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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	Attributes (behaviour)	Consequences
Emotional wellbeing Hunter (2009) Huber and Sandall (2009) Aune et al. (2014) Hunter (2015)	Positive presence and calm Listening Acknowledging feelings Empathy Reassurance Affirmation Sensitivity	Relational continuity MW compassion MW understanding Mutual recognition Therapeutic space Respect for woman Empowerment
Psychological health Bradfield et al. (2019c) Perriman et al. (2018) Nystedt et al. (2014)	Trusting relationship Woman‐centred care Known midwife Continuity of midwifery care Co‐participation Nurturance Helpfulness	Impact on MW and woman Greater satisfaction Personalised care Psychological and physical support Decreased anxiety/fear Courage to give birth
Spiritual health Hunter et al. (2017) Dahlberg and Aune (2013)	Giving of self Engagement/connectedness Mindfulness Intuitive Awareness/recognition	Empowered woman Provides confidence Positive birth experience Holistic care provision Acknowledging expectations
‘With woman’ antecedents	Attributes (process)	Consequences
Midwifery knowledge Bradfield et al. (2018a,b) Brady et al. (2019) Leap (2009)	Dynamic developing construct Control and empowerment Woman‐centred care Midwifery guidance	Partnership Empowers women Supports/hinders behaviours Safe, supportive and gentle
Midwifery skills Power et al. (2016) Bradfield et al. (2019b) Astrup (2016)	Responsibility to the woman Advocacy Communication Professional expertise, identity Midwifery responsibility and flexibility	Teaches competence and confidence Better birth experience Greater maternal satisfaction
‘With woman’ antecedents	Attributes (environmental)	Consequences
Physical wellbeing McDonald (2011) Reed et al. (2016)	Continuous support Birth aids/equipment Sustaining strength Comfort Touch or closeness/support Companion/doula One‐to‐one care/carer Ritual companion	Reduced pain, less analgesia Shorter labour, fewer operative outcomes Maternal satisfaction Personal attention Continuous labour support Being there Better birth experience
Resources: organisational factors and costs Leinweber and Rowe (2010) Yoshida and Sandall (2013) Knapp (2017a,b) Amir and Reid (2018)	Staff shortages/lack of time Reduced maternity services Cost to midwives Burnout	Serious incidences Morbidity/mortality Midwifery burnout Midwifery dissatisfaction

As identified from the literature above, the ‘with woman’ concept is a complex phenomenon and includes a range of antecedents. These consider emotional, psychological and spiritual wellbeing, physical health, midwifery knowledge and skills and resource implication to fulfil the concept. Each of these antecedents will be considered in turn and the attributes pertaining to behaviour, process and environment are examined for the subsequent consequences.