Moral distress and ethical challenges in midwifery experiences: A scoping review

Healthcare ethics involves applying ethical frameworks (principlism, consequentialism, virtue ethics, and care ethics) to guide healthcare decisions. This study aims to review the stresses and ethical tensions experienced by midwives to provide a clearer understanding of these issues. Researchers searched PubMed, Scientific Information Database, Scopus, and WOS using keywords ("ethical challenges," "ethical distress," "moral distress," "moral tensions," "stress," "psychological/emotional distress," "professional practice," "decision-making," "ethical professionalism," "midwifery," "midwife," "obstetrics," and "delivery"). Over 3 months (June-September 2024). Full texts of 26 articles were included. Although scoping reviews synthesize existing literature and do not involve primary data collection, our study formally obtained ethical approval from the Ethics Committee of Mazandaran University of Medical Sciences for our support in the development of this research to ensure methodological rigor and transparency. Ethical code: IR.MAZUMS.REC.1403.557. From 2227 records, 2010 underwent screening; 26 were reviewed. Findings revealed three categories of ethical challenges and tension: Professional challenges: Burnout; complex emergency decision-making; work-life imbalance; insufficient system support; stressful environments; knowledge gaps; resource shortages; decision discrepancies with clients; fear of punitive errors; limited autonomy; lack of professional recognition, Moral/Psychological challenges: Anxiety; inadequate peer support; poor client communication; low decision-making confidence; discomfort conveying adverse news; privacy protection difficulties, Social challenges: Societal expectations for precise clinical decisions in uncertainty and unwavering adherence to ethics despite constraints. Midwives face significant challenges requiring careful attention and broad knowledge for ethical decisions in complex, unexpected cases.