Rejecting Perfection, Valuing Imperfection in Perinatal Care: a Mixed-Methods Study of Responsive Practice Through The Five Misfits by Beatrice Alemagna

Abstract Picture books are recognised within the medical humanities as narrative tools capable of supporting reflective practice, emotional awareness and professional development among healthcare practitioners. In perinatal care, where relational demands are high and emotional exposure is constant, they may help practitioners examine implicit professional models, including attitudes towards vulnerability, imperfection and paternalism. This mixed-methods study explored how 34 perinatal professionals attending a postgraduate training programme interpreted The Five Misfits by Beatrice Alemagna, and how engagement with its characters supported reflection on responsive models of care. Forum-based written reflections following a facilitated reading of the picture book were analysed through inductive thematic analysis; eight thematic dimensions relevant to responsive care were scored on a bipolar scale (−2 to +2), and character profiles were compared statistically and read alongside qualitative excerpts. Participants rejected a professional stance characterised by perfectionism and the imposition of solutions, associated with paternalism and with negative emotional responses (90%), while symbolic representations of imperfection linked to flexibility, emotional openness and creative adaptation were predominantly valued (73– 95% positive feelings). A third position, associated with passivity and exhaustion, elicited predominantly negative emotions (85%) while generating the highest levels of self-reflection; facilitated discussion enabled participants to acknowledge these aversive reactions and reframe them, supporting more nuanced interpretations of vulnerability in care relationships. Carefully guided engagement with a metaphor-rich picture book can help practitioners confront uncomfortable emotional reactions and re-examine implicit norms of care in emotionally demanding settings.