Background The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. Research Objectives The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. Research Design This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual (...) interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. Results Four key themes described the threats to women’s dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. Conclusion The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth. (shrink)

Qualitative research, particularly phenomenology, is increasingly popular as a method for midwifery and health-related research. These approaches enable rich and detailed explanations to be uncovered and bring experience to life. Important recommendations and practice- based implications may then be raised and debated for future use. This book brings together a range of phenomenological methods and insights into one accessible text. Illustrated with plenty of examples of successful phenomenological research, Qualitative Research in Midwifery and Childbirth keeps the focus applied to (...) midwifery and childbirth and makes clear the links to practice throughout. The book introduces three key phenomenological approaches âe" descriptive, interpretive and the life world âe" and includes a comparative chapter which discusses the differences between these varied perspectives and methods. Each chapter focuses on how these approaches are used within midwifery research. The remaining chapters present a number of different research projects. These demonstrate how different phenomenological approaches have been used to explore and uncover experiences of childbirth and maternity as well as offering important insights into how women experience different facets of the birth experience during the antenatal, intra-partum and postnatal period. Designed for researchers and students undertaking research projects on midwifery and childbirth, this text includes contributions from a range of international and highly regarded phenomenological authors and researchers. (shrink)

Background: The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described. Aim: The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century. Research design: This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the (...) journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson. Ethical considerations: This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met. Findings: Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century. Conclusion: History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife’s profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth. (shrink)

Consideration of the evolutionary and cross-cultural history of childbirth reveals many differences between the ways in which most human females have experienced childbirth and the ways in which most women in contemporary industrialized obstetric settings experience the event. In this paper I review two of these differences: the pain and anxiety of labor and delivery and the discontinuity of care provided for the mother and infant. I argue that much of the dissatisfaction with birth practices in the United (...) States results from the failure of modern obstetric practice to meet the evolved needs of mothers and infants. (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)

Native women residing in the Subarctic and Arctic are currently struggling for the right to decide whether they will be hospitalized or have a midwife present for the birth of their children. The argument presented in this review paper outlines the cultural and clinical factors in favour of recognizing and legalizing traditional midwifery in the North and critically examines the statistical and safety concerns raised by those arguing against giving Northern Native women an alternative to evacuation from their home communities.

Background: Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. Aim: This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. Research design: The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal (...) communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women’s labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. Findings: The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. Discussion: The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. Conclusion: Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results. (shrink)

Background: The public domain of midwifery practice, represented by the educational and hospital institutions could be blamed for a subconscious ethical dilemma for midwifery practitioners. The result of such tension can be seen in complaints from maternity service users of dehumanised care. When expectations are not met, women report dehumanising experiences that carry long term consequences to both them and their child. Objectives: To revisit the ethical foundation of midwifery practice to reflect the feminist Ethic of Care and reframe what (...) is valuable to women and midwives during the childbirth experience. Research Design: A comprehensive literature review is presented from the midwifery and feminist ethics discourse. Ethical Considerations: Nil to report. Findings: Women are vulnerable during childbirth as they need care, yet they prioritise elements of relationship in their experience. The Ethic of Care approach equalises the relationship between the midwife and the woman, providing the space for relationship building and allowing midwives to meet the expectations of their accepted responsibility. Discussion: Some midwives manage to balance the demands of the institution with the needs of the woman. This is described as both an emotional and professionally challenging balancing act. Conclusion: Until there is a formal acknowledgement of the different ethical approach to midwifery practice from within the profession and the Institution, midwifery identity and practice will continue to be compromised. (shrink)

This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model of Care offers a (...) set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the (...) practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

Background The existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire). Methods The study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with (...) the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ. Results The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B. Conclusions It can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them. (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)

This article investigates the uneasy process of integrating midwifery’s alternative, women-centered model of childbirth care within the medically-dominated healthcare system in Canada. It analyses the impure processes of rhetorical identification and differentiation that characterized the debate about how to regulate midwifery in Ontario by examining a selection of submissions from diverse health care groups with vested interest in the debate’s outcome. In divergent ways, these groups strategically appeal to the value of the “public interest” in order to advance professional (...) concerns. The study considers the implications of this rhetorical process for re-defining midwifery’s distinctive professional identity in relation to other health professions, to the state, and to the women for whom midwives care. Likewise, it suggests the relevance of rhetorical analysis for understanding the discursive formation and re-formation of health models, values, and professions in Western culture. (shrink)

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons giving (...) birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)

In the face of increasing intervention in childbirth, ‘normal birth’ is currently being promoted by the World Health Organization, national governments, professional bodies and other organisations throughout the world. This paper takes a postmodernist stance and explores the idea of the ‘normal’ before going on to analyse normal childbirth, referring to concepts of the normal and the natural. It refers to historical developments in childbearing and lay organisations along with research relating to women’s views of childbirth, to (...) question the appropriateness of using ‘normal’ to describe the very individual experiences of childbirth. It laments the way in which women have been treated and arguably continue to be ‘cared for’ in maternity/obstetric services. It adds to the current discussion by recalling psychoanalytical theory and philosophical analysis to conclude with a call for future consideration of the ‘good‐enough’ birth instead of concentrating on promoting normal birth which is very difficult, if not impossible to define in retrospect, or to prospectively promote. (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)

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)

The home birth movement in the United States is an alternative health belief system that promotes a model of pregnancy and childbirth contradictory to the conventional biomedical model. The alternative model stresses normalcy and non-intervention and is informed by an ideology that promotes individual authority and responsibility for health and health care. It is founded in an epistemological system that assigns primacy and goodness to the Natural, fuses moral and practical injunctions in the arena of health behavior, and valorizes (...) subjective as well as objective sources of knowledge. ( Natural = as found in nature without technical intervention). Differences of opinion with the conventional medical model of childbirth do not spring from misunderstanding of this model, but from disagreement with it. Members of this movement are typically educated, middle class, and white. Keywords: alternative childbirth, home birth, midwifery, out-of-hospital birth. (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)

Despite increasing recognition of the ways in which ethical and social values play a role in science (Kitcher 2001; Longino 1990, 2002), scientists are often still reluctant to acknowledge or discuss ethical and social values at stake in their research. Even when research is closely connected to developing public policy, it is generally held that it should be empirical data, and not the values of scientists, that inform policy. According to this view, scientists need not, and should not, endorse non-epistemic (...) values related to their research, as doing so may bias their assessment of what the evidence is. As a result, debates over science-based policy tend to be construed solely as empirical discussions to be .. (shrink)

This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent‐centred procedures, as well as in (...) unconsented interventions, in ordinary, non‐medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non‐therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Circumcision Decision:A Journey of Inquiry, Courage and DiscoveryLaurie EvansBefore becoming a mother, I was teaching parents to massage their babies and offering trainings for professionals. To promote my work, in 1984, I exhibited at the Whole Life Expo in New York City. When I returned to my booth after a break, I noticed someone had left a pamphlet by Edward Wallerstein, who wrote "Circumcision: An American Health Fallacy." (...) Since I am naturally curious, I read it. Disturbed, I thought of tossing it. But, how could I be teaching a nurturing technique for newborns and avoid this topic? As a Jewish woman, how would I make the decision for my own future sons? Little did I know this one piece of paper would lead me on a path of inquiry that would change my life.One of the presenters at this conference was Dr. Robert Mendelsohn, an Orthodox pediatrician. Although Dr. Mendelsohn realized some parents would allow circumcision for religious reasons, he was honest enough to dispel every medical myth and explain the harm of removing normal functioning tissue. He also described possible complications from removing the foreskin, including infection, hemorrhage, and although rare, death.To learn more, I read whatever I could find on the topic. I attended midwifery and childbirth conferences to promote my work and prepare for when I became pregnant. I decided to ask about circumcision, but the conversations were awkward and I received little helpful information. I found that circumcision was a taboo topic; few people wanted to talk about it. Why? Doctors who perform circumcisions, nurses who recommend it, and parents who consent to it do not want to face the reality of the harm they cause. Instead of facing the pain, they avoid the topic, and the procedure continues. Most men do not want to discuss or think about their own circumcisions. I learned that we need to have compassion during these conversations.A Jewish ritual ceremony (bris) is performed on the eighth day after the boy's birth, and includes circumcision and prayers. At a bris, friends and relatives are invited to observe and celebrate. It is part of my heritage. I tried to talk to my relatives about the information I had found, but everyone refused to discuss it. This avoidance made my decision very difficult. Then, for the first time, I was invited to a bris; I didn't want to attend. However, I had been at the boy's birth, so I decided to go to offer support. During the circumcision, my reaction was intense: I wanted to take the baby and run. I felt like an accomplice. I wanted to grab people by the [End Page E2] shoulders and scream, "How dare you?" I vowed I would never attend another bris, and I made the decision to write publicly instead of anonymously.I still had doubts, because I didn't know one intact adult male. What if I were to have a son, keep him intact, and he developed a complication later in life? I have learned that doctors are not taught non-invasive solutions, so most circumcisions performed after infancy are unnecessary. A Jewish doctor recommended a circumcision for a seventynine year old man who had a persistent rash that would not respond to treatment. Our organization suggested that he apply topical acidophilus. After he followed the recommendation, the rash disappeared, so he canceled the circumcision.In 1985, I became pregnant. Like many women I spoke to, I didn't want to face the circumcision decision, so I prayed for a girl. Our childbirth educator shared about male circumcision, which led to conversations with my husband. These tense interactions ended in an impasse. I wondered how this decision would impact my marriage. I experienced immense relief that my firstborn was a girl. Time was on my side.One day while walking in New York City, I serendipitously crossed paths with my childbirth educator. She was going to the United Nations to oppose female circumcision. I was in my 30s and had a master's degree in teaching. I had studied massage and anatomy. Yet, I had never heard about this tribal ritual. I had... (shrink)

Background: Midwifery students are confronted with several ethical dilemmas and challenging situations during clinical midwifery care practice. Since ethical competence of midwifery students is under development, it is important to support the students’ learning progress of ethical issues from diverse viewpoints. Objective: From the perspective of didactics of caring science and the context of midwifery students, to explore how midwifery students’ experience supports for ethical competence in midwifery education and investigate how ethically challenging situations have been carried out during clinical (...) midwifery care practice. Design: Qualitative, explorative and descriptive design with inductive nature. Methods: Focus group interviews with nine Swedish midwifery students. Hans-Georg Gadamer’s philosophical hermeneutics was applied to guide the interpretation. Ethical considerations: Ethical principles and scientific guidelines were followed. Informed consent was obtained from the participants. Confidentiality was respected and quotations anonymised. Results: Receiving support when ethically challenging situations occur in clinical midwifery practice is important and necessary. One main theme, such as support is a human and caring factor in the midwifery students’ Bildung process on ethical competence, and four subthemes, such as supporting through trust and responsibility; supporting through dignity and respect; supporting through truthfulness and justice; and supporting through dialogue and reflection, were created from the hermeneutical interpretation. Discussion: Teaching ethics should be carefully planned, consistent and continue throughout the midwifery education. There is dispersion in the pedagogy of ethical situations, the methods and perceptions associated with it, and in obtaining possible support for students. Developing well-experienced methods could benefit the support of midwifery students’ ethical competence when they experience ethically challenging situations in midwifery care practice. (shrink)

Despite the fact that the requirement to obtain informed consent for medical procedures is deeply enshrined in both U.S. moral and legal doctrine, empirical studies and anecdotal accounts show that women's rights to informed consent and refusal of treatment are routinely undermined and ignored during childbirth. For example, citing the most recent Listening to Mothers survey, Marianne Nieuwenhuijze and Lisa Kane Low state that "a significant number of women said they felt pressure from a caregiver to agree to having (...) an intervention that they did not want during birth". Specifically, Nieuwenhuijze and Low cite that "19% of women who did not have epidural analgesia felt... (shrink)

Background: Ethical care in maternity is fundamental to providing care that both prevents harm and does good, and yet, there is growing acknowledgement that disrespect and abuse routinely occur in this context, which indicates that current ethical frameworks are not adequate. Care ethics offers an alternative to the traditional biomedical ethical principles. Research aim: The aim of the study was to determine whether a correlation exists between midwifery-led care and care ethics as an important first step in an action research (...) project. Research design: Template analysis was chosen for this part of the action research. Template analysis is a design that tests theory against empirical data, which requires pre-set codes. Participants and context: A priori codes that represent midwifery-led care were generated by a stakeholder consultative group of nine childbearing women using nominal group technique, collected in Perth, Western Australia. The a priori codes were applied to a predesigned template with four domains of care ethics. Ethical considerations: Ethics approval was granted by the Edith Cowan University research ethics committee REMS no. 2019-00296-Buchanan. Findings: The participants generated eight a priori codes representing ethical midwifery care, such as: 1.1 Relationship with Midwife; 1.2 Woman-centred care; 2.1 Trust women’s bodies and abilities; 2.2. Protect normal physiological birth; 3.1. Information provision; 3.2. Respect autonomy; 4.1. Birth culture of fear (midwifery-led care counter-cultural) and 4.2. Recognition of rite of passage. The a priori codes were mapped to the care ethics template. The template analysis found that midwifery-led care does indeed demonstrate care ethics. Discussion: Care ethics takes into consideration what principle-based bioethics have previously overlooked: relationship, context and power. Conclusion: Midwifery-led care has been determined in this study to demonstrate care ethics, which suggest that further research is defensible with the view that it could be incorporated into the ethical codes and conduct for the midwifery profession. (shrink)

Background: Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. Objective: The aim of this study was to explore midwifery students’ reactions to a number of ethical dilemmas relating to women’s experiences of (...) reproductive decision making. Design: A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. Setting: A University in Turkey was the setting for this study. Participants: Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. Ethical considerations: The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. Results: Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were ‘the right to information’, ‘choice and protection’, ‘parental rights and welfare of the women’, ‘make a decision’ and ‘women rights and sexual abuse’. Conclusion: This study has shown that while students respected women’s choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress. (shrink)

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research design: The (...) theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection. (shrink)

The Theaetetus’s midwife metaphor contains a puzzling feature, often referred to as the “midwife paradox”: the physical midwives must have first given birth to their own children in order to have the necessary experience to practice their art. Socrates, however, seems to disavow having any children of his own and thus appears to be unqualified to practice philosophical midwifery. In this paper, I aim to dissolve the midwife paradox by arguing that it rests on problematic assumptions, namely, that Socrates never (...) gave birth to a child at all or the child of wisdom in particular, and that he is primarily an intellectual midwife. I offer a new interpretation of Socratic midwifery, arguing that what Socrates may have birthed in the past which qualifies him for midwifery is his virtuous recognition of his ignorance, and that this “epistemic virtue” is also the proximate goal of Socratic midwifery. (shrink)

_Grey’s Anatomy_, one of the most-watched primetime medical dramas in the USA, has been on the air for two decades now. Though scholars have examined the influence the show has on medical students and the viewing public, the import of the narrative structure and genre conventions of the show in exerting that influence has been underanalyzed. In this article, I map the general narrative formula of the show, which positions doctors as the subjects and patients as the objects, in order (...) to demonstrate how such a formula works to humanize physicians and consolidate biomedical authority. I focus specifically on narratives of pregnancy and childbirth in the show’s earliest and most popular seasons to reveal the limits and possibilities of representing alternatives to medicalized birth within the genre constraints of medical drama. Ultimately, the result of investing only in doctors with subjectivity constitutes patients as the acted-upon, a formula that renders the agency over childbirth squarely in the hands of the physician. Such a representation has consequences, I argue, both for the viewing public’s understanding of childbirth and for the roles doctors and birthing patients are expected to play. (shrink)

Midwifery work and the making of narrativeThis paper draws on a study of birth support conducted across three Melbourne maternity units. Midwife informants were asked to participate in semistructured interviews with two researchers and describe the activity and role of lay birth support people. In the course of the study, the activity of the midwives themselves became a research focus. The study found that one of the key tasks midwives described was assisting birthing women to develop and negotiate satisfactory birth (...) narratives that could encompass the intense and sometimes difficult experience of birth. Midwife informants offered strategies for the development of such narratives as part of their professional and personal labour in the birth room. (shrink)

Julius Tomin has recently questioned the new orthodoxy, stemming from Burnyeat's impressive article, that Socratic midwifery is not genuinely Socratic. I understand that many will feel the need to question Burnyeat's position, but I am unhappy that Aristophanes' comedy has once again been thought to give support to the view that Socrates had been known as an intellectual midwife. Thus my response will concentrate on our understanding of Clouds, and in particular on the key passage at 135ff.

In Plato's Theaetetus Socrates is portrayed as a midwife of the intellect. The comparison of Socratic questioning to midwifery had until recently been commonly attributed to Socrates himself. In 1977 M. F. Burnyeat published Socratic Midwifery, Platonic Inspiration, which transformed the way in which the dialogue has since been perceived. The author maintains that the midwife comparison is in no sense to be attributed to the historical Socrates.

Background: Most undergraduate midwifery curricula comprise ethics courses to strengthen the moral competences of future midwives. By contrast, surprisingly little is known about the specific moral competences considered to be relevant for midwifery practice. Describing these competences not only depends on generic assumptions about the moral nature of midwifery practice but also reflects which issues practitioners themselves classify as moral. Objective: The goal of this study was to gain insight into the ethical issues midwives encounter in their daily work, the (...) key competences and resources they consider indispensable to understand and deal with them, and to assess phenomena linked to moral distress. Methods: We conducted individual semi-structured interviews with eight midwives and two other health professionals, varying in terms of years of experience and work setting. Interview transcripts were analyzed in an interdisciplinary research group, following thematic analysis. Ethical considerations: This study was not subject to approval according to the Swiss Law on Research with Humans. Participants were informed about the study goals and gave written informed consent prior to participation. Results: External constraints limiting the midwife’s and the patient’s autonomy and resulting interpersonal conflicts were found to be the most relevant ethical issues encountered in clinical practice and were most often associated with moral distress. These conflicts often arise in the context of medical interventions midwives consider as not appropriate and situations in which less experienced midwives in particular observe a lack of both interprofessional communication and trust in their professional competence. Ethical issues related to late abortions or prenatal diagnostics and selective abortions were also frequently addressed, but many midwives involved had learned to cope with them. Discussion: In the light of the ethical issues and factors contributing to phenomena of moral distress, an empirically grounded profile of moral competences is drafted. Curricular implications in the light of possible adaptations within undergraduate midwifery education are critically discussed. (shrink)

Philosophical inquiry into pregnancy, childbirth, and mothering is a growing area of interest to academic philosophers. This volume brings together a diverse group of philosophers to speak about topics in this reemerging area of philosophical inquiry, taking up new themes, such as maternal aesthetics, and pursuing old ones in new ways, such as investigating stepmothering as it might inform and ground an ethics of care. The theoretical foci of the book include feminist, existential, ethical, aesthetic, phenomenological, social and political (...) theories. These perspectives are then employed to consider many dimensions of pregnancy, childbirth, and mothering, which are of central importance to human existence, but are only rarely discussed in philosophical cannons. Topics include pregnancy and embodiment, breast-feeding, representations – or the lack thereof – of pregnant and birthing women, adoption, and post-partum motherhood. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Environmental Midwifery and the Need for an Ethics of the Transition:A Quick Riff on the Future of Environmental EthicsStephen M. Gardiner (bio)It is worth remembering that in many ways environmental ethics is a very successful field. Over the course of only thirty or forty years, we have reached a point at which almost every significant philosophy program in the country offers a course in environmental ethics, there are several (...) established and well respected journals, and the subject is regarded as one of the core areas of "applied ethics." This is quite an achievement; and one that is easy to forget. (When I listen to the complaints of environmental colleagues in other disciplines, or of philosophers working in many areas of applied ethics, I am vividly reminded.)Still, there is a sense that the job is only half done. For one thing, although environmental ethics classes are ubiquitous, they are usually undergraduate survey courses taught by nonspecialists. For another, although good work appears in the specialist journals, it rarely makes it into the "mainstream" journals that most philosophers read. Finally, although environmental ethics counts as one of three or four core areas of applied ethics, environmental philosophers are rarely hired by (so-called) top departments (and if they are, it is often not because they are environmental philosophers, but because of the other things they do).Now, many questions arise about this situation. One of them, of course, is whether there is some kind of "glass ceiling" on environmental ethics, and if there is, what causes it? Another is whether the core problem [End Page 122] is that we're just not all that good at environmental ethics (yet)? These are reasonable worries (about which my own views would be rather sanguine). But I am more concerned about another issue, which one might call that of "interfacing".The claim that environmental ethics has some problems in interacting with philosophy more generally, with allied disciplines, and with the wider public has been widely discussed in recent years, especially in the emergence of what has come to be called "environmental pragmatism." There is something important about this debate, but my own sense is that it can become overblown. For example, when I teach my undergraduate survey course, mainly to nonphilosophers, they are, if anything, more excited about the Land Ethic, Biocentric Egalitarianism, and the worth of species than about climate change and sustainability. Still, there is something going on. However sympathetic they are to philosophy, I have the sense that my students (as well as my colleagues in other disciplines and the wider public) are dissatisfied. Having heard the critiques and the first set of grand visions, the new challenges and their problems, they want more. Irritatingly, they want to know what to do now—either how to turn grand visions into actions, or (more usually) how to successfully muddle through in the absence of a compelling grand vision. In short, they want an ethics for the transition.For what it is worth, my sense is that the main task of an ethics for the transition lies somewhere between grand theory and pragmatism. What people are hoping for is a way to transform serious environmental concern into social change. But they want this transformation to be responsive to, reflective of, and integrated with wider values. Sensing that modern life has significant vices, but also major virtues, they wish to see environmental ethics synthesize their concerns in new and creative ways. In short, like a Socratic midwife, they want environmental philosophy to help them to articulate the way forward.I'm sympathetic to the need for an ethics for the transition. I also think that taking on the task of articulating such an ethic may help the field to break through some of the institutional constraints now restricting it. But mainly it just seems to be a worthy topic in its own right. Environmental ethics should try to become an ethics for living now. In the nicest sense of the phrase, it should seek to "grow up."Stephen M. Gardiner Stephen M. Gardiner is an Associate Professor in the Department of Philosophy and the Program on Values in Society at the... (shrink)

Medical malpractice has attracted the attention of people and the media all over the world. In Turkey, malpractice cases are tried according to both criminal and civil law. Nurses and midwives in Turkey fulfill important duties in the distribution of health services. The aim of this study was to reveal the legal procedures followed in malpractice allegations and malpractice lawsuits in which nurses and midwives were named as defendants. We reviewed 59 nursing and midwifery lawsuits reported to the Higher Health (...) Council between 1993 and 1998. Health professionals were held liable in 59% of the lawsuits. Midwives had the highest percentage of malpractice liability (52%), followed by physicians (29%) and nurses (19%). To reduce potential liability, nurse education should be improved, a nursing malpractice law should be enacted, and instructions for nursing procedures should be formulated. (shrink)

This book offers a distinctive interpretation of Hegel's Phenomenology of Spirit. It suggests that Hegel's approach in the 1807 Phenomenology is akin to Socratic 'midwifery'. The book starts from the midwife figure in Plato's dialogue Theaetetus. There Socrates elicits from Theaetetus his views on the nature of knowledge, without imposing on him his own ideas thereof. Similarly, in the 1807 Phenomenology Hegel elicits a series of shapes of consciousness and spirit, and uncovers the implications of each one of them. In (...) the same way as Socrates subjected in his interlocutor's views to an internal criticism to see whether they were valid or not, Hegel subjects the various 'shapes of consciousness' to an immanent critique, in the course of which each oneof them proves to be inadequate on its own terms. Like the Platonic dialogue Theaetetus, Hegel's Phenomenology does not end in a positive doctrine. So the Phenomenology of Spirit introduces us to philosophical science in a negative sense, that is, by showing what philosophical science is not. In this way it prepares the ground for science proper, namely, Hegel's Science of Logic. (shrink)

Professional ethics is one of the important topics, which includes various rights such as respecting the patient’s right to choose, being useful, being harmless, and respecting the justice, integrity, and confidentiality of information. Adherence to these principles can increase the quality of care and patient satisfaction. Since determining the current attitude of students towards ethics plays an important role in educational programs, this study was conducted to evaluate the attitude of nursing and midwifery students of Kermanshah University of Medical Sciences (...) towards six principles of professional ethics. In this cross-sectional study, 76 undergraduate nursing and midwifery students were selected to participate in this study by census method. The data collection tool was a valid and reliable questionnaire on the principles of medical ethics. Data were analyzed using descriptive and inferential statistics. The study sample consisted of 49 nursing and 27 midwifery students with an average age of 23 ± 1.4 years. The mean score of nursing and midwifery students’ attitude towards medical ethics was 95.01 ± 4.8 in basis of 100, and was 94.56 ± 4.9 for nursing students and 96.04 ± 4.7 for midwifery students. Majority of the samples had positive attitude towards medical ethics and 3.73% had a relatively positive attitude. No statistically significant relationship was found between the attitude of students and variables of gender, field of study, marital status, and age. All students in this study had a positive attitude towards the principles of medical ethics, and this is a valuable asset for clinical environments. To increase the generalizability of the study, further studies with bigger sample size on the students of various disciplines of medical sciences is recommended. (shrink)

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet is used cautiously due (...) to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress. (shrink)

Shared decision making has become the standard of care, yet there remains no consensus about how it should be conducted. Most accounts are concerned with threats to patient autonomy, and they address the dangers of a power imbalance by foregrounding the patient as a person whose complex preferences it is the practitioner's task to support. Other corrective models fear that this level of mutuality risks abdicating the practitioner's responsibilities as an expert, and they address that concern by recovering a nuanced (...) but genuinely directive clinical role. Cribb and Entwistle helpfully categorize models of shared decision making as ‘narrower’ and ‘broader’ and praise the latter's ‘open‐ended and fully dialogical ways of relating’. However, they stop short of providing a philosophical account of how that dialogue works. In this paper, a nurse–midwife and a philosopher collaborate to argue that the Socratic model of dialogue offers a solution to the practitioner–patient dilemma. In the Theaetetus, Socrates compares dialogical reasoning to ‘midwifery with all its standard features’. By means of a three‐way analogy, elements of midwifery practice are used to illuminate features of Socrates' claim that his dialogue is like midwifery; those features are then translated into an approach to shared decision making as the ‘midwifery of good thinking’ which both midwives and physicians would do well to adopt. A key concept that emerges is the need for practitioners to make a risk‐confidence assessment of the particular content of any decision to appropriately modulate their role in the practice of shared decision making. (shrink)

Background: As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity. Aim: The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a (...) care ethics framework and definition for midwifery practice. Method: The scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was applied to the databases CINAHL, MEDLINE, PschInfo and Pubmed which were searched in September 2019 and again in July 2021. The inclusion criteria were guided by the mnemonic for search terms: Participants, Concept, and Context (PCC) and included variations of health care professionals, care ethics and utilization. The search was limited to qualitative studies published in English between 2010 and 2021. A data extraction tool was used to extract and synthesize data into categories. The articles were screened for eligibility by title, abstract and full text review, by two independent reviewers. Ethical Considerations: The scoping review was guided by ethical conduct respecting authorship and referencing sources. Results: Twelve of the initially identified 129 studies were included in the scoping review. Data synthesis yielded four categories of care ethics use by health professionals: relationship, context, attention to power and caring practices. In combination, the evidence forms a framework for care ethics use in midwifery practice. Conclusion: Care ethics use by health professionals enhances ethical sensitivity. A framework and definition for care ethics for midwifery practice is proposed. This review will be of interest to midwives and other health practitioners seeking to enhance ethical sensitivity. (shrink)