Legal and ethical aspects in obg 0109

INTRODUCTION
• Laws and ethics are often seen as
complimentary to each other , but at same
time they are also seen as opposite sides of a
coin. Midwives must follow standard and
regulations that range from the national level
to the individual area of practice, such as
hospital, labor and delivery unit.

1.NATIONAL STANDARDS OF PRACTICE
-various levels of legal regulations
and standards define midwifery
practice. National standards provide
an expectation of delivery care. The
educational programs of midwifery
assure that all new nurse midwives can
safely deliver care within the scope of
usual midwifery practice

2.STATE LICENSE
• Midwifery practice is regulated in the state of
practice through license to practice. If a
midwife practices in two states, she must be
licensed by both states. State license is meant
to protect the consumers by ensuring that the
midwife has appropriate education for the
profession and can provide safe care.

• It tells that a midwife’s duty must be
evaluated according to the availability of
medical and practical knowledge that would
be used in the treatment of similar patients
under similar circumstances , by competent
midwives, given the facilities , resources and
options available.(2001)
3.COMMUNITY STANDARDS

4.INSTITUTIONAL POLICIES
• The hospital laws govern midwives working in
the hospital. The midwife working in the
hospital should review the policies of the units
in which midwifery care is provided.

5.PROFESSIONAL NEGLIGENCE
• Medical malpractice is the legal error committed by medical
personnel. In legal terms, this error is tort a civil wrong that
injuries a person. If a tort is intentional , it becomes a crime of
assault or battery . Negligence, a form of malpractice, is an
unintentional tort.
To prove a negligent tort occurred , 4 elements must be there;
1. A duty must exist between the injured party and the
professional accused of wrong doing.
2. A breach of duty must have occurred. The midwife must have
practiced outside the standard of care for a breach to occur.
3. The breach of duty must be proximate cause of the claimed
injury.
4. There must be damage or injuries to the claimant that are
recognized by the law and compensable.

LEGAL ISSUE IN
OBSTETRIC AND
GYNAECOLOGY

• Many legal issues are involved in obstetric and
gynecology. Law suites against the nurse include
the following;
PROBLEMS OF MEDICATION: nurses provide
medication to the clients . Certain problems can
occur during giving medication which can result
into allegation against nurses, such as improper
dosage of medication, improper client medication,
wrong route of medication and wrong time.
FAILURE IN MONITORING OF THE CLIENT : it is the
responsibility of the nurse to monitor the client
regularly depending upon the condition of the
client. She is expected to monitor the condition of
the client admitted with any gynecological
problem.

During antenatal period also, monitoring is essential so that
any complication can be prevented. Nurse has to monitor
the client during antenatal , intranatal and postnatal
period. Failure of this can result into a legal issue.
FAILURE TO REPORT CHANGES IN THE PATIENT : nurses do
the regular monitoring and the assessment of the client.
During assessment , she may notice any change in the
client’s condition. This has to be brought to the notice of
the physician. With this, a precious life can be saved.
FAILURE IN ASSESSING THE CLIENT : assessment is the first
thing which nurses have to do . Based on the assessment
care is provided to the patients. She is responsible for
assessing and reporting any minute change in the client’s
condition. Higher levels of assessment skills have to be
maintained by the nurses in all the specialty areas.

• ABORTIONS : many abortions are performed
illegally. Nurses have the right to refuse to assist in
the procedure of the abortion. If the abortion is
performed under the act of medical termination of
pregnancy, she can assist the physician in this.
Patient who has undergone abortion needs care and
monitoring . It is the nurses legal responsibility to
care for such client.
• NURSING CARE OF NEWBORN : nurses have many
responsibility for the newborn. She has to take the
foot print of the newborn, cord is clamped, wrist
band has to be put for the identification , proper
warming is maintained etc. there are many
responsibilities which the nurses have to carry.

ETHICS IN MIDWIFERY AND
GYNAECOLOGY
• According to Thompson and Thompson , to be
professional is to be ethical, and to be ethical is
to be professional . To be ethical requires an
understanding of ethics, values, moral
reasoning, and ethical decision – making . The
nature of ethics requires one to focus on what
it means to be human and how to interact with
others in a respectful manner.
• The goal of ethical midwifery is to do the right
thing for the right reasons. Knowing how to
make good decisions as well as why these
decisions were made constitutes of ethical
midwifery practice.

• The study of ethics will provide the framework for
exploration and aid resolution of dilemmas. Different
people may understand different things from the same
words. So ethics helps them to understand , what they
think and feel about any given situation.
• A neonatal nurse is a professional with special
training, skill, and knowledge in the care of newborns
and their families. The neonatal nurse is accountable
to the patient, profession , and employer. Failure of the
neonatal nurse to meet these obligations can result in
liability in the profession, liability in the employment ,
a civil suit, or a criminal conviction.

1.Ethical principle of beneficence: the ethical
principle of beneficence requires one to act in a
way that is expected reliably to produce the
greater balance of benefits over harms in the
lives of others.
2. Non- maleficence: It means that health
professionals should prevent causing harm and
is understood as expressing the limits of
beneficence.
3. Respect for autonomony: This principle
requires one always to acknowledge and carry
out the value based preference to adult,
competent patient.
www.freelivedoctor.com

4. Beneficence and respect for autonomy in
gynecological practice: Beneficence based and
autonomy based clinical judgment in gynecology
practice are usually in harmony. For example; a
woman may present with an ectopic pregnancy. The
gynecological must explain diagnostic findings and
potential for maternal death and unlikelihood of
spontaneous resolution
When there is no reasonable alternative to
manage the patient’s condition, clinical judgment is
beneficence based.

• Example- Screening for cervical cancer by
pap smear which will protect and promote
the health interest of patient.
• 5. Caring: the health professionals usually
care for their clients and as such would
always have their best interest in mind.
Making decisions on behalf of others is
caring for clients because health
professional education and training
enables them to know best. At the same
time, it does not give right to the health
professionals to override someone’s views
and wishes.

• Empowerment and advocacy; One of the
important role of the midwife is to support
and help woman to exercise their autonomy
. This is empowerment. Educating and
supporting is one of the major roles of
midwife, as well as laying emphasis on the
public health and health promotion.
• Advocacy means speaking out for
someone’s rights. It is considered useful in
the situations where the clients have been
unable to make their own choices. It means
speaking up for what the person wants to
happen.

• Health as a basic right for all: Women often
lacked basic human rights because they
were viewed as less than human, less than
person, by many societies. Maternal deaths
and disabilities are the tragic example of
this. In order for the women to be healthy
and valued for themselves, not as a
producer of children or a sexual playmate,
they must be given the same status as men
in society (ICM 1990). Women must also
demand equal treatment and equal right to
health and well being.

• Some other ethical issues are:
 Conceptus issues related to IVF, Cloning,
Surrogate mother.
 Abortion, foetal rights versus rights to
mother.
 Use of fetal tissue for research
 Resuscitation continuation
 Number of procedures as child

• American college of Nurse – Midwives: Code
of ethics
A certificate nurse-midwife has
professional moral obligations. The purpose
of this code is to identify obligations which
guide the nurse-midwife in the practice of
nurse-midwifery. This code further serves to
clarify the expectations of the profession to
consumers, the public, other professionals
and to potential practitioners.

1. Nurse-midwife exists for the good of
women and their families. This good is
safeguarded by practice in accor-dance
with the ACNM philosophy and ACNM
standards for the practice of Nurse – Mid
wifery.
2. Nurse – Mid wives uphold the belief that
child bearing and maturation are normal
life processes . When intervention is
indicated, it is integrated into care in a way
that preserves the dignity of the woman
and family

3.Decision regarding Nurse Mid-wifery care
requires client participation in an ongoing
negotiation process in order to develop a safe
plan of care. This process consider cultural
diversity, individual autonomy and legal
responsibilities.
4.Nurse Mid-wives share professional
information with their clients that leads to
informed participation and consent. This
sharing is done without coercion, or
deception.

5.Nurse mid-wives practice competently. They
consult and refer when indicated by their
professions scope of practice and/or personal
limitations.
6.Nurse mid-wives provide care without
discrimination based on race, religion, life-
style, sexual orientation, social – economic
status or nature of health problem.
7.Nurse mid-wives maintain confidentially
except when there is a clear, serious and
immediate danger or when mandated by law.

8.Nurse Mid-wives take appropriate action to
protect clients from harm when endangered
by incompetent or in ethical practices.
9.Nurse Mid-wives interact respectfully with
the people with whom they work and practice.
10.Nurse Mid-wives participate in developing
and improving the care of women and families
through supporting the profession of nurse –
midwifery, research, and the education of
nurse – midwifery students and nurse –
midwives.

11.Nurse mid-wives promote community,
state, and national efforts such as public
education and legislation, to ensure access to
quality care and to meet the health needs of
women and their families.

PREPARING FOR PARENTHOOD
AND PRECONCEPTION PLAN

• Pregnancy preparedness makes sense,
particularly because many pregnancies are
unexpected. A developing fetus is highly
susceptible to birth defects and other
problems during the eight weeks of
pregnancy, a time when women may not
realize they are expecting and typically long
before their first visit with a healthcare
professional to address their pregnancy, we
need to start pregnancy care Before
conception. To start care before conception
requires planning.

• But this planning is critical in making ‘’every
child a wanted child” and every pregnancy
as healthy as possible for both mother and
baby.
• Experts agree that the first step in planning
a healthy pregnancy begins before
conception. Important genetic
developments in the embryo occur before a
woman realize that she is
preganant;therefore, maintaining a healthy
lifestyle before pregnancy occurs can reduce
of complication later on in the pregnancy.

• Smoking: Smoking is the risk of unborn baby,
reducing the baby’s chance of growing to their full
potential in the womb and increasing the chances of
complications such as premature birth. Smoking
increases baby’s chances of respiratory problems
and ‘cot death’
Smoking increases the likelihood of baby developing
asthma and other allergic conditions. Actually it
increases the chances of nearly everything.
• Alcohol: It affects ovulation, increases rate of mis
carriage, growth retardation, prematurity. It can lead
fetal alcohol syndrome, which leads to learning and
physical disability and behavior problem.

• At this stage carry on exercising as normal.
Swimming is ideal throughout pregnancy, so is
walking and even more strenuous forms of
exercise such as running and cycling are
suitable pre and during pregnancy. It is
important to exercise regularly and maintain a
proper weight before and during pregnancy.
Women who are overweight may experience
medical problem such as high blood pressure
and diabetes. Women who underweight may
have babies with low baby weight.

• Diet: Eating a balanced diet before and during
pregnancy is not only good for the mother’s overall
health, but essential for nourishing the fetus. Being
overweight or underweight can affect normal
ovulation, decrease chance of getting pregnant and
increase pregnancy complications.
• The length of time between pregnancies: A short
amount of time between pregnancies is known to be
a risk factor for preterm birth, low birth weight and
infant deaths. It is recommended that the time from
delivery of one child to conception of next child at
least 18 months.
• Assessment of chronic conditions: Women who have
chronic medical conditions, like diabetes and
hypothyroidism, should talk to their doctors before
becoming pregnant. It is important to have the
disease under control before pregnancy.

• Advice for men: Wear loose fitting shorts, trousers.
Avoid hot baths, instead take cold showers. Cut down
smoking alcohol. Loose weight and avoid exposure to
chemicals.
- See doctor regularly and follow instructions about
sensible eating, vitamin supplements and exercise. Ask
your doctor to recommend a good book on prenatal care
and preparing for baby.
- Choose a birthing facility. Whether you select a
traditional hospital, a center staffed by midwives or
another delivery option will depend on your health, your
baby’s health, your doctor’s advice, your special needs,
your personal philosophy and your insurance coverage.

- Choose a child birth class. Investigate classes
available at your local hospital, community
health center or community college. You can
also ask your doctor or mid wife for
recommendations. Find out who teaches the
classes, what method is used and how much
information on labor and deliver is offered.

Aspects of Pre-
Pregnancy care
Exercise & Relaxation
* Regular moderate
exercise
Avoid Hazards
*Smoking
*Alcohol
*Drugs
Diet
• Well balanced Diet
• Bread & Cereals
• Fresh fruits & Vegetables
• Fresh containing protein
• Dairy products
Avoid exposure to pollutants
• Lead
• Pesticides
• Ionizing radiations
Avoid exposure to infections
• Expose to Rubella infection
• Avoid pregnancy following
immunization of rubella
• Treat infection such as Urinary,
Vaginal etc. Before conceiving

PARENTHOOD PREPARATION
It includes various aspects such as:
o Physical preparation
o Psychological preparation
o Functional preparation
o Physical preparation:
 Age more than 18 years for girls & 21 years for boys.
 Diet- She should not be anaemic or malnourished.
 No hazards exposure: She should not be exposed to hazardous substances before & during
pregnancy.
 Free of infections such as Rubella.
 Avoid contraceptive pills: She should discontinue oral contraceptives at least 3 and preferably
6 months before trying to get pregnant.
o Psychological preparation
 Mentally the couple should be prepared to have a baby.
 Loved & Secured
 Away from violence
 Mature enough by brain
o Financial preparation
 The couple should prepare themselves to meet the increasing need of finances for the care
required during pregnancy, delivery & the entry of the new corner i.e new born baby.

• Benefits of preconception care:
 Increased fertility for you and your partner( Even for
older couples)
 Healthy conception, pregnancy and birth
 Reduced risk of miscarriage, premature birth or
abnormality
 Decreased occurrence of common complaints such as
morning sickness
 A successful alternative to assisted reproductive
programs for many fertility problems
 May improve the success rate of IVF
 Increased chance of a natural, intervention free birth
 Reduced risk of post natal depression
 Successful and long term breast feeding
 Children those are healthy, intelligent, well balanced, and
happy.

• Special preconception advices in specific cases:
1. Condition- Obesity
Problem in Pregnancy; Neural tube defects,
diabetes, cesarean section, high blood pressure.
Preconception advice; Weight loss before
pregnancy decreases the risks of this bad outcomes.
2. Condition – Smoking
Problem in Pregnancy ; Low birth weight,
Preterm birth
Preconception advice; Stop smoking before
pregnancy.

3. Condition – Diabetes
Problem in Pregnancy ; Miscarriage,
increase in birth defects if poorly controlled,
macrosomia.
Preconception advice; Work with your
doctor to manage blood sugars.
4. Condition – Folic acid deficiency
Problem in Pregnancy ; Neural tube
defects. The neural tube is already formed by
the 14th day of pregnancy.
Preconception advice; Supplementing diet
with folic acid reduces Neural tube defects.

5. Condition – Alcohol
Problem in Pregnancy ;Fetal alcohol
syndrome and other alcohol related
syndrome.
Preconception advice; Stop taking alcohol
during pregnancy.
6. Condition – Epilepsy
Problem in Pregnancy ; Some epilepsy
medications can cause fetal abnormality.
Preconception advice; Work with your
doctor to adjust medications.

7. Condition – Hyper tension
Problem in Pregnancy ;There is an increased risk of
preeclampsia, Kidney problems and fetal growth
retardation.
Preconception advice; Work with your doctor to
ensure blood pressure is controlled.
8. Condition – Sexually transmitted infections
Problem in Pregnancy ; Gonorrhea, chlamydia:
Infertility, fetal death, fetal disability (E.g: Mental
retardation, blindness), chronic pelvic pain.
HIV: Can be transmitted to fetus and cause disability
and death.
Preconception advice; Early diagnosis and
treatment will decrease risk of mother to child
transmission.

9. Condition – Hypothyroidism
Problem in Pregnancy ;Early in pregnancy,
women need an increase in thyroid medication.
This ensures that the fetus has appropriate
development of its neurological system .
Preconception advice; Works with your
doctor to ensure the doses of thyroid medicine
are adjusted.
10. Condition – Dental caries, gingivitis, oral
health
Problem in Pregnancy ; Can lead to preterm
delivery and preterm labor.
Preconception advice; Maintain good oral
hygiene, regular dental visits.

Parenthood brings about extensive changes to one’s life in
its entirely, having an impact on various aspects of life. The
mother experience significant physical changes all through
the period of pregnancy while a birth of a newborn can also
influence one’s home, job and financial options. By putting in
place an effective parenting plan will enable individuals to
tackle these points conveniently before they turn out to be
issues of major concern. Being a parent is the most unselfish
act of attention one can make. By becoming a parent it implies
that one is willingly dedicating ones entire life to look after
the child since a parent’s responsibility is an enduring task,
which has the biggest pleasure and reward but at the same
time it is a job from which one can never really quit.
Parenting can be one of life’s most challenging experience.
With proper guidance parenting also can be one of life’s most
rewarding experience. Communications with the partner is of
utmost importance in making decisions about child bearing.

• Some of the important facts to look for are:
1. Before the arrival of the baby it is vital to make the
necessary alterations in the house to enable more
space.
2. Working mothers need to make an applications for
maternal leave and make proper endeavors to get
hold of financial funds as they will be certainly be
required to pay off the various expenses that
parent have to incur during the birth of baby as
well the days following it.
3. Financial planning is extremely important and is
something that should be kept in place with the
progress of the child’s life. Necessary funds have to
made available to the child for his or her varied
requirements including the expenses that have to
met while the child goes to school, college and
other such activities.

Having a birth is a vital decision. There are
some practical issues that need to be looked at
when planning pregnancy: Financial,
Emotional, the strength of couple’s
relationship and their values and belief
concerning child rearing. As well, pregnancy
planning is an opportunity to focus on one’s
physical health. Some steps need to be taken
care of, as the couple is preparing for
parenthood.

Legal and ethical aspects in obg 0109

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