New research explores midwives' work situation and environment

Midwives report a considerably worse work environment, from several aspects, than people on the Swedish labor market in general. A stressfully high work pace, high emotional demands and low influence are among the factors involved. A new thesis at the University of Gothenburg has presented these results.

There does not appear to be a shortage of midwives in Sweden but a lack of sustainable working conditions and a sustainable working life.”

Malin Hansson, PhD, Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg

Her thesis comprises several studies. One is based on a national survey in which 2,060 midwives at various workplaces around Sweden were questioned about their working environment. The midwives’ mean aged were 48 and they had been in the profession for an average of 16 years. Only 52 percent worked full-time. Their responses, given in February–April 2020, were compared with a working Swedish reference population.

The midwives reported negative ratings, significantly worse than the reference population, for work pace, role conflicts, burnout, quantitative and emotional demands, influence, recognition, and self-rated health.

Both meaningful and stressful

The respondents also gave low ratings to what is known as “organizational justice” — that is, how employees perceive the fairness of their own organization’s behavior, decisions, and actions, and how these, in turn, affect the employees and their trust in the organization.

In some areas, midwives showed positive deviations from the reference population. The aspects concerned were the meaning of their work and its rich variety. However, maintaining a sense of meaningfulness in a strained context requires professional courage. Meaningfulness and professional courage can be seen as health-promoting protective resources that need to be strengthened, Hansson says.

“Midwives report great meaning in their work, but also a strained work situation that entails a work environment that is factory-like and over medicalized, with high demands and inadequate organizational resources and support systems.”

Changed management and governance

According to Malin Hansson, the studies in her thesis provide support for increased staffing and a strengthened professional role that requires clarification at various levels — including that of management. This would make it possible for midwives to work in a woman-centered, evidence-based way, founded on the midwife's area of ​​expertise. In addition, there is support for the model of one-to-one care.

There is also a need for more differentiated health care and more levels of care that would open up for a range of services, from home births to midwifery-led units, with highly medicalized hospital care where necessary. This would be better for the women and, at the same time, make obstetric care more likely to succeed in retaining midwives, and in attracting new graduates and those who have left the profession.

An improved work situation and better work-related health for midwives should, moreover, be cost-effective and help to provide safe, high-quality, woman-centered care in the area of sexual, reproductive, and perinatal health in Sweden, Hansson states.

"The findings in the thesis lay the foundation for health care organizations to implement the required structural changes in terms of governance, management, organization, and resource allocation, so as to influence and improve the working environment and working conditions for midwives," she concludes.

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