Better Births. Anna Brown

https://doi.org/10.1002/14651858.CD004667.pub5.

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      23 Walsh, D. and Devane, D. (2012). A metasynthesis of midwife‐led care. Qualitative Health Research 22 (7): 897.

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      Foreword

      I am delighted to welcome you to this essential text: Better Births: The Midwife ‘with Woman’. I know the passion and dedication shown by the Lead Author and Editor, Dr Anna M. Brown as I have been fortunate to work with her for many (nearly 20) years! Many of the other authors are also colleagues and practice partners which gives me a real sense of pride in the enthusiasm shown by the clinicians who I work alongside.

      The introductory chapter sets the scene clearly for the focus of the book, detailing the stories from Midwives on being ‘with women.’ The importance of sharing our experiences is paramount in supporting the learning and reflection of our colleagues, students and the generation of professionals. Indeed, the voice of women also comes through clearly; thank you to all those who have shared their personal experiences of pregnancy and birth, your courage and honesty will support learning for the profession.

      I would personally like to thank the contributors of this book as I know it will form a valuable resource for all who access it. I look forward to seeing our Surrey students ‘thumbing’ through it, knowing that it is being opened more widely across the next generation of this vibrant group of professionals.

      Professor Melaine Coward Head of School, School of Health Sciences, University of Surrey Interim Executive Dean, Faculty of Health and Medical Sciences

1 An Evolutionary Concept Analysis

       Anna M. Brown, Kath Lawton, Lauren Brown; Victoria Walker, Lucy Jane, Paruit Cass (midwives); and Emily and Victoria (women)

      This exploration of the ‘with woman’ concept stems from a need to understand the perceptions of women and midwives of its meaning. It is hoped that a broader understanding of the concept will encourage midwives to work towards engagement with women to fulfil the true meaning of the concept. Hunter (2002) suggests that the ‘with woman’ concept involves emotional, physical, spiritual and psychological events or phenomenon and its meaning fluctuates according to process, behaviour or environment towards the purpose that its serves (Rodgers 1989; Higgins et al. 2017).

      Higgins et al. (2017, p. 30) identified that many concepts in healthcare can have different meaning to individual professions and likewise to the patients themselves, ‘shaped by the relationship between the patient and the provider and the environment in which healthcare delivery takes place’. In bringing together a mutual understanding, by midwife and woman, it will improve the process and outcomes or consequences of the concept. In addition, a brief historic review will place the ‘with woman’ concept in its context.

A Historic Review of Being ‘with Woman’

Contemporary British midwifery education often includes a consideration of the historical context of midwifery, and as such many midwives will be aware that the term ‘midwife’ derives from Anglo‐Saxon, meaning ‘with woman’. This terminology itself identifies the role of the midwife, and the importance it puts on the person whom the midwife attends. However, it is acknowledged that the voice of this woman has historically been unheard (Evenden 2000), as has the voice of the midwife (Harley 1993). This lack of voice generally stems from a lack of strong historic evidence, resulting in the historic misrepresentation of midwives (McIntosh 2012; Marland 1993; Harley 1990). Oral histories such as Leap and Hunter (1993) and collected letters such as Llewelyn Davies (1915) do give us an insight into the more recent past, but to go further back presents challenges. What evidence we do have, in terms of parish registers (Allison 2016) or material from early midwives' licenses (Evenden 2000; Harley 1990), does not directly inform us about the relationship between midwife and woman.

      Taking all this into account, then much of how early midwives were viewed by the woman they cared for must be inferred from such records. Evenden (2000) acknowledges that childbirth practices of seventeenth‐century midwives often comes from second‐hand sources, or ‘prescriptive information from non‐participating males’ (p. 79), and these are often more a direction as to what the midwife should do; for example, how to prepare the bed, the lighting within the room, and how to examine the woman and physically care for her in labour. There isn't any evidence of the relationship between mother and midwife beyond this care given. This does not appear to be unusual, with a textbook written in 1671 by Jane Sharpe, a midwife, also focusing on the physical care given. What does give an indication of satisfaction of the care provided is the ‘repeat business’ that Evenden (2000) found in her exploration of midwives in seventeenth‐century London, with women often recommending their midwife to family and friends.

      Where we do have direct evidence of midwives' attitudes to women, it can appear alien to the concept of women‐centred care and being ‘with woman’. Leap and Hunter (1993) describe how their ‘romantic expectations about our midwifery heritage’ were dashed by the authoritarian stance of some of the midwives they interviewed for their oral history, with these midwives taking a somewhat patronising approach to the woman in their care, one being quoted as saying ‘They had to be taught to be good mothers. Some of them were very foolish and irresponsible’ (Leap and Hunter 1993, p. 193). It is perhaps not suprising that this was the point of view of this midwife, when it is considered that midwifery textbooks at the time when she was likely to have been in training were prescriptive in the expectations of pregnant woman – down to what was appropriate clothing (Myles 1953).

      A more humanistic approach to the mother–midwife relationship in a ‘with woman’ phenomenon is central to midwifery practice today. This is a physical manifestation of the relationship created by midwives with women. On the other hand, the ‘with woman’ concept is a mental construct, conceived and created in midwifery practice, to capture the essence, values, behaviours and functions of this special relationship. The ‘with woman’ concept is explored more closely in the following chapters and is specifically examined through a theoretical framework in the next section.

Rodgers' Concept Analysis Framework

      Rodgers (1989) suggests that defining a concept can be difficult if the attributes that shape the concept are not clear. The author suggests that the different aspects of a concept are created through an evolutionary view, associated with its attributes, through the process of concept change and development. Such development can only occur if the ‘with woman’ concept is significant to both midwife and mother, is used to fulfil physical, emotional, spiritual and psychological needs and is applied through midwifery skills and shared knowledge in this partnership. In addition, such a concept is influenced by a set of internal and external factors before it can be achieved (Burgess 2014; Sheen et al. 2016; Foster 2017). The woman–midwife relationship is a key factor in fulfilling the aims of the ‘with woman’ concept and must include attributes of confidence, competence and compassion demonstrated by the midwife (Menage et al. 2017; Knapp 2017a; BenZion 2018), the environment in which care is given (i.e. woman and midwife focused place of birth, such as the woman's home or a birth centre/midwifery‐led unit) (Davis and Homer 2016), and the resources and cost that will affect the birth outcome (Leinweber and Rowe 2010). This ‘with woman’ concept is increasingly significant depending on such factors and how effectively it is achieved considering the