Exploring moral distress in Australian midwifery practice

Area of Science:

• Nursing and Midwifery
• Healthcare Ethics
• Psychological Well-being

Background:

• Moral distress, psychological harm from conflicting values, is increasingly recognized in healthcare.
• Existing research on moral distress in midwifery is fragmented, often focusing on isolated practice aspects.
• Australian midwives are contemplating leaving the profession, with moral distress a potential contributing factor.

Purpose of the Study:

• To investigate the experiences and consequences of moral distress among Australian midwives.
• To understand how moral distress influences midwifery practice and career decisions.

Main Methods:

• Qualitative study employing semi-structured interviews with 14 Australian midwives.
• Thematic analysis of transcribed interview data using NVIVO12© software.
• Exploration of midwives' lived experiences with moral distress in their professional context.

Main Results:

• Three primary themes emerged: moral compromise, moral constraints/dilemmas/uncertainties, and professional/personal consequences.
• Midwives reported an inability to advocate effectively due to hierarchical and oppressive health service structures.
• Experiences of moral compromise were identified as a significant catalyst for moral distress.

Conclusions:

• Moral distress is a present reality for Australian midwives, exacerbated by cumulative moral compromise.
• The study suggests a potential trajectory from moral frustration to moral distress and moral injury with repeated exposure.
• Differences in outcomes between early-career and experienced midwives highlight the cumulative nature of moral distress as a significant concern.