The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work p<.001; CBI Client p<.001) and Anxiety (p=.007) and Depression (p=.004) sub-scales. Midwives providing continuity reported significantly higher scores on the PEMs Autonomy/Empowerment subscale (p<.001) and the Skills and Resources subscale (p=.002). There was no difference between the groups in terms of satisfaction with time off and work-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward.

Fenwick J ，Sidebotham M ，Gamble J ，Creedy DK ... -  《-》

Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey.

Creedy DK ，Sidebotham M ，Gamble J ，Pallant J ，Fenwick J ... -  《BMC Pregnancy and Childbirth》

Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors.

The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress. Cross sectional research design using an online survey. The WHELM survey tool was developed within the Australian maternity context and includes a number of validated measures: The Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), as well as items from the Royal College of Midwives (RCM) 'Why Midwives Leave' study (Ball et al., 2002). United Kingdom. An on-line survey was distributed via the RCM to all full midwife members in 2017 (n = 31,898). The demographic and work-related characteristics of the sample were analysed using descriptive analyses. Levels of depression, anxiety, stress and burnout, measured by the CBI and DASS scores, were analysed using non-parametric statistical tests. Comparisons were made between groups based on demographic and work characteristics. Mann-Whitney U tests were used for two group comparisons, and Kruskal Wallis tests were used for groups with 2+ groups. Given the large number of analyses undertaken, statistically significant comparisons were identified with a conservative alpha level (p < .01). A total of 1997 midwives responded to the survey, representing 16% of the RCM membership. The key results indicate that the UK's midwifery workforce is experiencing significant levels of emotional distress. 83% (n = 1464) of participants scored moderate and above for personal burnout and 67% (n = 1167) recorded moderate and above for work-related burnout. Client-related burnout was low at 15.5% (n = 268). Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%), anxiety (38%) and depression (33%). Personal and work-related burnout scores, and stress, anxiety and depression scores were well above results from other countries in which the WHELM study has been conducted to date. Midwives were more likely to record high levels of burnout, depression, anxiety and stress if they were aged 40 and below; reported having a disability; had less than 10 years' experience; worked in a clinical midwifery setting, particularly if they worked in rotation in hospital and in integrated hospital/community settings. Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability. There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels.

Hunter B ，Fenwick J ，Sidebotham M ，Henley J ... -  《-》

Comparing caseload and non-caseload midwives' burnout levels and professional attitudes: A national, cross-sectional survey of Australian midwives working in the public maternity system.

Caseload midwifery has many benefits for women and their babies, however only around 8% of women receive caseload care in the public maternity system in Australia. Midwives working within caseload models are required to provide activity-based care (working on-call, responsively to the needs of their caseload of women) rather than undertaking shift work. There has been debate regarding the impact of caseload work on midwives, but recently caseload work has been associated with higher professional satisfaction and lower burnout when compared to midwives working in traditional models. However, there continues to be debate about the impact of caseload on midwives, so further investigation is needed. A national cross-sectional survey of midwives working in Australian public hospitals that have birthing services was undertaken. We explored burnout and midwives' attitudes to their professional role using the Copenhagen Burnout Inventory and the Midwifery Process Questionnaire, respectively. Comparisons were made across three groups of midwives: those who worked in the caseload model, midwives who did not work in this model but worked in a hospital with a caseload model, and midwives who worked in a hospital without a caseload model. We received 542 responses from midwives from 111 hospitals from all Australian states and one of the territories. Of respondents, 107 midwives worked in a caseload model, 212 worked in a hospital with a caseload model but did not work in caseload, and 220 midwives worked in a hospital without a caseload model. Midwives working in caseload had significantly lower burnout scores in the personal and work-related burnout subscales, and a trend toward lower scores in the client-related burnout subscale. They also had higher scores across all four subscales of the midwifery process questionnaire, demonstrating more positive attitudes to their professional role. Although concerns have been raised regarding the impact of caseload midwifery on midwives, this national study found that midwives working within caseload had a more positive attitude to their work and lower burnout scores than those not working in the model, compared with both midwives working in a hospital with a caseload model and midwives working in a hospital without caseload. This large national study does not support earlier suggestions that caseload midwifery causes increased burnout. Given the benefits of caseload for women and their infants, and the benefits for midwives found in this study, policy-makers and health care providers should focus on how the caseload model can be expanded to provide increased access for both women and midwives.

Dawson K ，Newton M ，Forster D ，McLachlan H ... -  《-》

Personal, professional and workplace factors that contribute to burnout in Australian midwives.

This study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives. Burnout is prevalent in the midwifery workforce. Burnout adversely affects the well-being of midwives, diminishes the quality of care they provide and can shorten career duration. Self-administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression. A total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643; 64.9%) and work-related burnout (N = 428; 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5-10 years were more likely to report work and client-related burnout. Similarly, midwives reporting a lack of satisfaction with work-life balance were also more likely to report personal and work-related burnout. Family-friendly work environments that facilitate work-life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work-life balance and provide significant mental health benefits to participating midwives.

Fenwick J ，Lubomski A ，Creedy DK ，Sidebotham M ... -  《-》