Global perspectives of midwifery ethics: Crucial features for practice via an international Delphi study

Background: Practising ethically as a midwife is essential for providing high quality care during pregnancy, childbirth, and the postpartum period. Whilst midwives may have theoretical knowledge of ethics, applying ethical care in practice may be challenging. There is a gap in the literature that describes how midwives themselves conceptualise, interpret, and apply ethics in their practice. 

Aim: To describe midwives’ perceptions, and experiences of ethics in midwifery practice, and to determine the crucial features of midwifery ethics. 

Methods: Fifty participants from 21 countries participated in the study. A two-round Delphi approach was employed. Round Two required participants to enter the REDCap portal to rank and comment on statements about midwifery ethics that were derived from qualitative data collected and thematically analysed in Round One. 

Finding: Fourteen characteristics captured in four domains were developed from the study that describe what midwives perceive ethical midwifery and maternity care to be. The four domains are: Midwifery ethics are founded in midwifery philosophy, Midwifery ethics as relational Care, Midwifery ethics are embodied (lived or intrinsic), Midwifery ethics demonstrate advocacy. 

Conclusion: The domains and characteristics of midwifery ethics provide insights into midwives’ unique ethical practices and represent foundational information to inform the practical application of midwifery ethics. The participants’ perceptions and experiences demonstrate a deeply rooted desire for a midwifery ethics construct that is underpinned by midwifery philosophy, focused on reproductive justice, and is aligned to and demonstrates solidarity with women’s autonomy in childbearing and more broadly