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 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)

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)

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)

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)

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)

In this editorial, we argue that midwives should focus on climate change, a link which has been underexplored.

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)

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: 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)

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.

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)

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.

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.

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)

© 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)

In Topics I.2, Aristotle famously claims that dialectic, as a critical inquiry, affords the path to the primary principles of science. This article sets out from the assumption that Aristotle shares with Plato the suspicion that dialectical critique cannot contribute to the advancement of scientific knowledge as long as it is of the Socratic, elenctic kind, since its only benefit is to refute false beliefs. But when Plato in the Theaetetus has Socrates act as a midwife to his fellow men, (...) he offers an alternative picture of dialectical critique that also, it is argued, captures the spirit of Aristotle’s dialectical work, especially as pursued in the Metaphysics. In Aristotle, however, the mission of Socratic midwifery, to help other individuals give birth to knowledge that was already innate to them, is transformed into a project that centers on the liberation of the as yet dormant and inarticulate truth of the tradition. (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)

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)

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)

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)

The Theaetetus's midwifery metaphor is well-known; less discussed is the brief passage accusing Socrates of behaving like Antaeus. Are philosophers midwives or monsters? Socrates accepts both characterizations. This passage and Socrates's acceptance of the metaphor creates a tension in the text, birthing a puzzle about how readers ought to understand the figure of the philosopher. Because metaphors play a pivotal role in the dialogue's ethical project, the puzzle presents not simply a textual tension but a question of how and (...) why to be a philosopher. (shrink)

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We (...) propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles. (shrink)

It is important to define and practice ethical rules and codes for professionalisation. Several national and international associations have determined midwifery ethical codes. In Turkey, ethical rules and codes that would facilitate midwifery becoming professionalised have not yet been determined. This study was planned to contribute to the professionalisation of midwifery by determining national ethical values and codes. A total of 1067 Turkish midwives completed the survey. The most prevalent values of Turkish midwives were care for mother–child (...) health, responsibility and professional adequacy. The preferred professional codes chosen by Turkish midwives were absence of conflicts of interest, respect for privacy, avoidance of deception, reporting of faulty practices, consideration of mothers and newborns as separate beings and prevention of harm. In conclusion, cultural values, beliefs and expectations of society cannot be underestimated, although the international professional values and codes of ethics contribute significantly to professionalisation of the midwifery profession. (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)

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in (...) this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio‐political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency‐structure interaction and stresses the centrality of agents’ roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives’ relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report. (shrink)

Background In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students’ support for CO, following legal reform. Methods From October 2017 to May 2018, we surveyed medical and midwifery students from seven universities (...) located in Santiago, Chile. Universities included 4 secular and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology and five offering midwifery degrees. We used generalized estimating equations to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level. Results 333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform and refer abortion-seeking patients, a minority would personally use conscientious objection to avoid caring for a patient seeking abortion. About half of religious-university students and one-fifth of secular-university students support objections at the institutional level. Conclusions Most students support the regulated use of CO which preserves patients’ access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections. (shrink)

Values‐based practice is deemed essential for healthcare provision worldwide. In England, values‐based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students’ personal values align with the values of the National Health Service (NHS), which focus on compassion and patient‐centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students’ perceptions of their values over the duration of their education programme as a (...) ‘values journey’. The aim of this hermeneutic longitudinal focus group study was to explore the ‘values journey’ of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this. (shrink)

This book describes in detail the important issues in these professions, accountability, standards of conduct, and the framework of the disciplinary process, ...

This paper develops a framework for establishing rigour for a discourse analysis of professional transition in midwifery, theorised as a ‘female professional project’. Discourse analysis has gained recognition as a useful approach in nursing and midwifery research. It provides an alternative to those qualitative approaches that propose to reveal a ‘reality’ from the perspective of the individual experience, and that this lived experience can be directly represented in language. There are multiple discourse analytic approaches, and often researchers are (...) not explicit about what type they are employing. Furthermore, to date there are few clear guidelines for what constitutes rigour in a discourse analytic study. Rigour in qualitative research broadly falls into two categories: the replication perspective that argues for the maintenance of criteria of validity and reliability, usually with an underpinning assumption (often unquestioned) that a ‘truth’ can be revealed. The second is the parallel perspective that questions the ontological and epistemological assumptions of the replication perspective and argues for the development of criteria that reflect the assumed questionable nature of truth and reality. Transferring these criteria to a discourse analytic study revealed some problems. A common challenge identified in achieving rigour in discourse analysis is the maintenance of congruity between the epistemological and ontological basis of a piece of research and the actual analysis conducted or reported. A framework is proposed to address these incongruities and includes six elements. As nurses and midwives increasingly employ discourse analysis in their research, attempts to clarify how rigour will be determined are important if the outcomes of such research are to be seriously considered for their implications for theory, policy and practice. (shrink)

Background: Double degrees in nursing and midwifery have evolved in Australia as a proposed solution to possible impending shortages of qualified midwives in the healthcare workforce. The double degree is seen as a more acceptable option in non-metropolitan areas in particular. Concern has been expressed however, about dilution of midwifery philosophy and graduates opportunities in respect of future clinical practice. Aim: This study aimed to provide a better understanding of motivations and intentions of students who undertake the Bachelor (...) of Nursing Science/Bachelor of Midwifery double degree. Methods: A cross-sectional survey design was employed at four universities that offered double degrees in nursing and midwifery in three states of Australia. Students enrolled in first and fourth year of a double degree and graduates of a double degree were invited to complete an online survey comprised of Likertscales and items requiring free text responses. Quantitative data was analysed using SPSS and thematic analysis was used to analyse the qualitative data. Findings: Participants indicated a clear preference for midwifery as a career with this preference increasing for each cohort at each stage of study. Discussion: Primary reasons for selecting a double degree were perceived increased opportunity for employment and use of nursing skills to enhance midwifery practice in a population with growing co-morbidities. A strong identification with midwifery philosophy and identity was also demonstrated.Conclusion: An understanding of motivations and career intentions of students undertaking double degree studies can inform future program development and workforce planning. (shrink)

The purpose of this study was to determine the professional and personal values among midwifery students in Turkey and to identify whether the years of study affected these values. A total of 192 participants were asked to prioritize 16 professional and 36 personal values. The relationship between the year of study and value ranking was analyzed by Kruskal–Wallis test. The first three of the professional values were justice, equality, and human dignity. Equality ranked sixth among the personal terminal values, (...) and it increased with the years of study. Of personal instrumental values, responsibility and cleanliness ranked second and fifth, which are of central importance for the profession of midwifery. However, the other two important values, privacy and preventing unnecessary suffering, ranked lower when the years of study increased, in other words when the students confront clinics. Since these values are important for midwifery, ethics courses should be given throughout the midwifery education to prepare students for the challenges they face in the clinical environment. (shrink)

Within the context of global debates about safety and ethics of supporting women to give birth at home, it is important to analyse documents governing midwifery and obstetric practice and influence decision‐making around place of birth. In Australia, the United States and the United Kingdom, relatively small numbers of women choose to give birth at home despite their midwifery colleges' support. In the United States and Australia, the obstetric colleges do not support homebirth and these countries have lower (...) numbers of women who birth at home, compared with the United Kingdom. There are numerous regulatory and industry challenges for midwives attending homebirths. This paper reports on a Foucauldian analysis of Australian obstetric and midwifery colleges' position statements about homebirth, who have conflicting views, with the view to understanding their arguments and underlying assumptions. The documents highlighted tensions between competing discourses of risk and autonomy and differences in academic argument. Opportunities for strengthening their statements are highlighted. The methodology is applicable for future analysis of similar documents governing practice in other countries. (shrink)

본 논문은 플라톤에 의해 해석되어 구현된 소크라테스의 철학적 방법으로서 ‘문답식 대 화법(=변증법)’과 플라톤 대화편 『테아이테토스』에서 묘사되는 ‘소크라테스의 산파술’과 의 관계에 관한 비판적 고찰을 목적으로 한다. 이에 필자는 우선 ‘산파술’에서 ‘논박술’을 배제하여 이해하려는 해석 전통을 비판적으로 검토하고, 이러한 이해가 편협되어 있음을 지적할 것이다. 이를 바탕으로 필자는 『테아이테토스』에서 묘사된 ‘산파술’은 반드시 ‘논 박술’과 결합된 방식으로 사용되는 방법임을 관련 텍스트의 분석을 근거로 주장한다. 또 한, 플라톤에 의해 기획된 ‘소크라테스의 산파술’은 논박술과 함께 상기술로 구성됨으로써 ‘소크라테스적 문답식 대화법(=변증법)’ 전체를 지칭하는 비유로서 이해되어야 함을 입증 하고자 (...) 한다. (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)

Although disgust is recognized as a common and prominent emotion in healthcare, little is known about how healthcare professionals understand, experience and conceptualize disgust. The aim of the study was to gain an in‐depth understanding of how nursing and midwifery students experience, understand and cope with disgust in their clinical work. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Six participants (all women: two nursing students, four midwifery students) from a university in the South of (...) England were interviewed. Four superordinate themes with eight subthemes were identified. Overall, findings suggest that participants experience both moral and physical disgust; however, they find it difficult to talk about and use other terms to describe their experience. Findings are discussed through the lens of social identity theory, to understand the relevance of professional identity and how this might further maintain the disgust taboo. The strategies participants have developed in order to cope with disgust are explored and understood within the current healthcare climate. Future research should focus on ways of addressing the experience of disgust by healthcare professionals in order to improve the quality of care provided, especially in the climate of the COVID‐19 crisis. (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)