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The social context in which choices about care are made are not made in isolation but through an understanding of a professional's true autonomy. A relational model of autonomy is defined by Christman (2015) as the ‘relatedness [that] plays in both persons' self‐conceptions … and the dynamics of deliberation and reasoning’ and is relevant in relation to informed choices in decision making through the dynamics of shared knowledge and negotiation of shifting power between the woman and the midwife (Nieuwenhuijze et al. 2014). Both midwife and woman must become responsible for the consequences of choices made when engaging with and embracing their autonomy.

Relational autonomy creates a space in which women are supported to develop their skills, self‐confidence and self‐esteem to recognise the social context for their decisions (Meadow 2014). However, the principle of respect is key in enabling shared decision making in support of relational autonomy (Lewis 2019). Midwives need to recognise their capability to self‐trust (McCourt and Stevens 2009), to have self‐esteem, self‐respect and act effectively, underpinned by their values and evidence‐based professional knowledge. Women, on the other hand, must be aware of constraining factors, such as organisational resources, when making choices and decisions (Thompson 2013). However, the woman in labour needs to be free from pain and fear, unhindered by medical interventions and afforded her dignity through a relationship with midwives based on trust and sympathetic understanding of her individual needs in a caring and nurturing environment (Morad et al. 2013). Midwives must therefore seek alternative approaches to the care they provide through the value of relational autonomy in which the midwife's and the woman's autonomy is negotiated respectfully to reach an informed decision (Noseworthy et al. 2013). The resulting empowerment process is mutual within the context of midwives ‘being with others’ rather than fulfilling midwifery skills and tasks (Hermansson and Martensson 2011). Parents, once informed and made aware of available resources and possibilities, will be able to agree on choices and willingly participate in the decision‐making process towards a safe and fulfilling birth experience (Halfdansdottir et al. 2015). In addition, Hall et al. (2018) indicate that women's dynamic experience of birth is influenced by the confidence felt in the belief that one's body is able to give birth, whilst drawing on emotional and physical support to cope with the experience and a sense of control over pain and pain relief to ensure comfort and increased relaxation.

The relational model also considers relational continuity which enables professionals to provide holistic care through their presence whilst providing emotional support in the woman–midwife relationship. Quality and content of care is perceived by women to be important in enabling a positive birthing experience (Dahlberg and Aune 2013), aided by the nurturing presence of the midwife as her advocate and companion. The concept of the ‘ritual companion’ has been explored from an Australian perspective and concludes that two contrasting types of midwifery practice were being facilitated: that of the ‘rites of passage’ during childbirth, in which the woman–midwife relationship is enabling and empowering and, the ‘rites of protection’ in which labour is perceived to be a time of danger and requires monitoring and assessment to provide a sense of control over the childbirth process (Reed et al. 2016).

Earlier literature advocates for a ‘caring presence’ in the true sense of ‘with woman’ that involves a personal connection between woman and midwife placing the woman at the centre of the relationship and creating an environment of security and trust (Pembroke and Pembroke 2008). With this commitment by midwives to positively enhance the birth experience, the authors suggest that the spirituality of midwifery is played out through the concepts of responsiveness and availability. It is viewed sensitivity and respects the uniqueness of each woman. As identified in the study by Brown (2012), midwives are ‘with woman’ when they are perceptive enough to read the situation and are responsive to her needs and values. This requires the midwife to be available as a ready listener and include herself in the protective sphere that women retreat to when in labour. In addition, it needs the midwife to understand and be actively involved in providing the information and skills to enable the woman to make the right decisions.

Women and midwives are generally in agreement about the need to achieve a positive outcome for every birthing experience. This agreement is based on shared values of solidarity which promote and champion physiological birth through social and mutual support and minimum intervention (Brown and Gallagher 2015). The concept of solidarity as applied to bioethics results in cohesion and integration connected through similar aspirations (Prainsack and Buyx 2011) of mother and midwife in an interdependent relationship to achieve a safe and effective birth outcome. An integration of solidarity with an ethos of midwifery practice can only be achieved through reciprocity of information, transparency and honesty between childbearing women and the health professional to maintain the ‘with woman’ concept (Dann 2007). In making rational choices, the midwife and woman must justify their decisions by considering the value that is placed on the birthing experience. This shared solidarity is demonstrated through mutually shared responsibility between mother and midwife who take on personal accountability for choices and decisions made.