Ethics for Midwives

Introduction to Ethics  Our care for patients should be based on sound judgement (or evidence based practice!!  some of this judgement is about having a strong sense of what is right or wrong  having a strong sense of what we should be doing and shouldn’t be doing as midwife  having a strong sense of what our priorities ought to be

Ethical historical trend Before 1939:-  Malpractice.  Few standard and regulations present:-  Increased surgery and life support measures.  Develop in drugs (antibiotics), (analgesics) and others. 3

Ethical historical trend (con.)  Nurses more skilled in dealing with medical and surgical cases.  More care in standard and policy (code of ethics).  Increased advanced technology increased specialization in different studies. 4

 Increased public involvement in the community.  Progress nurses specialty.  Universities-degrees: autonomy. 5

Definition of ethics Ethics originated from a Greek word “Ethos” meaning custom, habit, conduct and also called Moral Philosophy (science of morals). Ethics is commonly defined as the philosophical study of right action and wrong action Ethics includes duties and responsibilities. Ethics studies voluntary actions carried out with sufficient knowledge and choice. 6

Morals and Ethical The words "morals" and "ethical" originally mean much, the same thing:  Ethics came from Greek  Morals came from Latin Both words refer to the general area of rights and wrongs in theory and practice of human behavior. Distinction has grown up between "morals" and "ethical". 7

Morals refer to the standards of behavior actually held or followed by individuals and groups. Ethics refers to the science or study of morals and it is an activity in the academic context(moral philosophy). OR Ethics: Is a system of moral or philosophical principles that direct the actions as being either right or wrong 8

Morals or Morality Morals or Morality refers to the following:  The ownership of personnel values and rules of behavior  Rules of conduct regulating our social interactions  Culture-specific more grounded in religion/ ideology  Ethics refers to the collective of beliefs and values system of any moral community or professional group. 9

Comparison of morals and ethics Morals:  Principles and rules of right conduct.  Private and personal.  Commitment to principles and values are defended in daily life Ethics:  Formal reasoning process used to determine right conduct  Professionally and publicly stated.  Inquiry or study of principles and values  Process of questioning and perhaps changing one’s morals

Why do midwifery need Ethics? Ethics for midwife serve as a foundation for midwifery ethical practice:  It provides guidance for ethical relationships, responsibilities, behaviors and decision-making  It is to be used in conjunction with the professional standards, laws and regulations that guide practice.  The code serves as a means of self-evaluation and self- reflection for ethical midwifery practice and provides a basis for feedback and peer review.

Why do midwifery need Ethics?  It also serves as an ethical basis from which midwives can advocate for quality work environments that support the delivery of safe, compassionate, competent and ethical care.  Midwives recognize the privilege of being part of a self- regulating profession and have a responsibility to merit this privilege.

Why do midwifery need Ethics?  The code informs other health-care professionals as well as members of the public about the ethical commitments of the midwives and the responsibilities midwives accept as being part of a self-regulating profession.

Important Question In Ethics What do we mean by ethics? Why it is important to midwives? What are the major ethical issues facing the midwife in today's world?

What makes an action (behavior) moral or not What- The act itself Why- The motive. Circumstances: when, where, how, to whom and how often.

The kinds of acts that are of interest to ethics Those that we ought to do e.g. saving live Those that we ought not to do e.g. harm other. Those that we may either do or not do disconnect mechanical ventilator.

The International Confederation of Midwives (ICM)  The International Confederation of Midwives (ICM), founded in 1919, currently represents a federation of midwifery associations from 100 nations of the world.

 The ICM and its members associations represent the organized efforts of midwives in countries, to speak for themselves on matters that affect the occupation and the profession, and to speak out with a unified voice about matters that affect the health of women, families and communities 18

The International Confederation of Midwives (ICM) This includes advocacy for development of national health strategies in all countries that would give midwives and doctors complementary roles in maternity care, as well as equal involvement insetting public health policy (Högberg, 2004 ).

Definition of the Midwife A midwife Is a person who has successfully completed a midwifery education program that is duly recognized in the country where it is located & has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery

Scope of midwifery Practice The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice before pregnancy, during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.

Scope of Practice This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counseling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care 23

Scope of Practice A midwife may practice in any setting including the home, community, hospitals, clinics or health units.

Skills of the midwife 1) Advising on health 2) Assessment 3) Managing care 4) Independent action 5) Initiating the action of others 6) Undertaking care prescribed by the doctor 7) Communication 8) Research awareness 9) Evidence based practice 10) A team member 11) Ethical issues

1.Advising on health  She deals with healthy women and her family  The midwife has a responsibilities toward herself and her colleagues  Promote healthy living through the education both before and after birth of a baby

2.Assessment Take into account not just the physical parameters of health but must recognize the social, emotional and psychological factors influencing health

3.Managing care  A midwife must be competent to diagnose the pregnancy and carry out the examination of the women and their babies  She plan the necessary care,implement the care and evaluate the effectiveness of the plan which has been carried out

4.Independent action  The midwife is the expert in normal midwifery and has an obligation to care for the mother and the baby  In emergency situation she is trained to take immediate action to treat woman or baby while summoning medical aids

5.Initiating the action of others  The midwife may have need of the expertise and intervention of other discipline  Obstetrician and pediatrician may be called upon to give aids when abnormalities arise  Social worker, physiotherapist, dieticians are among other professional to whom the midwife may refer in appropriate circumstances

6.Undertaking care prescribed by the doctor  The duty of the midwife is to administer care and treatment prescribed by the doctor.  She is expected to interpret the orders,question or even challenging. She may argue the doctor to take an action. when a midwife has called the doctor, the responsibilities for the problem becomes his and there remains the a duty to continue caring for the mother and the baby.

7.Communication  The skillful midwife develops effective communication with her clients, colleagues and those in other disciplines.  This involve enabling them to express their wishes and views and exercising empathy toward them

8.Research awareness  As midwifery research grows year by year, it becomes increasingly important for the competent midwife to be alert to new knowledge that has been established by research and to develop a questioning attitude toward her own practice

9.Evidence based practice  The midwife responsibilities is to make use of all available resources to inform her practice including experiential knowledge.  She has a duty to weigh up the latest clinical evidence that elicited by her personal observation and to take account of her experiences and the woman’s wishes

10.A team member  Being an independent practitioner goes hand by hand with membership of the multidisciplinary team which existing to care for the mothers and the babies.  The midwife must understand the roles of her colleagues and build harmonious relationships with them

11.Ethical issues  The midwife must consider ethical matter as maintaining confidentiality, maintaining and improving one’s own professional competence, while acknowledging any limitation.  Promotion the clients' independence and respect them as unique individuals

A profession usually has  Unique knowledge  A licensing process.  Having a code of ethics  Lengthily socialization  Autonomy of practice  Admission criteria  University qualification  A socially-required activity  Sharing asset of values about work  Commitment for professional development

Characteristics of midwifery profession  Midwifery profession requires an extended education of its members, as well as a basic liberal foundation.  Midwifery profession has a theoretical body of knowledge leading to defined skills, abilities and norms.  Midwifery profession provides a specific service.  Members of a profession have autonomy in decision- making and practice.  The profession has a code of ethics for practice.