Five reasons why midwives stay in the job

Five factors are cited as crucial for midwives' job satisfaction. They include possibilities for development, role conflict resolution, and burnout avoidance, as a University of Gothenburg study shows.

The study is published in BMC Health Services Research. The first author is Malin Hansson, midwife and Ph.D., of the Institute of Health and Care Sciences at the University.

Her thesis on midwives' work situations and professional roles created a big stir when it was presented last year. The findings showed that midwives report a considerably worse work environment than employees on the Swedish labor market as a whole.

Hansson's study clarifies the five factors with the very heaviest impact on midwives' job satisfaction. The factors are, both positive (possibilities for development, quality of work, recognition) and negative (role conflict and burnout).

Major health care challenges

The results are based on a national survey that asked 2,060 midwives about their work environment. They were asked to appraise variables connected to job satisfaction as such. The respondents' average age was 48, with 16 years' midwifery experience. Nearly half worked part-time.

"Today, every region in Sweden is reporting a shortage of midwives, resulting in great challenges to health care. Knowing what promotes midwives job satisfaction is a key factor in retaining midwives in the profession and attracting new ones to all midwives' areas of expertise," Hansson says.

What promoted job satisfaction was having opportunities for professional development and being able to apply their skills. It was also important for the work to be of a consistently high quality—a fundamental indicator of the organization's performance as well.

Another central factor was recognition: that the midwives' occupational expertise was put to use and they were able to conduct their work independently. Midwives estimated a lower recognition than the reference population with people from across the labor market.

Focus on variation and childbirth

Role conflicts with various expectations from different individuals were a burdensome negative factor that midwives ranked considerably higher than people in other occupational categories. Avoiding burnout was also crucial for their job satisfaction. In addition, midwives also reported a higher degree of physical and mental exhaustion than the reference population.

According to Hansson, the study supports the view that midwives' occupational role needs reinforcing and that their autonomous area of expertise requires clarification in organizations where they work. This should enable midwives to work in a woman-centered, evidence-based way, using their professional skills.

"What's required is more differentiated care provision and more levels of care that allow a broad range of services, from home births to midwife-led units and highly medicalized hospital care, depending on the needs and wishes of the individual giving birth. We need proper, timely care at the right level to achieve a balance in which we don't necessarily give everyone highly medicalized care. That's neither cost-effective nor evidence-based," Hansson concludes.