Midwives’ ethical practice in selected labour units in Tshwane, Gauteng Province, South Africa
Main Article Content
Abstract
Background. Midwives provide the majority of maternal and child healthcare in South Africa (SA). The care provided by midwives during childbirth is a unique life experience for women, and in order to provide safe care, midwives are expected to comply with ethical principles, policies and legislation governing their profession, as guided by the International Confederation of Midwives.
Objective. To establish midwives’ perception of ethical and professional practice in selected labour units of public healthcare, in Tshwane District, Gauteng Province, SA.
Methods. A qualitative, exploratory, descriptive cross-sectional design was applied by use of in-depth interviews. Non-probability purposive sampling was used to draw a sample from midwives with 2 or more years of experience working in the labour units. Data saturation was reached with the eighth participant. The digitally recorded interviews were transcribed verbatim. Data analysis was based on interpretive description.
Results. The findings revealed that midwives do understand the ethical code of conduct. They experience challenges such as staff shortages, non-compliance with policies and lack of managerial support, which compromise ethical conduct to a certain extent.
Conclusion. It is hoped that the suggested administrative, midwifery practice and research recommendations will guide the process of empowering midwives in ethical practice.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJBL is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Maphumulo M. Various departments of health sued for millions. City Press, 20 April 2011.
Child K. Hospital horrors costing SA plenty. Sunday Times, 17 January 2014. https://www.timeslive.co.za/news/2014-01-17-hospital-horrors-costing-saplenty (accessed 21 April 2022).
Hood L, Fenwick J, Butt J. A story of scrutiny and fear: Australian midwives’ experiences of an external review of obstetric services, being involved with litigation and the impact on clinical practice. Midwifery 2010;26(3):268-285. https://doi.org/10.1016/j.midw.2008.07.008
Sturm BA, Dellert J. Exploring nurses’ personal dignity, global selfesteem and work satisfaction. Nurs Ethics 2016;23(4):384-400. https://doi.org/10.1177/0969733014567024
Nyathi M, Jooste K. Working conditions that contribute to absenteeism among nurses in a provincial hospital in Limpopo Province. Curationis 2008;31(1):28-37. https://doi.org/10.4102/curationis.v31i1.903
McHale J, Tingle J. Law and Nursing. St Louis: Elsevier, 2007.
Arries E. Practice standards for quality clinical decision-making in nursing. Curationis 2006;29(1):62-72. https://doi.org/10.4102/curationis.v29i1.1052
Kulju K, Stolt M, Suhonen R, Leino-Kilpi H. Ethical competence: A concept analysis. Nurs Ethics 2016;23(4):401-412. https://doi.org/10.1177/0969733014567025
Ito C, Natsume M. Ethical dilemmas facing nurses in Japan: A pilot study. Nurs Ethics 2015;23(4):432-441. https://doi.org/10.1177/09697330/5574923
Kinnane JH. Everyday encounters of everyday midwives: Tribulations and triumph for ethical practitioners. Aust J Midwives 2008. Carseldine: PhD thesis, University of Queensland, 2008. https://eprints.qut.edu.au/16700 (accessed 8 July 2014).
International Council of Nurses. The ICN Code of Ethics for Nurses. Geneva: ICN, 2012.
South African Nursing Council. The relationship between the scopes of practice, practice standards and competencies. Pretoria: SANC, no date.
Waghmare PR. Legal and ethical aspects of midwifery nursing: Descriptive approach to assess the knowledge of maternity nurses. Juni Khyat 2020;10(6):168-172.
Christensen LB, Johnson RB, Turner LA. Research Methods, Design and Analysis. 12th edition. Edinburgh: Pearson, 2015.
Burnard P, Morrison P, Gluyas H. Nursing Research in Action: Exploring, Understanding and Developing Skills. 3rd edition. New York: Macmillan Education, 2011.
Barbour R. Introducing qualitative research: A student guide to the craft of doing qualitative research. Los Angeles: Sage, 2014.
Polit DF, Beck CF. Nursing Research: Generating and Assessing Evidence of Nursing Practice. 10th edition. Philadelphia: Wolters Kluwer Health, 2017.
Burns N, Grove SK. The Practice of Nursing research. 8th edition. Philadelphia: Saunders Elsevier, 2017.
South African Nursing Council. Competencies for midwives specialists. Pretoria: SANC, 2014.
Rich K, Butts JB. Foundations of Ethical Nursing Practice. Burlington: Jones & Barlett Learning, 2020.
South African Nursing Council. Code of ethics for nursing practioners in South Africa. Pretoria: SANC, 2013.
Smith KV, Godfrey NS. Being a good nurse and doing the right thing: A qualitative study. Nurs Ethics 2002;9(3):301-312. https://doi.org/10.1191/0969733002ne51209
Griffith R. Accountability in midwifery practice: Answerable to mother and baby. Br J Midwifery 2012b;20(8):601-602. https://doi.org/10.12968/bjom.2012.2007.525
Erasmus K. To err is human, where does negligence malpractice and professional misconducts fit the puzzle. J Professional Nurs Today 2008;12(5):5-8. https://hdl.handle.net/10520/EJC79242 (accessed 21 April 2022).
Klebanow D. The practice of malpractice. USA Today 24 March 2014.
Lewis P. Hard and difficult times – the provision of good midwifery care. Br J Midwifery 2012b;5:310-311. https://doi.org/10.12968/bjom.2012.20.5.310
South Africa. Children’s Act No. 38 of 2005.
Griffith R. Midwives and confidentiality. Br J Midwifery 2008;16(1):51-53. https://doi.org/10.12968/bjom.2008.16.1.27934
McLeod-Sordjan R. Evaluating moral reasoning in nursing education. Nurs Ethics 2015;21(4):473-483. https://doi.org/10.1177/0969733013505309
Lachman VD. Applying the ethics of care to your nursing practice. Medsurg Nurs 2012;21(2):112-116. https://doi.org/10.1177/0969733010396818
Wallace BC. Nurse staffing and patient safety: What’s your perspective? Nurs Manag 2013;44(6):49-51. https://doi.org/10.1097/01.NUMA.0000430406.50335.51
Alliance for Health Policy and Systems Research. Responding to the needs of decision makers. Annual Report, 2011. Geneva: World Health Organization, 2011.
South African Nursing Council. SANC registration and enrollment figures. Pretoria: SANC, 2014.
Ergin A, Ozcan M, Aksoy SD. The compassion levels of midwives working in the delivery room. Nurs Ethics 2020;27(3):887-897. https://doi.org/10.1177/0969733019874495journals.sagepub.com/home/nej
Ho LF. Medico legal aspects of obstetrics: The role of the midwife in Hong Kong. Hong Kong J Gynecol Obstet Midwifery 2009a;9:58-62. hkjgom.org/sites/default/files/pdf/v-09-p58-UA907.pdf (accessed 21 April 2022).
Department of Health, South Africa. The National Strategic Plan for Nurse Education, Training and Practice 2012/13 - 2016/17. Pretoria: Government Printers, 2011.
Mathibe-Neke JM, Rothberg A, Langley G. The perception of midwives regarding psychosocial risk assessment during antenatal care. Heal SA Gesondheid 2014;19(1):742-750. https://doi.org/10.4102/hsag.v19i1.742
Khali DD. Nurses’ attitude towards ‘difficult’ and ‘good’ patients in eight public hospitals. Int J Nurs Pract 2009;15(5):437-443.
Khali DD, Karani AK. Are nurses victims of violence or perpetrators of violence? Kenyan Nurs J 2005;33(2):4-9.
AbuAlRub R. Job stress, job perfomance and social support among hospital nurses. J Nurs Scholarsh 2004;36:73-78. https://doi.org/10.1111/j.1547-5069.2004.04016.x
Whyte A. Reputation on the line: Alison Whyte tracks the recent history of care
failings that have put nurses’ image in the spotlight. Nurs Stand 2011;26(12):18-21. https://doi.org/10.7748/ns.26.12.18.s27
Miya RM. Reflections: A life shared for the sick and knowledge dispensation. Nurs Update 2015;40(1):30-31.
Yarbrough S, Martin P, Alfred D. Professional values, job satisfaction, career development, and intent to stay. Nurs Ethics 2017;24(6):675-685. https://doi.org/10.1177/0969733015623098
Abuya T, Ndwiga C, Ritter J, et al. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. BMC Pregnancy Childbirth 2015;15(224):1-14. https://doi.org/10.1186/s12884-015-0645-6
Mayra K, Matthews Z, Padmadas SS. Why do some health care providers disrespect and abuse women during childbirth in India? Women Birth 2020:1-11. https://doi.org/10.1016/j.wombi.2021.02.003
Ishola, F, Owolabi O, Fillipi V. Disrespect and abuse of women during childbirth in Nigeria: A systematic review. PLOS One 2017;12(3):1-17. https://doi.org/10.1371/journal.pone.0174084
Hashish EAB. Relationship between ethical work climate and nurses’ perception of organizational support, commitment, job satisfaction and turnover intent. Nurs Ethics 2017;24(2):151-166. https://doi.org/10.1177/0969733015594667
Papastavrou E, Efstathiou G, Andreou C. Nursing student’s perception of patient dignity. Nurs Ethics 2016;23(1):92-103. https://doi.org/10.1177/0969733014557176
Hallam JL, Howard CD, Locke A, Thomas M. Communicating choice: An exploration of mothers’ experiences of birth. J Reprod Infant Psychol 2016;34(2):175-184.
London L, Baldwin-Ragaven L. Human rights and health: Challenges for training nurses in South Africa. Curationis 2008;31(1):5-18. https://doi.org/10.4102/curationis.v31i1.898
Numminen O, Leino-Kilpi H, Isoaho H, Meretoya R. Ethical climate and nurse competency. Nurs Ethics 2015;22(8):845-859. https://doi.org/10.1177/0969733014557137
Welsch Jensen LE, Small R, et al. Nurses’ perceptions of ethical issues in an academic hospital setting. Sigma Theta Tau International Conference, 2014.
Silen M, Ramklint M, Hansson MG, Haglund K. Ethics rounds: An appreciated form of ethics support. Nurs Ethics 2016;23(2):92-103. https://doi.org/10.1177/0969733014560930
Oosthuizen SJ, Berg A, Pattison RC, Grimbeek J. It does matter where you come from: Mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa. Reproductive Health 2017;14(151):1-11.
Butler MM, Fullerton J, Aman C. Competencies for respectful maternity care: Identifying those most important to midwives worldwide. Birth 2020;47(4):346-