The structure of ethical dilemmas of midwives involved in the care of women who were diagnosed with fetal abnormality during prenatal tests.

Purpose To elucidate the structure of ethical dilemmas on the basis of the experiences of midwives involved in the care of women who were diagnosed with fetal abnormality during prenatal tests. Methods After ethical considerations were made, unstructured interviews were conducted on 8 midwives who had the aforementioned experiences; their "feelings," "perception," "thoughts," and "way of thinking" were extracted and analyzed qualitatively and inductively. Results Twenty-three concepts and 6 categories were extracted. In their relation with pregnant women, the midwives experienced actual dilemmas faced by healthcare providers, realized the difficulty of interventions in reproductive health, and "reaffirmed the position of midwives in organizations." In addition, inexperienced midwives lacked self-confidence and were confronted with their own sense of values and sense of ethics, and because of "the hardship and difficulty of involvement as primary care providers," they occasionally felt the limitations of nursing care. However, despite the burden caused by a shortage of human resources and problems within the system, the midwives found support in "the sense of satisfaction and sense of fulfillment that they get from being closely involved with mothers," and found a meaning in their involvement from the time of pregnancy. In addition, in some instances, they empathized with the pregnant women as if it were from the perspective of a family member, and built up, at an emotional level, the hopes regarding the vitality of the child. By starting to share time during pregnancy, the midwives were faced with "the difficulty of confronting a handicapped child because of their potentially biased sense of values," and therefore, doing so was an opportunity for them to confront their own sense of values. It also gave the midwives "an opportunity to reconsider the meaning of prenatal tests." Sharing time with pregnant women while experiencing dilemmas was an opportunity for them to explore the best ways to be helpful as midwives, and "continuing the relationship while sharing the death of a child" gave them an opportunity to mature themselves as midwives. Conclusion While deepening their relationship with pregnant women, the midwives experienced the difficulty to confront their own sense of values with issues such as the diagnosis of prenatal tests and handicapped children and experienced dilemmas associated with gender role expectations in consequence of the fact of belonging to the same sex as the pregnant women. Despite the feeling of satisfaction from being a reliable presence, the resulting hard and busy work created an environment prone to dilemmas and burnout. In addition, in their reproductive healthcare work environment, where life and death coexist side by side, they acted with self-defense by controlling their emotions and by lowering their sensibility to ethics. However, the dilemmas that the midwives experienced have been addressed as individual problems, and since there was no occasion to examine the ethical issues, which could only be experienced in clinical settings, this resulted in a vicious cycle. [ABSTRACT FROM AUTHOR]