Claiming an Ethic of Care for midwifery

Abstract

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.

Beyond autonomy: Care ethics for midwifery and the humanization of birth

“…13 MacLellan (p. 806) states that 'refocusing midwifery practice back to a foundation built on the ethic of care could alleviate and reverse this decline into dehumanized care, as the moral force of responsibility and relationship is stressed'. 3 We agree with this, holding that an emphasis on the moral primacy of the relationship would necessarily decrease the power of the institution, as midwives can first and foremost dedicate their attentiveness and responsibility to the women in their care. Midwives will often provide woman-centred care to the best of their ability-up to the point where they bump up against institutional requirements.…”

“…32 It is also evident that while the principle of autonomy assumes a level playing field, the reason it can be so easily overturned in maternity care is because women do not have equal power within the institutions of medicine and the hospital-although this imbalance is hidden by the 'political myth of independence and autonomy that is embodied by the institution' (p. 806). 3 Medicine not only has the power to decide which knowledge is valid, what counts as safe and which options are provided, health professionals also hold professional power over women in individual clinical circumstances. [33][34][35][36] They have the power of the institution and their professional knowledge and status behind them, while women, as the recipients of care, are more vulnerable.…”

“…i Maternity care providers, and those with a broader interest in pregnancy and childbirth, therefore need to consider how the ideal of 'woman-centred care' is to be maintained under current models. Engaging with 'ethics of care' theory, MacLellan 3 proposed that moving beyond an atomistic, principles-based ethics which is often swayed to support institutioncentred care, to an ethics based on relationship and responsibility is better aligned with midwifery practice. We advance this argument for drawing on ethics of care as a way of overcoming these inherent ethical problems.…”

A concept analysis of compassionate midwifery

“…MacLellan () noted the emotional and professional balancing act that midwives encounter in their work. Hunter (2006a, 2006b) studied the way community midwives cope with this emotional nature of their work using Hochschild's () framework of emotional labour.…”

“…Frohlich and Schram () call for the communication of risks and choices to promote knowledge, understanding and respectful compassionate care. Failure to explain and inform in a balanced way leads to women feeling that they are removed from decision‐making and women describe the ill‐effects of feeling that things were done to them rather than for them (MacLellan ). Similarly, The Joanna Briggs Institute () noted that although women value practical care and support in relation to breastfeeding, the style and way information is shared and help is offered is important.…”