Exploring moral problems and moral competences in midwifery: A qualitative study

Oelhafen, Stephan; Monteverde, Settimio; Cignacco, Eva

doi:10.1177/0969733018761174

Cited by 22 publications

(61 citation statements)

References 31 publications

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“…While many women prefer a vaginal birth, any concern for the child’s health tends to overrule other arguments when discussing possible interventions [72]. This is why “playing the dead baby card” is so effective, because none of the people involved – neither the woman nor the HCP – want to take responsibility for a negative outcome [73]. HCP have the power to modulate women’s fears and can either frighten them by stressing possible risks or empower them to take an active role in their childbirth.…”

Section: Discussionmentioning

confidence: 99%

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

Oelhafen

Trachsel

Monteverde

et al. 2020

Preprint

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Background In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women's higher age at childbirth and thus a higher need for control and security cannot entirely explain this rise in obstetric interventions. Another potential factor is that women feel coerced to agree to interventions; however, the prevalence of coercive interventions is unknown. Methods In a nationwide cross-sectional online survey, we assessed mothers' satisfaction with childbirth and the prevalence of informal coercion during childbirth and of women at risk for postpartum depression. We used multivariable logistic regression to estimate the risk associated with multiple individual and contextual factors. Women at least 18 years old who gave birth in Switzerland within the previous 12 months were recruited online via Facebook ads or offline via various channels. Results A total of 6'054 women completed the questionnaire (drop-out rate 16.2%). An estimated 26.7% experience some form of informal coercion during childbirth. Having a cesarean section or instrumental vaginal birth was associated with an increased risk to experience informal coercion (all risk ratios > 1.5). The risk was also increased for women with a migrant background, women living in more urban regions and women with a risk pregnancy. Also, women to whom having a self-determined vaginal birth is important reported on informal coercion more often. Being at risk for postpartum depression was mostly associated with having an emergency cesarean section, having been transferred to hospital and the experience of informal coercion. Also, women with a migrant background seem to be at a higher risk to develop postpartum depression or having other mental health issues. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth experience and women who experienced informal coercion reported lower satisfaction. Conclusions One in four women experience informal coercion during childbirth, and this experience is associated with being at risk for postpartum depression and lower satisfaction with childbirth. Health care professionals should make every effort to prevent informal coercion and ensure sensitive aftercare for all new mothers in order to prevent traumatic effects.

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Section: Discussionmentioning

confidence: 99%

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

Oelhafen

Trachsel

Monteverde

et al. 2020

Preprint

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“…In conducting a web-based cross-sectional questionnaire survey and subsequent factor analyses and multiple regression analyses, the goal of the current project was to understand the structure of ethical issues and moral competences in midwifery, and to estimate the factors leading to moral distress and its negative consequences, such as fatigue or thinking about leaving one’s job. Based on a qualitative interview study that we conducted (Oelhafen et al, 2019), we generated a comprehensive list of items measuring the disturbance level and frequency of ethical issues and the moral competences needed to cope effectively with these situations. After exploratory factor analysis, the three factors moral conflicts, abortions , and asymmetries of power and authority emerged as groups of ethical issues, and assertiveness, moral motivation , and self-distancing as relevant moral competences.…”

Section: Discussionmentioning

confidence: 99%

“…Taking account of these requirements, and based on the results of a qualitative interview study being published elsewhere (Oelhafen et al, 2019), we developed a questionnaire specific to the midwifery setting in order to assess:…”

Section: Introductionmentioning

confidence: 99%

Moral distress and moral competences in midwifery: A latent variable approach

Oelhafen

Cignacco

2018

J Health Psychol

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Like other health professionals, midwives need moral competences in order to cope effectively with ethical issues and to prevent moral distress and negative consequences such as fatigue or impaired quality of care. In this study, we developed and conducted a survey with 280 midwives or midwifery students assessing the burden associated with ethical issues, moral competences, and negative consequences of moral distress. Results show that ethical issues associated with asymmetries of power and authority most often lead to the experience of distress. The results are critically discussed in the context of the conceptualization and operationalization of moral distress.

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“…Moral distres kavramı ilk olarak yetişkin yoğun bakım servislerinde ve sağlık çalışanı olarak da hemşirelerle çalışılan bir kavramdır. Zaman içerisinde bu kavramın, sağlık hizmetlerinin pediatri (13,24), acil servis (25), psikiyatri (12,26) ve onkoloji (8,27) gibi pek çok faklı alanını ve hekim (8,(27)(28)(29), eczacı (30), psikolog (31) ve ebe (32) gibi farklı disiplinlere mensup sağlık çalışanlarını da etkilediği görülmüştür. Moral distres kavramı psikiyatri alanında 2000'li yılların başlarından beri ilgi odağı olmaya başlamıştır.…”

Section: Moral Distresunclassified

Psychiatry services and moral distress (tur)

Kovancı¹,

Özbaş²

2019

J Clin Psy

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It is known that ethical issues frequently become the main topic of conversation in psychiatry services. Healthcare professionals, who face ethical problems, seek to overcome them via laws, regulations and institutional legislations. However, these systems are not always influential in solving the problems and moral integrity of the individuals are negatively affected. Moral distress was originally defined as occurring when a healthcare personnel knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action and it is common event in psychiatric field. Moral distress is affected by external (institutional), clinical and individual factors depending on the characteristics of healthcare service system, healthcare personnel and service receiver group. Furthermore, moral distress negatively affects the health, care quality of the healthcare personnel and patient safety. This review has been prepared with a view to drawing attention to the concept of moral distress, which has significant effects on the health of healthcare personnel and service quality, analyzing it specifically in psychiatry field.

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Exploring moral problems and moral competences in midwifery: A qualitative study

Abstract: In the light of the ethical issues and factors contributing to phenomena of moral distress, an empirically grounded profile of moral competences is drafted. Curricular implications in the light of possible adaptations within undergraduate midwifery education are critically discussed.

Cited by 22 publications

References 31 publications

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

Moral distress and moral competences in midwifery: A latent variable approach

Psychiatry services and moral distress (tur)

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