Midwives' practices and beliefs about discharging clients from their practice

Area of Science:

• Healthcare Ethics
• Clinical Practice Management
• Midwifery

Background:

• Client discharge is a complex decision for clinicians facing irresolvable conflicts.
• Legal and ethical considerations are paramount before terminating a professional relationship.

Purpose of the Study:

• To survey certified nurse-midwives regarding their practices and beliefs on client discharge.
• To understand the frequency, circumstances, and reasons for client discharge in midwifery.

Main Methods:

• A preliminary survey was distributed to 111 certified nurse-midwives.
• Data collected on past discharge experiences, beliefs about discharge, and reasons for/against discharge.

Main Results:

• 83.7% discharged five or fewer clients; 36.9% never discharged a client.
• 77.5% believe midwives should discharge clients under certain circumstances.
• Antepartum care was the most common period for discharge, often due to noncompliance, behavior, or missed appointments.

Conclusions:

• While most midwives believe client discharge is sometimes appropriate, actual discharge rates are low.
• Empathy and colleague disagreement are significant factors influencing the decision not to discharge.
• Further research into ethical guidelines and support for midwives navigating client discharge is warranted.