Occupational burnout and work factors in community and hospital midwives: A survey analysis

Background

community-based midwifery practice has been promoted in the UK maternity policy over the last decade as a means of increasing continuity of care. However, there have been growing concerns to suggest that the community-based continuity model may not be sustainable due to the high levels of occupational burnout in midwives resulted by increased on-call work.

Aims

this paper attempted to identify work factors associated with the levels of burnout in community midwives as compared to hospital midwives, aiming at contributing to the debate of organising sustainable midwifery care.

Methods

a statistical analysis was conducted drawing on data from a survey of all midwives working at one Hospital Trust in England (n=238). Occupational burnout was measured using the Maslach Burnout Inventory (MBI).

Results

the sample midwives (n=128, 54%) had significantly higher levels of burnout compared to the reference groups. Multiple regression analysis identified as follows: (1) high levels of occupational autonomy were a key protective factor of burnout, and more prevalent in the community, (2) working hours were positively associated with burnout, and community midwives were more likely to have higher levels of stress recognition, and (3) support for work-life-balance from the Trust had a significant protective effect on the levels of burnout.

Conclusion

the results should be taken into account in the maternity policy in order to incorporate continuity of care and sustainable organisation of midwifery care.     

A qualitative study of the Australian midwives’ approaches to Listeria education as a food-related risk during pregnancy

Objective

to explore midwives’ perceptions of food-related risks and their approaches to Listeria education during pregnancy.

Design

an exploratory design within a qualitative framework.

Setting

one private and two public hospitals in New South Wales, Australia.

Participants

10 midwives providing antenatal care in the selected hospitals.

Findings

midwives had a range of approaches, from active to passive, to Listeria education. The main education provided was focused only on some of the high Listeria-risk foods with little education on safe food-handling practices. Midwives’ perception of food-related risks was a function of their limited scientific knowledge and their reliance on their experiential knowledge and their common sense. System constraints such as temporal pressure, limited availability of educational materials and low adherence to Listeria recommendations within the health system were also identified to influence midwives’ practice.

Key Conclusions

professional practice guidelines regarding food safety and Listeria education are needed, together with relevant professional training and review of hospital practices in relation to this important health issue.     

Chinese midwives’ experience of providing continuity of care to labouring women

Objective

to explore and describe Chinese midwives’ experience of providing one-to-one continuity of care to labouring women.

Design

a qualitative study using a phenomenological approach. Data were collected using open-ended, tape-recorded interviews. The analysis of the transcribed texts included searching for themes sorted into clusters for a final expression of the essential structure of the phenomenon.

Setting

Obstetrics and gynaecology hospital of Fudan University, Shanghai, China.

Participants

12 midwives, providing one-to-one continuity of care to labouring women.

Findings

two main categories were identified: (1) midwives’ feelings on providing continuity of care, and (2) impact of on-call system on midwives providing continuity of care. Key themes emerged from each main category: (1) ‘playing important roles in labour care’, ‘gaining a sense of self-achievement’, ‘falling into exhaustion and frustration’ and ‘coping with caring work’; and (2) ‘on-call syndrome’, ‘affecting personal lives’ and ‘managing on-call shift’. The midwives experienced mixed feelings of being with women and expressed their adaptation to being on-call, which was the essence of this study. They played important roles in caring for women, gained a sense of self-achievement and developed suitable coping strategies. However, they also indicated the impact of the on-call system upon them in the process of providing continuity of care.

Conclusion and implications for practice

midwives have gained both positive and negative experiences when providing continuity of care to labouring women. The positive aspects may facilitate other professional midwives working in a similar role, whereas the negative aspects may inform them of learning to live with this situation, and may also have implications for managers to develop new approaches to the organisation and provision of continuity of care to support midwives’ practice, and to fully utilise ‘flexibility’ under an on-call system.     

Men's involvement in antenatal screening: a qualitative pilot study using e-mail

Objectives

this study aimed to explore and analyse men's involvement in antenatal genetic screening and testing in England, and evaluate the use of e-mail communication as a method of health research with men.

Design

after receiving a favourable ethical opinion, a longitudinal qualitative pilot study was undertaken.

Participants

eight men, whose partners were pregnant, were recruited by purposive sampling.

Findings

findings indicated that the men experienced ambivalence, doubts and uncertainty about medically identified genetic risks, and also experienced an ‘emotional rollercoaster’, which was associated with their involvement in antenatal genetic screening and testing. Although connectedness with their partners and shared decision making were highly valued, men's involvement was mediated by their partners and health professionals, including midwives.

Conclusions and implications for practice

the implications of findings for medicalisation theory and future research are discussed. Using e-mail was a success in that the strong pilot data produced provides a stimulus for future research. In addition, implications for policy and practice are also considered, specifically the importance of addressing ambivalence and mediation if midwives are to communicate effectively when working with men and women regarding antenatal genetic screening and testing.     

An evaluation of the Africa Midwives Research Network

Objectiveto evaluate the strengths and limitations of the Africa Midwives Research Network (AMRN) and provide feedback and direction to the network and the funding body.Designa qualitative study incorporating visits to three African countries and Sweden, using interviews, non-participant observation, an internet survey and review of records.Settingprincipally Tanzania, Uganda, Zambia and Sweden.FindingsAMRN can be described as a small, dispersed, loosely coupled professional network which has made considerable impact on midwifery practice in the areas of its members. The biennial scientific conferences could be perceived as AMRN's flagship activity and have been notably successful, becoming renowned internationally. Around 1500 midwives have benefited from educational programmes at regional or national level. These include research methodology, evidence-based practice, scientific writing and communication skills. Attention needs to be given to some aspects of governance and organization, as well as to communication strategies including websites and newsletters. Technical support from the Karolinska Institute in Stockholm has provided good collegiate support and proved to be cost effective.Key conclusionsAMRN has shown resilience and continuity since its inception and has made a palpable difference to the quality of midwifery care and the professional development of midwives within the remit of its members. AMRN needs to be consolidated before expanding further. The work of AMRN is particularly pertinent in the context of the millennium development goals.     

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

ObjectiveTo explore midwives’ experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour.DesignA qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically.SettingTwo metropolitan maternity units in Queensland, Australia.ParticipantsEleven midwives who had administered SWI for back pain in labour in a randomised controlled trial.FindingsThree major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice.Key conclusionsWhilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use.Implications for practiceThe procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women.