Research Article| Volume 33, ISSUE 6, e519-e526, November 2020

“I’m sure we talked about it”: Midwives experiences of ethics education and ethical dilemmas, a qualitative study

  • Michele Megregian
    Corresponding author.
    Nurse-Midwifery, School of Nursing, Oregon Health & Science University, United States
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  • Lisa Kane Low
    School of Nursing and Department of Women's Studies and Department of Obstetrics and Gynecology, University of Michigan, 400 North Ingalls Suite 3160, Ann Arbor Michigan, 48103, United States
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  • Cathy Emeis
    Director of the Nurse-Midwifery Program, School of Nursing, Oregon Health & Science University, 3455 US Veterans Hospital Rd, Portland, OR, 97239, United States
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  • Raymond de Vries
    School of Public Health and Primary Care Maastricht, University Maastricht, Maastricht, Universiteitssingel 60, 622ER Maastricht, The Netherlands

    Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Rd Ann Arbor, MI, 48109, United States
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  • Marianne Nieuwenhuijze
    Professor of Midwifery, Research Centre for Midwifery Science, Zuyd University, Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
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Published:January 27, 2020DOI:



      Midwives are expected to identify and help resolve ethics problems that arise in practice, skills that are presumed to be taught in midwifery educational programs. In this study, we explore how midwives recognize ethical dilemmas in clinical practice and examine the sources of their ethics education.


      We conducted semi-structured, individual interviews with midwives from throughout the United States (U.S.) (n = 15). Transcripts of the interviews were analysed using an iterative process to identify themes and subthemes.


      Midwives described a range of professional ethical dilemmas, including challenges related to negotiating strained interprofessional relationships and protecting or promoting autonomy for women. Ethical dilemmas were identified by the theme of unease, a sense of distress that was expressed in three subthemes: uncertainty of action, compromise in action, and reflecting on action. Learning about ethics and ethical dilemmas occurred, for the most part, outside of the classroom, with the majority of participants reporting that their midwifery program did not confer the skills to identify and resolve ethical challenges.


      Midwives in this study reported a range of ethical challenges and minimal classroom education related to ethics. Midwifery educators should consider the purposeful and explicit inclusion of midwifery-specific ethics content in their curricula and in interprofessional ethics education. Reflection and self-awareness of bias were identified as key components of understanding ethical frameworks. As clinical preceptors were identified as a key source of ethics learning, midwifery educators should consider ways to support preceptors in building their skills as role models and ethics educators.


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