Removal of babies at birth and the moral distress of midwives

Abstract

Background Midwives and nurses appear vulnerable to moral distress when caring for women whose babies are removed at birth. They may experience professional dissatisfaction and their relationships with women, families and colleagues may be compromised. The impact of moral distress may manifest as anger, guilt, frustration, anxiety and a desire to give up their profession. While there has been much attention exploring the concept of moral distress in midwifery, this is the first study to explore its association in this context. Aim This article explores midwives’ experiences of moral distress when providing care to women whose babies were removed at birth and gives valuable insight into an issue nurses and midwives encounter in their profession. Methods Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate data; mothers were interviewed face to face and midwives through focus groups. The images and audio data were collected, transcribed and analysed for emerging themes. For the purpose of this article, only the midwives’ stories are reported. This research received a favourable ethical opinion from the University of Surrey Ethics committee. Ethical considerations This study received a favourable ethical approval from a higher education institutes ethics committee. Results Midwives who care for women whose babies are removed at birth report it as one of the most distressing areas of contemporary clinical practice. Furthermore, they report feelings of guilt, helplessness and betrayal of the midwife–mother relationship. Many of the midwives in this study state that these experiences stay with them for a long time, far more than more joyful aspects of their role. Conclusion Midwives experience moral distress. Support systems, education and training must be available to them if we are to reduce the long-term impact upon them, alleviate their distress and prevent them from leaving the profession.

Moral distress in midwifery practice: A concept analysis

“…Action referred to any instances where the midwife felt she was contributing to harm during her care of the woman. 14,43 Inaction related more specifically to situations where the midwife did not speak up or challenge or aspects of care that they felt was detrimental to the woman or her interests. 8,43…”

“…14,43 Inaction related more specifically to situations where the midwife did not speak up or challenge or aspects of care that they felt was detrimental to the woman or her interests. 8,43…”

“…Midwives often felt conflicted when they did not agree with other members of staff, or they did not advocate for the woman when they felt it was warranted. 8,43 This related to aspects of care such as interventions the midwife felt were unnecessary, 45 as well as derogatory comments made about the woman by other members of staff, 43,45 Midwives often felt a sense of obligation to uphold the decisions made by medical staff. This was attributed to both hierarchical structures within the organisation, 8,14,44 and a perceived loyalty to the doctors, despite disagreeing with their chosen course of care.…”

“…Of the eight articles included in this concept analysis, five were qualitative, 8,14,15,43,44 two were quantitative 13,45 and one mixed-methods 46 research (Table 2). Included articles described care during labour and birth, TOP, removal of babies from their mother for child protection orders, as well the daily work of midwives and the contested nature of maternity care systems.…”

Characterizing newborn and older infant entries into care in England between 2006 and 2014

“…Existing evidence makes a clear case for English pre-birth child protection procedure to be strengthened ( Lushey et al, 2018 ; Marsh, Robinson, Shawe, & Gallagher, 2019 ; Mason et al, 2019 ), to improve early intervention, potentially reduce the need for entry into care in infancy, and to reduce risk of local authorities infringing parents’ rights under Article 8 of the EHRC (the right to respect for private and family life) ( R (G) v Nottingham City Council , 2008 ). Furthermore, with s 20 arrangements commonly used to place infants, particularly newborns, into care, eligibility for free non-means tested legal aid should be extended to any parent subject to pre-birth child protection procedures to improve legal representation and advocacy for vulnerable families.…”