Legal Accountability in the Delegation of Authority from Obstetricians to Midwives in Maternal and Child Hospitals
Abstract
According to Law No. 4 of 2019 concerning Midwifery, midwives are recognized as part of the health workforce, alongside physicians, who are authorized to provide medical services. In practice, midwives interact directly with both patients and other healthcare professionals during service delivery. In many instances, a delegation of authority from physicians, especially specialists, to midwives is necessary to ensure effective inter-professional collaboration. This study aims to know about legal accountability in the delegation of authority from obstetricians to midwives in maternal and child hospitals. The research employed a literature review design using a comprehensive strategy. Articles were sourced from international research journal databases accessed via the internet, specifically ScienceDirect, PubMed, and Google Scholar. All searches were conducted in May-June 2025, focusing on articles published between 2016 and 2024. The keywords used in this literature review were adapted from the Medical Subject Heading (MeSH) terms, including "legal accountability,” “the delegation of authority from obstetricians to midwives,” “maternal,” and “legal and policy aspects.” A total of 265 articles were identified, with 40 articles meeting the criteria and having full-text access, and 6 articles ultimately meeting the inclusion criteria. The findings of various juridical studies reveal two major themes concerning the delegation of authority from obstetrician-gynecologists to midwives within hospital settings: (1) the limitation of delegation authority, and (2) the lack of legal responsibility from both parties involved. The legal accountability involved in the delegation of authority from an obstetrician to a midwife encompasses three domains: civil liability, criminal liability, and administrative liability.
References
Arief Fakrulloh, Z., & Lubna, L. (2023). Legal Review of Hospital Responsibility for Medical Actions Carried Out By Doctors. Jurnal Indonesia Sosial Sains, 4(12), 1237–1247. https://doi.org/10.59141/jiss.v4i12.934
Assegaf, S. G., Mathius, D., & Mansyur, M. (2023). Pertanggungjawaban Hukum Atas Pelimpahan Wewenang Dokter Spesialis Kandungan Kepada Bidan. ARMADA : Jurnal Penelitian Multidisiplin, 1(10), 1233–1240. https://doi.org/10.55681/armada.v1i10.900
Bernitz, S., Øian, P., Sandvik, L., & Blix, E. (2016). Evaluation of satisfaction with care in a midwifery unit and an obstetric unit: a randomized controlled trial of low-risk women. BMC Pregnancy and Childbirth, 16(1). https://doi.org/10.1186/s12884-016-0932-x
Damayanti, F. N., Mulyanti, L., & Poddar, S. (2023). Juridical Study of Criminal Law on Delegation of Authority of Obstetricians and Gynecologists to Midwives in Health Services. Jurnal Hukum Novelty, 14(2), 272–287. https://doi.org/10.26555/novelty.v14i2.a25748
Flaga-Gieruszyńska, K., Kożybska, M., Osman, T., Radlińska, I., Zabielska, P., Karakiewicz-Krawczyk, K., Jurczak, A., & Karakiewicz, B. (2020). Telemedicine services in the work of a doctor, dentist, nurse and midwife – analysis of legal regulations in Poland and the possibility of their implementation on the example of selected European countries. Annals of Agricultural and Environmental Medicine, 27(4), 680–688. https://doi.org/10.26444/aaem/116587
Franchuk, V. V., Myroshnychenko, M. S., Hnatjuk, M. S., Kalyniuk, N. M., Humenna, N. V., Narizhna, A. V., Franchuk, U. Ya., Hladii, O. I., & Franchuk, M. V. (2023). Implementation Of The Decision Tree Method In Expert Analysis Of The Medical Errors In Obstetric Practice. Polski Merkuriusz Lekarski, 51(2), 128–134. https://doi.org/10.36740/merkur202302104
F. Vernon, L. (2015). A Brief Overview of How Male Medicine Co-Opted the Midwife’s Role in the Birth Process. Open Journal of Nursing, 05(09), 758–764. https://doi.org/10.4236/ojn.2015.59079
Healy, S., Humphreys, E., & Kennedy, C. (2016). Midwives’ and obstetricians’ perceptions of risk and its impact on clinical practice and decision-making in labour: An integrative review. Women and Birth, 29(2), 107–116. https://doi.org/10.1016/j.wombi.2015.08.010
Homer, C. S. (2016). Models of maternity care: evidence for midwifery continuity of care. Medical Journal of Australia, 205(8), 370–374. https://doi.org/10.5694/mja16.00844
Jane, S., Hora, S., Simon, G., A., S., & D., D. (2016). Midwife-led continuity models versus other models of care for childbearing women. In C. P. and Childbirth Group (Ed.), Cochrane Database of Systematic Reviews. Wiley. https://doi.org/10.1002/14651858.cd004667.pub5
Hollander, M., & van Dillen, J. (2016). Women Refusing Standard Obstetric Care: Maternal Fetal Conflict or Doctorpatient Conflict? Journal of Pregnancy and Child Health, 03(02). https://doi.org/10.4172/2376-127x.1000251
Indar. (2017). Etikolegal dalam Pelayanan Kesehatan. Yogyakarta: Pustaka Pelajar.
Isnanto, B. (2021). Tanggung Jawab Bidan Sebagai Tenaga Kesehatan Terhadap Kerugian Pasien. https://doi.org/10.52103/JMH.V9I1.67
Jefford, E., Nolan, S. J., & Jomeen, J. (2020). Is the Concept of Midwifery Abdication Evident in Australian Case Law? A Systematic Review of Legal Literature, Court/Tribunal Decisions, and Coronial Findings. International Journal of Childbirth, 10(4), 217–233. https://doi.org/10.1891/ijcbirth-d-20-00038
Kilpatrick, S. J., Menard, M. K., Zahn, C. M., & Callaghan, W. M. (2019). Obstetric Care Consensus #9: Levels of Maternal Care. American Journal of Obstetrics and Gynecology, 221(6), B19–B30. https://doi.org/10.1016/j.ajog.2019.05.046
King, T. L. (2015). Interprofessional Collaboration: Changing the Future. Journal of Midwifery & Women’s Health, 60(2), 117–119. https://doi.org/10.1111/jmwh.12318
Lastini, Ketut, et al. (2020). "Perlindungan Hukum Profesi Bidan dalam Pelimpahan Wewenang Tindakan Medis." Mimbar Keadilan, vol. 13, no. 2.
Maillefer, F., de Labrusse, C., Cardia-Vonèche, L., Hohlfeld, P., & Stoll, B. (2015). Women and healthcare providers’ perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study. BMC Pregnancy and Childbirth, 15(1). https://doi.org/10.1186/s12884-015-0477-4
Maskawati. Muji iswanty. Andriani Misdar. (2018). Hukum Kesehatan: Dimensi Etis Dan Yuridis Tanggung Jawab Pelayanan Kesehatan. Yogyakarta: Liter.
Neilson, D. (2015). Making Home Birth Safer in the United States Through Strategic Collaboration: The Legacy Health System Experience. Birth, 42(4), 287–289. https://doi.org/10.1111/birt.1220
Pattypeilohy, A., Sutarno, S., & Adriano, A. (2018). Kekuatan Hukum Pelimpahan Wewenang Dari Dokter Kepada Ners Ditinjau Dari Aspek Pidana Dan Perdata. Jurnal Ilmiah Hukum LEGALITY, 25(2), 172. https://doi.org/10.22219/jihl.v25i2.6000
Peraturan Perundang-Undangan Kitab Undang-Undang Hukum Perdata, Burgerlijk Wetboek Tahun 2008, diterjemahkan R. Subekti dan R. Tjitrosudibio, PT Pradnya Paramita, Jakarta
Peraturan Menteri Kesehatan Republik Indonesia Nomor 1464 Tahun 2010 tentang Perizinan dan Penyelenggaraan Praktik Kebidanan
Peraturan Menteri Kesehatan Nomor 2052/MENKES/PER/X/2011 tentang Izin Praktek dan Pelaksanaan Praktik Kedokteran
P. , G., C., K., C., B., & Y., E. (2015). [Delivery by midwife in full autonomy. Literature review and analysis of 80 months of activity at the University Hospital Erasme]. Revue Medicale de Bruxelles.
Russell, K. (2018). Factors that support change in the delivery of midwifery led care in hospital settings. A review of current literature. Women and Birth, 31(2), e134–e141. https://doi.org/10.1016/j.wombi.2017.08.129
Sfregola, G., Laganà, A. S., Granese, R., Sfregola, P., Lopinto, A., & Triolo, O. (2016). Work load and management in the delivery room: changing the direction of healthcare policy. Journal of Obstetrics and Gynaecology, 1–6. https://doi.org/10.1080/01443615.2016.1229276
Setyianta, P. T. (2018). Kajian Yuridis Pelimpahan Kewenangan Dokter Umum Kepada Bidan Dalam Pelayanan Obstetri Dan Neonatal Emergensi Dasar Di Puskesmas Gandrungmangu Satu. Jurnal Idea Hukum, 4(2), 1023-1055. https://doi.org/10.20884/1.jih.2018.4.2.99
Sriram, S., Almutairi, F. M., & Albadrani, M. (2024). Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies. Journal of Clinical Medicine, 13(22), 6629. https://doi.org/10.3390/jcm13226629
Suhelianah, S., Fauziah, F., & Fitriana, M. N. F. A. A. (2022). Perlindungan Hukum terhadap Bidan yang Melakukan Penyalahgunaan Wewenang Ditinjau dari Undang-Undang Nomor 4 Tahun 2019 tentang Kebidanan (Studi Kasus di PMB Bidan R Desa Cikumbueun, Pandeglang). Yustisia Tirtayasa: Jurnal Tugas Akhir, 2(3), 172. https://doi.org/10.51825/yta.v2i3.17316
Susiswo, S., & Wulan, S. E. R. (2023). Legal Protection For Midwives Performing Medical Procedures (Case Study Of Bandung Kebonjati Hospital). Jurnal Darma Agung, 31(1), 837. https://doi.org/10.46930/ojsuda.v31i1.3133
Undang-Undang Nomor 29 Tahun 2004 tentang Praktek Kedokteran (Lembaran Negara RepublikIndonesia Tahun 2004 Nomor 116, Tambahan Lembaran Negara Republik Indonesia Nomor 443)
Undang-Undang Nomor 4 Tahun 2019 Tentang Kebidanan
Ubassandrio, D., Rabbani, R. A.-T., Wahyudin, W., Indraswari, S. P., & Harmono, H. (2024). Resolution Of Cases Of Alleged Malpractice Of Bidan In Supporting Birth In Hospitals By Penal Mediation (Case Study Of Alleged Midwife Malpractice In A Cirebon Regency Hospital). Journal of Social Science (JoSS), 3(7), 1738–1746. https://doi.org/10.57185/joss.v3i7.348
Wahyudi, S., (2011). "Tanggung Jawab Rumah Sakit terhadap Kerugian Akibat Kelalaian Tenaga Kesehatan dan Implikasinya." Jurnal Dinamika Hukum Vol 11, No. 3: 505-521.
Yang, Y. T., & Kozhimannil, K. B. (2015). Making a Case to Reduce Legal Impediments to Midwifery Practice in the United States. Women’s Health Issues, 25(4), 314–317. https://doi.org/10.1016/j.whi.2015.03.006.
Copyright (c) 2025 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
