Cesarean Quilt · Renée Hoffman
January 15, 2026Obstetric Violence as Gender-Based Violence: what it is, how it is perceived, and how it can be addressed
January 27, 2026One-day reflection workshop on respectful maternity care using moral case deliberation (MCD)
This workshop is specifically designed for the final phase of midwifery education, when students are close to entering professional practice and can benefit from deeper ethical reflection.
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)
Workshop Goals
This workshop provides a one-day reflective learning experience using the Moral Case Deliberation (MCD) method. MCD is a structured, dialogue-based approach used in healthcare to support ethical reflection, clarify values, and strengthen respectful, woman-centred care. The method has been shown to improve midwives’ knowledge and practice regarding Respectful Maternity Care (RMC).
Based on the Moral Case Deliberation method evaluated in: Samsami, Z. M. Chananeh, F. Kamali and R. Bagherzadeh Moral case deliberation to promote reflection on respectful maternity care Nursing Ethics 2025 Vol. 32 Issue 1 Pages 222-235
By the end of the workshop, participants will be able to
• Recognise and articulate ethical dilemmas related to respectful maternity care.
• Apply the 10-step MCD model to analyse a complex moral case.
• Reflect on the values, norms, and competing perspectives involved in real-life dilemmas.
• Consider alternative courses of action and what they imply for autonomy, dignity, safety, and professional integrity.
• Develop confidence in navigating ethically challenging situations as new professionals.
• Translate insights from MCD into everyday midwifery decision-making.
Target group and group size
This workshop is designed for approximately 40 midwifery students, but the model is flexible.
Recommended group structure:
• Six groups of 6–7 students.
• Each group works through the same MCD case in parallel.
• Plenary sharing at the end allows comparison across groups.
Example case
The article by Samsami et al. provides a detailed example of a moral case suitable for use in MCD: a scenario involving a 16-year-old woman in labour who refuses a vaginal examination.
This case illustrates a wide range of ethical tensions, including autonomy, informed consent, cultural influences, fetal and maternal safety, professional responsibility, communication and trust, and power imbalances.
While this example is useful for demonstrating the depth and complexity of cases that can be explored with the MCD method, educators are encouraged to select or develop cases that reflect the specific clinical, cultural, and organisational contexts in which their students or colleagues practice.
Schedule overview
Workshop activity
09:00–09:20 — Welcome & introduction (MCD Step 1)
Format: Plenary
• Introduction to RMC, IPOV, and workshop purpose
• Explanation of the MCD method and structure
Mentimeter (pre-session):
• Word cloud: “What comes to mind when you think of ethical challenges in midwifery practice?”
• Likert: “How confident do you feel navigating ethical dilemmas?”
• Open: “What kinds of situations challenge your values as a student midwife?”
09:20–09:30 — Presentation of the MCD case (MCD Step 2)
Format: Plenary
• Facilitator introduces the case scenario
09:30–10:00 — Formulating the moral question & clarification (MCD Steps 3–4)
Format: Group work (facilitator circulating)
• Formulate the central moral question (“What is the moral dilemma?” / “What is at stake?”)
• Work through clarifying questions from the case document
• Facilitator supports accurate framing of the dilemma
10:00–10:15 — Break
10:15–11:00 — Analysing the case & exploring alternatives (MCD Steps 5–6)
Format: Group work
• Identify values, norms, and perspectives
• Generate possible actions and analyse what values each action expresses
11:00–11:15 — Break
11:15–12:00 — Individual choice & dialogical inquiry (MCD Steps 7–8)
Format: Individual work → group work
Individual reflection (write your personal moral standpoint using prompts):
• “It is morally justified that I choose option X because…”
• “Despite value/norm Y, I choose…”
• “To act according to this option, I would need…”
Group dialogue:
• Share personal standpoints
• Explore differences and similarities
• Discuss how shared values can lead to different conclusions
2:00–12:45 — Lunch
12:45–13:30 — Creation of a conclusion (MCD Step 9)
Format: Group work
• Create a shared conclusion: central values, insights, unresolved tensions
• Prepare key ethical insights for presentation
13:30–13:45 — Break
13:45–14:30 — Group presentations
Format: Plenary
• Each group presents its MCD process and key learnings
• Facilitator highlights cross-group themes: recurring values, conflicting responsibilities, ethical complexity, relevance for midwifery identity and RMC practice
14:30–14:45 — Break
14:45–15:15 — Evaluation (MCD Step 10)
Format: Plenary
• Step 10 evaluation prompts:
– “How do you evaluate the outcomes of this case?”
– “How did you experience the process?”
15:15–16:00 — Final reflection & closing of the day
Format: Plenary
• Facilitator summarises key insights from the day
• Final reflective round: “How will today’s ethical deliberation influence your transition into practice?”
Mentimeter (post-session):
• Word cloud: “What does ethical midwifery practice mean to you now?”
• Likert: “How confident do you now feel navigating ethical dilemmas?”
• Open: “Which value will guide you as a new midwife?”
Suggestions for adaptations
This workshop is designed to be adaptable to different educational settings and group sizes.
It can be adapted by modifying:
-
Case selection: Choose dilemmas relevant to local practice.
-
Group size: Groups of 3–8 students work well.
-
Mentimeter questions: Adjust them to the cultural context and desired level of reflection.
We have developed an example case inspired by interviews with Norwegian midwifery students, which we plan to use when running the workshop with midwifery students. However, we strongly encourage educators to create or adapt cases that are relevant to their own setting, taking into account local clinical practices, cultural norms, national guidelines, and the specific group of learners for whom the workshop is intended.
Case example from a Norwegian midwifery student
A primiparous woman is in the final minutes of the second stage of labour. The supervising midwife anticipates that the perineum might tear and performs an episiotomy without informing the woman or obtaining consent.
The birth proceeds smoothly, and the woman appears unaware that the procedure occurred. A midwifery student is assisting in the room. The student notices that:
-
No information or explanation was provided prior to the episiotomy.
-
No attempt was made to obtain consent.
-
The woman was not given an opportunity to participate in the decision.
-
The student feels uncomfortable but is unsure of her professional role.
After birth, the woman is transferred to the postnatal ward. During routine checks, she asks the student why she is sore and whether she tore. She does not yet know she had an episiotomy.
The student suddenly realises she must decide how to act. She understands the importance of honesty, informed consent, trust, and professional responsibility, but she is also aware of hierarchy, her own vulnerability as a trainee, and the potential consequences of raising concerns.
The student considers several possible actions
| Action | Description | Potential values expressed | Potential risks |
|---|---|---|---|
| Tell the woman that she received an episiotomy | Explain what happened, why the soreness might be present, and that the procedure was performed during birth. | Honesty; respect for autonomy; transparency. | Contradicting the supervising midwife; undermining team cohesion; unclear boundaries of student responsibility. |
| Encourage the woman to speak with the supervising midwife | Avoid disclosing the procedure directly, but gently suggest that she asks the attending midwife about the birth events. | Promoting communication; supporting the woman’s right to information. | The woman may feel dismissed, confused, or unsupported; the midwife may not disclose fully. |
| Speak privately with the supervising midwife before saying anything to the woman | Raise the concern and ask how the midwife wants the situation handled. | Professional accountability; respect for hierarchy; learning through dialogue. | The midwife may become defensive; the woman remains uninformed in the meantime. |
| Bring the issue to the clinical mentor or university supervisor | Seek guidance outside the immediate clinical team. | Safeguarding the learning environment; ethical reflection; organisational responsibility. | Escalation; potential tension between placement site and educational institution. |
| Document the situation in the reflective log without taking direct action | Choose not to intervene at this stage but use the experience for reflection, supervision, or future learning. | Self-awareness; caution; humility. | Passivity; potential complicity; continued lack of transparency for the woman. |
| Decide not to act at all | Avoid involvement to protect her own position, evaluation, and relationship with the clinical team. | Self-preservation; realism about student status. | Ethical distress; missed opportunity to advocate; undermining respectful care principles. |
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.
