Understanding the moral nature of intrapartum nursing.

Objective: To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth.

Design: Qualitative critical narrative.

Setting: Labor and birth unit in an urban Canadian hospital.

Participants: Fourteen intrapartum registered nurses.

Methods: Critical narrative analysis using a feminist ethics perspective.

Results: Nurses understood their moral responsibilities to laboring women in a variety of ways depending on the nurses' personal and professional experiences, the people involved, and the context of care. Four themes were identified: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. A key factor influencing responses to women was the degree to which expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women, and their families. Although nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. Nurses also described limits of their responsibilities for others, which departed from the idealized expectations often reflected in professional guidelines

Conclusion: These findings suggest a need to challenge assumptions related to the provision of choice and family centered care to create environments that can support and sustain understanding and trust between nurses and women giving birth. In addition, given the lack of shared understandings of what constitutes best care, there is a need to develop collaborative models of care that include the voices of women as a central component.