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Midwives' statement of ethics.

[The following working draft of the first part of the MANA Statement of Values and Ethics is both insightful and brilliant in its formulation and has been reprinted here with permission of the Ethics Committee Chair, Anne Frye, 189 Pine St, New Haven, CT 06513. Ed.]

We, as women and as midwives, have a responsibility to educate ourselves and others regarding our values and ethics. Our exploration of ethical midwifery is a critical reflection of moral issues as they pertain to maternal/child health on every level. This statement is intended to provide guidance for professional conduct in the practice of midwifery, as well as for MANA's policy making, thereby promoting quality care for childbearing families.

First, we recognize that values often go unstated, and yet our ethics (how we act) proceed directly from a foundation of values. Since what we hold precious infuses and informs our ethical decisions and actions, the Midwives' Alliance of North America wishes to explicitly affirm our values as follows:

I. Woman as an Individual

with Unique Value and


A. We value women and their creative, life-affirming and life-giving powers which find expression in a diversity of ways.

B. We value a woman's right to make choices regarding all aspects of her life.

II. Mother and Baby as


A. We value the oneness of the pregnant mother and her unborn child; an inseparable and interdependent whole.

B. We value the birth experience as a rite of passage; the sentient and sensitive nature of the newborn; and the right of each baby to be born in a caring and loving manner, without separation from mother and family.

C. We value the integrity of a woman's body and the right of each woman and baby to be totally supported in their efforts to achieve a natural, spontaneous vaginal birth.

D. We value the breastfeeding relationship as the ideal way of nourishing and nurturing the newborn.

III. The Nature of Birth

A. We value the essential mystery of birth. (1)

B. We value pregnancy and birth as natural processes that science will never supplant. (2)

C. We value the integrity of life's experiences; the physical emotional, mental, psychological and spiritual components of a process are inseparable.

D. We value pregnancy and birth as intimate, internal, sexual and private events to be shared in the environment and with the attendants a woman chooses. (3)

E. We value the learning experiences of life and birth.

F. We value pregnancy and birth as processes which have lifelong impact on a woman's self-esteem, ability to nurture, health, and healing.

IV. The Art of Midwifery

A. We value our right to practice the art of midwifery. We value our work as an ancient vocation of women which has existed as long as humans have lived on earth.

B. We value expertise which incorporates academic knowledge, clinical skill, intuitive judgment and spiritual awareness. (4)

C. We value all forms of midwifery education and acknowledge the ongoing wisdom of apprenticeship as the original model for training midwives.

D. We value the art of nurturing the intrinsic normalcy of birth and recognize that each woman and baby have parameters of well-being unique unto themselves.

E. We value the empowerment of women in all aspects of life and particularly as that strength is realized during pregnancy, birth and thereafter. We value the art of allowing that strength to manifest openly so that women can birth unhindered and secure.

F. We value skills which support a complicated pregnancy or birth to move toward a state of greater well-being or to be brought to the most healing conclusion possible when that hope is lost. We value the art of letting go. (5)

G. We value the acceptance of death as an appropriate outcome. We value our focus as supporting life rather than avoiding death. (6)

H. We value standing for what we believe in the face of social and political oppression.

V. Woman as Mother

A. We value a mother's intuitive knowledge of herself and her baby before and after birth. (7)

B. We value a woman's innate ability to nurture her pregnancy and birth her baby; the power and beauty of her body as it grows and the awesome strength summoned in labor.

C. We value the mother as the only direct care provider for her unborn child. (8)

D. We value supporting a woman in a non-judgmental way, whatever her state of physical, emotional, social or spiritual health. We value the broadening of her available resources whenever possible so that the desired goals of health, happiness and personal growth are realized according to her needs and perceptions.

E. We value the right of each woman to choose a caregiver appropriate to her needs and compatible with her belief systems.

F. We value pregnancy and birth as rites of passage integral to a woman's evolution into mothering.

G. We value the potential of partners, family and community to support women in all aspects of birth and mothering. (9)

V. The Nature of Relationship

A. We value relationship. The quality, integrity, equality and uniqueness of our interactions inform and critique our choices and decisions.

B. We value caring for women to the best of our ability without prejudice against their age, race, religion, culture, sexual orientation, physical abilities, or socio-economic background.

C. We value honesty in relationship.

D. We value direct access to information readily understood by all.

E. We value our relationship to a process larger than ourselves, recognizing that birth is something we can seek to learn from and know, but never control. (10)

F. We value humility in our work. (11)

G. We value the concept of self responsibility and the right of individuals to make choices regarding what they deem best for themselves. We value the right to true informed choice, not merely informed consent to what we think is best. We support people to make decisions based on their own values and respect those values as precious.

H. We value sharing information and our understanding about birth experiences, skills and knowledge.

I. We value the midwifery community as a support system and essential place of learning and sisterhood.

J. We value diversity among midwives, recognizing that it broadens our collective resources and challenges us to work for greater understanding of birth and each other.

K. We value the recognition of our own limits and limitations.

L. We value mutual trust and respect, which grows from a realization of all of the above. (1) Mystery is defined as something that has not or cannot be explained or understood; the quality or state of being incomprehensible or inexplicable; a tenet which cannot be understood in terms of human reason. (2) Supplant means to supersede by force or cunning; to take the place of. (3) In this context, internal refers to the fact that birth happens within the body and psyche of the woman: ultimately she, and only she, can give birth. (4) An expert is one whose knowledge and skill is specialized and profound, especially as the result of practical experience. (5) This addresses our desire for normal birth whenever possible and recognizes that there are times when it is impossible. That is to say, a woman may be least traumatized to have a cesarean and a live baby, but the hope of a normal spontaneous vaginal birth, in this case, is lost. We let go of that goal to achieve the possibility of a healthy baby. Likewise, the situation where parents choose to allow a very ill or deformed child to die in their arms rather than being subjected to multiple surgeries, separations and ICU stays. This too is a letting go of the normal for the most healing choice possible within the framework of the parents' ethics given the circumstances. What is most healing will, of course, vary from individual to individual. (6) We place the emphasis of our care on supporting life (preventive measures, good nutrition, emotional health, etc.) and not pathology, diagnosis, treatment of problems, and heroic solutions in an attempt to preserve life at any cost of quality. (7) This addresses the medical model's tendency to ignore a woman's sense of well-being or danger in many aspects of health care, but particularly in regard to her pregnancy. (8) This acknowledges that the thrust of our care centers on the mother, her health, her well-being, her nutrition, her habits, her emotional balance and, in turn, the baby benefits. This view is diametrically opposed to the medical model which often attempts to care for the fetus/baby while dismissing or even excluding the mother. (9) While partners, other family members and woman's larger community can and often do provide her with vital support, we wish to acknowledge that many women find themselves pregnant in abusive and unsafe environments. (10) Seek is the key word; we recognize that we can never fully know birth. (11) We acknowledge that in birth and life there are no guarantees, and that our best decisions in the moment may lead to unforeseen outcomes. These recognitions necessitate and maintain humility.
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Title Annotation:Midwives' Alliance of North America
Publication:Special Delivery
Date:Dec 22, 1991
Previous Article:"Sisters on a journey": Midwives' Alliance meets in El Paso.
Next Article:Celebrate Midwives' Day May 5.

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