woman’ at the point of birth. The purpose of this study was to develop a better understanding of ‘hidden’ skills that midwives perceive they need to draw upon to truly be ‘with woman’. The findings suggest that midwives fulfil the ‘with woman’ concept in different ways and identify several attributes which describe the interplay between woman and her midwife during the time of birth.
The perceived therapeutic relationship between women and midwives is one attribute of this concept which a midwife perceived as building ‘a relationship with them [women] and understanding what they want’. ‘Identifying their needs without them having to ask you.’ ‘Being in tune with their [women's] emotional state’ and ‘being trusted’. ‘Having a good interpersonal relationship.’ ‘If you don't have that empathy you don't build up that rapport with women … pick up cues from the women.’ Another attribute of the ‘with woman’ concept is being able to identify and support women's needs and was seen by midwives as ‘being perceptive to their needs’ and ‘responding to things that she [the woman] says, by nodding to acknowledge you've heard what she said’ and ‘it's about what her [woman's] body is doing and what your body is doing in response’, ‘… and being sensitive to when some parents don't want you with them’.
Another interesting attribute of the ‘with woman’ concept became apparent in this study (Brown 2012). This was demonstrated through compassion, by giving women time to adjust during their pregnancy and in labour played out through watching and waiting. A midwife said, ‘You can show presence, a supportive presence, its watching and waiting, it's not just doing.’ Another midwife said, ‘You just need the women to get used to their surroundings, and to me, they just need to get used to my voice.’ ‘Kindness is so hard to measure, and it is a sixth sense … and I think it's sensitivity – there is something there that you cannot explain but you have a feeling’ and ‘reading the situation’ and ‘knowing when you should shut up and when you shouldn't’, ‘the language you use because you have to adapt to their [the women's] ability to understand the language you are using’ and ‘tone of voice’; ‘recognising when it is good not to say anything’ and ‘recognising silence’.
Findings from this study (Brown 2012) suggest a resulting consequence of the above ‘with woman’ attributes which was a positive birthing experience overall. One participant said, it is ‘not just being there, but exploring everything that will make labour time and delivery bring pleasure to them, something they will always remember’ and ‘make her [the woman] feel empowered’ whilst ‘being an advocate for her’ and ‘just keeping her the focus’. A midwife succinctly explained that, ‘part of it is your own personality … an innate thing … your own belief … a self‐awareness’, whilst another midwife sums up the learning from being ‘with woman’ in terms of, ‘By just being there I am able to instil autonomy and confidence.’ One midwife concludes, ‘A good midwife achieves an awful lot by doing nothing and that is what it's all about.’ ‘Women are great teachers and so always use them as a resource as well, be good listeners and if you listen to women, then very often they're very, very intuitive to their own bodies so they can teach us a lot and we can learn a lot from them.’
Donna's Stories
Rosie*'s Story
Being a community‐based midwife, means that our contact with women is on a one‐to‐one basis, outside of the hospital environment. Often in GP surgeries, clinics or women's homes. As such, we have the opportunity to bond with the women in our care and provide them with not only clinical care but continuity, friendship and support in a way that is less possible within a busy hospital‐based setting.
I have found that having had the opportunity to build relationships with women during their pregnancy, they will seek my support more willingly than other healthcare professionals as there is a level of trust that has been built.
I recently saw Rosie for her antenatal check. I could tell the moment she came into my room that she was distressed, as was her partner John. They had received the news that their baby was very likely to have a life‐limiting condition. They had attended a number of scans to confirm this, and only a matter of days before hand, had the confirmed diagnosis. Although they had been given the clinical outlook from the medical professionals they had seen, in their words: ‘no‐one had given them the space to understand what this would mean for them, and what their choices were’.
This is not normally a conversation held in a community setting, as there are specialist healthcare professionals that are trained in this field; but they wanted my support. From a deeply personal perspective as a mother I was desperately upset for them, while also knowing the clinic appointments are only 20 minutes long, and I knew that this was not going to be a quick chat and I had a busy clinic. I was worried that I wouldn't have all the answers, but I gave them the space to talk about everything that had happened. Rosie cried, and John just held his head in his hands. Sometimes all the clinical training in the world can't give you the words for a time like this. I held Rosie's hand and asked how I could help. She needed someone to talk to her in ‘lay’ terms; simply to discuss what their options were.
I gave the couple what information I was able to and then made phone calls to the relevant support teams to get advice. There were no decisions made in the room at that point, but I assured Rosie she had my support in whatever decision she made. They left with a clear idea of what their options were, and in circumstances like this, that is whether to continue the pregnancy or not.
I have to be honest that when I started my midwifery journey, I had ‘rose coloured spectacles’ about the role of a midwife, bringing new life into the world. I still have a great belief that all birth is sacred, but there are times when my personal and professional beliefs are challenged. No textbook or hospital policy can give you the insight needed to deal with deeply emotional situations such as talking to a woman about whether or not to continue her pregnancy. I could only support Rosie in the right choice for her. I told her she was a brave woman who would make the right decision for her and her baby and family.
Forty‐five minutes later the couple left the clinic, and I cried on my own. There were now two women in the waiting room, eagerly waiting for my care and attention to discuss their continuing pregnancies. I composed myself and carried on with clinic, apologising to everyone for the rest of the clinic about being late, but assuring them that they would have my care attention for however long they need it.
Being a midwife is a privilege, walking ‘with women’ at every point during their pregnancy, birth and beyond and is often full of pure joy and the wonder of new life, yet can be interspersed with tragic and ethically challenging moments where the support of a midwife is second to none.
Lois*'s Story
Whilst working on labour ward, I cared for a woman who had her first baby. Our shifts are 12.5 hours long, so we spent a good amount of time with Lois and Jake, her birth partner. I got to know them well and at the end of the shift I left and wished them well.
Three weeks later I came onto shift and Lois's name was on the board as having just arrived in triage. I offered to go and see her as I already knew her. Upon greeting the couple, Jake was holding the baby, who was well and settled. However, Lois had been suffering with her mental health since birth, despite good family and community midwife support. Jake stated that overnight Lois had been having psychotic episodes and had come to triage.
Lois remembered me and embraced me when I entered the room, so very happy to see someone she knew. She was very lucid, and I was able to take her observations and talk to her about her baby. She had struggled with breastfeeding over the last few weeks but was now
