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Research into respectful maternity care

  • Period: September 2019 to 31 August 2022
  • Status: ongoing

Researchers of the Care Ethics chair group are investigating how care ethics can contribute to respectful maternity care on the part of obstetricians. The project is funded by ZonMw through the Ethics and Health programme.  


The study is focused on developing a relational-ethical perspective on maternity care by obstetricians, where good care focuses on both mother and child and not just on the birth of a healthy child. The study uses a combination of theoretical and empirical research to study both favourable and unfavourable maternity care experiences among mothers, their partners, and obstetricians.

This project originated in the research network ‘Concerning Maternity’, set up by Joanna Wojtkowiak and Inge van Nistelrooij in 2017 to address ethical and existential issues in the context of maternity. The project has so far resulted in three conferences where various issues were explored, and in the establishment of the said research network in which researchers from several universities regularly convene to promote research into a range of aspects concerning maternity and parenthood.

Specifically regarding maternity care, there are for example questions concerning mothers’ experiences during pregnancy and childbirth. Within this area, stakeholders have been advocating ‘respectful maternity care’, in which women’s voices are heard. However, research shows that many women do not experience the maternity care provided in that way, see for instance this article (in English). It is not unusual for care centres to deny women their autonomy and to violate their dignity. This also occurs in maternity care, which actually seeks to support women during pregnancy and childbirth. The new research project concentrates on this experience. It raises questions concerning the autonomy and responsibilities of women and obstetricians during childbirth, with the goal of making these discussable within the obstetric practice from a relational care ethical perspective. 

The project premise is that respectful maternity care is hindered for lack of a suitable ethical framework regarding the approach to maternity care. Compared to for instance care for the elderly or the sick, maternity care is unique for being focused on both the pregnant woman and her foetus: thus, on two people who are inextricably connected with respect to the care provided. Within the classic bio-ethical framework, this plurality regularly leads to an opposition where the ‘rights’ of the woman and of the foetus must compete, with the foetus generally receiving priority at the expense of the childbearing woman.

This research project aims to recast this maternal-foetal ‘conflict’ as a ‘relationship’, and thereby to develop an alternative, care ethics-based relational approach to pregnancy and childbirth. Care ethics offers such a relational alternative, where conflicts are not disregarded but instead addressed from a position of shared responsibility. Counter to the individualistic approach, this approach enables a focus on shared responsibilities and on seeking what’s good for both parties (or better yet, for all stakeholders).

The project comprises both theoretical and empirical research according to the Utrecht care ethics model. Theoretical research serves to elaborate the concepts of ‘relationality’ and ‘violence’, with a view to obstetric practices. The qualitative empirical research has been designed to enable a democratic dialogue among all stakeholders (mothers, partners and obstetricians) aimed at developing practical tools to prevent avoidable injury in maternity care. The theoretical and empirical studies will be combined into a care-ethical vision on obstetric maternity care.


The project ‘CARE-study: Controversies surrounding Autonomy and Responsibility: a care-Ethical study into the mother-midwife relation’ is performed  by Rodante van der Waal, who is also pursuing a PhD programme.  Supervisors: Prof. Carlo Leget and Dr. Inge van Nistelrooij.


This project (project number 85401 1008) is funded by ZonMW through the Ethics and Health programme.


Project leader is Dr. Inge van Nistelrooij,

Researchers of the Care Ethics chair group are investigating how care ethics can contribute to respectful maternity care on the part of obstetricians.