Novel solutions to the midwifery retention crisis in England: an organisational case study of midwives' intentions to leave the profession and the role of retention midwives.

PROBLEM/BACKGROUND: Midwifery retention is a global issue, but less is known regarding what motivates midwives' intention to stay or leave within individual organisations. In 2021, NHS England funded maternity organisations to employ retention midwives. To date, the impact of these roles has not been evaluated. AIM: To explore the views of midwives regarding their intentions to leave or stay within one English organisation and to provide insights into the perceived impact of the role of retention midwives. METHODS: An instrumental case study was carried out in one organisation. Data a mixed methods survey (n=67/91) and interview data (n=7). Quantitative data was analysed using descriptive and inferential statistics; qualitative data using thematic analysis. All data was synthesised together. FINDINGS: The three themes included 'Values-based tensions: The eroding role of the midwife'; 'Discerning differences: Intentions to leave or stay'; 'Retention midwives: Activities and impact'. DISCUSSION: We found that there was a clear link between midwives' intention to leave or stay and their workplace roles; specialist midwives were more likely to stay, report satisfaction, autonomy, and feel a sense of contribution or effectiveness in their role compared to those in other roles. The retention midwives were making a positive difference to midwives' experience of the workplace. CONCLUSION: Midwives working within the same organisation have different experiences of their role and job satisfaction. Future work should consider applying the positive elements of the specialist roles to the wider midwifery workforce to enhance retention. The retention midwife role shows promise, but further evaluation is required.

Enhancing the competencies of obstetrical nurses and midwives in high-risk pregnancy management through simulation-based training in Lao people's democratic republic: A pilot study.

BACKGROUND: Simulation-based training has been widely used as a valuable strategy for learning and evaluating clinical skills at different levels of nursing and midwifery education. The impact of simulation training on intensive management for high-risk pregnancy in a low-resource setting has been limited. AIM: To examine the effect of simulation-based training with low-fidelity mannequins on obstetrical nurses and midwives' knowledge, attitude, and skills for high-risk pregnancy management in a low-resource setting. METHOD: During September 2023, twenty-five obstetrical nurses or midwives who worked in five tertiary public hospitals in Vientiane Prefecture participated in the three-day training workshops for intensive management in high-risk pregnant women and newborns that used a simulation-based training approach integrating problem-based learning. The evaluated criteria of knowledge, attitudes, and skills pre- and post-test scores were statistically compared. FINDINGS: Workshop trainees demonstrated an increase significantly in knowledge for high-risk pregnancy management (p = 0.012), attitude toward high-risk pregnancy management (p = 0.000), and attitude toward simulation-based training design (p = 0.002). The clinical skills were used on the simulation performance checklist, and the pre-posttest gain in overall performance scores had a statistically significant difference (p = 0.000). The mean score of postpartum hemorrhage management skills was 11.48±2.23, which increased the highest score among all skills. CONCLUSIONS: The simulation-based training in high-risk pregnancy management improves the knowledge, attitude, and skills of nurses and midwives in low-resource settings. Next steps include direct observation of trainees in the clinical setting to assess their competence in ensuring patient safety, achieving positive pregnancy outcomes, and enhancing satisfaction.

Experiences of workplace conflicts by midwives and implications for their wellbeing in selected hospitals in the Northern Region of Ghana.

AIM: Conflicts are ubiquitous in human societies and manifest in varied forms and scales within societies, communities and organisations. While many studies have investigated workplace conflicts, least attention has been paid to how midwives differently experience these conflicts and the impacts of these conflicts on their wellbeing. This study fills this gap by investigating the multifaceted impact of workplace conflicts on the wellbeing of midwives. METHOD: The study employed a purely qualitative approach within the analytical framework of the Stress Theory of organisational conflicts. Thirty-five participants were selected for the study through an expert purposive sampling technique. Interviews and Focus Group Discussions were used to collect primary data for the study. Collected data were analysed using an inductive thematic analytical technique. RESULTS: The findings highlight the multifaceted impact of conflict on both the professional and personal well-being of midwives. Conflicts induce severe physical and psychological strains on midwives, generate fears, angst, and anxieties, and disrupt social harmony prompting exclusion and discrimination among midwives in the hospital. CONCLUSION: We argue that apart from task-demand generated stress, workplace conflicts prompt both physical and psychological stress on midwives which culminate into a myriad of physical, emotional, and mental health issues. IMPLICATION FOR PRACTICE: Initiation of conflict resolution and mediation training programs for midwives so as to equip them with essential skills for effectively managing and resolving workplace conflicts. Setting up internal grievance mechanisms for midwives in their work places and training of midwives on social skills, and stress management skills.

Assessment of professional empowerment among midwives in selected LAC: A multisite descriptive study.

OBJECTIVE: to identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DESIGN: A quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SETTINGS: Clinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. PARTICIPANTS: A total of 1127 responses from midwives with different professional backgrounds were included in the study. FINDINGS: A total mean score of 73.28 (74.23-72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.

Job satisfaction in midwives working in labour ward: A systematic review with meta-analysis.

PROBLEM: There is little documented evidence of job satisfaction in midwives who work in birthing rooms. BACKGROUND: Job satisfaction in midwives who work in birthing rooms may have changed in recent decades due to the medicalization of maternal health. AIM: To analyse job satisfaction levels among midwives working in birthing rooms. METHODS: We searched Web of Science, SCOPUS, MEDLINE, CUIDEN and CINAHL for observational and mixed method studies. The literature search was carried out from September to October 2022. FINDINGS: A total of 13 studies were included in the systematic review. A meta-analysis of the variable "midwives' job satisfaction" was performed on 12 of the studies. Midwives rated their job satisfaction positively: DME, CI (95%) = 1.24 [0.78, 1.69]. Subgroup 1: DME, CI (95%) = 2.41 [2.05, 2.76]); Subgroup 2: DME, CI (95%) = 0.76 [0.65, 0.86]; subgroup 3: DME, CI (95%) = 1.11 [0.95, 1.27]; subgroup 4: DME, CI (95%) = 0.10 [-0.11, 0.31]. DISCUSSION: Although midwives show high levels of satisfaction, the heterogeneity of instruments, lack of specificity and limited number of studies found restrict the outcomes. CONCLUSION: There are no specific measurement instruments for assessing job satisfaction among midwives working in labour wards, so it is possible that these data do not correspond to reality as they do not take into account specific professional aspects within this field of practice.

Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review.

PROBLEM: Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises. BACKGROUND: Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances. AIM: To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care. STUDY METHODS: Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework. FINDINGS: We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice. CONCLUSION: The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Predictors of burnout among midwives working at public hospitals in northwest Ethiopia, 2022: A multi-centred study.

PROBLEM: Midwives are susceptible to burnout due to the physically and emotionally demanding nature of their job. Burnout is an occupational phenomenon with far-reaching consequences. AIM: This study aimed to assess the magnitude of burnout and predictors among midwives working at public hospitals in northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was employed to include 640 study participants. Data were collected using a self-administered questionnaire, entered into Epi-data 4.6 software, and exported to SPSS version 25 for analysis. A multivariable linear regression analysis model was fitted to identify factors contributing to midwives' burnout. FINDINGS: The overall prevalence of midwives' burnout was 55.3 % (95 % CI = 51.7-58.9). The prevalence of personal, work-related, and client-related burnout was 58.3 %, 60.3 %, and 55.5 %, respectively. Factors that were significantly associated with burnout includes workplace violence (ß = 5.02, CI: 2.90, 7.13), not receiving training (ß = 4.32 CI: 1.81, 6.80), being exposed to blood and body fluids or needle stick injuries (ß = 5.13 CI: 3.12, 7.13), low superior support (ß = 5.13 CI: 1.94, 5.30), working in tertiary hospitals (ß = 12.77 CI: 9.48, 16.06), and job rotation of six months or less (ß = 16.75, CI: 13.12, 20.39). CONCLUSION: This study found that the prevalence of burnout among midwives was significantly high. Addressing burnout requires implementing effective burnout prevention measures including enhancing management support, offering professional training, creating a conducive working environment, and adhering to standard precautions.

A greater nurse and midwife density protects against infant mortality globally.

PURPOSE: As the largest profession within the health care workforce, nurses and midwives play a critical role in the health and wellness of families especially children and infants. This study suggests those countries with higher nurse and midwife densities (NMD) had lower infant mortality rates (IMR). DESIGN AND METHODS: With affluence, low birthweight and urbanization incorporated as potential confounders, this ecological study analyzed the correlations between NMD and IMR with scatterplots, Pearson r correlation, partial correlation and multiple linear regression models. Countries were also grouped for analysing and comparing their Pearson's coefficients. RESULTS: NMD inversely and significantly correlated to IMR worldwide. This relationship remained significant independent of the confounders, economic affluence, low birthweight and urbanization. Explaining 57.19% of IMR variance, high NMD was implicated in significantly reducing the IMR. PRACTICE IMPLICATIONS: Countries with high NMD had lower IMRs both worldwide and with special regard to developing countries. This may interest healthcare policymakers, especially those from developing countries, to consider the impacts of global nursing and midwifery staffing shortages. Nurses and midwives are the group of healthcare professionals who spend most with infants and their carers. This may be another alert for the health authorities to extend nurses and midwives' practice scope for promoting infant health.

A cross-sectional survey of the mental health of midwives in Ontario, Canada: Burnout, depression, anxiety, stress, and associated factors.

PROBLEM: Burnout and the psychological co-morbidities stress, anxiety and depression have a significant impact on healthcare providers, including midwives. These conditions impact the quality of care provided to women, and midwives' ability to remain in the profession. BACKGROUND: There is growing concern regarding the retention of maternity care providers in Canada, particularly midwives. Nationally, 33% of Canadian midwives are seriously considering leaving practice; impacts of the profession on work-life-balance and mental health being commonly cited reasons. Burnout has been shown to contribute to workplace attrition, but little is known concerning burnout among Canadian midwives. AIM: To assess levels of stress, anxiety, depression, and burnout among midwives in Ontario, Canada and potential factors associated with these conditions. METHODS: A cross-sectional survey of Ontario midwives incorporating a series of well-validated tools including the Copenhagen Burnout Inventory and the Depression, Anxiety and Stress Scale. FINDINGS: Between February 5, and April 14, 2021, 275 Ontario midwives completed the survey. More than 50% of respondents reported depression, anxiety, stress, and burnout. Factors associated with poor mental health outcomes included having less than 10-years practice experience, identifying as a midwife with a disability, the inability to work off-call, and having taken a prior mental health leave. DISCUSSION & CONCLUSION: A significant proportion of Ontario midwives are experiencing high levels of stress, anxiety, depression, and burnout, which should be a serious concern for the profession, its leaders, and regulators. Investment in strategies aimed at retaining midwives that address underlying factors leading to attrition should be prioritized.

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry.

OBJECTIVES: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.