want to push? Smell after a toilet visit is a common workplace taboo,
irrespective of having SPT related problems). Further the quote does not entirely capture what
you have written in the preceding text.
Discussion
In this section you describe that Simone de Beauvoir's framework did not fully fit your findings.
Instead, you introduce Foucault to interpret your results? This makes one wonder whether
Simone de Beauvoir’s framework is helpful to understand your results. Or rather does it hinder
the understanding of your results, which are really important and needs to be highlighted, i.e.,
how women with SPT-related symptoms experience their working life?
The discussion does not entirely relate to your findings. Is there no related research within in your
field that is in line or contradicts your findings? Further, I don't see that body image, surveillance
and media are mentioned by women in your study, but this makes up for a substantial part of
the discussion. (line 536-546)
Implications for practice, conclusion
According to the author guidelines for BMC Women's health, the subheading Conclusion
is needed. Therefore, I suggest shortening and merging these two paragraphs to increase
readability.
Strengths and limitations
Can you please discuss the transferrability of your findings . Further I wonder whether your
preunderstanding could be seen as a limitation?  Or hhow you handled your preunderstanding
References
Review the number of references in the manuscript. Even if BMC women's health has no limit,
77 references are quite many. BMC writes in its policy that: Authors should not use an excessive
number of citations to support one point.