Ethical & Legal Issues in

Midwifery Practice
 Introduction

• Legal: “legal” is an adjective and a noun used to describe anything that

concerns the law or its workings.

• Ethical: Ethics seeks to resolve questions of human morality by defining

concepts such as good and evil, right and wrong, virtue and vice, justice
and crime.
 Introduction

• Midwife: A midwife is a person who has successfully completed a

midwifery education programme that is duly recognized in the country
where it is located and that is based on the ICM Global Standards of
Midwifery Education, who has acquired the requisite qualifications to be
registered and/or legally licensed to practice midwifery and the title
‘midwife’, and who demonstrates competency in the practice of
midwifery.
 Introduction

• Midwifery is a professional discipline which combines science, art and

strong ethical values. (Nursing and Midwives Studies)
 1. Beneficence

5. Confidentiality 2. Autonomy
Principles
of Ethics

3. Non-
4. Justice
maleficence
 Principles of Ethics - 1. Beneficence

• Beneficence is to act in the best interests of the patient, and to balance

benefits against risks.

• The benefits that medicine is competent to seek for patients are the
prevention and management of disease, injury, handicap and
unnecessary pain and suffering and the prevention of premature or
unnecessary death.
 Principles of Ethics - 2. Autonomy

• Autonomy means to respect the right of the individual.

• Respect for autonomy enters the clinical practice by the informed consent.

• It is respect for the women’s autonomy that underpins the requirement for
informed consent (Evidence based midwifery).
 Principles of Ethics - 2. Autonomy

• This process usually understood to have 3 elements

• Disclosure by the physician to the patient’s condition and its management,
• Understanding of that information by the patient and
• A voluntary decision by the patient to authorize or refuse treatment.
 Principles of Ethics - 2. Autonomy

• This process usually understood to have 3 elements

• Disclosure by the physician to the patient’s condition and its management,
• Understanding of that information by the patient and
• A voluntary decision by the patient to authorize or refuse treatment.
 Principles of Ethics - 3. Non-maleficence

• Non-maleficence means that health personnel should prevent causing harm

and is best understood as expressing the limits of beneficence.

• This is commonly known as ‘primum non nocere’ or first to do no harm.

 Principles of Ethics - 4. Justice

• Justice signifies to treat patients fairly and without unfair discrimination,

there should be fairness in the distribution of benefits and risks. Medical
needs, and benefits should be properly weighed.
 Principles of Ethics - 5. Confidentiality

• Confidentiality is the basis of trust between health personnel and patient. By

acting against this principle one destroys the patient trust.
 1. The right to freedom from coercion in
decision making.

2. The right to use informed choice is care,

Patients’ Rights by having access to relevant information
upon which decisions are based.
 3. The right to be treated with respect and
dignity without reference age, marital, socio-
economic, ethnic, national, political, mental,
Patients’ Rights
physical or religious status.

4. The right to know who will participate in

her care and obtain additional consultation.
 5. The right to full disclosure of financial
factors involved in her care.

6. The right to accept or to refuse treatment of

Patients’ Rights
her choice.

7. The right to absolute privacy except where

this right is pre-empted by law.
 8. The right not to be abandoned neglected or
Patients’ Rights discharged room care without an opportunity
to find other health provider.
 9. Patients or individuals who require health
care services have right to make their own
Patients’ Rights decision about the opinions for treatment or
other related issues. The process of obtaining
permission is called informed consent.
 Code of Ethical Midwifery Practice

• Midwives rights

• Midwives responsibilities
Code of Ethical Midwifery Practice - Midwives rights

1. The right to receive reasonable compensation for services

rendered.

2. The right to receive honest, relevant information from

patients upon which caring is based.
Code of Ethical Midwifery Practice - Midwives rights

3. The right to discharge patients from her care, provided adequate

information from patients upon which caring is based.

4. The right to refuse care to patients with whom no midwife-

patient relationship has been established.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

1. The obligation to honour the confidence of those

encountered in the course of midwifery practice and to
regard everything seen and heard as inviolable, remembering
always that a midwife’s highest loyalty is owed to her
patient and not to her health care providers.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

2. The obligation to serve as the guardian of normal birth,

alert to possible complications, but always on guard arbitrary
interference in birthing process for the sake of convenience
or the desire to use human beings in scientific studies and
training.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

3. The obligation, when referring a patient to another health

care provider, is to remain responsible for the patient until
she is either she is discharged or formally transferred.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

4. The obligation to provide complete, accurate and relevant

information to patients so that they can make informed choices
regarding their health care.

5. The responsibility to developed and utilize a safe and

efficient mechanism for medical consultation, collaboration and
referral.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

6. The obligation never to comment on another midwife’s or other

health provider’s cares without first contraction that practitioner
personally.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

7. The responsibility to assist others who wish to become midwives

by honestly and accurately evaluating their potential and
competence and sharing midwifery knowledge and skill to extent
possible without violating another section in this code.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

8. The obligation to pursue professional development through on

going evaluation of knowledge and skill and continuing education
including diligent study of all subjects relevant to midwifery.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

9. The obligation to accurately document the patient’s history,

condition, physical progress and other vital information obtained
during patient care.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

10. The responsibility to maintain accountability for all midwifery

care delivered under her supervision.

• Assignment and delegation of duties to other midwives or

apprentices should be proportionate to their educational
preparation and demonstrated proficiency.
 Code of Ethical Midwifery Practice - Midwives
responsibilities

11. The midwife primary responsibility is to promote the well-

being of the childbearing women.

The obligation to know and comply with all legal requirements

related to midwifery practice without the law provide for the
unobstructed practice of midwifery within the state
 • Informed Decision Making
LEGAL AND • Individual requires health services
ETHICAL have right to make their own
PRINCIPLE IN decision about the options for
THE PROVISION treatment or other related issues.
OF HEATH • The process of obtaining
SERVICES permission is called informed
consent.
LEGAL AND ETHICAL PRINCIPLE IN THE PROVISION
OF HEATH SERVICES

• The Health care Provider Should Disclose the following details

• The individual currently assessed health status regarding the general
or reproductive health.
LEGAL AND ETHICAL PRINCIPLE IN THE PROVISION
OF HEATH SERVICES

• The Health care Provider Should Disclose the following details

• Reasonable accessible medical, social and other means of response to
the individual’s condition including predictable success rate, side-
effects and risk.
LEGAL AND ETHICAL PRINCIPLE IN THE PROVISION
OF HEATH SERVICES

• The Health care Provider Should Disclose the following details

• In implication for the individual, general, sexual and reproductive
health and life style decline any of the options or suggestions.
LEGAL AND ETHICAL PRINCIPLE IN THE PROVISION
OF HEATH SERVICES

• Competent delivery services

• Every individual has the rights to receive treatment by competent
heath care provider who knows to handle the situation quite well.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING
• Many legal issues are involved in case of mother and her infant. The
common causes of law suits against the nurse include:

1. Problems of medication 4. Failure to report changes in client

2. Failure in adequate client monitoring 5. Abortion
3. Failure to adequate assess the client 6. Nursing care to the new-born:
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 1. Problems of medication: Nurses are authorised to administer

medication. So, many allegations against nurse regard to medication are
their like improper patient identification, wrong medication dosages, route
or time, failure to monitor side effects.

• E.g. nurses are involved in administration of oxytocin in augment of the

labour
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 2. Failure in adequate client monitoring: Nurse is required to monitor

the client at appropriate time interval that depends upon the client
condition.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 2. Failure in adequate client monitoring: The delivering mother must be

adequately monitor to prevent maternal complication, during prenatal
period, check foetal condition during labour and continuous observation of
mother and foetus during first 24 hours after delivery.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 3. Failure to adequate assess the client: Nurse in all speciality areas

must maintain higher level of assessment skill.

• They are responsible for minute by minute evaluation of client progress.

 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 4. Failure to report changes in client: Whenever the nurse’s

assessment indicates that the client condition has changed, the
nurse must notify the physician.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 5. Abortion: Nurse cannot be forced to participate in the procedure they

find morally offensive.

• Nurse has a right to refuse to assist with abortion if it is not performed

with Medical Termination of Pregnancy Act.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 6. Nursing care to the new-born: These are certainly legal requirements

in providing nursing care of new-born, such as properly identify the infant
mother pair as soon as possible with figure point, foot print, and wrist
band or obtaining blood samples for phenylketonuria testing when
required by law.
 LEGAL ISSUES IN MATERNAL AND INFANT
NURSING

• 6. Nursing care to the new-born: Standard of practice includes providing

clear airways, clamping the umbilical cord, apply silver nitrate or
antibodies to the edge and minimising stress of dying and keeping infant
warm.
 INTERNATIONAL CODES OF ETHICS FOR
MIDWIVES

• The aim of the International Confederation of Midwives (ICM) is:

• To improve the standard of care provided to woman, babies and
families throughout the world through the development, education and
appropriate utilization of the professional midwife.
 INTERNATIONAL CODES OF ETHICS FOR
MIDWIVES

• The aim of the International Confederation of Midwives (ICM) is:

• In keeping with this aim, the ICM sets forth the following code to
guide the education, practice and research of midwife.
 INTERNATIONAL CODES OF ETHICS FOR
MIDWIVES

• The aim of the International Confederation of Midwives (ICM) is:

• This code acknowledges women as persons with human rights, seeks
justice for all people and equity in access to health care, and is based on
mutual relationships of respects, trust and the dignity of all members of
society.
 INTERNATIONAL CODES OF ETHICS FOR
MIDWIVES

• The aim of the International Confederation of Midwives (ICM) is:

• The code addresses the midwife’s ethical mandates in keeping with the
mission, the International definition of Midwife, and standards of ICM
to promote the health and well-being of women and newborns within
their families and communities.
 INTERNATIONAL CODES OF ETHICS FOR
MIDWIVES
• The aim of the International Confederation of Midwives (ICM) is:
• Such care may encompass the reproductive life cycle of the woman from the
pre-pregnancy state right to the menopause and to the end of life.
• These mandates include how midwives relate to others; how they practice
midwifery; how they uphold professional responsibilities and duties; and
how they are to assure the integrity of the profession of midwifery.
INTERNATIONAL CODES OF ETHICS
FOR THE MIDWIFERY RELATIONSHIPS
 International Codes of Ethics for The Midwifery
Relationships

• 1. Midwives develop a partnership with individual women in which

they share relevant information that leads to informed decision-
making, consent to an evolving plan of care, and acceptance of
responsibility for the outcomes of their choices.

• 2. Midwives support the right of women/families to participate

actively in decisions about their care.
 International Codes of Ethics for The Midwifery
Relationships
• 3. Midwives empower women/families to speak for themselves on
issues affecting the health of women and families within their
culture/society.

• 4. Midwives, together with women, work with policy and funding

agencies to define women’s needs for health services and to ensure
that resources are fairly allocated considering priorities and
availability.
 International Codes of Ethics for The Midwifery
Relationships

• 5. Midwives support and sustain each other in their professional

roles, and actively nurture their own and others’ sense of self-
worth.

• 6. Midwives respectfully work with other health professionals,

consulting and referring as necessary when the women’s need
for care exceeds the competencies of the midwife.
 International Codes of Ethics for The Midwifery
Relationships

• 7. Midwives recognise the human interdependence within their

field of practice and actively seek to resolve inherent conflicts.

• 8. Midwives have responsibilities to themselves as persons of

moral worth, including duties of moral self-respect and the
preservation of integrity.
 International Codes of Ethics for The Practice of Midwifery

• 1. Midwives provide care for women and child bearing families with
respect for cultural diversity while also working to eliminate harmful
practices within those same cultures.

• 2. Midwives encourage the minimum expectation that no woman or

girl should be harmed by conception or child bearing.
 International Codes of Ethics for The Practice of Midwifery
• 3. Midwives use up-to-date, evidence-based professional knowledge
to maintain competence in safe midwifery practices in all
environments and cultures.

• 4. Midwives respond to the psychological, physical, emotional and

spiritual needs of women seeking health care, whatever their
circumstances (non-discrimination).
 International Codes of Ethics for The Practice of Midwifery
• 5. Midwives act as effective role models of health promotion for
women throughout their life cycle, for families and for other health
professionals.

• 6. Midwives actively seek personal, intellectual and professional

growth throughout their midwifery career, integrating this growth
into their practice.
The professional
responsibilities of
midwives
 The Professional Responsibilities of
Midwives
• 1. Midwives hold in confidence client information in order to
protect the right to privacy, and use judgement in sharing this
information except when mandated by law.

• 2. Midwives are responsible for their decisions and actions,

and are accountable for the related outcomes in their care of
women.
 The Professional Responsibilities of
Midwives
• 3. Midwives may decide not to participate in activities for which they
hold deep moral opposition; however, the emphasis on individual
conscience should not deprive women of essential health services.

• 4. Midwives with conscientious objection to a given service request will

refer the woman to another where such a service can be provided.
 The Professional Responsibilities of
Midwives
• 5. Midwives understand the adverse consequences that ethical and
human rights violations have on the health of women and infants, and
will work to eliminate these violations.

• 6. Midwives participate in the development and implementation of

health policies that promote the health of all women and childbearing
families
1. Midwives ensure that the advancement
of midwifery knowledge is based on
activities that protect the rights of Advancement of
women as persons.
midwifery
2. Midwives develop and share knowledge and
midwifery knowledge through a variety
of processes, such as peer review and
research. practice
 Advancement of
3. Midwives contribute to the formal
education of midwifery students and midwifery
ongoing education of midwives.
knowledge and
practice
Standards • Midwifery practice as conducted by

for the certified nurse-midwives (CNMs) and

certified midwives (CMs) is the

Practice independent management of women’s

of
health care, focusing particularly on
pregnancy, childbirth, the postpartum

Midwifer period, care of the newborn, and the

family planning and gynaecologic needs
y of women.
Standards
for the • The CNM and CM practice within

Practice
a health care system that provides
for consultation, collaborative

of management, or referral, as
indicated by the health status of the
Midwifer client.

y
Standards
for the • CNMs and CMs practice in accord

Practice with the Standards for the Practice

of
of Midwifery, as defined by the
American College of Nurse-

Midwifer Midwives (ACNM).

y
Standards
for the • Nurses should be updated with

Practice the legal and ethical issues in

of
midwifery nursing in order to
protect themselves from lawsuits.

Midwifer (Journal of Science)

y
 • The midwife

1. Is certified by the designated

Standard I certifying agent.
Midwifery Care Is 2. Shows evidence of continuing
Provided By competency as required by the
Qualified designated certifying agent.
Practitioners
3. Is in compliance with the legal
requirements of the jurisdiction
where the midwifery practice occurs.
 Standard II • The midwife
Midwifery Care
1. Demonstrates and utilizes federal
Occurs In A Safe
and state regulations that apply to the
Environment
practice environment and infection
Within The
control.
Context of The
2. Demonstrates a safe mechanism for
Family,
obtaining medical consultation,
Community And A
System Of Health collaboration and referral.

Care 3. Uses community services as needed.

 Standard II • The midwife
Midwifery Care
4. Demonstrates knowledge of
Occurs In A Safe
medical, psychological, economic,
Environment
cultural and family factors that affect
Within The
care.
Context of The
Family, 5. Demonstrates appropriate
Community And A techniques for emergency
System Of Health management including arrangements
Care for emergency transportation.
 Standard II
Midwifery Care
Occurs In A Safe
Environment • The midwife
Within The
6. Promotes involvement of support
Context of The
Family, persons in the practice setting.

Community And A
System Of Health
Care
 • The midwife

Standard III 1. Practices in accord with the

Midwifery Care Philosophy and the Code of
Supports Individual Ethics of Nurse Midwives.
Rights and Self- 2. Provides clients with a
Determination description of scope of midwifery
within Boundaries services and information
of Safety
regarding the client’s rights and
responsibilities.
 Standard III • The midwife

Midwifery Care 3. Provides clients with information

Supports Individual regarding, and/or referral to, other
Rights and Self- providers and services when
Determination requested or when care required is not
within Boundaries within the midwife’s scope of
of Safety practice.
 Standard III • The midwife
Midwifery Care
4. Provides clients with information
Supports Individual
regarding health care decisions and
Rights and Self-
the state of the science regarding
Determination
within Boundaries these choices to allow for informed

of Safety decision-making.
 Standard IV
Midwifery Care Is
Comprised of • The midwife
Knowledge, Skills
1. Collects and assesses client care
and Judgements
data, develops and implements an
That Foster the
Delivery of Safe, individualized plan of management

Satisfying and and evaluates outcome of care.

Culturally
Competent Care
 Standard IV • The midwife
Midwifery Care Is
2. Demonstrates the clinical skills
Comprised of
and judgements described in the Core
Knowledge, Skills
Competencies for Basic Midwifery
and Judgements
Practice.
That Foster the
Delivery of Safe, 3. Practices in accord with the

Satisfying and Standards for the Practice of

Culturally Midwifery.
Competent Care
 Standard IV
Midwifery Care Is
Comprised of • The midwife
Knowledge, Skills
4. Practices in accord with
and Judgements
service/practice guidelines that meet
That Foster the
Delivery of Safe, the requirements of the particular

Satisfying and institution or practice setting.

Culturally
Competent Care
 Standard V
Midwifery Care Is
Based Upon
Knowledge, Skills • The midwife:
and Judgements
1. Maintains written documentation of the
Which Are
Reflected In parameters of service for independent and
Written Practice collaborative midwifery management and transfer
Guidelines and Are
of care when needed.
Used To Guide The
Scope of Midwifery
Care And Services
Provided To Clients
 Standard V
Midwifery Care Is
Based Upon • The midwife:
Knowledge, Skills
and Judgements 2. Has accessible resources to provide evidence
Which Are based clinical practice for each speciality area
Reflected In
which may include but is not limited to primary
Written Practice
Guidelines and Are health care of women, care of the child-bearing
Used To Guide The family and newborn care.
Scope of Midwifery
Care And Services
Provided To Clients
 Standard VI
Midwifery Care • The midwife
Is Documented 1. Uses records that facilitate communication of
In A Format information to clients, consultants and institutions.
That Is
2. Provides prompt and complete documentation of
Accessible And
evaluation, course of management and outcome of
Complete
care.
 Standard VI
Midwifery Care • The midwife
Is Documented 3. Promotes a documentation system that provides
In A Format for confidentiality and transmissibility of health
That Is records.
Accessible And
4. Maintains confidentiality in verbal and written
Complete
communications.
 Standard VII
Midwifery care is • The midwife
evaluated 1. Participates in a program of quality management
according to an for the evaluation of practice within the setting in
established
which it occurs.
program for
quality 2. Provides for a systematic collection of practice
management that data as part of a program of quality management.
includes a plan to
identify and
resolve problems
 Standard VII
Midwifery care is
evaluated
• The midwife
according to an
established 3. Seeks consultation to review problems, including
program for peer review of care.
quality
4. Acts to resolve problems identified
management that
includes a plan to
identify and
resolve problems
 Standard VIII
Midwifery practice • The midwife
may be expanded 1. Identifies the need for a new
beyond the ACNM
procedure taking into consideration
core competencies to
consumer demand, standards for safe
incorporate new
procedures that practice, and availability of other
improve care for qualified personnel.
women and their
families
 Standard VIII
Midwifery practice • The midwife
may be expanded 2. Ensures that there are no
beyond the ACNM
institutional, state, or federal statutes,
core competencies to
incorporate new regulations or by laws that would
procedures that constrain the midwife from
improve care for incorporation of the procedure into
women and their practice.
families
 • The midwife
Standard VIII
3. Demonstrates knowledge and
Midwifery practice competency including:
may be expanded
Knowledge of risks, benefits and
beyond the ACNM
client selection criteria.
core competencies to
Process for acquisition of required
incorporate new
skills.
procedures that
Identification and management of
improve care for
complications.
women and their
families Process to evaluate outcomes and
maintain competency.
 Standard VIII
Midwifery practice
may be expanded • The midwife
beyond the ACNM
4. Identifies a mechanism for
core competencies to
incorporate new obtaining medical consultation,
procedures that collaboration and referral related to
improve care for this procedure.
women and their
families
 Standard VIII
Midwifery practice
• The midwife
may be expanded
beyond the ACNM 5. Maintains documentation of the
core competencies to process used to achieve the necessary
incorporate new knowledge, skills and ongoing
procedures that
competency of the expanded or new
improve care for
procedures.
women and their
families
 CONCLUSION
Legal issues can occur anytime during the service period of the nurses
in the working field because of any negligence, malpractices or any
violation of the code of the ethics.

Standardized care is very important, and all the nurses should follow
all the standards of care in order to provide competent care and avoid
any kind of problems during their work period.
 CONCLUSION
So far, we have seen the legal and ethical issues in midwife practices,
code of ethics and standing orders to improve the standard of care
provided to women, babies and families throughout the world through
the development, education and appropriate utilization of the
professional midwife.
References
• Book reference
1. Basavanthappa BT, Essential of Midwifery & Obstetrical Nursing, First Edition (2011), Page:
17
2. NavadeepKaurBrar& HC Rawat, Textbook of Advance Nursing Practice, Jaypee Brothers
Medical Publishers (P) Ltd, First Edition (2015), Page: 22
Journal reference
1. AylaBerkitenErgin et al, Nursing and Midwife Studies, 2013,Sep, Vol:2, Issue:3, Page: 21-27
2. Alison Ledward, Evidence Based Midwifery, 28th Feb, 2011
3. Judith A Lothian, Journal of Prenatal Education, J Perinat educ. 2009, Vol:18, Issue: 1, Page:
1-3
4. Candice M. O’Malley, The Journal of Undergraduate Nursing Writing, Aug, 2013, Vol: 6,
Issue: 9
5. Priyanka Das et al, Journal of Science, 2014, Vol: 4, Issue: 9, Page: 546-550