1. Enhancing an ethico-legal conducive intrapartum care environment
Dr J M Mathibe-Neke
M M Mashigo (Posthumus)
University of South Africa
SOMSA 2017

2. Background
Researcher participated in the investigation of malpractices at SANC
Observed a variety of emotions displayed during disciplinary hearings
MOU’s with higher statistics of litigations in Gauteng Province were identified as the study context
Aimed to explore the midwives’ understanding of ethical practice
Explore the midwives’ experiences of unethical behavior and professional malpractice

3. Research methodology/design
Qualitative, exploratory descriptive cross sectional study
Context was Gauteng Province MOU’s
Criteria (midwives with two or more continuous years of working in the labour unit)
In-depth interviews were conducted
Data saturation was reached with the 8th participant
Strategies/recommendations to enhance ethico-legal behavior developed based on findings

4. Findings X4 participants were reported for negligence
Midwives are aware of ethical conduct
Shortage of human and material resources as a barrier
Non-compliance to policies (Code of Ethics)
Poor confidence in decision-making
Lack of management support

5. Outcome of litigations
X3 never gave evidence in a litigation
Aquited due to compounding factors
Delivery in an ambulance with no midwife
Failure to assess leading to delivery outside the clinic premises
Still birth due to meconium stained liqour
X1 was charged and suspended for 2 years
Anger, guilt, frustration, fear, loss of confidence, discouraged

6. Strategies to enhance ethico-legal practice
Ethico-legal competence
Upholding the ethics of caring
Management’s ethical leadership
In-service education on ethical practice
Multidisciplinary Ethics rounds
Rights-based approach to intrapartum care (RSA Constitution, 1996)

7. Ethico-legal competence
ANTEDESCENTS
ATTRIBUTES
CONSEQUENCES
Professionalism
Character growth/strength
Effective application of ethical and legal knowledge in practice
Ethical perception and legal awareness
Virtuous midwife
Ethical knowledge
best possible solutions
for ethical conflicts
Moral judgement skills
Skills acquisition
Commitment
Enhanced maternal and
foetal wellbeing
Experience of a midwife
Willingness to do good
Interpersonal skills
Management of barriers to
ethical sensitivity
Workplace ethico-legal climate
Women empowerment

8. Conceptual framework for the “ethics- of –care” (Kuis et. al, 2014)
Caring relationship
Protects, enhances and preserves the woman’s dignity, humanity and wholeness 2
Therapeutic relationship
Trust in midwife, positive collaborative and affective bond between midwife and women, empathy, shared decision-making, communication 3
Four aspects of assessing good care
Humanistic care,
Relational care,
Clinical care
Comforting care

9. Clashing principles Intrapartum care
Autonomy/self-determination and beneficence/ duty to care
Confidentiality and informed consent
Justice and rights
Beneficence and non-maleficence

10. Recommendations
Education: Strengthening the undergraduate curriculum on ethical and legal practice
Practice: Exploring ethical practice skills within managers
Research: Replicating the study on a larger sample with more objectives

11. Conclusion
A good midwife shows concern for women by caring for them efficiently, effectively and attentively thus fostering their well-being. It has been proposed that if one fails to be a good midwife, that it is because one does not make an effort or is unwilling to act, rather than being unable to act (Dewey 1983)