The world needs midwives

Maternal and infant health are a global priority. Midwives are pivotal to the wellbeing of women and their babies. Indeed, there is an urgent call to upscale midwifery to stem the rates of women and babies who are injured or die in childbirth. However, in Australia, like many other high-income countries, there is another type of crisis occurring that we can no longer ignore – midwives in significant numbers are leaving the profession.

Why midwives leave

Midwives are feeling demoralised, disempowered, and overwhelmed. Some of the reasons for this are medicalisation of birth, a lack of autonomy and under-staffing. These factors are leaving midwives emotionally fragile and feeling unsupported by their managers (Catling & Rossiter, 2020; Hunter et al, 2018; Pezaro et al. 2016).

There are heartbreaking accounts of midwives responding to this blog discussing the results of the Work, Health and Emotional Lives of Midwives (WHELM) study (Hunter et al, 2018). The WHELM study surveyed the wellbeing of nearly 2000 midwives in the UK and found significant levels of emotional distress, burnout, stress, anxiety, and depression. Two thirds of participants stated that they had thought about leaving their profession in the last six months, and alarmingly, early career midwives were over-represented in those leaving (Harvie et al, 2019).

Australian research echoes findings about midwives who have left the profession (Matthews, 2021), along with similar findings about work-related distress (Creedy et al., 2017; Catling & Rossiter, 2020). A Royal College of Midwives document Why midwives leave – revisited (2016) reported that 88% of midwives who had left the profession might consider returning if there were appropriate staffing levels. Eighty percent of midwives said they would return if their workplace culture was changed for the better, although this report did not outline what a positive workplace culture was.

Positive workplace culture

We suggest the following list (although not exhaustive) highlights some important things that midwives want from maternity services:

• fully staffed ward/unit with adequate resources for staff to do their jobs;
• visible managers who provide support to their staff to excel and flourish
• support to engage in educational opportunities, support to attend conferences / seminars / complete higher degrees
• emotional support following adverse events
• timely feedback and assistance with relationships in the workplace including zero tolerance for bullying behaviour
• autonomy in practice with multi-disciplinary assistance when indicated
• opportunity to work in midwifery continuity of care

In essence, a positive workplace culture would have trust in, and collegiality with, work colleagues and knowledge that your work with women was high-quality and valuable.

How best to support midwives?

Clinical supervision is a well-known supportive strategy that has been used in many health disciplines to help promote staff professional development and health and wellbeing. Transforming Maternity Care Collaborative’s Director of Workforce, Associate Professor Christine Catling, gained a National Health and Medical Research Council investigator grant over the next 5 years to investigate whether group clinical supervision makes a difference to Australian midwives and the midwifery workplace culture.

The trial of group clinical supervision

The cluster randomised controlled trial (for maternity units in Greater Sydney) will involve 12 maternity sites (the ‘clusters’). Each cluster will be randomised to either receive the intervention (group clinical supervision) or not.

The trial will measure midwifery burnout rates (using the Copenhagen Burnout Inventory), the perceptions of their workplace culture (using the Australian Midwifery Workplace Culture tool), and intentions to leave the profession. For the intervention sites, the efficacy of the clinical supervision will be measured through using the Clinical Supervision Evaluation Questionnaire (Horton, 2008).

The results of this 5-year study are forthcoming. This year the research team will conduct a review of all available research evidence (both qualitative and quantitative) on group clinical supervision. Pending the study results, midwives and managers of maternity units could think about their workplace culture. Specifically, what they can do to build an environment where staff want to work, feel supported and feel safe.

References

Catling, C. & Rossiter, C. (2020). Midwifery workplace culture in Australia: A national survey of midwives. Women and Birth, 33(5), 464-472.

Creedy, DK., Sidebotham, M., Gamble, J., Pallant, J. & Fenwick, J. (2017). Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy and Childbirth, 17(1), 1-8.

Harvie K., Sidebotham, M. & Fenwick. J. (2019) Australian midwives’ intentions to leave the profession and the reasons why. Women and Birth, 32(6), e584-e593.

Horton S, de Lourdes Drachler M, Fuller A, de Carvalho Leite JC. (2008). Development and preliminary validation of a measure for assessing staff perspectives on the quality of clinical group supervision. International Journal of Language and Communication Disorders, 43, 126–34.

Hunter B, Henley J, Fenwick J et al. (2018). Work, Health and Emotional Lives of Midwives in the United Kingdom: The UK WHELM study. School of Healthcare Sciences, Cardiff University.

Matthews, R. (2021). Impact of stage of career on burnout and experience of work for midwives and neonatal nurses working in a tertiary service. Paper presented at the PSANZ Digital Congress.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. & Gerada, C. (2016). ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on, Women and Birth, 29(3), e59-e66.

Royal College of Midwives. (2016). Why midwives leave – revisited. RCM, London.