competence and personal and professional self‐development as supporting attributes. A ‘good midwife’ is perceived by women to be able to provide them with information and is competent in fulfilling their needs whilst they feel listened to (Overgaard et al. 2014). In addition, women want to be individuals cared for by a midwife who provides ‘presence’ and makes them feel safe and cared for through their attitude and behaviour (Dahlberg et al. 2016).
One aspect which develops skills and knowledge essential to the ‘with woman’ competence is the reflective process: both internal as a reflective process and shared through discussion or story‐telling. Johns and Freshwater's (1998) interpretation of reflection, although now dated, is still relevant in that practitioners' experience informs embodied knowledge translated into clinical decisions to become intuitive knowledge. The relationship between a midwife's practice experiences and self‐development through reflection transforms perceptions and beliefs and ultimately results in skilled empathetic midwifery practice and competence. One paper from Australia explores the issues surrounding the situation when a woman declines recommended care (Jenkinson et al. 2017). The authors examine, from a feminist perspective, how the woman's and the midwife's autonomy may be upheld with specific guidance from clinicians providing care in this situation and suggest that models of care which support reflexive practice may enable midwives to advocate the right of refusal and maintain the ‘with woman’ concept empathetically.
Table 2.1 summarises the literature in relation to ‘with woman’ concept from an ethical perspective for both women and midwives. Rodgers' framework (1989) underpins the analysis in terms of antecedents, attributes and consequences.
Conclusion
Rodgers's framework (1989) suggests that related concepts exist as part of a network of concepts that provide significance to the concept of interest. In the analysis, related concepts were identified related to the continuity of carer, the ritual companion and the ‘good’ midwife in examining the literature. The impact of the continuity of carer concept suggests attributes of confidence to offer choices of sound judgement by midwives in their relationship ‘with woman’. The consequences are respect for ‘women’ autonomy, empowerment to make the right decisions, fulfilling women's expectations and preserving safe midwifery care. These attributes are explored further in Chapter 3.
Ethical issues related to fulfilling the ‘with woman’ concept, which examine the impact of moral and practice dilemmas on delivery of current midwifery practice, underpin the consequences of this and related concepts. Midwives' and women's perspectives of ethical practice, embedded in shared knowledge, power and trust, have highlighted the challenges faced in making decisions to ensure safe and positive birth experiences; this is within the remit of relational autonomy and codes of professional midwifery practice. The stories that follow illustrate how midwives fulfil and deliver compassionate, empathetic and ethical ‘with woman’ care and how one woman challenged routine care and opted for an unconventional delivery to achieve the transformative and life‐changing experience of birthing her baby.
Table 2.1 Concept Analysis of the ethical perspective of being ‘with woman’.
| ‘With woman’ antecedents | Evidence | Attributes (A) and consequences (C) |
|---|---|---|
| Continuity of carer | Taylor et al. (2018) and Yoshida and Sandall (2013) raised issues practical barriers to C of C role | Confidence (A) Safety (A) Need for training (C) Adequate staffing (C) Sound leadership and Management (C) |
| Decision making | Katz Rothman (2013) Challenges to making decisions as a social process based on bioethics Chadwick (2015) importance of safety | Mother–midwife relationship (A) Respect for autonomy (A) Promoting professionalism and trust (A) Preserving safety (C) prioritising people (C) Effective practice (C) |
| Care and responsibility | MacLellan (2014) The role of care and responsibility through ethics of care Newnham and Kirkham (2019) Dodwell and Newburn (2010) explore relational support | Actions and judgement (A) Interpersonal relationship (C) Valued social relationship (C) Balance of care and responsibility (A) Compassion (C) Non‐maleficence and accountability (C) Offering choices and fulfilling women's expectations (A) Control (C) Empowerment (C) |
| Choices | Jefford and Jomeen (2015) impact on midwives' working practices Hastings‐Tolsma and Nolte (2014) ‘failure to rescue’ Griffiths (2011) law of negligence Smith (2016), Jefford and Fahy (2015) intuitive humanistic theory. Daemers et al. (2017) sharing decision making Newnham et al. (2017) lack of choices. Borelli et al. (2017) influencing factors on the expectations of the midwife's role | Legal and professional accountability (A) Autonomous practice (C) Professional vulnerability (C) Defensive practice (C) ‘Safe’ practice (A) Interventions in childbirth (C) Right not to be harmed (A) Midwifery evidence and logical rationale (C) Intuitive practice to include knowledge, experience and attitudes (C) Fulfilling women's wishes (C) Centres the woman (C) Organisational & resource limitations (A) Biased and not true informed consent (C) May impact their place of birth choices (C) Need for safety and fulfilling experience (C) |
| Relational autonomy | Christman (2015) dynamics of deliberation and reasoning Nieuwenhuijze et al. (2014) Thompson (2013) women's awareness of constraining factors Morad et al. (2013) trusting relationships. Noseworthy et al. (2013) relational autonomy Hall et al. (2018) women's dynamic experience of birth Meadow (2014) Social context of relational model and Lewis (2019) principle of respect. Dahlberg and Aune (2013) quality and content of care | Informed choices (A) Shared knowledge (C) Negotiation (C) Shifting power between woman and midwife (C) Professional self‐esteem & self‐respect(C) Women's dignity (A) Mutual trust & sympathetic understanding (C) Caring and nurturing environment (A) ‘Being with others’ (C) Women's autonomy fulfilled (A) Confidence and self‐belief in the body's ability to give birth (C) Creating a space to develop skills (A) Self‐confidence and self‐esteem for women (C) Holistic care through presence and emotional support by MWs (C) Importance of positive birth experience(A) MW as advocate & companion (C) |
| Ritual companion | Reed et al. (2016) ‘Rites of passage’ Pembroke and Pembroke (2008) women at centre of care Brown (2012) ‘with woman’ Moloney & Gair (2015) compassion Raynor and England (2010) transparency and therapeutic communication Dierckx de Casterlé (2015) ethical perspectives of the skilled companion | Rites of protection (A) Relationship that is enabling and empowering (C) Caring presence (C) Environment of security and trust (A) Spirituality (A) Responsiveness and availability (C) Perceptiveness (A) Responsive to needs and values (C) Empathy and intuition (A) Warmth and acceptance (C) A fulfilling birth experience (C) Empathetic presence (A) Women feel accompanied and supported (C) |
| ‘The good midwife’ | Nicholls and Webb (2006) Byrom and Downe (2010) key elements of the good midwife Overgaard et al. (2014) Dahlberg et al. (2016) attitudes and behaviour | Clinical competence (A) Well‐developed skills of compassion, kindness, knowledge and skills (C) Women provided with information and listened to (C) Fulfil women's needs (C) Feel safe and cared for (C) |
A Midwife's Story
Anna's Story
In
