A good relationship between a midwife and a woman can have a hugely beneficial effect on the progress and normality of labour. It can also affect her sense of achievement and her satisfaction with the birth experience.
Relationship building should ideally begin with ante-natal care. If she becomes familiar with you and feels comfortable with you during her pregnancy, it will be much easier for her to relate to you when she goes into labour. However it is still quite possible to establish a positive relationship if you meet her for the first time when she is already in labour.
Help her to feel she can trust you
Relationships are complex things, and forming a good relationship depends on many different factors (including the personalities of the midwife and the woman). However one of the key factors here is clearly trust: to have confidence in you a woman must feel that you are competent, in control and on her side.
You can't take it for granted that she feels this, particularly when she is distracted by pain and anxiety. So you need to signal by your attitude towards her and by your actions that she can trust you. And to do this, you must first feel confident in yourself.
Be clear about the 'boundaries' of the relationship
The relationship between a woman giving birth and her midwife can be a very intense and intimate one. This can encourage both parties to develop unwarranted assumptions and expectations about each other. It is thus very important to remember that it is not a friendship, even if it may have many elements in common with a friendship (such as reciprocal love, intimacy, trust, warmth and genuine concern).
The relationship you have with her is for the specific purpose of giving and receiving midwifery care. Once this purpose has been achieved, the relationship has served its purpose. But it may still be difficult to say goodbye - parting without leaving 'unfinished business' (unresolved needs and feelings) is an art that takes some learning. It is therefore important that the relationship ends well, which means without dependency and with positive feelings on both sides.
Tips and tricks
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Develop an open-ended conversational style - one that encourages her to talk about herself. This will help you to quickly establish a rapport, and enable you pick up useful cues about what she is feeling.
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Remember that some women want silence - this can feel like a challenge when you need to to build a relationship quickly (especially if you meet her for the first time in labour). It needn't be. Just try to be present and attentive.
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Don't take initial rejection personally - back away slightly before trying another approach. Remember that her feelings in labour are ebbing and flowing. You are the beach, solid and available, for when the tide turns.
Further reading
Freeman LM, Timperley H, Adair V (2004) Partnership in midwifery care in
New Zealand Midwifery 20 (1): 2-14
Kennedy HP et al (2004) The landscape of caring for women: a narrative study of midwifery practice.
Journal of Midwifery and Women's Health 49 (1):14-23
Kirkham M (2000)
The midwife-mother relationship Macmillan Press, London
Walsh D (1999) An ethnographic study of women's experience of partnership caseload midwifery practice: the professional as a friend
Midwifery 15: 165-176
