Midwive's Perception of Ethical Behaviours and Professional Malpractices in Labour Units of Tshwane Gauteng Province

INTRODUCTION

Midwives form the backbone of maternal and child health care in South Africa. The care provided by midwives during childbirth is a unique life experience and they are therefore expected to comply with policies and legislation governing their profession so that they are able to pick up complications and intervene accordingly (Maputle and Hiss, 2010 : 5).Midwifery practice is governed by skills and knowledge which provides grounding to ethical clinical decision making.

South Africa is recently burdened by serious adverse events in its health care institutions and these malpractices leads to litigations. In 2011 the Minister of health released the amounts of lawsuits  

already paid by the various Provincial Departments of health amounting to R1.7 billion in the past seven years related to gynaecology,  midwifery and surgical procedures  and R100 million was for Gauteng department of Health. All these lawsuits are related to obstetric malpractices (Maphumulo, 2011:13).   Furthermore the SA-News released a statement which revealed that the Gauteng Department of Health has 306 negligence claims totalling R1286 billions of which 155 claims were for damages around childbirth (Child, 2014:01).The ethical and professional conduct of nurses and midwives is questionable, and when mistakes happen, the clients not satisfied about the care given to them or where an injury has occurred they often seek legal advice or approach the court of law (McHale and Tingle 2007:53).

Aim: The purpose of this study is to enhance awareness of ethical and professional malpractice in midwifery care.

Research design

A qualitative, exploratory, descriptive and cross-sectional design was followed in this study to explore the midwives understanding of ethical behaviour and professional malpractices in a specific setting using a phenomenological approach. This method  enabled the researcher to describe the perceptions of midwives and lived experiences of ethics and professional malpractices in their work environment (Gu, Zing, and Ding, 2009:6).The method was suitable for this study as the  researcher used in-depth interviews to collect  data from participants . Research was conducted at a natural setting in a private room close to the labour ward to ensure privacy (Moule and Goodman 2014:175).

An exploratory study often explores research question in which there is little known about the phenomenon with the aim to determine the extent of involvement in relation to a particular problem (Basavanthappa, 2010: 182).The objective of this research was to explore and describe the perception of midwives on ethical and professional malpractices issues in the selected labour units of Gauteng Province. From the explanation given almost all of the participants were once involved in a malpractice error, and were able to share their knowledge and experiences with the researcher.

A cross-sectional study examines data at some point in time, meaning that data is collected on  one occasion with the subjects.  Basavanthappa (2010:187).

 POPULATION

For this study population refers to all midwives working in the labour units of Tshwane in Gauteng Province. The target population was all midwives with two or more years’ experience working in the selected labour units in Tshwane Gauteng Province. The researcher purposefully sampled those midwives who are providing care to women in the active phase of labour. Purposive sampling is a non-probability sampling in which data is collected from a group of participants with specific key characteristics Moule and Goodman (2014:360). Participants were recruited and selected based on their experience and knowledge of the phenomenon under study. The purpose of the study was clearly explained to participants to enable them in making an informed decision to participate in the study freely and further that they have the right to withdraw from the study Basavanthappa (2010:219), Streubert and Carpenter (2011:128).  

Participants signed the consent form to participate after all explanation about the study had been given by the researcher. The rights and autonomy of both institutions and participants were protected throughout the study. The researcher made sure that all information given by the participants was treated with strict confidentiality. The names of participants were given identification codes in order to protect their identity. 

Beneficence and non- maleficence:  The researcher did not envisage any physical, psychological or emotional harm to the participants and institutions as the objective of the study was to explore the midwives’ perception of ethical behaviours and professional malpractices within the selected labour units ( Moule and Goodmann 2014:60).

Justice: all participants were treated fairly and with respect by researcher, not looking at their skin colour nor educational background. The findings of the study will be shared with all the institutions where the research was conducted as well as the ethics committee in that district (Polit & Beck, 2004:147). Mautner( 2002), in Tjale and De Villiers (2004:224) states that justice includes all habits and dispositions of a good citizen and therefore the researcher made sure that the participants  were given a fair chance to participate in the study. This is also supported by the theory of Principalism applied to this study.

Data collection: Individual in-depth interviews using open ended questions was used to collect data. Interviews were recorded using an audio tape recorder which was later transcribed verbatim. Data collection was continuous until saturation was reached. Saturation was reached with the eight (n=8) participant. The researcher ensured that private information is not collected and that the participant’s thoughts are not misused .

Data analysis

Data analysis started during interviews and continued throughout the transcription of recorded interviews. According to (Burns & Grove, 2013: 643), data collection and data analysis in qualitative research can be done simultaneously till saturation is reached. Taylor and Francis ( 2013:193 ) affirms that in qualitative research data analysis may be undertaken collectively in meeting with participants through  summarized stories , reflections and notes taken by the researcher, that will eventually emerge into themes , subthemes and concepts. The above method was used in this study and seven major themes emerged as midwives work experiences, understanding of ethics and malpractices, ethical decision making, and poor decision making, litigation experiences,  Factors contributing to professional malpractices, impact of malpractices and litigations and  recommendations.  

Findings: the results of the study revealed that midwives  understand the ethical code of conduct however due  to some structural problems they end up with serious adverse events. The following factors were identified namely: shortage of staff, shortage of material resources, and non-compliance of midwives to policies such as BANC Tool and guidelines, fear of decision making, lack of management support makes their work very much challenging. That litigations makes them to be discouraged and demotivated. Midwives were comfortable with the obstetrician-led model of care where they rely with obstetrician to take decisions for them. 

Ethical consideration: Ethical clearance was obtained from Tshwane Ethics and Research  Committee and the University of South Africa. The ethical principles set out by the International Council of Nurses’ Code of Ethics for Nurses (2006) was followed as a guide for this study. The rights and privacy of the institutions and participants were maintained throughout the study.

Conclusion: More similar studies need to be conducted in other institutions. It is hoped that the findings of this research will make contributions to midwifery training and practice. 

Keywords: Labour unit, Professional misconducts, ethical behaviour, Midwife, perceptions, professional malpractices