being with woman
sara wickham


Just a few thoughts...

The term 'midwife' comes from the old English 'mid wyf', meaning "with woman". (This is why male midwives are still called midwives and not 'midhusbands'.)

But what does 'being with' women really entail? Why is it so difficult to achieve today? Why do so many women feel that no-one is really 'with' them at all?

It is relatively easy to be 'with' someone, yet not truly 'with' them at all. I have a friend who is very skilled at being present with me while I am shopping, without actually paying any attention to where we are going or what is being bought. Instead, this person's mind will be happily wandering elsewhere!

Because of the ability we humans have to be 'with and yet not really with', we need to differentiate between experiencing the physical presence of a person and experiencing the true companionship, support and attention of that person. This is one of the first issues that we should think about as midwives. How often are we present, while our mind wanders on other things? How often can we muster our attention to truly be present with someone and retain that focus for as long as they need us to?

Then there is the question of 'being with' or 'making better'. Imagine a woman you know walks into the room you are in now and bursts into tears. What would you do?

There are a range of possible answers to this question, but two of them are as follows:

1. I would ask her what was wrong, and try to talk it through / make it better / solve the problem.

2. I would hold / hug / cuddle her, make her tea, listen to her and respond to her requests.

Neither of these is 'right' or 'wrong'. The first response is characteristic of a 'problem solver'. The key is to find out what the problem is, so that it can be made better as soon as possible. Although this is an over-generalisation, men are more likely to respond in this way than by giving an answer along the lines of number 2.

The second response is more that of a 'comforting companion'. The emphasis is not on pinpointing or analysing exactly what is wrong, but on offering support and love through the experience. Again, while women are more likely to respond in this way, this is - in general - a different rather than a 'better' way to act.

But which of these responses do women in labour prefer? And which is a better response to the experience of birth?

While both types of responses have their place, there are a number of reasons which support the second type of response as being more appropriate when women are experiencing the journey and the sensations of labour.

Women experiencing the sensations (which I am deliberately not describing as 'pain') in labour often need to make noise to cope with these. Just as women who are upset may prefer the 'cuddle and cup of tea' response from their friends rather than an immediate analysis of the issues, women in labour often wish that their companions and attendants would respond in this way than by offering an immediate list of options, pain relief and suggestions of things to 'make it better'.

How comfortable are we with other people's pain? With a woman's tears? With strong emotions? Do we do what we do to make them feel better, or are we really comforting ourselves?

In my experience, women who truly need something for pain will not hesitate to ask for this. Women who have not asked for this, but whose companions keep offering 'solutions' may eventually agree to a solution. But often this is either because they are concerned that they are being a nuisance to others (who feel they have to keep offering a solution to the problem), or because they feel that, if their companions don't feel they are coping, then perhaps they aren't coping and therefore need help.


Being 'with woman' is also about being with what a woman truly wants. If a woman truly wants an epidural, having been given all of the information about this, then she should be supported in this choice. If a woman wants a water birth, she should again be given information and supported in her choice. These are relatively easy choices to support.

What about when a woman, who has accessed all of the appropriate information, wants something which is very unusual? She may want to make a choice which nobody has ever made before, or which her companions cannot understand. How easy is it to be 'with' a woman then?

Perhaps this is the mark of a truly good midwife, in the traditional and broadest sense of the word. A midwife can be with a woman on her journey and act as her advocate in supporting all of her choices, no matter how unusual.