Midwifery students play a vital role in the maternity system, not only as the future of the midwifery workforce, but through their interactions with women and their families (Tickle et al, 2022). Research suggests that midwifery students' interactions with women and their families may provide a positive influence on a range of outcomes, such as increased rates of spontaneous vaginal birth and reduced rates of perineal trauma (Tickle et al, 2022). However, there is limited understanding of how midwifery students learn to be ‘with woman’, a vital learning outcome in the journey to becoming a midwife, as a cornerstone philosophy of midwifery. Commitment to continuous quality improvement is key in ensuring the midwifery profession is empowered with quality education to provide women with safe, competent and quality care throughout their childbearing continuum (World Health Organization, 2019). The experiences and learning of midwifery students are a vital area of research in ensuring midwifery students are empowered in the midwifery profession and workforce.
Being with woman is a central tenet of midwifery care, and a necessity in midwifery students' learning, pedagogy and curriculum. Understanding how being with woman is translated by midwifery students into clinical practice and interactions with women and families is of utmost importance, ensuring that the future midwifery workforce is well prepared, and this essential philosophy is embedded in practice. Currently, there is limited understanding of how being with woman is perceived and practised by midwifery students. To the best of the authors' knowledge, there are no existing or in-progress systematic or scoping reviews.
The philosophical concept of being with woman is unique and of fundamental importance to midwifery (Bradfield et al, 2019a). Its significance is embedded in midwifery standards, frameworks, ethics and regulations internationally (Bradfield et al, 2018; Crepinsek et al, 2023; International Confederation of Midwives, 2024). Being with woman occurs across all interactions and contexts, from preconception throughout the antenatal, intrapartum and postnatal periods, and encompasses three essential components: philosophy and professional identity, partnership and practice (Bradfield et al, 2019b).
Philosophically and professionally, midwives embody the concept of being with woman if they reflect notions of deep reverence to the needs and aspirations of women and their families, approaching their care with warmth, centring their approach around being with woman. Demonstrating being with woman in practice requires the midwife to implement highly individualised, holistic, woman-centred care, in which the woman and her individual needs, wants, aspirations and safety are placed at the centre of the midwife's care, intertwined with empowerment and informed choice in all elements of care provision (Bradfield et al, 2018; Bradfield et al, 2019b). Bradfield et al (2018) described the presence of a midwife with woman in practice as one that is acutely aware and supportive of the woman's emotional, physical, spiritual and psychological needs. Unique and individual partnerships are essential in being with woman, as these deeply trusting partnerships in essence must encompass equality, empowerment, deep respect, sensitivity, reflexivity, flexibility and advocacy for and with the woman (Bradfield et al, 2019a). The notion of being with woman is a dynamic and ever evolving relationship between the midwife and the woman.
Though being with woman is, by nature, gendered language, this philosophical concept at its core encapsulates the promotion of respect, equality, dignity and trust, providing the basis for a philosophy that is highly adaptable in the context of gender diversity and inclusivity (McCann et al, 2021). With the growing number of transgender, non-binary and gender diverse people experiencing pregnancy and parenthood, the consideration of midwifery care and application of the philosophy of being with woman in these contexts is of notable importance (Barros-Lees, 2021; Goldberg and Ross, 2022; Grant et al, 2022; Copeland et al, 2023; Crossan et al, 2023).
While the focus and scope of this review is not around gender diversity, it can be recognised that many of the principles embedded in being with woman are applicable in gender diversity. The authors acknowledge that the terminology of ‘with woman’ and use of gendered language is embedded and applied in Australian midwifery (Nursing and Midwifery Board of Australia, 2018), and as such, will use this terminology throughout this scoping review. With foundations of individualised care, trust, equality and respect being fundamental aspects of providing midwifery care, these concepts can be embedded across the journey of all persons accessing maternity care. As such, ‘woman-centred care’ and being ‘with woman’ are terms that have the capacity to be inclusive of those experiencing pregnancy and birth across a broad spectrum of gender identity.
At the time of writing, limited knowledge, understanding or evidence provided insight into the experiences and perspectives of midwifery students learning to be with woman. This scoping review mapped the existing literature and available evidence, and provides direction for further research based on concepts that arise in the review. The objective was to examine and map available contemporary literature that explores the experiences of midwifery students learning to be with woman to gain meaningful understanding of their perspectives and identify gaps in the literature.
Methods
This scoping review was conducted according to the Preferred Reporting Items for Scoping Reviews, as outlined by the Joanna Briggs Institute (Aromataris and Munn, 2020). A priori protocol was registered through the Open Science Framework: osf.io/tfcye. A scoping review was selected as a contemporaneous method to map literature and identify existing gaps in knowledge. An initial desktop review revealed limited existing literature regarding the topic, further lending to a scoping review as the most appropriate strategy to review the experiences of midwifery students' learning to be with woman.
Eligibility criteria
Inclusion criteria encompassed studies from peer-reviewed journals published between 2018 and 2024, as this allowed for contemporary research to be included. While international journals were included, in relation to Australian literature, 2018 marked the update and release of the Australian ‘midwifery standards for practice’, replacing the ‘national competency standards for the midwife’, and a focus on providing woman-centred care is an important feature of the updated standards (Nursing and Midwifery Board of Australia, 2018). Journal articles were inclusive of any location geographically; however, only articles published in English were included to minimise the potential for article and data quality to be compromised in translation. The inclusion of international publications provided an opportunity to extend the breadth of eligible articles to explore midwifery students' experiences. All included articles required access to the full text to enable a comprehensive review of each article.
Articles were deemed relevant to the scoping review by pertaining to:
Exclusion criteria were applied to articles that were not published or peer-reviewed, and literature reviews were excluded.
The term ‘midwifery student’ was selected to be inclusive of all pathways to becoming a qualified, registered midwife, including direct entry Bachelor of Midwifery, Master of Midwifery, combined Bachelor of Nursing and Midwifery and Graduate Diploma of Midwifery.
Search strategy
To ensure a refined and comprehensive search strategy, a librarian was engaged to provide guidance and assistance throughout the search. The onboarding of an experienced librarian supported use of a thorough and effective search strategy. CINAHL and PubMed search engines were primarily used to yield results, in addition to AusHealth, Medline and PsycInfo, which provided no new results.
Search terms, shown in Table 1, included ‘midwifery students’ and ‘student midwives’ with all variations, in conjunction with ‘experiences’, ‘perspectives’, ‘with woman’ and ‘woman centred’. The search terms were applied to both titles and abstracts of publications. With guidance from the librarian, Boolean operators, MeSH terms and search strategies were refined and implemented to yield best result potentials. Broad search terms such as ‘experiences’ and ‘perspective’ provided a breadth of results, enabling review of articles for alignment with the research topic and the concept of being with woman. Article reference lists were further hand searched to identify possible studies for inclusion, but this yielded no new results. The search was conducted in July 2022, October 2022 and finally in April 2024.
| Database | Terms | Key words |
|---|---|---|
| CINAHL | S1 and S2 | (MH “Students, Nurse Midwifery” OR MH “Students, Midwifery” OR AB student midwives OR midwifery student) AND (TI experience* OR AB experience* OR TI perspective* OR AB perspective*) |
| S1 and S3 | (MH “Students, Nurse Midwifery” OR MH “Students, Midwifery” OR AB student midwives OR midwifery student) AND (AB with-woman OR TI with-woman) | |
| S! and S4 | (MH “Students, Nurse Midwifery” OR MH “Students, Midwifery” OR AB student midwives OR midwifery student) AND (AB woman-centr* OR TI woman-centr*) | |
| PubMed | S1 | (experience*[Title/Abstract] OR perspective*[Title/Abstract]) AND (((“Midwifery”[MeSH Terms] AND “students, nursing”[MeSH Terms]) OR (“midwifery-student”[Title/Abstract])) OR (“student-Midwives”[Title/Abstract])) |
| S2 | (woman-centr*[Title/Abstract]) AND (((“Midwifery”[MeSH Terms] AND “students, nursing”[MeSH Terms]) OR (“midwifery-student”[Title/Abstract])) OR (“student-Midwives”[Title/Abstract])) | |
| S3 | (with-woman*[Title/Abstract]) AND (((“Midwifery”[MeSH Terms] AND “students, nursing”[MeSH Terms]) OR (“midwifery-student”[Title/Abstract])) OR (“student-Midwives”[Title/Abstract])) |
Selection
Titles and abstracts were reviewed by one author to indicate suitability and alignment with the topic; where an abstract was unavailable, the full text was reviewed where possible. All remaining articles were reviewed in full text to determine suitability to informing the scoping review. Most articles were excluded upon further review based on absence of reference to themes relating to being with woman, or not pertaining to the experience or perceptions of midwifery students. Selection of sources was completed by the first author and were reviewed in collaboration with the second and third authors providing feedback.
Figure 1 shows the flowchart of the selection of sources. After using key terms to search databases, 1172 items were identified. A title review excluded 1058 records, and a further 36 were excluded as duplicates. The abstracts of the remaining 78 articles were reviewed for suitability, and 69 were excluded because they did not pertain to the perspectives or experiences of midwifery students learning to be with woman. Nine articles were included in this scoping review.
Data charting process
A data charting form was developed collaboratively by three reviewers to determine which variables to extract. One reviewer independently charted and collated the data and variables. The results were regularly reviewed and discussed with all reviewers. Any disagreements were resolved by checking and reviewing among the authors, including for the data charting form, which was also continually updated and reviewed throughout the process and was based on the Joanna Briggs Institute's data extraction tool (Aromataris and Munn, 2020). Data items extracted included country of origin, study aims, methods, participants, analysis and themes explored or findings.
Screening
The evidence was extracted through a process of data immersion and mapping of themes, reviewed and supported by two reviewers. Full details of theme mapping are available from the authors on reasonable request.
Synthesis
Key themes were identified in the reviewed literature through content analysis. Themes relating to midwifery students learning to be ‘with woman’ were identified through a process of data immersion. Themes were mapped from each article and reviewed by three reviewers.
Results
The characteristics of the reviewed articles are outlined in Table 2. Articles included were published between 2018 and 2023. To provide maximum breadth of literature, a range of international articles were included, with publications from Australia, the Netherlands and Japan. The identified literature was generally qualitative, and, as anticipated of qualitative research, the sample sizes were generally small, ranging from 5–54 participants. Data collection methods varied, with primary methods consisting of focus groups or individual interviews.
| Authors, year and country | Aim | Methods and participants | Data collection and analysis | Summary of findings |
|---|---|---|---|---|
|
Baird et al, 2022
|
Looking at midwifery students' experiences of extended group practice placement | Qualitative descriptive approach, n=15 third-year student midwives that completed 6-month placement | Semi-structured focus group interviews recorded and transcribed. Inductive thematic analysis | Extended placement supported students learning to be with woman in positive and effective manner |
|
Fontein-Kuipers and Romeijn, 2018
|
Evaluation of ISeeYou project, created to provide students with woman-centred learning outcomes | Ethnographic project, participant observation with n=54 first-year midwifery students | Students' narrative of lived experiences collected. Analysis not explicitly outlined, quotations appeared extracted and organised into strengths, weaknesses opportunities and threats analysis | Project facilitated active engagement with women and learning outcomes relating to woman-centred care |
|
Hainsworth et al, 2023
|
Exploring learning experiences associated with continuity of care experience | Qualitative approach with n=9 Bachelor of midwifery students from varying years | Focus group interviews. Reflexive thematic analysis | Student learning enhanced through continuity of care experience by forming relationships with women and midwife |
|
Kuliukas et al, 2020
|
Exploring perceptions of being ‘with woman’ from clinical experience | Exploratory, descriptive qualitative method with 19 midwifery students | Face-to-face or telephone interviews recorded and transcribed. Thematic analysis, manual coding, line by line, NVivo V11 | Being with woman enabled informed consent and facilitated connection between student and woman. Woman was at centre of care. Could occur in range of contexts, influenced by preceptor. Learning to be with woman was evolving process, best exemplified through continuity of care, impacted by role and workload |
|
Nieuwenhuijze et al, 2020
|
How midwifery students identify role models | Descriptive qualitative study of n=44 midwifery students | Focus group and individual interviews. Inductive content analysis | Positive role models displayed woman-centred care, students likely to assimilate ideal characteristics demonstrated by positive role models |
| Noya et al, 2021 |
Perceptions of learning using storytelling of women's experiences | Pilot, qualitative content analysis with n=5 second year midwifery students | Semi-structured focus groups. Five stage analysis, outlined by Vaughn (1996) | Highlighted respect and its importance, particularly in line with World Health Organization recommendations. Respect derived from being with woman through storytelling |
|
Sidebotham and Fenwick, 2019
|
Exploring experiences of extended caseload placement | Qualitative descriptive approach with n=12 third-year midwifery students at facility in southeast Queensland | Recorded and transcribed conversational, semi-structured phone interviews. Thematic analysis, constant comparison, line by line coding | Extended placement in case loading model gave students enhanced experience of learning to be with woman and richer learning outcomes overall |
|
Thompson et al, 2019
|
Understanding needs in advocating for physiological birth | Qualitative study with n=37 fourth-year midwifery students, all female aged 20–25 years | Semi-structured focus groups, attitude, social influence and self-efficacy model. Focus groups led by one researcher, notes taken by second. Audio recordings. Thematic analysis, NVivo | Conflict between midwifery philosophy and woman-centred care. Development of personal power, collaboration, preceptor and hierarchy influence, highlights importance of reflection |
|
Tickle et al, 2023
|
Evaluating impact of feedback provided by women based on continuity of care | Qualitative approach with n=44 second- or third-year midwifery students | Reflections submitted as part of midwifery education requirement collected and analysed thematically | Students learning to be with woman enhanced through receiving and reflecting on feedback from continuity of care women |
The major themes identified were continuity of care, partnership with women, preceptor and practitioner impact, and context.
Continuity of care
In most of the reviewed literature, it was clear that continuity of care models and learning experiences greatly enhanced midwifery students' ability to develop understanding and attributes of being with woman. Baird et al (2022) demonstrated that continuity of care provided a segue by which midwifery students were able to develop awareness and understanding of women's navigation of their care throughout their pregnancy. The widened perspective and experience of the spectrum of maternity care provided through student continuity contributed to midwifery student's learning to be with woman. Fontein-Kuipers and Romeijn (2018), Sidebotham and Fenwick (2019) and Hainsworth et al (2023) highlighted that learning to be with woman was facilitated through relationships uniquely developed between midwifery students and women in a continuity of care learning experience. Overall, midwifery students were provided with strong and positive learning opportunities relating to being with woman in a continuity of care model.
Partnership with woman
Partnership with woman was noted across all reviewed literature as a key aspect of midwifery students learning to be with woman. Developing a partnership with the woman being cared for was linked to midwifery students developing traits aligned with the philosophy of being with woman. These included an understanding of the woman's perspective, needs and wants; developing a supportive, trusting, meaningful and caring relationship; advocacy; and individuality in care provision (Fontein-Kuipers and Romeijn, 2018; Sidebotham and Fenwick, 2019; Thompson et al, 2019; Kuliukas et al, 2020; Nieuwenhuijze et al, 2020; Baird et al, 2022; Noya et al, 2022; Hainsworth et al, 2023; Tickle et al, 2023)
Preceptor and practitioner impact
The impact of preceptors and practitioners on midwifery students' learning was notable. Thompson et al (2019) explored the significance of role models in midwifery students' learning; however, this key theme was frequently raised organically across the literature in the review. Relationships developed between midwifery students and preceptors were significant in empowering midwifery students to develop the skills, attributes and philosophies needed for being with woman (Sidebotham and Fenwick, 2019; Thompson et al, 2019; Nieuwenhuijze et al, 2020; Baird et al, 2022). Midwifery students were able to adopt and develop attributes aligning with being with woman based on the attributes and skills demonstrated by preceptors. Midwifery students actively identified and embedded ‘positive’ preceptor attributes in their own midwifery philosophy, while rejecting and defying attributes considered to be ‘negative’ (Sidebotham and Fenwick 2019; Kuliukas et al, 2020; Nieuwenhuijze et al, 2020; Baird et al, 2022). The adoption and rejection of midwifery attributes in midwifery students' personal midwifery philosophies illustrates the influence of preceptors and practitioners.
Context
The impact and range of contexts in which midwifery students were able to learn to be with woman was noted. Fontein-Kuipers and Romeijn (2018), Sidebotham and Fenwick (2019), Kuliukas et al (2020), Nieuwenhuijze et al (2020), Baird et al (2022) and Noya et al (2022) all demonstrated varying contexts in which midwifery students experienced and developed understanding of being with woman. The contexts included learning in contrasting clinical settings, as well as learning though storytelling, peer-to-peer learning and reflection. Noya et al (2022) and Tickle et al (2023) highlighted that learning to be with woman had the potential to occur outside of clinical settings, such as through ‘storytelling videos’ of women sharing their experiences, receiving and reflecting on feedback from women, and peer-to-peer learning.
Learning to be with woman was experienced in a range of physical contexts, including community and midwifery group practice. The value and essential components of being with woman were emphasised when contrasted with the challenges of being with woman in a fast-paced, task-orientated setting. Additionally, contexts of learning to be with woman spanned across the childbearing continuum and through observing interactions in a multidisciplinary team.
Discussion
As a key aspect of the midwifery philosophy, learning to be with woman is a critical element for midwifery students. It requires students to develop an in-depth understanding of and skills in establishing meaningful relationships with women, supporting the diverse and individual needs and wants of women in their care. The present review highlighted the influence of continuity of care, preceptors and practitioners and the context for learning, as well as the need for partnership with woman.
Midwifery students were able to access rich learning opportunities in models that were consistent with and embodied a continuity of care model. Through this, they were able to become involved and experience key learning by forming partnerships with women. Forming meaningful partnerships was identified as pivotal in students developing an understanding of the significance and impact of meaningful and trusting relationships. Internationally, the World Health Organization (2018) and the International Confederation of Midwives (2024) recognise and highlight continuity of care and meaningful partnerships to be essential aspect of midwifery care and philosophy. The relationships developed through continuity of care and the essential component of forming partnerships are illustrative of being with woman (Bradfield et al, 2019b).
Learning could occur across a range of learning platforms and models of care, including through physical interactions with women and families, interactions with preceptors (for example, a partnered midwife with whom the midwifery student works during clinical placement), peers and lecturers, storytelling and reflection. Additionally, experiencing contrasts in models of care and provision of care gave midwifery students opportunities to identify aspects of care that did not align with a philosophy of being with woman, contributing to their professional development and understanding of midwifery philosophy. The importance and significance of preceptor impact was acknowledged as being instrumental in providing midwifery students with practical learning opportunities to be with woman. Midwifery students identified that through trusting and established preceptor relationships, opportunities to confidently provide woman-centred care were afforded, in addition to valuable reflective opportunities to further develop professional identity and understanding of being with woman (Sidebotham and Fenwick, 2019; Nieuwenhuijze et al, 2020; Baird et al, 2022).
Limitations
The primary limitation identified in conducting this scoping review was the lack of existing literature exploring the experiences of midwifery students learning to be ‘with woman’. Based on the paucity of understanding and existing literature on midwifery students' experiences of being with woman, and the importance of this tenet that is central to the midwifery philosophy, further research would provide additional valuable insight into the process of midwifery students learning to be with woman.
Conclusions
This scoping review explored the literature regarding midwifery students' experiences and perspectives of learning to be with woman. These experiences were enhanced through continuity of care and forming meaningful partnerships with women. Role modelling by preceptors of being with woman impacted learning both positively and negatively. The contexts in which midwifery students experienced learning opportunities were also highlighted; these included physical contexts, such as maternity care settings, and theoretical contexts of storytelling, reflection and peer-to-peer learning. Furthermore, this scoping review identified that there is limited literature that provides insight into midwifery students' experiences of learning to be with woman.