Background Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. Method For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of (...) RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. Result There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives’ conceptualizations of RMC, Midwives commitment to woman’s rights, The value and impact of RMC to midwives, Midwife’s perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives’ recommendations for optimal RMC practice. Conclusion In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required. (shrink)

Muslim Midwives: The Craft of Birthing in the Premodern Middle East. By Abner Giladi. Cambridge Studies in Islamic Civilization. New York: Cambridge University Press, 2015. Pp. x + 195. $95.

The aim of this study was to understand how mothers experienced midwives' uncaring behaviour and actions during birth. Sixty-seven first-time mothers took part in the study, in which data were collected through interview. The interview text was analysed using hermeneutic text analysis. Nearly half of the mothers interviewed (n = 32) said that midwives did not care for them. The findings show that midwives' behaviour was humiliating when they ignored mothers and held them in contempt. The mothers (...) felt further humiliated when the midwives did not believe them, treated their bodies in a careless manner and tended to put blame on them. Through their behaviour and actions, some midwives have shown that they no longer have a caring attitude as an element of their professional practice and that they have ignored ethics by offending mothers' sense of dignity. (shrink)

Premarital sexual relations are unacceptable for women within Turkish society's understanding and perception of honour. If there is any suspicion about virginity, young girls are forced to undergo hymen examination against their will, which frequently results in attemped suicide. The most frequent cause of suicide in young Turkish girls is hymen examination. Nurses and midwives are always involve in this procedure. The purpose of this study was to determine the views of and approaches to hymen examination by nurses and (...) midwives. Of those who participated in this study, 80.2% had been present during a hymen examination, 40.4% indicated that virginity had a special significance in the society owing to social pressures, and 37.5% indicated that they agreed with the view that the idea of virginity puts restraints on a woman's sexual life, whereas sexual activity is a physiological need. They also indicated their opposition to hymen examination imposed without the individual's consent. They agreed that stopping this practice depended more on the social structural changes required than on legal measures. (shrink)

When the midwife Jane Sharp wrote The Midwives Book in 1671, she became the first British woman to publish a midwifery manual. Drawing on works by her male contemporaries and weaving together medical information and lively anecdotes, she produces a book that is instructive, accessible, witty, and constantly surprising.

Background: Compassion-based practices in midwifery are the most important expression of the depth of care quality. This concept is insufficiently represented in literature, therefore, studies on this subject are of utmost importance. Objectives: This study aims to determine the levels of compassion of midwives working in the delivery room and the factors affecting these levels. The study was carried out in Kocaeli, Turkey. Methods: This descriptive study was carried out from 1 February to 15 April 2019 in delivery rooms (...) of six different hospitals located in the provincial centre of Kocaeli, Turkey, with 78 actively working midwives. Data were collected using a ‘Compassion Scale’ and analysed using the Mann–Whitney U test, the Kruskal–Wallis H test and the Spearman correlation test. Ethical considerations: This study was conducted according to ethical scientific guidelines. Results: The compassion score of the midwives were found to be 4.19 ± 0.39. The total compassion score was affected by professional factors such as number of patients, alternating shift work, number of traumatic births and work satisfaction. While the kindness subscores decreased depending on shift work and number of traumatic births, it was determined that the midwives who were satisfied with their work had higher kindness scores than those who were not. Also, as the age and professional experience of the midwives and the number of traumatic births increased, their indifference score also increased. Midwives who reported that they were not satisfied with their job had higher scores regarding separation and disengagement scores than those who were satisfied with their job. Conclusion: It was determined that the compassion levels of midwives were found to be negatively affected by factors such as age, professional experience, job satisfaction and number of monthly traumatic births in a month. They should be reminded that compassionate midwifery care for women is a basic human right. (shrink)

Background Midwives frequently encounter ethical dilemmas in a critical unit such as a delivery room. Determining these ethical dilemmas is very important to prevent ethical problems and develop an ethical approach. Aim This study aims to identify the ethical dilemma experiences of midwives working in delivery rooms in Turkey. Research design This study follows a qualitative phenomenological research design. Participants and research context The sample comprised 13 midwives with at least two years working experience in delivery rooms, (...) having completed the midwifery program of Manisa Celal Bayar University Health Sciences Institute in the 2017–2018 academic year. Data were collected through audio-recorded semi-structured interviews to reveal their experiences. Content analysis was done using the Nvivo software package program. All interviews were digitally recorded, transcribed verbatim, and transferred into NVivo for analysis. Ethical considerations Ethical approval was granted by Manisa Celal Bayar University University Health Sciences Ethics Committee (Date: 16.12.2016 No: 372). Participation in this study was voluntary. Written and verbal consent was gained. These consents include protecting midwives’ privacy, keeping information confidential, and/or allowing the participant to remain anonymous. Findings Four themes were identified: differences of approach to the birth process, hospital management, communication, and differences in ethical approach. Several factors explained these ethical dilemmas while the midwives adopted different approaches to ethical decision making. Discussion These midwives experienced various dilemmas while working in the delivery room and are aware of most of them. They also took responsibility in the decision-making process and experienced many intense emotions that they had to cope with. Conclusion The ethical dilemmas faced by these midwives while working in delivery rooms were mainly caused by hierarchy. Future studies could investigate clarifying job descriptions of midwives, who are authorized to manage normal births under their own responsibility, within the hospital management and the health care team. (shrink)

Background. Midwives provide the majority of maternal and child healthcare in South Africa. The care provided by midwives during childbirth is a unique life experience for women, and in order to provide safe care, midwives are expected to comply with ethical principles, policies and legislation governing their profession, as guided by the International Confederation of Midwives. Objective. To establish midwives’ perception of ethical and professional practice in selected labour units of public healthcare, in Tshwane District, (...) Gauteng Province, SA. Methods. A qualitative, exploratory, descriptive cross-sectional design was applied by use of in-depth interviews. Non-probability purposive sampling was used to draw a sample from midwives with 2 or more years of experience working in the labour units. Data saturation was reached with the eighth participant. The digitally recorded interviews were transcribed verbatim. Data analysis was based on interpretive description. Results. The findings revealed that midwives do understand the ethical code of conduct. They experience challenges such as staff shortages, non-compliance with policies and lack of managerial support, which compromise ethical conduct to a certain extent. Conclusion. It is hoped that the suggested administrative, midwifery practice and research recommendations will guide the process of empowering midwives in ethical practice. (shrink)

The majority of midwives in the UK are employed within the NHS. They are legally bound to fulfil their contractual obligations to their employers. At the same time they are professionally mandated to interpret and act on the UKCC's Code of professional conduct. Midwives have always maintained that they are autonomous practitioners, and the Code is written in a way that endorses this belief. Underlying the Code is the assumption that midwives have moral and professional freedom to (...) act on its imperatives. However, midwives' claim to autonomy is flawed, and therefore the Code's claim to be a source of empowerment is also flawed. Underlying the difficulties is a conflict derived from the imposition of a deontologically-based professional Code on to a workforce that is constrained within and employed by the utilitarian-based NHS. (shrink)

This study steps beyond the traditional arguments of feminism and examines homebirth from a libertarian perspective. It addresses the debate over homebirth and midwifery, which includes the use of direct-entry midwives as well as the philosophical implications of individual autonomy expressed through consumer choice. Furthermore, this paper demonstrates that the medical establishment gains economic and political control primarily through medical licensing, and uses the state to undermine personal freedom as it advances a government-enforced monopoly on birth. At the same (...) time, empirical studies have established a substantial record of high safety and low medical complication rates for homebirth as compared to hospital births. Ultimately, the state’s restriction on medical choices is incompatible with the nonaggression principle and voluntarism, and therefore, with libertarianism. (shrink)

Faye Thompson believes there is and draws upon personal narratives from both mothers and midwives to support this belief.

Practitioners’ ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong ‘action’ for resolving dilemmas. They exclude context and relationship. Personal narratives (...) of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between work-place/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics. (shrink)

In this article, I argue that despite their philosophical differences, Nietzsche and Kierkegaard share a philosophical method or style rooted in the irony of Socrates. Such irony, when used to distance the author of a written work from its reader, effects the same sort of relationship between the author and the truth as was characteristic of Socrates. Thus, by way of writing in a certain, artful way, both Kierkegaard and Nietzsche are able to pull away from their readers, depriving themselves (...) of all authority and leaving the question of what is true in what they write ultimately up to the consideration, discernment and interpretation of the reader. As such, I conclude, Nietzsche and Kierkegaard are akin as two different instances of the Socratic midwife or maieutician. (shrink)

Background: Nurses and midwives have a professional obligation to promote health and prevent disease, and therefore they have an essential role to play in vaccination. Despite this, some nurses and midwives have been found to take an anti-vaccination stance and promulgate misinformation about vaccines, often using Facebook as a platform to do so. Research question: This article reports on one component and dataset from a larger study – ‘the positives, perils and pitfalls of Facebook for nurses’. It explores (...) the specific issue of nurses and midwives who take an anti-vaccination stance, deemed to be unprofessional by crossing professional boundaries and by providing medical information on Facebook that is not within their scope of practice. Participants: Data were collected via an online worldwide survey from nurse and midwife participants, distributed and ‘snowballed’ through relevant nursing and midwifery groups on Facebook. In total, 1644 Registered Nurses and Midwives, and Enrolled Nurses worldwide attempted the online survey. There were 1100 (66.9%) completed surveys and 54 partially (33.1%) completed surveys. Semi-structured interviews were also conducted online using Skype® with 17 participants in Australia. Ethical considerations: Ethical processes and procedures have been adhered to relating to privacy, confidentiality and anonymity of the participants. Findings/results: A mixed-methods approach was used, including descriptive and content analysis of the quantitative survey data and thematic analysis of the qualitative interview data. The main theme ‘blurred boundaries’ was generated, which comprised three sub-themes: ‘follow the science, ‘abuse of power and erosion of trust’ and ‘the moral and ethical responsibility to safeguard public health’. The results offer an important and unique understanding of how nurses and midwives interpret the conduct of fellow health professionals as unprofessional and crossing the professional boundary if they used Facebook to promulgate anti-vaccination messages and/or give medical advice online. Conclusion: There are many positives and negatives for nurses and midwives associated with using Facebook for personal and professional communication, which is in keeping with the results of the larger study from which this article is taken. Professional behaviour is a key theme in the larger research as is the ethical construct of ‘every act has a consequence’; however, in this article, the theme ‘blurred boundaries’ offers an overall understanding of how nurses and midwives interpret the behaviour of their colleagues who espouse anti-vaccination sentiment and/or give medical advice online that is outside their scope of practice and education. (shrink)

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the (...) perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North‐western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self‐improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity. (shrink)

Introduction: Midwives play an important role in maintaining and increasing women’s health and well-being. Training professional midwives is one of the main policies of any healthcare system. Since the number of complaints against midwives has increased recently, this study was conducted to explore the perspectives of midwives regarding patients’ complaint to authorities and their impacts on the profession of midwifery. Methods: Being conducted in 2013, this qualitative study was the first of its type in Iran. Data (...) were collected through in-depth semi-structured interviews with 14 midwives working in different cities across the country. The participants were selected using a purposive sampling method. Interviews were transcribed verbatim and analyzed following a qualitative content analysis approach. Written text was then coded, and themes were extracted from the data. Ethical considerations: The study was conducted with midwives’ free informed consent and was approved by Ethics Committee of Tehran University of Medical Sciences. Findings: By analyzing the data, four main themes regarding the impact of complaint on midwifery profession were developed. These included the following: “dissatisfied of midwifery, professional deviation, obsession with work, and weakening of the professional status.” Conclusion: The experience of patients’ complaint to legal authorities against midwives was described, by participants, as a painful experience. Lack of midwives’ knowledge about professional rules and litigation process created many problems for them and could negatively affect their practice and the society’s attitude toward midwifery. Thus, we suggest that in order to prevent such problems, midwives and midwifery students should be educated regarding factors that have the potential to create such problems and also prevention strategies. (shrink)

One of the Sustainable Development Goals is to reduce the global maternal mortality rate. Antenatal care is a crucial component in achieving this goal. The aim of our study is to reveal the perceptions and expectations of midwives and women regarding antenatal care. In this qualitative study, Husserl's philosophy of phenomenology was adopted to emphasize the knowledge of experiences. One-to-one in-depth interviews were conducted with 31 participants – 15 midwives and 16 women – who received antenatal care in (...) Türkiye. Each interview was recorded and transcribed verbatim. The data obtained from the research were analyzed using traditional content analysis, resulting in five main themes and ten sub-themes. The main themes were "Lack of knowledge/awareness," "Midwifery in Antenatal Care Services," "Practices within the Scope of Antenatal Care," "Factors Hindering Receiving Antenatal Care," and "Expectations from Antenatal Care." The women participating in the research could not define the concept of "Antenatal care" and did not consider the service they received during pregnancy as antenatal care. It was determined that midwives could not provide quality antenatal care services to women for various reasons. Midwives should raise women's awareness about antenatal care, which includes examination, treatment, education, and counselling. In addition, the areas of need of primary health care services should be determined, and necessary improvements should be made. (shrink)

Background: When individuals are aware of the appropriate ethical practice, but lack the ability to do it, they will suffer from moral distress. Moral distress is a frequent phenomenon in clinical practice which can have different effects on the performance of physicians, nurses, and midwives, and therefore patients and health care systems. Research objective: The present study aimed to determine the severity and frequency of moral distress in midwives working in birth centers. Research design: This study is a (...) descriptive cross-sectional research. Researcher-made questionnaire was used to gather data. Participants and research context: A total of 180 midwives working in the labor ward of the public birth centers affiliated to Shahid Beheshti University of Medical Sciences were included to the study by census. Ethical considerations: Official permission for data collecting was obtained from the directors of the birth centers affiliated to Shahid Beheshti University of Medical Sciences. Then, after explaining the objectives of the study and assuring the confidentially of information, verbal consent of the participants was obtained. Findings: The total mean ± standard deviation of the severity and frequency of moral distress were 3.85 ± 0.75 and 3.03 ± 0.48, respectively. The highest severity and the lowest frequency of moral distress were obtained for the assistance for abortion and the lowest severity of moral distress was related to the organizational domain. However, the highest frequency of moral distress was related to futile care field. The mean of moral distress severity in the midwives with associate degree was significantly lower than other levels of education. Also, there was a significant relationship between age and moral distress frequency (p = 0.010). Discussion: The midwives’ moral distress was relatively high as expected. This finding is consistent with the results of similar studies in intensive care unit nurses. Conclusion: After identifying the level and most important factors of moral distress among midwives, the next step is empower them to prevent moral distress, in particular efforts to change structures. (shrink)

Nurses and midwives are part of health care in all the stages of our lives from preconception to death. Recent scientific advances have introduced new techniques of screening and diagnosis linked to stem cell isolation and therapies. These could affect us at any age and therefore nurses will be involved as carers and patients advocates for these techniques. In this article stem cell techniques and therapies are outlined, as well as some of the ethical challenges faced by various nursing (...) groups, whether in adult, learning difficulties, mental health, paediatric, primary care, public health or health visiting areas. Nurses have to understand the ethical issues and the rights of all parties (donor, recipient and families), which may conflict with each other, to be able to weigh up the benefits and costs to each group involved. Answers have to be found on a case-by-case basis within local moral frameworks and law. Nurses represent all parties in these therapies and act as advocates for every patient group. They need to act in an interprofessional environment to promote the best interests of all their clients, both clinically and ethically. (shrink)

Midwives and nurses play a critical role in safeguarding the lives of women in resource-constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary-level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and (...) nurses and semistructured interviews, field notes and documentary materials were used to generate in-depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 56-58, July 2012.

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and (...) Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research. (shrink)

“Granny midwives” often based their authority to practice midwifery on the spiritual traditions of rootwork or conjure passed down by the foremothers who trained them. However, granny midwives were compelled to give up their conjure-infused methods of birthing if they wanted to become licensed or be authorized by the state to continue their practice of midwifery. In response, some granny midwives refused to recognize the authority of the state in the birthing realm, willfully retaining rootwork in their (...) birthing practices. In this article, I contrast the response of granny midwives, a politics of refusal, with another major tradition in African American thought, a politics of recognition, such as gaining citizenship and rights, permits, and licenses from the state. Due to the political stakes of the granny midwife's conflict with the state, I argue that black feminists often endow the figure of the granny midwife with the political significance of refusal in our emancipatory imaginaries. To demonstrate this, I will analyze the interventions in black liberation politics that two black feminist writers make through their invocation of granny midwives: Zora Neale Hurston's essay, “High John de Conquer,” and Toni Morrison's novel, Paradise. (shrink)

In this article, we explore the act of resistance by nurses and midwives at the nexus of abortion care and gender-based violence. We commence with a brief overview of a multiphased extended grounded theory doctoral project that analysed the individual, situational and socio-political experiences of Australian nurses and midwives who provide abortion care to people victimised by gender-based violence. We then turn to Essex's conceptualisation of resistance in health and healthcare and draw upon these concepts to tell a (...) unifying and cohesive story about how nurses and midwives exercise their politics. Vignettes taken from the three study phases are provided for demonstrative purposes. Finally, we discuss the potential of resistance in health and healthcare as a postmodern feminist research tool to analyse acts by nurses and midwives that could be categorised as political. (shrink)

Background: When midwives are not treated with respect and their professional competencies are not recognised, their professional dignity is violated. Objective: This study explored and described how the professional dignity of midwives in the selected hospital can be enhanced based on their experiences. Research design: A descriptive phenomenological research design was used with in-depth interviews conducted with 15 purposely selected midwives. Ethical considerations: The Faculty of Health Sciences Research Ethics Committee of the University of Pretoria approved the (...) study. The research was conducted in an academic tertiary hospital with voluntary participants. Findings: To dignify midwives it is essential to enhance the following: ‘to acknowledge the capabilities of midwives’, ‘to appreciate interventions of midwives’, ‘to perceive midwives as equal health team members’, ‘to invest in midwives’, ‘to enhance collegiality’, ‘to be cared for by management’ and ‘to create conducive environments’. Conclusion: The professional dignity of midwives is determined by their own perspectives of the contribution that they make to the optimal care of patients, the respect that they get from others and the support that hospital management gives them. With support and care, midwives’ professional dignity is enhanced. Midwives will strive to render excellent services as well as increasing their commitment. (shrink)

This qualitative study describes midwives’ experiences in relation to termination of pregnancy for fetal abnormalities, and their corresponding professional and ethical position. Thirteen midwives working in a university clinic were interviewed about their problems in this respect. The information gathered was evaluated by using qualitative content analysis. The study focused on the emotional experience of the midwives, their professional position, and ethical conflict. In this situation, midwives are faced with a conflict between the woman’s right to (...) self-determination on one hand and the right to life of the child on the other. This conflict causes a high level of emotional stress and, subsequently, professional identity problems. Although questions concerning the child’s right to life are generally suppressed, the ethical principle of the woman’s right to self-determination is rationalized. Although this process of rationalization seems to present a false ethical decision, it enables midwives to continue with their daily professional duties. As far as orientating midwives to the value of these women’s right to self-determination is concerned, it must be assumed that they have made an ethical decision to which they have given insufficient thought. This problem is exacerbated by the fact that midwives are largely excluded from the decision-making process of the parents in question. They cannot therefore help in this process in a valuable and responsible way by providing clear information and proposing objective criteria. In relation to the tasks they are expected to fulfil, these midwives revealed that they were in a state of professional confusion. (shrink)

Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion. We conducted a systematic (...) review of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection. Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons. The reasons and their associated mentions in this category outnumber those in the sum of the other three categories. We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals. (shrink)

Background Midwives and nurses appear vulnerable to moral distress when caring for women whose babies are removed at birth. They may experience professional dissatisfaction and their relationships with women, families and colleagues may be compromised. The impact of moral distress may manifest as anger, guilt, frustration, anxiety and a desire to give up their profession. While there has been much attention exploring the concept of moral distress in midwifery, this is the first study to explore its association in this (...) context. Aim This article explores midwives’ experiences of moral distress when providing care to women whose babies were removed at birth and gives valuable insight into an issue nurses and midwives encounter in their profession. Methods Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate data; mothers were interviewed face to face and midwives through focus groups. The images and audio data were collected, transcribed and analysed for emerging themes. For the purpose of this article, only the midwives’ stories are reported. This research received a favourable ethical opinion from the University of Surrey Ethics committee. Ethical considerations This study received a favourable ethical approval from a higher education institutes ethics committee. Results Midwives who care for women whose babies are removed at birth report it as one of the most distressing areas of contemporary clinical practice. Furthermore, they report feelings of guilt, helplessness and betrayal of the midwife–mother relationship. Many of the midwives in this study state that these experiences stay with them for a long time, far more than more joyful aspects of their role. Conclusion Midwives experience moral distress. Support systems, education and training must be available to them if we are to reduce the long-term impact upon them, alleviate their distress and prevent them from leaving the profession. (shrink)

This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. Between October 2011 and January 2012, questionnaires that included questions concerning eight stress factors, the Professional Quality of Life Scale, and the Japanese version of the Frankfurt Emotional Work Scale, were answered by 255 nurses and midwives working in abortion and childbirth services. Professional Quality of Life scores (compassion (...) fatigue, compassion satisfaction, burnout) were significantly associated with stress factors and emotion work. Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors “thinking that the aborted fetus deserved to live” and “difficulty in controlling emotions during abortion care” were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives. (shrink)

The Midwives Book; or, The Whole Art of Midwifery Discovered, published in London in 1671 by the midwife Jane Sharp and now edited and annotated by Elaine Hobby, is a valuable contribution to an important topic in women's history that makes a relatively obscure female author accessible to a wider audience. Although Sharp's manual has been generally available as a primary source through a reprint edition published by Garland in 1985, Hobby's notes and glossary of medical terms will assist (...) the lay reader as well as those with a special interest in early modern midwifery in coming to terms with information Sharp thought would be of value to midwives of the period.Recent research has cast new light not only on who London midwives were but on how they were trained and licensed. As Hobby rightly points out, it is also important to understand the type of manuals available to them, even though these manuals were of limited use for the actual practice of child delivery. Since the medical practices of the early modern period embraced the humoral theory , The Midwives Book contains much advice that modern medical practice would decry. However, it has been demonstrated elsewhere that experienced, licensed midwives, trained in a “hands‐on” system, did not rely on the printed word for their knowledge. Just as well, since even such an experienced practitioner as Sharp has borrowed from earlier male medical authors, trained in the Galenic tradition, in addition to publications that may have been authored by other London midwives.Aside from the short introduction, this book is Sharp's original six‐part work, with minor emendations as well as brief definitions and explanations. It begins with a description of female and male “generative parts” and moves on to conception, sterility, the conduct of labor, “miscarrying,” illnesses and diseases related to pregnancy, postpartum care, wet nurses, and, finally, a discussion of the normal newborn as well as common childhood diseases.The main strength and contribution of this new edition of The Midwives Book is that it makes readily available a carefully edited and annotated primary source by a seventeenth‐century woman who is addressing her peers. Although the subject matter was generally acknowledged as relating to “women's work,” female authors rarely entered the domain of the male medical “expert.” Sharp's was a voice normally excluded from the public forum provided by publication. This edition will be welcomed by those working in women's history, especially the history of medicine and midwifery, as well as those with a general interest in early modern English texts. (shrink)

Les sages-femmes en France incarnent une subtile synthèse du cure et du care, entretenant une ambiguïté qui fonde une partie de leur identité professionnelle et qui brouille les pistes des stéréotypes de genre. En fonction du contexte social et politique qui conditionne leur mode d’exercice, ces professionnel.le.s développent spontanément des stratégies pour équilibrer les tensions qui existent entre ces deux pôles. Elles/ils vont ainsi promouvoir tantôt leurs compétences dans le care comme valeur ajoutée par rapport aux autres acteurs médicaux, tantôt (...) leur expertise médico-technique et leur autonomie de pratique, affirmant ainsi leur appartenance au monde médical et scientifique. Cet article s’inscrit dans une double approche d’analyse en sciences sociales et d’expérience professionnelle de trente années en tant que sage-femme. (shrink)

While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care (...) by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them. (shrink)

Background The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic’s compassion fatigue, few studies include midwives. Research objective The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity. Research design (...) This is a descriptive-correlation study. Participants The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study. Ethical considerations Approval from the researcher’s university Institutional Review Board for ethical review was obtained with the code of IRB 20/510. Findings The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives’ mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model. Discussion Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives’ symptoms of compassion fatigue. Conclusion The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health. (shrink)

BackgroundConsidering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM).Materials and methodsThis was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual (...) interviews with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba’s criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI).ResultsFourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) "professional Commitments" with 30 items; 2) "providing midwifery services to the client and her companions” with 26 items; 3) “relationship with colleagues" with 11 items; 4) “herself” with 6 items; 5) “education and research” with 8 items; and, 6) “management” with 11 items.ConclusionICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care. (shrink)

The way in which midwives relate to expectant parents during the process of childbirth greatly influences the parents’ childbirth experiences for a long time. We believe that examining and describing ways of relating in naturally occurring interactions during childbirth should be considered as an ethical responsibility. This has been highlighted in relation to parents’ experiences and in the light of the relational ethics of Løgstrup. Four couples’ and nine midwives’ ways of relating were documented by 27 hours of (...) observation, including 14.5 hours of video-recorded sessions. A qualitative content analysis was conducted. The midwives strongly influenced the different ways of relating and three aspects of professional competence were disclosed. The results can contribute to reflections about current praxis as an ethical demand for midwives. (shrink)

Background Given that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven (...) CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor. Methods This study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper. Results There were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process. Conclusions Accuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice. (shrink)

Introduction Although there have been reports of misbehavior and disrespectful maternal care by healthcare providers worldwide, there are few intervention studies aimed at promoting respectful care, particularly among midwives. Research objectives The aim of this study was to examine the effect of Moral Case Deliberation (MCD) on the of midwives’ knowledge and practice in the field of respectful maternity care. Research design and methods This semi-experimental study involved 46 midwives working in the maternity departments of two hospitals (...) affiliated with Bushehr University of Medical Sciences in 2023. The two hospitals were randomly divided into control and intervention groups. All midwives from both hospitals were included in the study. The Dilemma Method of MCD was implemented for midwives of intervention hospital. The Midwives’ Knowledge and Practice of Respectful Maternity Care scale was used for data collection. It was administered both before and two weeks after the intervention. Data were analyzed using SPSS (version 20). Ethical considerations The study was approved by ethics committee of Bushehr University of Medical Sciences in Bushehr, Iran (ethics code: IR.BPUMS.REC.1402.017). All participants provided written informed consent. Findings The intervention group showed a significantly greater increase in knowledge scores from pre-test to post-test compared to the control group ( p <.001). The intervention group had a significantly higher mean change score in practice self-assessment and practice peer evaluation, from pre-test to post-test, than in the control group ( p <.001). Discussion MCD based on the dilemma method can improve practice in the field of respect-oriented midwifery care by increasing knowledge and potentially changing attitudes. Conclusion The Dilemma Method of MCD improved midwives’ knowledge and practice regarding respectful maternity care. This method can be included in the midwifery care quality improvement program to promote respectful maternity care. It is necessary to develop methods for wider dissemination of MCD in the cultural context of Iran. (shrink)

This article is a discussion of the recently emerging critique of pro‐breastfeeding discourses in academic literature, and what this means for midwives and other professionals who find themselves promoting breastfeeding because of professional expectations or indeed workplace policies. Various strands in the debate are explored, starting with dominant and familiar ‘evidence’ and descriptions of breastfeeding and breastmilk that are carried through to international policies that advocate breast over formula feeding. We then consider evidence predominantly from social science literature that (...) has found some women's experiences of infant feeding to be at variance with the dominant pro‐breastfeeding ideology. We argue that midwives and others delivering maternity care are the means to deliver the policy aspirations contained in the World Health Organization (WHO, 2018) Baby Friendly Hospital Initiative document that makes selective positive claims about breastfeeding without adequately considering its potential drawbacks. We conclude that although the benefits of breastfeeding tend to be exaggerated in promotional material, on balance the weight of evidence still favours breast over formula feeding. We challenge the charge that breastfeeding jeopardises women's financial position by arguing that it is not breastfeeding per se that impacts negatively on women's economic prospects, but rather the way in which society is socially organised. (shrink)

© 2019 The Author. Background: The phenomenon of being 'with woman' is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the 'with woman' phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being 'with woman' during labour and birth from the perspective of midwives' working in a model where care is (...) provided by a known midwife. Methods: A descriptive phenomenological design was employed with ten midwives working in a 'known midwife' model who described their experiences of being 'with woman' during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience. Results: Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being 'with woman', confirming that this relationship extends beyond the woman - midwife relationship to include the woman's support people and family. Being 'with woman' during labour and birth in the context of the relationship facilitates woman-centred care. Being 'with woman' influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being 'with woman' in the known midwife model are shared by midwives. Conclusions: Findings offer valuable insight into midwives' experiences of being 'with woman' in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being 'with woman' which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being 'with woman' provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being 'with woman' in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery. (shrink)