Impact of ethical dilemmas in midwifery practice: An interpretative phenomenological analysis

Background Midwives frequently face ethical dilemmas that affect clinical judgment, quality of care, and well-being, particularly in low-resource settings such as Ethiopia where hierarchical systems, resource constraints, and sociocultural norms strongly influence practice. However, evidence on their impacts remains limited. Research aim This study aimed to describe and interpret midwives lived experiences of the impacts of ethical dilemmas on their practice in northwestern Ethiopia. Research design A qualitative phenomenological study using Interpretative Phenomenological Analysis (IPA) explored how midwives make sense of the impact of ethical dilemmas relation to moral agency, professional identity, and relational care. Participants and research context The study was conducted from January 2 to April 30, 2026, in three referral hospitals in northwestern Ethiopia. Midwives with at least 2 years of clinical experience and experience of ethical dilemmas were purposively identified and invited. Thirteen midwives were finally included in the analysis after achieving interpretive sufficiency. Ethical considerations Ethical approval was obtained from a university-affiliated institutional review board (Ref No: DKU/COHS/RCS/42/2026). Results Ethical dilemmas had multidimensional impacts on patients, midwives, and the healthcare system, which midwives interpreted as threats to moral agency, professional identity, and relational care. For patients, they were experienced as restricted autonomy, compromised care, emotional harm, and fetal risk. Midwives made sense of these experiences as creating persistent moral tension that shaped their professional self-understanding, resulting in moral distress, fear, anxiety, emotional exhaustion, reduced job satisfaction, and compromised decision-making. At the system level, dilemmas were understood as embedded in hierarchical decision-making, resource constraints, and sociocultural pressures, leading to inefficiencies, inequities in care, ethical tensions, and reduced trust. Conclusion Ethical dilemmas in midwifery are structurally produced conditions that generate moral strain, weaken professional identity, and compromise equitable care. Addressing them requires institutional reforms that strengthen ethical support, professional autonomy, and resources in maternity care.