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“When ‘respect’ interrupts care”
The workshop presents an ethical dilemma about uninterrupted skin-to-skin contact after birth: a nurse suggests interrupting it in the name of “respect” for the mother, even though she has not expressed discomfort.
The case invites participants to reflect on how to protect evidence-based care while respecting the woman’s autonomy and recognising the newborn as a subject of rights. It also explores the role of professionals, doulas and institutions when external interventions may disrupt a stable physiological process.
This workshop is licensed under Creative Commons Attribution–NoDerivatives 4.0 International (CC BY-ND 4.0). You may share the material unchanged, provided proper attribution is given. Sharing adapted material is not permitted without the creators’ explicit permission. Authors (attribution required): Mirjam Lukasse and Enid Leren Myhre (University of South-Eastern Norway)
Table of contents
Context
A healthy woman gives birth vaginally at term without complications. Immediately after birth, the newborn is placed skin-to-skin with the mother. Both are clinically stable, and breastfeeding begins spontaneously.
The institution has an in-house doula, whose role is to accompany the process and actively safeguard uninterrupted skin-to-skin contact during the first hour, in line with institutional protocols and scientific evidence.
Approximately 20 minutes after birth, the mother remains quiet, connected with her baby. She does not express discomfort or request any change. The doula stays nearby, attentively observing the process without intervening.
At that moment, a staff nurse, known for intervening in a similar way in other situations, approaches and says aloud:
“Mommy, if you’re uncomfortable, it might be better to take the baby off you. Respectful birth is not only about the baby, it also has to respect the woman.”
Until then, the woman had not expressed any discomfort. The comment introduces the idea that skin-to-skin contact might be burdensome or something she needs to endure.
The nurse suggests interrupting skin-to-skin contact in order to weigh and measure the newborn and to continue later.
The doula perceives that a physiological process is being interrupted by an external interpretation and feels her institutional role is being undermined.
The professional responsible for the mother–baby dyad observes the situation and must decide how to intervene.
Central moral question
How should professionals act when a colleague invokes the language of “respect” to interrupt a physiological process that the woman herself had not questioned, and who holds the ethical responsibility to safeguard that process?
Ethical framing note: the newborn as a subject of rights
This case also invites reflection on the newborn as a subject of rights.
Uninterrupted skin-to-skin contact is not only a matter of maternal comfort or professional preference, but a fundamental component of the newborn’s right to protection, regulation, and early bonding.
Ethical deliberation therefore involves balancing respect for the woman’s autonomy with the newborn’s right to care that supports physiological and emotional integrity from the very first moments of life.
Contextual note
It is important to consider that this case takes place in a public hospital in South America, where uninterrupted skin-to-skin contact is not yet a standard or universally established practice. In many settings, protecting skin-to-skin requires active advocacy by individual professionals and is often in tension with long-standing routines, workload pressures, and biomedical priorities.
This context shapes both the frequency of such dilemmas and the ethical weight of the decisions involved.
Ethical tensions involved
- Physiological process vs discursive intervention
- Respect for women vs inducing a need that was not expressed
- Institutional role of the doula vs informal authority of other professionals
- Language of respectful care vs deep understanding of care processes
- Protection of bonding vs routine practices framed as respectful
Possible courses of action (MCD action table)
A. Accept the nurse’s intervention
- Description: Skin-to-skin contact is interrupted to carry out routine procedures.
- Values supported: Apparent respect for the woman, team harmony
- Values at risk: Evidence-based care, physiological process, institutional role of the doula
- Possible consequences: Normalises third-party reinterpretation of care without an expressed need from the woman.
B. Actively protect uninterrupted skin-to-skin contact
- Description: The professional explains that no discomfort was expressed and safeguards the process.
- Values supported: Evidence-based care, bonding, professional integrity
- Values at risk: Interpersonal tension, conflict with the nurse
- Possible consequences: Preserves the process but may generate team friction.
C. Redirect the question to the woman
- Description: The woman is gently asked what she needs at that moment.
- Values supported: Autonomy, active listening
- Values at risk: Introducing doubt into a stable situation
- Possible consequences: May empower the woman, but can also create unnecessary uncertainty.
D. Explicitly reinforce the doula’s institutional role
- Description: The doula’s role as guardian of the process is clearly acknowledged within the team.
- Values supported: Institutional coherence, interdisciplinary respect.
- Values at risk: Defensive reactions from other professionals.
- Possible consequences: Strengthens the care framework but requires institutional backing.
E. Do not intervene
- Description: The situation is allowed to unfold without positioning.
- Values supported: Conflict avoidance
- Values at risk: Ethical responsibility, protection of care
- Possible consequences: Leaves the process vulnerable to external interpretations.
Guiding questions for deliberation
- Can the language of “respect” itself become a form of inappropriate intervention?
- What responsibility does a professional have when introducing a need the woman did not express?
- Who safeguards the physiological process when multiple care figures are present?
- How can women be protected without inducing discomfort or doubt?
- What institutional support is needed to sustain respectful, evidence-based practices?
Project IPOV RESPECTFULCARE has received funding from the European Union’s HORIZON-MSCA-2022-Staff Exchange programme. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Research Executive Agency (REA). Neither the European Union nor the granting authority can be held responsible for them.