Scenario Analysis: This scenario is professionally challenging because it requires the midwife to balance immediate patient needs with established quality and safety protocols. The pressure to provide care quickly can sometimes conflict with the need for thorough documentation and adherence to established guidelines, which are crucial for patient safety and legal accountability. Careful judgment is required to ensure that expediency does not compromise the quality or safety of care provided. Correct Approach Analysis: The best professional practice involves immediately initiating the necessary emergency interventions while simultaneously ensuring that a qualified colleague is alerted to assist with documentation and to provide a second assessment. This approach ensures that the patient receives prompt, life-saving care without sacrificing the integrity of the record-keeping process, which is a fundamental requirement for quality assurance and legal protection. Adherence to established protocols for emergency situations, including the principle of having a second qualified practitioner involved in critical care and documentation, is paramount in maintaining high standards of midwifery practice and patient safety, as mandated by professional midwifery bodies and regulatory authorities in the Indo-Pacific region. Incorrect Approaches Analysis: One incorrect approach is to delay essential documentation until after the immediate crisis has fully subsided. This failure to document in a timely manner can lead to incomplete or inaccurate records, which compromises the continuity of care, hinders future clinical decision-making, and can have serious legal ramifications if the patient’s condition deteriorates or if an audit is required. It violates the principle of contemporaneous record-keeping, a cornerstone of professional accountability. Another incorrect approach is to rely solely on the midwife’s memory for all details of the emergency. While memory is important, it is fallible, especially under stress. Official documentation serves as an objective record of events, interventions, and patient responses. Failing to document contemporaneously or have a second person assist with documentation undermines the reliability of the record and can lead to misinterpretations or omissions, impacting patient safety and professional standards. A third incorrect approach is to delegate the entire documentation process to a junior or less experienced staff member without direct oversight or immediate input from the primary midwife. While teamwork is essential, the primary midwife remains ultimately responsible for the accuracy and completeness of the patient’s record, especially during a critical event. This delegation without appropriate supervision risks significant errors or omissions in the documentation, failing to meet the expected standards of care and accountability. Professional Reasoning: Professionals should employ a structured approach to critical incidents. This involves prioritizing immediate patient safety and stabilization, followed by clear communication and delegation of tasks. In this context, the decision-making process should prioritize the “assess, stabilize, document, and communicate” framework. The midwife must first assess the situation and initiate life-saving measures. Simultaneously, they should recognize the need for assistance and ensure a second qualified practitioner is involved. This second practitioner can assist with care and take on the responsibility of contemporaneous documentation, ensuring accuracy and adherence to protocols. This collaborative approach upholds both immediate patient well-being and the integrity of the professional record, aligning with best practices in quality and safety.

This scenario is professionally challenging because determining eligibility for advanced competency assessments requires a nuanced understanding of both individual professional development and the specific requirements of the assessment framework. Misinterpreting eligibility criteria can lead to wasted resources, professional frustration, and potentially compromise the integrity of the assessment process. Careful judgment is required to ensure that only those who meet the defined standards are admitted, thereby upholding the quality and safety of midwifery practice in the Indo-Pacific region. The best professional practice involves a thorough review of the candidate’s documented professional experience, including the nature and duration of their midwifery practice, any prior relevant training or certifications, and evidence of continuous professional development specifically related to advanced midwifery skills and quality improvement initiatives. This approach is correct because it directly aligns with the stated purpose of the Advanced Indo-Pacific Midwifery Quality and Safety Competency Assessment, which is to identify and validate practitioners who possess the requisite skills and knowledge to contribute to enhanced quality and safety in midwifery care. Regulatory frameworks and professional guidelines for competency assessments universally emphasize the importance of objective evidence of experience and training that directly maps to the assessment’s objectives. Ethical considerations also mandate that assessments are fair, transparent, and based on demonstrable competence, ensuring that only qualified individuals are recognized. An approach that focuses solely on the number of years a midwife has been practicing, without considering the specific types of clinical experiences, the complexity of cases managed, or evidence of engagement with quality and safety principles, is professionally unacceptable. This fails to acknowledge that not all years of practice are equivalent in developing advanced competencies. It also overlooks the core purpose of the assessment, which is not merely longevity but demonstrated proficiency in advanced areas. Another professionally unacceptable approach is to rely on informal recommendations or peer endorsements without requiring verifiable documentation of skills and experience. While collegial support is valuable, it cannot substitute for objective evidence required by a formal competency assessment. This approach risks admitting individuals who may be well-regarded but lack the specific advanced skills and knowledge the assessment aims to evaluate, thereby undermining the quality and safety objectives. A further professionally unacceptable approach is to assume that completion of any postgraduate midwifery qualification automatically confers eligibility without verifying if the qualification’s content and learning outcomes are directly relevant to the advanced quality and safety competencies being assessed. The assessment is designed to evaluate specific competencies, and a generic postgraduate degree may not cover these in sufficient depth or with the required practical application. Professionals should employ a decision-making framework that begins with a clear understanding of the assessment’s stated purpose and eligibility criteria. This involves systematically evaluating each candidate against these defined requirements, prioritizing objective evidence of relevant experience, training, and demonstrated competence in quality and safety initiatives. When in doubt, seeking clarification from the assessment body or consulting relevant professional standards is crucial to ensure fair and accurate eligibility determination.

Scenario Analysis: This scenario is professionally challenging because it requires the midwife to balance the immediate physiological needs of a neonate experiencing respiratory distress with the established protocols for neonatal resuscitation and the need for parental involvement. The rapid deterioration of the neonate’s condition necessitates swift, decisive action, while the presence of anxious parents demands sensitive communication and reassurance. Failure to act appropriately can have severe consequences for the infant, while a lack of empathy or clear communication can cause significant distress to the family. Careful judgment is required to integrate clinical assessment, intervention, and family-centered care. Correct Approach Analysis: The best professional practice involves immediately initiating the Neonatal Resuscitation Program (NRP) guidelines, which are the internationally recognized standard for managing neonatal respiratory distress. This approach prioritizes the infant’s physiological stability by ensuring adequate ventilation and oxygenation. Simultaneously, it mandates clear, concise, and empathetic communication with the parents, informing them of the situation, the interventions being performed, and the rationale behind them. This aligns with the ethical principle of beneficence (acting in the best interest of the infant) and respect for autonomy (involving parents in the care of their child). The Indo-Pacific region generally adheres to these global standards for neonatal care quality and safety. Incorrect Approaches Analysis: One incorrect approach involves delaying resuscitation to first fully explain the situation to the parents. This prioritizes parental comfort over the infant’s immediate physiological needs, potentially leading to irreversible harm due to delayed oxygenation and ventilation. This fails to uphold the principle of beneficence and contravenes established resuscitation protocols designed for rapid intervention. Another incorrect approach is to proceed with resuscitation without any communication to the parents. While swift action is crucial, complete parental exclusion is ethically problematic and can lead to significant anxiety and distrust. It disregards the parents’ right to be informed and involved in their child’s care, potentially causing emotional distress and undermining the therapeutic relationship. This fails to respect parental autonomy and can negatively impact the family’s experience. A further incorrect approach is to delegate the primary resuscitation efforts to a less experienced team member while focusing solely on parental communication. While delegation is a part of team-based care, the most critical phase of neonatal resuscitation requires the most skilled practitioner to be directly involved. This approach risks suboptimal resuscitation due to potential skill gaps and delays in critical interventions, failing to ensure the highest standard of care for the neonate. Professional Reasoning: Professionals should employ a structured approach that integrates clinical assessment, evidence-based interventions, and ethical considerations. This involves a rapid assessment of the neonate’s condition, immediate initiation of appropriate resuscitation measures as per established guidelines (like NRP), and concurrent, clear, and compassionate communication with the parents. The decision-making process should prioritize the infant’s immediate physiological needs while ensuring the family is kept informed and supported throughout the event. This balanced approach ensures both optimal clinical outcomes and ethical care delivery.

The control framework reveals a critical juncture in maintaining the integrity and fairness of the Advanced Indo-Pacific Midwifery Quality and Safety Competency Assessment. The scenario presents a challenge because it requires balancing the need for consistent quality assurance with the individual circumstances of a candidate who has failed to meet the required standard. The professional challenge lies in upholding the assessment’s rigor and the public trust it represents, while also providing a fair and supportive pathway for professional development. Careful judgment is required to ensure that any deviation from standard policy is ethically sound, transparent, and does not compromise the overall competency standards. The best approach involves a thorough review of the candidate’s performance against the established blueprint weighting and scoring criteria, followed by a clear communication of the reasons for failure and the available retake options as outlined in the program’s official retake policy. This approach is correct because it adheres strictly to the documented assessment framework, ensuring objectivity and consistency. The blueprint weighting and scoring are the foundational elements of the assessment, defining what constitutes competency. The retake policy, when followed, provides a transparent and equitable process for candidates to demonstrate mastery after initial failure. This upholds the principles of fairness and due process, while also reinforcing the importance of achieving the defined quality and safety standards. An approach that bypasses the established retake policy to offer an immediate, informal re-assessment based on the assessor’s personal judgment is professionally unacceptable. This fails to adhere to the documented blueprint weighting and scoring, introducing subjectivity and potentially compromising the validity of the assessment. It undermines the established quality assurance mechanisms and creates an inequitable situation for other candidates. Furthermore, it risks setting a precedent that could erode the credibility of the entire competency assessment program. Another unacceptable approach is to simply deny any opportunity for a retake without a clear, documented justification based on the established retake policy. This is ethically problematic as it fails to provide a reasonable pathway for a candidate to demonstrate competency, especially if the initial failure was due to factors not directly related to their core midwifery knowledge or skills. It also fails to uphold the principle of supporting professional development, which is often an implicit goal of such assessments. Finally, an approach that involves altering the blueprint weighting or scoring for a specific candidate to allow them to pass is fundamentally flawed. This directly violates the integrity of the assessment framework. The blueprint weighting and scoring are designed to be objective measures of competency. Any alteration for an individual candidate introduces bias, invalidates the assessment results, and is a serious breach of professional ethics and regulatory compliance. It compromises the reliability and validity of the entire assessment process. Professionals should approach such situations by first consulting the official assessment blueprint, scoring rubrics, and retake policy. They should then objectively evaluate the candidate’s performance against these documented standards. If a candidate fails, the next step is to clearly communicate the specific areas of deficiency, referencing the blueprint and scoring. The available retake options, as per policy, should then be explained. Any consideration for exceptions or alternative pathways must be rigorously justified against the program’s overarching quality and safety objectives and documented transparently, ideally with oversight from a designated assessment committee or governing body.

Scenario Analysis: This scenario presents a significant professional challenge due to the inherent tension between the immediate need to address a critical safety concern and the established protocols for reporting and escalation. Midwives are entrusted with the direct care of vulnerable individuals, making timely and accurate communication paramount. However, they also operate within a structured healthcare system that relies on defined reporting lines and evidence-based decision-making to ensure patient safety and maintain accountability. The challenge lies in balancing the urgency of the situation with the requirement for due process and collaborative problem-solving. Correct Approach Analysis: The best professional practice involves immediately documenting the observed deviation from standard care and its potential impact on patient safety, followed by a direct, respectful, and evidence-based discussion with the supervising senior midwife. This approach prioritizes patient well-being by ensuring the concern is addressed promptly by the most appropriate senior clinician. It aligns with ethical principles of beneficence and non-maleficence, as well as professional guidelines that emphasize clear communication and escalation of concerns within the healthcare team. Regulatory frameworks often mandate reporting of adverse events and near misses, and this direct communication facilitates timely identification and management of potential risks, thereby upholding quality and safety standards. Incorrect Approaches Analysis: Initiating a formal written complaint to the hospital administration without first attempting to discuss the issue with the supervising senior midwife is procedurally premature and potentially damaging to professional relationships. While formal complaints are a necessary mechanism for addressing serious breaches, bypassing the immediate supervisory chain can be seen as undermining collegiality and the established pathways for resolving clinical issues. This approach fails to leverage the immediate expertise and authority of the senior midwife to rectify the situation, potentially delaying necessary interventions. Directly reporting the perceived substandard care to the patient’s family without first discussing it with the supervising senior midwife is a significant breach of professional ethics and patient confidentiality. While transparency with families is important, it must be managed through appropriate channels and with the consent and involvement of the clinical team. This action could erode trust within the healthcare team, create unnecessary anxiety for the patient and family, and bypass established protocols for communication and resolution of clinical concerns. It also risks misrepresenting the situation before a full understanding and appropriate response have been formulated by the senior clinical staff. Ignoring the observed deviation from standard care due to a desire to avoid conflict or potential repercussions is ethically indefensible and a direct failure to uphold the duty of care. This passive approach prioritizes personal comfort over patient safety, violating the fundamental principles of midwifery practice. It also contravenes regulatory requirements that mandate reporting of concerns that could impact patient outcomes, and it fails to contribute to the continuous improvement of quality and safety within the maternity service. Professional Reasoning: Professionals should employ a structured decision-making process when encountering potential quality and safety issues. This typically involves: 1. Immediate assessment of the risk to the patient. 2. Documentation of observations and potential impacts. 3. Direct, respectful communication with the immediate supervisor or senior clinician, presenting the concern with supporting evidence. 4. Collaborative problem-solving and agreement on a course of action. 5. Escalation through formal channels if the issue is not adequately addressed at the supervisory level. This process ensures that patient safety is prioritized while maintaining professional integrity and adherence to established healthcare governance.

The assessment process reveals a scenario that is professionally challenging due to the inherent complexities of integrating diverse cultural practices into established midwifery quality and safety frameworks within a community setting. The need to balance universal safety standards with culturally sensitive care requires nuanced judgment and a deep understanding of both regulatory requirements and community values. Careful consideration is needed to ensure that quality and safety are not compromised while respecting the autonomy and cultural identity of individuals and families. The best approach involves actively engaging community elders and leaders in the co-design and ongoing evaluation of continuity of care models. This collaborative strategy ensures that the models are not only clinically sound but also culturally appropriate and acceptable to the community. Regulatory frameworks, such as those emphasizing patient-centered care and cultural competency, support this inclusive methodology. Ethical principles of respect for autonomy, beneficence, and justice are upheld by ensuring that care delivery is informed by the lived experiences and cultural perspectives of the community being served. This fosters trust and improves engagement, ultimately enhancing the quality and safety of midwifery care. An approach that prioritizes the immediate implementation of standardized, Western-based continuity models without significant community consultation fails to acknowledge the importance of cultural safety. This can lead to mistrust, reduced uptake of services, and potentially unsafe practices if the implemented models do not align with community norms or understanding of health and well-being. Ethically, this approach violates the principle of respect for autonomy by imposing external models without genuine consent or co-creation. Another unacceptable approach is to delegate all cultural considerations to individual midwives without providing them with adequate training, resources, or institutional support. While individual midwives may strive for cultural sensitivity, this ad-hoc method lacks the systemic rigor required to ensure consistent quality and safety across the service. It places an undue burden on individual practitioners and risks creating disparities in care based on the personal capacity of each midwife, rather than on a robust, organization-wide commitment to cultural safety as mandated by quality and safety standards. A further professionally unacceptable approach is to view cultural safety as a secondary consideration, addressed only after clinical protocols are established. This hierarchical approach risks embedding cultural insensitivity into the core design of services. Quality and safety are intrinsically linked to the cultural appropriateness of care; ignoring this connection from the outset undermines the effectiveness and ethical standing of the entire care model. Professionals should employ a decision-making framework that begins with a thorough understanding of the specific cultural context and community needs. This involves active listening, building relationships with community stakeholders, and integrating their perspectives into the design and evaluation of care models. Regulatory guidelines and ethical principles should serve as a foundation, but their application must be adapted and informed by cultural intelligence and a commitment to genuine partnership. Continuous reflection and adaptation based on community feedback are essential for ensuring that quality and safety are achieved in a culturally safe and effective manner.

The performance metrics show a concerning trend in neonatal sepsis rates within a specific maternity unit. This scenario is professionally challenging because it directly impacts patient safety and requires a nuanced understanding of quality improvement processes within the context of midwifery practice. The pressure to reduce rates must be balanced with ensuring evidence-based interventions are implemented ethically and effectively, without compromising patient care or staff well-being. Careful judgment is required to identify the root causes and implement sustainable solutions. The best approach involves a comprehensive, multi-disciplinary review of existing protocols and practices related to neonatal sepsis prevention and management. This includes analyzing current documentation, staff training, and direct observation of care delivery. The justification for this approach lies in its adherence to the principles of continuous quality improvement, which are fundamental to maintaining high standards of care. Specifically, it aligns with the ethical imperative to provide safe and effective midwifery care, as mandated by professional midwifery standards and regulatory bodies that emphasize evidence-based practice and a commitment to patient outcomes. This systematic review allows for the identification of specific gaps or deviations from best practice, enabling targeted interventions. An approach that focuses solely on increasing the frequency of antibiotic administration without a thorough investigation into the underlying causes of the sepsis rates is professionally unacceptable. This would represent a failure to adhere to evidence-based guidelines, which advocate for judicious antibiotic use and emphasize the importance of identifying and addressing risk factors rather than simply treating symptoms. Such an approach could lead to antibiotic resistance and adverse drug reactions, directly contravening the duty of care. Another unacceptable approach would be to implement a blanket policy of increased surveillance for all newborns, regardless of individual risk factors. This is inefficient, potentially distressing for families, and diverts resources from more targeted interventions. It fails to acknowledge the principle of individualized care and the importance of risk stratification, which are core tenets of safe midwifery practice. Finally, an approach that involves blaming individual practitioners without a systemic review is ethically and professionally unsound. This ignores the complex interplay of factors that can contribute to adverse outcomes and undermines team morale and collaborative problem-solving. It is contrary to the principles of a just culture, which encourages reporting and learning from errors and near misses. The professional reasoning process for navigating such a situation should involve: 1) Acknowledging the performance data and its implications for patient safety. 2) Initiating a collaborative, evidence-based investigation into the root causes, involving all relevant stakeholders. 3) Developing and implementing targeted interventions based on the findings of the investigation. 4) Continuously monitoring the effectiveness of interventions and making adjustments as needed. 5) Fostering a culture of open communication and continuous learning.

Scenario Analysis: This scenario presents a significant professional challenge due to the rapid deterioration of a fetal condition during a planned induction, coupled with the patient’s expressed wishes and the potential for differing clinical opinions among the midwifery team. The core tension lies in balancing the immediate need for urgent intervention to ensure fetal well-being against respecting the patient’s autonomy and established birth preferences, all within the context of a high-stakes obstetric emergency. The need for swift, coordinated action while maintaining clear communication and ethical adherence is paramount. Correct Approach Analysis: The best professional practice involves immediate escalation of care and a collaborative discussion with the obstetric team to determine the most appropriate and timely intervention for fetal distress. This approach prioritizes fetal safety by acknowledging the urgency of the situation and leveraging the expertise of the wider multidisciplinary team. It aligns with the principles of shared decision-making, where the patient’s wishes are considered alongside clinical necessity and evidence-based practice. Regulatory frameworks governing midwifery practice in the Indo-Pacific region emphasize the duty of care to both mother and fetus, requiring midwives to act decisively in emergencies and to involve senior medical staff when fetal well-being is compromised. Ethical guidelines underscore the importance of beneficence (acting in the best interest of the patient and fetus) and non-maleficence (avoiding harm). Incorrect Approaches Analysis: One incorrect approach would be to delay informing the obstetric team, continuing with the induction protocol without immediate obstetric consultation, and solely relying on the midwifery team’s assessment. This fails to acknowledge the severity of the fetal heart rate changes, potentially delaying life-saving interventions and violating the duty of care to the fetus. It also disregards the principle of seeking expert opinion when faced with a critical situation beyond the immediate scope of midwifery management. Another incorrect approach would be to proceed directly to an emergency caesarean section without a thorough discussion with the obstetric team and confirmation of the need for such an urgent intervention. While caesarean section might ultimately be necessary, bypassing the collaborative decision-making process and the obstetric team’s assessment can lead to unnecessary surgical intervention, potential risks to the mother, and may not be the most appropriate immediate course of action based on the full clinical picture. This approach undermines the multidisciplinary nature of obstetric care and the established protocols for managing fetal distress. A further incorrect approach would be to solely focus on the patient’s initial birth plan and attempt to manage the fetal distress within the confines of that plan, without adequately considering the emergent fetal compromise. While respecting patient autonomy is crucial, it does not extend to allowing a situation to worsen if it directly endangers the fetus. This approach fails to uphold the midwife’s primary responsibility for fetal safety when faced with clear signs of distress. Professional Reasoning: Professionals should employ a structured approach to obstetric emergencies. This involves: 1. Rapid assessment of maternal and fetal status. 2. Recognition of critical signs (e.g., abnormal fetal heart rate patterns). 3. Immediate communication and escalation to the obstetric team. 4. Collaborative decision-making regarding the most appropriate intervention, considering fetal well-being, maternal condition, and patient preferences. 5. Clear documentation of all assessments, communications, and interventions. This systematic process ensures that patient safety and ethical principles are upheld in high-pressure situations.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between a midwife’s personal learning needs and the immediate demands of patient care, especially within the context of a high-stakes competency assessment. The pressure to perform well on the assessment can lead to a desire to prioritize personal preparation over immediate clinical responsibilities, creating an ethical dilemma. Careful judgment is required to balance professional development with the non-negotiable duty of care to patients. Correct Approach Analysis: The best professional practice involves a proactive and integrated approach to preparation. This means identifying necessary learning resources and developing a realistic timeline that accommodates both personal study and ongoing clinical duties. This approach is correct because it aligns with the ethical principles of beneficence (acting in the best interest of patients by ensuring competent care) and non-maleficence (avoiding harm by being adequately prepared). It also reflects professional accountability, acknowledging that preparation for assessment is a personal responsibility that should not compromise patient safety or the quality of care provided during the preparation period. Regulatory frameworks for midwifery competency assessments, such as those overseen by professional bodies in the Indo-Pacific region, emphasize continuous professional development and the maintenance of high standards of practice, which this integrated approach supports. Incorrect Approaches Analysis: Prioritizing intensive personal study immediately before the assessment, to the detriment of current patient care responsibilities, is professionally unacceptable. This approach fails to uphold the midwife’s primary duty of care, potentially compromising patient safety and the quality of care provided during that critical period. It also demonstrates a lack of professional responsibility in managing one’s workload and learning commitments. Another unacceptable approach is relying solely on informal discussions with colleagues without consulting official preparation materials or seeking structured guidance. This can lead to incomplete or inaccurate understanding of assessment requirements and may not cover the breadth of knowledge and skills assessed, thus failing to ensure adequate preparation and potentially leading to underperformance. Finally, delaying preparation until the last possible moment, driven by procrastination or underestimation of the assessment’s demands, is also professionally unsound. This often results in rushed, superficial learning, increased stress, and a higher likelihood of missing crucial information, ultimately failing to meet the expected competency standards and potentially impacting patient care. Professional Reasoning: Professionals facing similar situations should employ a structured decision-making process. First, clearly identify the competing demands: patient care responsibilities and assessment preparation. Second, consult official guidelines and resources for the competency assessment to understand the scope and expected level of knowledge. Third, realistically assess current workload and available time. Fourth, develop a phased preparation plan that integrates study with clinical duties, prioritizing essential learning and allocating sufficient time for each component. Fifth, seek clarification or support from supervisors or assessment bodies if challenges arise in balancing these demands. This systematic approach ensures that both patient care and professional development are adequately addressed, upholding ethical obligations and professional standards.

This scenario presents a professional challenge rooted in the inherent tension between patient autonomy, the duty of care, and the principles of evidence-based practice within the context of quality and safety standards. Midwives are tasked with upholding the highest standards of care while respecting individual choices, even when those choices deviate from established best practices. The pressure to conform to institutional protocols versus the imperative to provide individualized, culturally sensitive care creates a complex ethical landscape. Careful judgment is required to navigate these competing demands without compromising patient well-being or professional integrity. The best approach involves a comprehensive, patient-centered discussion that prioritizes informed consent and shared decision-making. This entails clearly explaining the evidence-based recommendations for routine antenatal screening, detailing the benefits and risks associated with each test, and respectfully addressing the patient’s concerns and reasons for refusal. The midwife must then document this discussion thoroughly, including the patient’s informed decision and the rationale provided. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest by providing information), non-maleficence (avoiding harm by respecting autonomy), and respect for autonomy (honoring the patient’s right to make decisions about their own healthcare). It also adheres to quality and safety frameworks that emphasize patient engagement and informed consent as cornerstones of safe and effective care. An approach that involves overriding the patient’s wishes and proceeding with screening without explicit consent is ethically unacceptable. This constitutes a violation of patient autonomy and potentially battery, as it infringes upon the patient’s right to bodily integrity. It also fails to uphold the principle of informed consent, a critical component of quality and safety in healthcare. Another unacceptable approach is to dismiss the patient’s concerns without adequate exploration or to pressure her into accepting screening. This demonstrates a lack of respect for the patient’s values and beliefs, undermining the therapeutic relationship and potentially leading to distrust and non-compliance with other aspects of care. It fails to meet the ethical obligation to provide care that is sensitive to individual circumstances and preferences. Finally, an approach that involves simply documenting the refusal without further engagement or exploration of the underlying reasons is insufficient. While respecting the patient’s decision, it misses an opportunity to ensure the patient is fully informed and to identify any potential underlying fears or misunderstandings that could be addressed. This passive approach may not fully meet the midwife’s duty of care to ensure the patient has made a truly informed decision. Professional decision-making in such situations should follow a framework that begins with active listening and empathetic engagement to understand the patient’s perspective. This is followed by clear, evidence-based communication of recommended care, tailored to the patient’s understanding. Crucially, the process must involve a thorough exploration of the patient’s values, beliefs, and concerns, facilitating a shared decision-making process. Documentation of the entire process, including the patient’s informed decision and the rationale, is paramount for accountability and continuity of care.