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ArticleActa obstetricia et gynecologica Scandinavica2025

Moral distress among maternity and neonatal healthcare workers during the COVID-19 pandemic in Sweden: Results from the COPE staff longitudinal cohort study.

Patricia Ernst, Karolina Linden, Marta Roczniewska, Emina Hadzibajramovic, Anna Wessberg, Ola Andersson, Ylva Carlsson, Sofie Graner, Maria Jonsson, Malin Veje and 2 more

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In one paragraph

Article in Acta obstetricia et gynecologica Scandinavica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Factors influencing turnover intention among midwives: a systematic review.Archives of public health = Archives belges de sante publique · 2026
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Patricia ErnstInstitute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0009-0009-9097-2500
Karolina LindenInstitute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-2792-3142
Marta RoczniewskaProcome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.ORCID https://orcid.org/0000-0003-0815-1455
Emina HadzibajramovicSchool of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Anna WessbergInstitute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0000-0001-8457-9651
Ola AnderssonDepartment of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden.ORCID https://orcid.org/0000-0002-3972-0457
Ylva CarlssonRegion Västra Götaland, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-1414-7279
Sofie GranerDepartment of Medicine, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden.ORCID https://orcid.org/0000-0003-1355-9973
Maria JonssonDepartment of Women's and Children's Health, Uppsala University, Uppsala, Sweden.ORCID https://orcid.org/0000-0002-2657-1958
Malin VejeDepartment of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Verena SengpielRegion Västra Götaland, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-3608-7430
Magnus AkerstromSchool of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-8469-6193

Funding

Forskningsrådet om Hälsa, Arbetsliv och Välfärd 2022-00187Svenska Forskningsrådet Formas 2020-02767The Swedish state under the ALF agreement between the Swedish government and the county councils KL ALFGBG-1006131The Swedish state under the ALF agreement between the Swedish government and the county councils VS ALFGBG-970689
6 · The paper itself

Abstract

introductionMoral distress arises when healthcare workers face difficult decisions without adequate information and/or when patient care is compromised due to limited resources, communication issues, or altered work routines in exceptional circumstances. While moral distress in maternity and neonatal healthcare workers (MNHCWs) has been noted, its prevalence, intensity, and impact on well-being and turnover in Sweden remain unexplored. The aim of this study was to investigate the level of disturbance and frequency of experiencing moral distress among Swedish MNHCWs during the COVID-19 pandemic and the effects on MNHCWs' well-being and intention to leave their job. MATERIAL AND

methodsA longitudinal cohort study was conducted during January-May 2021 (n = 645) and January-March 2022 (n = 503), utilizing the Moral Distress Scale-Revised (MDS-R). The study was set in hospital-based maternity and neonatal units across all 21 Swedish healthcare regions and included midwives, physicians, registered nurses, and assistant nurses. Quantitative and descriptive analyses were performed, with comparisons of moral distress levels between time points and professions. The main outcome measures were moral distress (level of disturbance and frequency) and intention to leave their job.

resultsAmong the respondents, 6%-47% reported being frequently exposed to morally challenging situations, and 51%-91% reported a high level of disturbance in connection to such situations. Uncertain staffing, continuity-of-care challenges, and limited opportunities for patient/family counseling posed frequent moral challenges across time and professions. Of the respondents, 14% in 2021 and 18% in 2022 considered leaving their jobs due to moral distress. There were no overall significant differences in outcomes between the two time points.

conclusionsSwedish MNHCWs commonly experienced moral distress during the COVID-19 pandemic. Interventions targeting underlying reasons may be needed to ensure the well-being of MNHCWs in situations when the healthcare system is under strained working conditions.

Indexed as

COVID-19Health PersonnelMoralsAdultEthical DilemmasFemaleHumansInfant, NewbornLongitudinal StudiesMaleMiddle AgedSARS-CoV-2SwedenCOVID‐19 pandemichealthcare workersmaternity healthcaremoral distressneonatal healthcareSweden

Identifiers

PMID40247755
PMCPMC12144571

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.