Table 6 The final version of the Code of Ethics for midwives in Iran ICEM

1) In the domain of "professional Commitments", the midwife should:

1–1) know her strengths and weakness regarding the services that she provides;

1–2) increase her competencies by improving her knowledge, skills, attitude, and behavior;

1–3) be conscientious, selfless, and responsible in providing midwifery services;

1–4) know the legal and ethical responsibilities of her profession so as not to harm the quality of providing services;

1–5) provide midwifery services respecting the dignity of clients and respecting their values, religious and cultural beliefs;

1–6) consider the principles of honesty, fairness, politeness, and kindness in providing services;

1–7) takes into account the cultural differences, customs, religion, and language of the clients, and her behavior is far from any kind of discrimination;

1–8) adhere to principles such as keeping the patient's secrets, respecting privacy, respecting individual independence and informed consent;

1–9) consider the principle of non-harm and superiority of the client's interests in providing midwifery services;

1–10) provide midwifery care and services based on professional standards and updated evidence-based information;

1–11) be aware and observe the coordination in the elements of care (including prevention, diagnosis, treatment, and rehabilitation);

1–12) know the existing laws in her different dimensions of work (including educational, research, managerial, and clinical activities) and adhere to them;

1–13) make decisions within the legal, ethical, cultural, and religious frameworks and based on scientific and evidence-based information;

1–14) Play an effective role in promoting the health of women, families, and society;

1–15) Respond to the special needs of vulnerable clients such as high-risk mothers and infants, women with chronic diseases, or AIDS, or alcohol and drug addiction, victims of violence, the homeless, prisoners, refugees, immigrants, and the elderly in providing midwifery services;

1–16) Providing safe services in a safe environment is a public responsibility;

1–17) provide midwifery services under existing regulations and instructions and report accurately and completely;

1–18) provide care in a proper environment regarding light, sound, heat, cleanliness, order, safety, and cheerfulness;

1–19) be meticulous in maintaining the safety of herself, the clients, and colleagues;

1–20) take necessary precautions to prevent diseases transmitted through blood, breath, and fluids;

1–21) provide on-time services with the appropriate follow-up;

1–22) implement the doctor's written orders;

1–23) be responsible for maintaining her professional competence and her behavior does not hurt her profession;

1–24) avoid accepting credits and privileges from the client and her companions, which causes moral problems in the present and future;

1–25) Be aware of the professional responsibilities of using social media

1–26) Provide midwifery services in exceptional circumstances, such as disasters (eg. earthquakes and floods) or an epidemic or pandemic of diseases (eg. the Covid-19 pandemic)

2) In the domain of "providing midwifery services to the client and her companions", the midwife should:

2–1) introduce herself and greet the client and use an identification card that shows her name and professional role;

2–2) establish effective communication with the patient and her companion with kindness and calmness to reduce their anxiety and help meet their needs;

2–3) ask the questions in a simple, clear, and understandable way for the clients and avoid judging her responses;

2–4) consider adequate time to answer the client's questions and educate the client and her companion;

2–5) Respond to the physical, psychological, spiritual, emotional, cultural, and social needs of the clients who are seeking midwifery care;

2–6) Educate self-care to clients who seek midwifery care services

2–7) provide the necessary information and skills to the client for her participation in the care process;

2–8) develop her knowledge about the culture and language of the area for effective communication with clients and colleagues;

2–9) consider the client's information confidential and do not share it with others without her consent, except in legal cases such as those that threaten her, her family, or society, and provide the minimum information

2–10) keep the client's information confidential and endured her that the information would only be shared with the treatment or research team;

2–11) Protect the client's information in the electronic transfer processes (through information technology, e-mail, fax, and social media applications) by considering the legal aspects

2–12) provide the necessary explanation before and during the services and inform the client about the results;

2–13) inform the client about her condition in all stages of care and make her and her family feel calm and safe;

2–14) provide a simple and understandable explanation about the benefits and harms of any care services (such as prescribing contraceptives) for making an informed decision;

2–15) explain the reason for any action (such as ultrasound for fetal health assessment);

2–16) obtain permission to transfer sensitive and confidential information to the companions;

2–17) be honest in dealing with the client and her companion;

2–18) be sensitive to human dignity by considering the privacy of the client while providing midwifery services;

2–19) provide midwifery services regardless of the client's sex, age, race, position, economic status, lifestyle, culture, political beliefs, and physical abilities;

2–20) consider the principle of individual independence and get permission from the client before providing any services;

2–21) Respect the client's autonomy, preferences and beliefs in choosing or rejecting treatment;

2–22) consider the client's or her guardian's level of knowledge and culture for providing the information, obtaining the consent, and making an informed decision;

2–23) provide midwifery services based on updated information and correct and fair decisions;

2–24) provide midwifery services that benefit the client (such as timely initiation of breastfeeding);

2–25) avoid performing invasive procedures without obstetric indication for the client, such as placing shaving, enema, induction, and episiotomy;

2–26) permitting the client's companion to participate in some care procedures if the client wishes;

2–27) respect the request of the client and his companion to choose a specific person to provide some services;

2–28) respects ​​the supportive role of the client's husband and family in the perinatal period;

2–29) be patient when facing different thoughts, opinions, and behaviors;

2–30) report any case of violation of the client's rights to the relevant official;

2–31) provide the necessary recommendations and training to the patient and her companion before discharge and schedule the follow-ups

3) In the domain of "relationship with colleagues", the midwife should:

3–1) know that the atmosphere governing the medical staff located in a department (in terms of compliance with ethical standards) is effective on the clients’ care services;

3–2) collaborate with her colleagues to provide quality midwifery services so that the client's needs can be met;

3–3) communicate with her colleagues respectfully, patiently, supportively, constructively, based on trust, flexible and away from stress and conflict;

3–4) respect the knowledge, experiences, expertise, views, feelings, opinions, priorities, and performance of her colleagues and consider them as valuable resources;

3–5) accept the differences between colleagues, value them and consider the need to have relationships away from discrimination in their profession;

3–6) pay attention and emphasize the role and expertise of other professionals who provide care and support services for clients;

3–7) report any cases of non-compliance with safety, incompetence, immorality, or illegality of services, to the responsible authorities;

3–8) respect the rights of colleagues and members of other disciplines who participate in informed, appropriate and correct decision-making;

3–9) be a positive midwifery model for the students;

3–10) behave respectfully with other midwives, professors, and students (if the center is educational);

3–11) take action by consulting with other colleagues or referring to competent care centers to solve the problem, if there is a problem

4) In the domain of ​​" herself" the midwife should:

4–1) try to develop spiritual and moral principles and institutionalize them in herself;

4–2) maintain her dignity and serve with self-respect;

4–3) be aware of her rights in the system and attempts to achieve the rights through the official legal ways

4–4) be aware of the rights and rules of the midwifery profession (such as the shifts, the ratio of midwives to clients, working hours, the wage, etc.) and try to solve the challenges in this field;

4–5) be diligent about maintaining her physical-, mental-, social- and spiritual health to provide higher-quality care;

4–6) ensures the confidentiality of her personal information and which is not available to others without the legal standards

5) In the domain of "education and research", midwives should:

5–1) considering policy makers’ opinions about the midwifery services that need research and improvement;

5–2) respect the right of people to participate or not participate in any research activity and assure them that their decision will not affect their services;

5–3) try to improve student's knowledge and skills as a teacher and improve their moral and professional practice;

5–4) respect the client's rights and consider ethics when clients are involved in the education;

5–5) be aware and improve her knowledge and ethics in midwifery;

5–6) respect the right of people to participate or not participate in any student’s education process and assure them that their decision will not affect their services;

5–7) not use her professional position to convince the client to participate in the research;

5–8) apply the principles and rules of ethics in research

6) In the domain of "management", a midwife should:

6–1) monitor and evaluate the quality of midwifery care processes and structure of services based on the standard;

6–2) Promote the knowledge and practice of midwifery through research and development of midwifery care standards;

6–3) ensure specific job descriptions for providing midwifery services in her management part;

6–4) ensure the adequacy, appropriateness, and sterility of the equipment to provide services;

6–5) ensure the safety of the work environment, tools, and equipment;

6–6) review and revise the guidelines, professional and ethical standards, and retraining courses for continuous quality improvement of midwifery services;

6–7) consider adherence to ethical principles in selecting midwifery students and staff;

6–8) ensure adequacy and appropriateness of the facilities for resting the clients' companions;

6–9) attempt to meet the rights of the midwives;

6–10) plan to decrease the stresses caused by the midwifery profession based on the research;

6–11) be familiar with the client's rights in providing services