Exploring barriers to professional ethics in intrapartum care: a qualitative study

Abstract

Professional ethics is a cornerstone of quality midwifery care and is essential for safeguarding women’s rights, dignity, and well-being during childbirth. Intrapartum care settings are among the most ethically complex clinical environments, where midwifery students and practicing midwives frequently encounter challenges that may hinder ethical practice. Understanding these barriers is crucial for promoting ethical care and improving maternal health services. This study aimed to explore barriers to professional ethics in intrapartum care from the perspectives of midwifery students and midwives. This qualitative study was conducted using a conventional content analysis approach. Participants were selected through purposive sampling with maximum variation from hospitals affiliated with Isfahan University of Medical Sciences, Iran. Twenty-one participants, including 13 undergraduate midwifery students, 6 midwives, and two faculty members in midwifery and reproductive health, were recruited. Data were collected through in-depth semi-structured interviews and analyzed according to the approach proposed by Graneheim and Lundman. Trustworthiness was established through credibility, dependability, confirmability, and transferability. Analysis of the interview data identified three overarching categories of barriers to professional ethics in intrapartum care: organizational, behavioral, and individual–psychological barriers. Organizational barriers included physician-centered dominance, hierarchical power relationships, limited educational opportunities, and resource shortages, which constrained professional autonomy and ethical decision-making. Behavioral barriers encompassed inappropriate interpersonal interactions, excessive workload, and overcrowded clinical environments that undermined motivation and hindered ethical practice. Individual–psychological barriers involved moral conflict, ethical uncertainty, occupational stress, and fear of challenging unethical practices, often leading to moral distress and feelings of guilt. These barriers interacted dynamically, shaping participants’ experiences of ethical practice within intrapartum care settings. Professional ethics in intrapartum care is influenced by a complex interplay of organizational, behavioral, and individual–psychological factors. Addressing these barriers requires supportive organizational policies, equitable interprofessional relationships, strengthened ethics education, and the creation of clinical learning environments that foster ethical competence and professional autonomy among midwifery students and midwives.