Ethical Issues in Maternity Care

  • Helen Crafter
  • Cathy Rowan


This chapter will address some of the ethical issues in the delivery of maternity services which may have long-term repercussions on the health of women, children and families. In particular, attention is given to fetal screening tests and the issues surrounding the autonomy of both women and midwives during the process of birth. The role of the midwife in the United Kingdom (UK), Italy and Iceland will also be explored. Although the UK and Italy are in the European Union, maternity and midwifery practice in the two countries differ considerably. Iceland is not a member state of the European Union, but is a member of the European Free Trade Association (EFTA) which gives Icelanders the same freedom of movement as members of the European Union. Consequently, the education and training of midwives in Iceland comply with the EU Midwives Directives (see Appendix 1). The similarities and differences in maternity practices will be considered and salient points drawn together.


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  1. Bewley, S., Roberts, L.J., Mackinson, A-M. et al. (1995) ‘First trimester fetal nuchal translucency: problems with screening the general population 2’, British Journal of Obstetrics and Gynaecology, 102(5): 386–8.CrossRefGoogle Scholar
  2. Boyle, M. (1994) Antenatal Investigations. (Books for Midwives Press: Hale Cheshire).Google Scholar
  3. Brunetti, A. (1993) ‘Midwifery in Italy’, MIDIRS Midwifery Digest, 3(1): 16–17.Google Scholar
  4. Campbell, R. and Macfarlane, A. (1994) Where To Be Born? The Debate and the Evidence, 2nd edn. (National Perinatal Epidemiology Unit: Oxford).Google Scholar
  5. Cao, A. (1993) ‘Preventing a genetic disease’, World Health, 46(6): 26–7.Google Scholar
  6. Chalmers, I., Enkin, M. and Keirse, M.J.N.C. (1989) Effective Care in Pregnancy and Childbirth. (Oxford University Press: Oxford).Google Scholar
  7. Council of Europe (1996) Recent Demographic Developments in Europe. (Council of Europe: Strasbourg).Google Scholar
  8. Department of Health (1993) Changing Childbirth Part 1: Report of the Expert Maternity Group. (HMSO: London).Google Scholar
  9. European Midwives Liaison Committee (1996) Activities, Responsibilities and Independence of Midwives within the European Union. (EMLC: Northampton).Google Scholar
  10. Frascassi, A. (1997) Personal communication.Google Scholar
  11. Gottfredsdottir, H. (1997) Personal communication.Google Scholar
  12. Gumbel, A. (1997) ‘Baby? I’d rather have a mobile’, Independent, 2 March, p. 16.Google Scholar
  13. Health Committee Second Report (1992) Session 1991–92: Maternity Services. (HMSO: London).Google Scholar
  14. McCourt, C. and Page, L. (1996) Report on the Evaluation of One-to-One Midwifery Practice. (The Hammersmith Hospitals NHS Trust and Thames Valley University: London).Google Scholar
  15. Mayes, G. (1997) Assistant Director for Midwifery Supervision and Practice, English National Board, personal communication.Google Scholar
  16. Morrin, N. (1984) ‘When in Rome’, Midwives Chronicle, August, 260–1.Google Scholar
  17. Nicolaides, K.H., Brizot, M.L. and Snijders, R.J.M. (1994) ‘Fetal nuchal translucency: ultrasound screening for fetal trisomy in the first trimester of pregnancy’. British Journal of Obstetrics and Gynaecology, 101(9): 782–6.CrossRefGoogle Scholar
  18. North Thames West Region (1995) Maternal Serum Screening for Down’s Syndrome and Open Neural Tube Defects: A Guide for Health Professionals. (Harrow North West Thames Region Institute for Medical Research: London).Google Scholar
  19. Olafsdottir, A. (1997) Personal communication.Google Scholar
  20. Olafsdottir, A. and Gottfredsdottir, H. (1996) ‘Are safety and economy justifiable reasons for the closure of birth centres?’, unpublished MA essay. (Thames Valley University: London).Google Scholar
  21. Olafsdottir, O.A. (1996) ‘Midwifery studies in Iceland’, International Confederation of Midwives 24th Triennial Congress Conference Proceedings, Oslo, May 26–31, p. 171.Google Scholar
  22. Poulengeris, P. and Flint, C. (1987) The ‘Know Your Midwife’ Report, unpublished.Google Scholar
  23. Prevedello, L. (1997) Personal communication.Google Scholar
  24. Rosser, J. (1996) ‘Informed choice — we have lift off!’, MIDIRS Midwifery Digest, 6(2): 142.Google Scholar
  25. Sigurdardottir, C.N.M., Oladottir, S.M., Gudmundsdottir, P. et al. (1996) ‘An alternative birth care unit in Reykjavik, Iceland’, International Confederation of Midwives 24th Triennial Congress Conference Proceedings, Oslo, May 26–31, p. 114.Google Scholar
  26. Simpson, C. (1997a) ‘Cardiac and circulatory conditions in the newborn’, in Sweet, B. and Tiran, D. (eds) Mayes Midwifery, 12th edn (Baillière Tindall: London), pp. 882–8.Google Scholar
  27. Simpson, C. (1997b) ‘Congenital malformations and conditions’, in Sweet, B. and Tiran, D. (eds) Mayes Midwifery, 12th edn. (Baillière Tindall: London), pp. 912–20.Google Scholar
  28. Simpson, J.L. (1996) ‘Genetic counseling and pre-natal diagnosis’, in Gabbe, S.G., Neibyl, J.R. and Simpson, J.L. (eds) Obstetrics: Normal and Problem Pregnancies, 3rd edn. (Churchill Livingstone: New York), pp. 215–48.Google Scholar
  29. Tew, M. (1995) Safer Childbirth? A Critical History of Maternity Care, 2nd edn. (Chapman & Hall: London).Google Scholar
  30. UK Collaborative Study on Alpha-fetoprotein in Relation to Neural Tube Defects (1977) ‘Maternal serum-alpha-fetoprotein measurement in antenatal screening for anencephaly and spina bifida in early pregnancy’, Lancet, 1(25): 1323–32.Google Scholar
  31. Wald, N., Kennard, A. and Densem, J. (1992) ‘Antenatal maternal serum screening for Down’s Syndrome: results of a demonstration project’, British Medical Journal, 305(3850): 391–4.CrossRefGoogle Scholar
  32. Whelton, J. (1990) ‘Sharing the dilemmas — midwives’ role in prenatal diagnosis and fetal medicine’, Professional Nurse, July, 514–15.Google Scholar
  33. Wiegers, TA., Keirse, M.J.N.C, Berghs, G.A.H. et al. (1996) ‘An approach to measuring the quality of midwifery care’, Journal of Clinical Epidemiology, 49: 319–25.CrossRefGoogle Scholar

Suggestions for further reading

  1. Abramsky, L. and Chappie, J. (eds) (1994) Prenatal Diagnosis: The Human Side. (Chapman & Hall: London).Google Scholar
  2. Marland, H. (ed.) (1993) The Art of Midwifery: Early Modern Midwives in Europe. (Routledge: London).Google Scholar
  3. World Health Organization (1996) Care in Normal Birth: A Practical Guide, Report of A Technical Working Group. (World Health Organization: Geneva).Google Scholar

Copyright information

© Helen Crafter and Cathy Rowan 1998

Authors and Affiliations

  • Helen Crafter
    • 1
  • Cathy Rowan
    • 1
  1. 1.Thames Valley UniversityLondonUK

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