Code for Ethical Midwifery Practice

The Association of Texas Midwives was established, in part, to further the goal of safe midwifery care in Texas. The adoption of a code of ethics is one way of achieving that goal. The purpose of this document is to provide midwives with a reference point from which to reflect on the conduct of themselves and others. This code should act as a guide for ethical decision-making and midwifery practice.

Additionally, the observance of ethical standards increases an awareness of midwifery, by both current and future practitioners, as a unique calling, responsive to the needs of birthing clients.

Finally, articulation of ethical standards is essential to the recognition of midwifery as a profession by the broader society. Adherence to the Code for Ethical Midwifery Practice by midwives will allow other practioners, clients of midwifery and their family members, and other professions to clearly understand the ethical values they can expect midwives to uphold.

For these reasons, the Association of Texas Midwives set forth the following CODE FOR ETHICAL MIDWIFERY PRACTICE.

A. CLIENT RIGHTS

An ethical midwife will respect the personal rights of their clients, including:

1. The right to be treated with respect and dignity without reference to, marital status, socioeconomic status, ethnicity, political affiliation, religious or sexual orientation.
2. The right to use informed choice in their care, by having access to relevant information upon which to base decisions.
3. The right to freedom from coercion in decision making.
4. The right to accept or to refuse treatment.
5. The right to full disclosure of financial factors involved in their care.
6. The right to know who will participate in their care and to obtain additional consultation of their choice.
7. The right not to be abandoned, neglected, or discharged from care without opportunity to find other care.
8. The right to absolute privacy except where this right is preempted by law.

B. MIDWIFE RIGHTS

A midwife respects their own rights as a care provider, including:

1. The right to refuse care to clients with whom no midwife/client relationship has been established.
2. The right to discharge clients from their care, provided adequate legal notice and referral to other care is extended.
3. The right to receive honest, relevant information from clients upon which to base care.
4. The right to receive reasonable compensation for services rendered.

C. MIDWIFE RESPONSIBILITIES

A midwife recognizes certain obligations and responsibilities which are intrinsic to ethical midwifery practice, including:

1. The obligation to serve as the guardian of normal birth, alert to possible complications, but always on guard against arbitrary interference in the birthing process for the sake of convenience.
2. The obligation to honor the confidence of those encountered in the course of midwifery practice and to regard everything seen and heard as inviolable, remembering always that a midwife's highest loyalties are owed to the client, to the profession of midwifery.
3. The obligation to provide complete, accurate and relevant information to the client so that they can make informed choices regarding their health care.
4. The obligation, when referring a client to another health care provider, is to remain responsible for the client until they are either discharged or formally transferred.
5. Midwives will avoid gossiping, bullying, misrepresenting or otherwise tarnishing the name of another midwife.
6. The responsibility to endeavor to develop and utilize a safe and efficient mechanism for medical consultation, collaboration and referral.
7. The obligation to continue professional development through ongoing evaluation of knowledge and skills, and continuing education, including diligent study of all subjects relevant to midwifery practice.
8. The obligation to know and comply with all legal requirements related to midwifery practice within the state of Texas, and to work within the law to provide for the unobstructed practice of midwifery within the state.
9. The responsibility to maintain accountability for all midwifery care delivered under their supervision. Assignment and delegation of duties to other midwives or apprentices should be equal to their educational preparation and demonstrated proficiency.
10. The obligation to accurately document and maintain records of the client's history, condition, physical progress and other vital information obtained during client care.

D. UNPROFESSIONAL CONDUCT

Conduct by a midwife which is likely to deceive, defraud, or injure clients, or which results from conscious disregard for the health and welfare of the client under the midwife's care, includes:

1. Knowingly or consistently failing to accurately document a client's condition, responses, progress, or other information obtained during care. This includes failing to make entries, destroying entries, or making false entries in records pertaining to midwifery care.
2. Performing or attempting to perform midwifery techniques or procedures in which the midwife is untrained by education and experience.
3. Failing to give care in a reasonable and professional manner, including maintaining a client load which does not allow for personalized care by the primary attendant.
4. Leaving a client intrapartum without properly terminating care and ensuring adequate care for the mother and infant (abandonment).
5. Delegation of midwifery care or responsibilities to a person who lacks the ability or knowledge to perform the function or responsibility in question.
6. Manipulating or affecting a client's decisions by withholding or misrepresenting information, in violation of the client's right to make informed choices in their health care.
7. Failure to report to the applicable state board or the appropriate authority in the Association, within a reasonable time, the occurrence of any violation of any legal or professional code.

E. VIOLATIONS

1.Violations of this Code should be reported to the Association for review. Findings from this review will be used to assist the midwife in improving their practice, and to restrict incompetent practitioners if necessary.

Standards for Midwifery Practice

1. DEFINITION

The midwife practices in accord with the Midwives Alliance of North America's Standards and Qualifications for the Art and Practice of Midwifery (except where it conflicts with Texas law), the ATM Statement of Values and Ethics, and demonstrates the clinical skills and judgments described in the MANA Core Competencies for Midwifery Practice.

1. STANDARDS

A. Skills - Necessary skills of a practicing midwife include the ability to: provide continuity of care to the client and their newborn during the maternity cycle; identify, assess and provide care during normal antepartal, intrapartal, postpartal, neonatal and newborn periods; identify and assess deviations from normal; maintain proficiency in life-saving measures by regular review and practice; manage emergency situations appropriately: use judgment, skill and intuition in competent assessment and response.

B. Appropriate equipment and treatment - Midwives carry and maintain equipment to assess and provide care for the client, the fetus, and the newborn; to maintain a clean and/or aseptic technique; and to treat conditions including, but not limited to, hemorrhage, lacerations, and cardio-respiratory distress. This may include the use of nonpharmaceutical agents, pharmaceutical agents by physician prescription or standing orders and equipment for suturing and resuscitation.

C. Records - Midwives keep accurate records of care provided for each client and newborn in their practice. Records reflect current standards in midwifery charting and are held confidential (except as legally required) and maintained as deemed necessary by law. Records shall be provided to the client on request. The midwife maintains confidentiality in all verbal and written communications regarding client care.

D. Data Collection – It is highly recommended that midwives collect data for their practice on a regular basis. Data collection will be used to further midwifery in Texas.

E. Medical Consultation, Collaboration, Referral, and Transfer - Midwives recognize there are certain conditions for which medical care is recommended. The midwife shall make a reasonable attempt to assure that their clients have access to consultation, collaboration, referral, and transfer to a medical care system when indicated.

F. Screening - Midwifery practice upholds the right to self-determination of consumers within the boundaries of safe care. Midwives will use risk factor assessments for initial and continuing eligibility for midwifery services. Clients will be informed of their risk status. It is the right and responsibility of the midwife to refuse or discontinue their services, and to make appropriate referrals when indicated or when client care falls outside and a midwife’s protocols or scope of practice.

G. Informed Choice - Each midwife will disclose in oral and written form to prospective clients the midwife’s scope of practice. This shall be accomplished through an Informed Choice and Disclosure Statement. The informed choice shall include statistics of the midwives’ experience, date and expiration of license date and expiration of midwives’ CPR and NNR certifications, and medical back-up arrangements. The disclosure statement shall include legal requirements of the midwife, prohibited acts as stated in the Midwifery Act and the name, address and telephone number of the Department of State Health Services Midwifery Program.

H. Continuing Education - Midwives shall update their knowledge and skills on a regular basis.

I. Peer Review - Midwifery practice includes an on-going process of case review with peers.

J. Practice Protocols - Each midwife shall develop protocols that are in agreement with the ATM Standards for Midwifery Practice, the ATM Statement of Ethics and the MANA Core Competencies for Midwifery Practice, in keeping with their level of expertise and remain within the Texas Law. Protocols shall be written, updated and maintained by the midwife.

K. Ethics - Midwives will maintain high ethical standards in their work, as evidenced by adherence to ATM's CODE FOR ETHICAL MIDWIFERY PRACTICE.

(1) International Confederation of Midwives (ICM) and Joint Study Group on Midwifery Care, rec. 1972. (2) Based on Midwives' Alliance of North America (MANA) "Standards/Qualifications for the Art and Practice of Midwifery,” March 1985.