Better Births. Anna Brown
to either the midwife and/or the woman herself.
In her presentation of how concepts can be analysed, Rodgers (1989) indicates a seven‐stage process or framework that will assist this investigation (Table 1.1). An examination of the literature will explore the historical use and linguistic interpretation of the term ‘with woman’ and identify the antecedents to being ‘with woman’ which can be viewed from physical, emotional, spiritual and psychological perspectives and carried out through knowledge and care skills by the professional. The next stage in Rodgers' (1989) framework is to identify the attributes which articulate the concept through common use of the ‘with woman’ term and identify references to the application in events and situations as a phenomenon. The antecedents generally precede a perspective or instance of the concept. Consequences of a ‘with woman’ concept follow as a result or an occurrence of the concept. A final stage in Rodgers' (1989) Conceptual Analysis framework is to clarify and illustrate the attributes of the concept through presentation of cases, as examples from everyday clinical practice and stories as told by midwives and women.
Table 1.1 Rodgers' Evolutionary Conceptual Analysis framework (1989).
| Identify and name the concept ‘with woman’Identify surrogate terms and relevant use of the conceptIdentify databases and search term for ‘with woman’Identify the attributes of the conceptIdentify the references, antecedents and consequences of the concept (Table 1.3)Identify concepts related to the ‘with woman’ conceptMidwives' and women's stories to illustrate the concept |
Search Strategy and Inclusion/Exclusion Criteria
A literature review was carried out using a search strategy identified by the editor and a midwife reviewer and applied to the following databases and the search terms as identified in Table 1.2. A range of literature in English, from academic journals and which were published in full text between 2009 and 2019, was identified and retrieved for review. Key search terms were ‘with woman’, midwifery, midwife, midwives, and mid* and related terms such as ‘with woman’, ‘being with woman’, ‘continuity of carer’, ‘known mid*’ and therapeutic relationship synonyms and abbreviations applied within the context of childbirth, such as ‘women centred care’ and combined with the Boolean operators of ‘AND’ and ‘OR’.
The following databases were accessed in the searches for literature published up to 2019 resulting in CINAHL, Medline, British Nursing Index, PsychINFO, Internurse and Nursing & Allied Health as working databases. The resulting literature was read for abstract content and then selected papers were scrutinised in full text to be included in the final number of papers identified. The results included an interpretation of the ‘with woman’ term which can sometimes be interchanged or used as a surrogate term. As identified in search terms, ‘with woman’ was associated with terms such as ‘continuity of care and carer’, ‘therapeutic relationship’, ‘woman centred care’, ‘doula or spiritual companion’ and ‘midwife led care’ or ‘known midwife’.
Table 1.2 Databases searched and number of articles selected for final review.
| Database | Number of hits after application of search terms | Number of articles selected for review | Articles accepted after review |
|---|---|---|---|
| CINAHL | 96 | 15 | 5 |
| Medline | 71 | 16 | 6 |
| BNI | 137 | 15 | 2 |
| PsychINFO | 48 | 8 | 5 |
| Internurse | 22 | 3 | 1 |
| Nursing & Allied Health | 10 | 2 | 2 |
| Screened for relevance and filters applied | Duplications removed | Total = 21 |
Data Extraction and Analysis
Two reviewers carried out the literature search and almost identical publications were listed in the final search. Titles containing the ‘with woman’, one‐to‐one care/carer, continuity of care/carer, doula and birth companion were combined with search terms of midwives, midwifery practice/care. Abstracts were also screened for these words or terms. The resulting studies were then scanned for attributes of behaviour, process or environment pertaining to the concept of being ‘with woman’. A second screening sought words or terms that expressed or described the consequence or result of the ‘with woman’ concept. Search results which contained none of the above criteria were excluded.
Both reviewers assessed the final papers selected and entered details of year of publication, reason for selection – i.e. ‘with woman’ term or associated terms in the title, abstract, or text content – on a simple data extraction sheet. The resulting literature was further analysed using the antecedents of emotional, psychological, spiritual and physical health, midwifery skills and knowledge and organisational working patterns, resulting in attributes pertaining to the behaviour, process and environment of the ‘with woman’ concepts and the resulting subsequent consequences as per Table 1.3 below.
Characteristics of the ‘with Woman’ Concept
Limited literature exists on the ‘with woman’ concept and mostly presents a professional point of view and the implications for midwives in attempting to fulfil the concept. Much of the research implies that the midwife ‘with woman’ has physical, mental and resource implications (Leap 2009; Hunter 2009; Leinweber and Rowe 2010; Aune et al. 2014; Hunter 2015; Astrup 2016; Power et al. 2016; Reed et al. 2016; Knapp 2017a; Hunter et al. 2017; Amir and Reid 2018; Bradfield et al. 2019b, c; Brady et al. 2019).
A dearth of literature on this topic, from women's perspectives, exists; particularly in publications outside the UK (Dahlberg and Aune 2013; Bradfield et al. 2018a). The evidence suggests that although some women document the various benefits for childbearing women when the midwife is ‘with them’ in various situations and aspects, many express differing views of the ‘continuity of care’ and carer concept (Huber and Sandal 2009; Nystedt et al. 2014; Perriman et al. 2018). Their childbirth outcomes are also affected in terms of morbidity, such as birth trauma – both physical and psychological – and neonatal outcomes (Yoshida and Sandall 2013; McDonald 2011).
Table 1.3 Antecedents, attributes and consequences of the ‘with woman’ concept resulting from Rodgers' Evolutionary Concept Analysis framework.
| ‘With woman’ antecedents |
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