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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- Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group.J. Contin. Educ. Health Prof. 2013; https://doi.org/10.1002/chp.21197
- The essential role of medical ethics education in achieving professionalism: the romanell report.Acad. Med. 2015; 90: 744-752
- Nurses’ professional values: influences of experience and ethics education.J. Clin. Nurs. 2019; https://doi.org/10.1111/jocn.14806
- Pediatricians’ reports of their education in ethics.Arch. Pediatr. Adolesc. Med. 2008; 162: 368-373
- Simulation: a new approach to teaching ethics.J Midwifery Women’s Heal. 2015; 60: 70-74
- A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation.J. Gen. Intern. Med. 2004; 19: 251-258
- Exploring moral problems and moral competences in midwifery: a qualitative study.Nurs. Ethics. 2018; https://doi.org/10.1177/0969733018761174
- Ethics education in midwifery education programs in the United States.J Midwifery Women’s Heal. 2016; 61: 586-592
- Qualitative Inquiry & Research Design.2007https://doi.org/10.1111/1467-9299.00177
- Ethical dilemmas in nursing: an integrative review.J. Clin. Nurs. 2018; https://doi.org/10.1111/jocn.14542
- OG. Between professional values, social regulations and patient preferences: medical doctors’ perceptions of ethical dilemmas.J. Med. Ethics. 2018; 44: 239-243
- How physicians face ethical difficulties: a qualitative analysis.J. Med. Ethics. 2005; 31: 7-14
- 8.2.14, Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data.2019
- Analysis in practice.(eds)in: Ritchie J. Lewis J. McNaughton Nicholls C. Ormston R. Qualitative Research Practice. 2nd editio. Sage Publications, London2014: 295-346
- Using thematic analysis in psychology.Qual. Res. Psychol. 2006; https://doi.org/10.1191/1478088706qp063oa
- Standards for reporting qualitative research.Acad. Med. 2014; https://doi.org/10.1097/acm.0000000000000388
- Johnson l. How many interviews are enough?: an experiment with data saturation and variability.Field methods. 2006; https://doi.org/10.1177/1525822X05279903
- Ethical sensitivity: state of knowledge and needs for further research.Nurs. Ethics. 2007; https://doi.org/10.1177/0969733007073694
- Nurse ethical sensitivity: an integrative review.Nurs. Ethics. 2018; https://doi.org/10.1177/0969733016646155
- Core competencies for basic midwifery practice.Am Coll Nurse Midwives Core Competencies. 2012; : 1-8
- Philosophy and Model of Midwifery Care.2014https://www.internationalmidwives.org/assets/files/definitions-files/2018/06/eng-philosophy-and-model-of-midwifery-care.pdf
- Beyond autonomy: care ethics for midwifery and the humanization of birth.Nurs. Ethics. 2019; https://doi.org/10.1177/0969733018819119
- ‘Such a waste’ – conflicting communicative roles of Dutch midwifery students in childbirth decision making.Midwifery. 2018; 64: 115-121
- Nurses experiences of ethical dilemmas: a review.Nurs. Ethics. 2019; https://doi.org/10.1177/0969733019832941
- Teaching interprofessional teamwork skills to health professional students: a scoping review.J. Interprof. Care. 2018; https://doi.org/10.1080/13561820.2017.1399868
- Moral distress: a review of the argument-based nursing ethics literature.Nurs. Ethics. 2015; https://doi.org/10.1177/0969733014557139
- The use and misuse of moral distress in neonatology.Semin. Fetal Neonatal Med. 2018; https://doi.org/10.1016/j.siny.2017.09.007
- Ethics education in MSN programs: a study of national trends.Nurs. Educ. Perspect. 2007; https://doi.org/10.1109/ISIE.2011.19
- The ethics curriculum for doctor of nursing practice programs.J. Prof. Nurs. 2008; 24: 270-274
- Essential Competencies for Midwifery Practice.2019https://www.internationalmidwives.org/assets/files/general-files/2019/02/icm-competencies_english_final_jan-2019-update_final-web_v1.0.pdf
- Increasing midwives’ ethical competence: a European educational and practice development project.Int J Ethics Educ. 2017; : 147-160
- Precepting 101: teaching strategies and tips for success for preceptors.J. Midwifery Women’s Heal. 2016; https://doi.org/10.1111/jmwh.12520
- Midwifing the student: creating an effective learning environment.J. Midwifery Women’s Heal. 2016; https://doi.org/10.1111/jmwh.12487
- A powerful midwifery vision”: dutch student midwives’ educational needs as advocates of physiological childbirth.Women Birth. 2019; https://doi.org/10.1016/j.wombi.2018.12.010
- Midwifery students’ perspectives on how role models contribute to becoming a midwife: a qualitative study.Women Birth. 2019; https://doi.org/10.1016/j.wombi.2019.08.009
- Hidden curricula, ethics, and professionalism: optimizing clinical learning environments in becoming and being a physician: a position paper of the American college of physicians.Ann. Intern. Med. 2018; https://doi.org/10.7326/M17-2058
- Obstetric Ethics and the Invisible Mother.Narrat. Inq. Bioeth. 2017; https://doi.org/10.1353/nib.2017.0068
Published online: January 27, 2020
Accepted: December 23, 2019
Received in revised form: December 23, 2019
Received: August 7, 2019
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.