{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:52:18Z","timestamp":1791233538284,"version":"4.1.0"},"reference-count":52,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019580","name":"Swedish Research Council Formas","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019580","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det f\u00f6r h\u00e4lsa, arbetsliv och v\u00e4lf\u00e4rd","doi-asserted-by":"publisher","award":["KL 2022-00187"],"award-info":[{"award-number":["KL 2022-00187"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001862","name":"Svenska Forskningsr\u00e5det Formas","doi-asserted-by":"publisher","award":["KL 2020-02767"],"award-info":[{"award-number":["KL 2020-02767"]}],"id":[{"id":"10.13039\/501100001862","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Women and Birth"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.wombi.2026.102374","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T07:11:34Z","timestamp":1786605094000},"page":"102374","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding moral distress in birth unit settings \u2013 A deductive interview study based on the Theory of Collective Capacity for Emotionally Charged Work"],"prefix":"10.1016","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9097-2500","authenticated-orcid":false,"given":"Patricia","family":"Ernst","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Akerstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie \u00d8stergaard","family":"Jaspers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Wienke","family":"Christiansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma Dybdal","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Roczniewska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Linden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"14","key":"10.1016\/j.wombi.2026.102374_bib1","article-title":"Work-related burnout and its associated factors among midwives working at public hospitals in northwest Ethiopia: a multi-centered study","volume":"14","author":"Mengistie","year":"2023","journal-title":"Front. Psychiatry"},{"issue":"5","key":"10.1016\/j.wombi.2026.102374_bib2","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1038\/s41372-021-01014-9","article-title":"Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic","volume":"41","author":"Haidari","year":"2021","journal-title":"J. Perinatol."},{"issue":"12","key":"10.1016\/j.wombi.2026.102374_bib3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/15265161.2016.1239782","article-title":"A broader understanding of moral distress","volume":"16","author":"Campbell","year":"2016","journal-title":"Am. J. Bioeth."},{"issue":"7","key":"10.1016\/j.wombi.2026.102374_bib4","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1111\/aogs.15125","article-title":"Moral distress among maternity and neonatal healthcare workers during the COVID-19 pandemic in Sweden: Results from the COPE staff longitudinal cohort study","volume":"104","author":"Ernst","year":"2025","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"10.1016\/j.wombi.2026.102374_bib5","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmqr.2024.100483","article-title":"Sources of moral distress among obstetrician-gynecologists after Dobbs: a qualitative, multi-state study","volume":"6","author":"Buchbinder","year":"2024","journal-title":"SSM - Qual. Res. Health"},{"key":"10.1016\/j.wombi.2026.102374_bib6","doi-asserted-by":"crossref","DOI":"10.1016\/j.srhc.2022.100755","article-title":"Working conditions for hospital-based maternity and neonatal health care workers during extraordinary situations \u2013 A pre-\/post COVID-19 pandemic analysis and lessons learned","volume":"33","author":"Akerstrom","year":"2022","journal-title":"Sex. & Reprod. Healthc."},{"issue":"10056","key":"10.1016\/j.wombi.2026.102374_bib7","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1016\/S0140-6736(16)31472-6","article-title":"Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide","volume":"388","author":"Miller","year":"2016","journal-title":"Lancet"},{"issue":"2","key":"10.1016\/j.wombi.2026.102374_bib8","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2022.04.033","article-title":"Society for maternal-fetal medicine special statement: cognitive bias and medical error in obstetrics\u2014challenges and opportunities","volume":"227","author":"Atallah","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"10.1016\/j.wombi.2026.102374_bib9","series-title":"Nursing practice: the ethical issues","first-page":"331","author":"Jameton","year":"1984"},{"issue":"2","key":"10.1016\/j.wombi.2026.102374_bib10","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1466-769X.2011.00484.x","article-title":"Integrity at work: managing routine moral stress in professional roles","volume":"12","author":"Cribb","year":"2011","journal-title":"Nurs. Philos."},{"key":"10.1016\/j.wombi.2026.102374_bib11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1186\/s12912-023-01407-5","article-title":"The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey","volume":"22","author":"Maunder","year":"2023","journal-title":"BMC Nurs."},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib12","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1111\/jonm.12046","article-title":"Moral distress, autonomy and nurse\u2013physician collaboration among intensive care unit nurses in Italy","volume":"22","author":"Karanikola","year":"2014","journal-title":"J. Nurs. Manag."},{"issue":"5","key":"10.1016\/j.wombi.2026.102374_bib13","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1111\/jan.15966","article-title":"Nurses\u2019 experiences of moral distress and how it affects daily work in surgical care\u2014a qualitative study","volume":"80","author":"Demir","year":"2024","journal-title":"J. Adv. Nurs."},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib14","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.wombi.2021.09.006","article-title":"Exploring moral distress in Australian midwifery practice","volume":"35","author":"Foster","year":"2022","journal-title":"Women Birth"},{"key":"10.1016\/j.wombi.2026.102374_bib15","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2019.08.008","article-title":"Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors","volume":"79","author":"Hunter","year":"2019","journal-title":"Midwifery"},{"issue":"5","key":"10.1016\/j.wombi.2026.102374_bib16","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1177\/09697330241281498","article-title":"Causes of moral distress among midwives: A scoping review","volume":"32","author":"Rost","year":"2025","journal-title":"Nurs. Ethics"},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib17","doi-asserted-by":"crossref","first-page":"457","DOI":"10.4300\/JGME-D-13-00256.1","article-title":"Recognizing and alleviating moral distress among obstetrics and gynecology residents","volume":"6","author":"Aultman","year":"2014","journal-title":"J. Grad. Med. Educ."},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib18","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout","volume":"86","author":"Demerouti","year":"2001","journal-title":"J. Appl. Psychol."},{"issue":"6","key":"10.1016\/j.wombi.2026.102374_bib19","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1177\/09697330231160006","article-title":"Sub-categories of moral distress among nurses: A descriptive longitudinal study","volume":"30","author":"Morley","year":"2023","journal-title":"Nurs. Ethics"},{"issue":"7","key":"10.1016\/j.wombi.2026.102374_bib20","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1002\/pon.6148","article-title":"Moral distress and ethical climate in pediatric oncology care impact healthcare professionals\u2019 intentions to leave","volume":"32","author":"Ventovaara","year":"2023","journal-title":"Psycho Oncol"},{"issue":"9","key":"10.1016\/j.wombi.2026.102374_bib21","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual. Health Res."},{"key":"10.1016\/j.wombi.2026.102374_bib22","doi-asserted-by":"crossref","unstructured":"Jaspers S., Christiansen S.W., Andersen E.D., Martin A., Madsen I.E.H. Collective Capacity Building for Emotionally Charged Work: A grounded theory of strategies for maintaining meaning and well-being in emotionally charged work [Internet]. PsyArXiv; 2026. Available from: https:\/\/osf.io\/preprints\/psyarxiv\/kh4yb_v1 doi:10.31234\/osf.io\/kh4yb_v1.","DOI":"10.1080\/17482631.2026.2722429"},{"key":"10.1016\/j.wombi.2026.102374_bib23","unstructured":"Lingsoft. Lingsoft transcription software [Internet]. Turku, Finland: Lingsoft. Available from: https:\/\/lingsoft.ai\/."},{"issue":"13","key":"10.1016\/j.wombi.2026.102374_bib24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"10.1016\/j.wombi.2026.102374_bib25","article-title":"Nurses\u2019 moral distress and ethical climate: a systematic review and meta-analysis","volume":"9697330251350384","author":"Xue","year":"2025","journal-title":"Nurs. Ethics"},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib26","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jogn.2022.04.007","article-title":"Moral distress and burnout in NICU Nurses","volume":"51","author":"Barr","year":"2022","journal-title":"J. Obstet. Gynecol. & Neonatal Nurs."},{"key":"10.1016\/j.wombi.2026.102374_bib27","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijnurstu.2021.103984","article-title":"Interventions to mitigate moral distress: a systematic review of the literature","volume":"121","author":"Morley","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib28","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1177\/09697330211035489","article-title":"Moral distress interventions: an integrative literature review","volume":"29","author":"Amos","year":"2022","journal-title":"Nurs. Ethics"},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib29","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1086\/JCE2020313283","article-title":"Debriefing as a response to moral distress","volume":"31","author":"Morley","year":"2020","journal-title":"J. Clin. Ethics"},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib30","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/CCM.0000000000000822","article-title":"A qualitative study exploring moral distress in the ICU team: the importance of unit functionality and intrateam dynamics*","volume":"43","author":"Bruce","year":"2015","journal-title":"Crit. Care Med."},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib31","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/PCC.0000000000002189","article-title":"Moral distress of clinicians in canadian pediatric and neonatal ICUs*","volume":"21","author":"Dryden-Palmer","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"10.1016\/j.wombi.2026.102374_bib32","doi-asserted-by":"crossref","DOI":"10.1016\/j.iccn.2021.103092","article-title":"Interventions to reduce moral distress in clinicians working in intensive care: a systematic review","volume":"66","author":"Imbulana","year":"2021","journal-title":"Intensive Crit. Care Nurs."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib33","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s40501-024-00338-5","article-title":"A review of interventional and preventative studies for moral distress and moral injury among healthcare workers","volume":"12","author":"Davis-Bosch","year":"2024","journal-title":"Curr. Treat. Options Psych."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib34","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1186\/s12913-025-13239-x","article-title":"From stress to support: an ethnographic journey of a staff-led wellbeing intervention in maternity services","volume":"25","author":"Knezevic","year":"2025","journal-title":"BMC Health Serv. Res."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib35","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3390\/ijerph22010064","article-title":"Psychosocial climate as antecedent for resources to manage emotional demands at work","volume":"22","author":"Andersen","year":"2025","journal-title":"Int. J. Environ. Res. Public. Health"},{"issue":"5","key":"10.1016\/j.wombi.2026.102374_bib36","doi-asserted-by":"crossref","first-page":"670","DOI":"10.3390\/ijerph22050670","article-title":"How superiors support employees to manage emotional demands: a qualitative study","volume":"22","author":"Andersen","year":"2025","journal-title":"Int. J. Environ. Res. Public. Health"},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/0969733017724354","article-title":"What is \u2018moral distress\u2019? A narrative synthesis of the literature","volume":"26","author":"Morley","year":"2019","journal-title":"Nurs. Ethics"},{"issue":"6","key":"10.1016\/j.wombi.2026.102374_bib38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303013","article-title":"Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies","volume":"19","author":"Beadle","year":"2024","journal-title":"PLOS ONE"},{"issue":"4","key":"10.1016\/j.wombi.2026.102374_bib39","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/nop2.1221","article-title":"A cross-sectional survey of moral distress and ethical climate \u2013 Situations in paediatric oncology care that involve children\u2019s voices","volume":"9","author":"Ventovaara","year":"2022","journal-title":"Nurs. Open."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib40","doi-asserted-by":"crossref","first-page":"3895","DOI":"10.1186\/s12889-025-25085-x","article-title":"Reducing the risk of burnout in human service professions: identifying practical strategies to manage emotional demands: a mixed-methods study in Denmark","volume":"25","author":"Andersen","year":"2025","journal-title":"BMC Public. Health"},{"issue":"6","key":"10.1016\/j.wombi.2026.102374_bib41","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.wombi.2018.11.010","article-title":"Relationships between working conditions and emotional wellbeing in midwives","volume":"32","author":"Cramer","year":"2019","journal-title":"Women Birth"},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib42","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1186\/s12913-022-07852-3","article-title":"Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study","volume":"22","author":"Hansson","year":"2022","journal-title":"BMC Health Serv. Res."},{"issue":"9931","key":"10.1016\/j.wombi.2026.102374_bib43","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/S0140-6736(13)62631-8","article-title":"Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study","volume":"383","author":"Aiken","year":"2014","journal-title":"Lancet"},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib44","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1186\/s12913-024-10812-8","article-title":"The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data","volume":"24","author":"Turner","year":"2024","journal-title":"BMC Health Serv. Res."},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib45","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1348\/096317909X470690","article-title":"Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement","volume":"83","author":"Dollard","year":"2010","journal-title":"J. Occup. Organ. Psychol."},{"issue":"3","key":"10.1016\/j.wombi.2026.102374_bib46","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/PTS.0000000000000058","article-title":"The relationship between patient safety culture and patient outcomes: a systematic review","volume":"11","author":"DiCuccio","year":"2015","journal-title":"J. Patient Saf."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib47","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2022.2051222","article-title":"The midwife\u2019s role in achieving the sustainable development goals: protect and invest together - the Swedish example","volume":"15","author":"Lindgren","year":"2022","journal-title":"Glob. Health Action."},{"key":"10.1016\/j.wombi.2026.102374_bib48","doi-asserted-by":"crossref","DOI":"10.17532\/jhsci.2019.820","article-title":"Women\u2019s education and profession midwifery in Nordic countries","author":"Pajali\u0107","year":"2019","journal-title":"JHSCI"},{"issue":"10","key":"10.1016\/j.wombi.2026.102374_bib49","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1111\/aogs.14935","article-title":"Women\u2019s use of Swedish health care during the postpartum period in relation to maternal country of birth\u2014A population-based study","volume":"103","author":"Berbres","year":"2024","journal-title":"Acta Obstet. Et. Gynecol. Scand."},{"issue":"1","key":"10.1016\/j.wombi.2026.102374_bib50","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J. Adv. Nurs."},{"key":"10.1016\/j.wombi.2026.102374_bib51","series-title":"The application of content analysis in nursing science research [Internet]","year":"2020"},{"issue":"9","key":"10.1016\/j.wombi.2026.102374_bib52","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O\u2019Brien","year":"2014","journal-title":"Acad. Med."}],"container-title":["Women and Birth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1871519226002155?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1871519226002155?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:56:05Z","timestamp":1791230165000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1871519226002155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":52,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["S1871519226002155"],"URL":"https:\/\/doi.org\/10.1016\/j.wombi.2026.102374","relation":{},"ISSN":["1871-5192"],"issn-type":[{"value":"1871-5192","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Understanding moral distress in birth unit settings \u2013 A deductive interview study based on the Theory of Collective Capacity for Emotionally Charged Work","name":"articletitle","label":"Article Title"},{"value":"Women and Birth","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.wombi.2026.102374","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier Ltd on behalf of Australian College of Midwives.","name":"copyright","label":"Copyright"}],"article-number":"102374"}}