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 ... -  《-》

Midwives' views of caseload midwifery - comparing the caseload and non-caseload midwives' opinions. A cross-sectional survey of Australian midwives.

Midwife-led continuity of care has substantial benefits for women and infants and positive outcomes for midwives, yet access to these models remains limited. Caseload midwifery is associated with professional satisfaction and lower burnout, but also impacts on work-life boundaries. Few studies have explored caseload midwifery from the perspective of midwives working in caseload models compared to those in standard care models, understanding this is critical to sustainability and upscaling. To compare views of caseload midwifery - those working in caseload models and those in standard care models in hospitals with and without caseload. A national cross-sectional survey of midwives working in Australian public hospitals providing birthing services. Responses were received from 542/3850 (14%) midwives from 111 hospitals - 20% worked in caseload, 39% worked in hospitals with caseload but did not work in the model, and 41% worked in hospitals without caseload. Regardless of exposure, midwives expressed support for caseload models, and for increased access to all women regardless of risk. Fifty percent of midwives not working in caseload expressed willingness to work in the model in the future. Flexibility, autonomy and building relationships were positive influencing factors, with on-call work the most common reason midwives did not want to work in caseload. There was widespread support for and willingness to work in caseload. The findings suggest that the workforce could support increasing access to caseload models at existing and new caseload sites. Exposure to the model provides insight into understanding how the model works, which can positively or negatively influence midwives' views.

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

Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia.

Newton MS ，McLachlan HL ，Willis KF ，Forster DA ... -  《BMC Pregnancy and Childbirth》

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 ... -  《-》

An evaluation of the satisfaction of midwives' working in midwifery group practice.

to examine changes in midwives' attitudes to their professional role following the introduction of midwifery group practice (MGP) (a caseload model of midwifery continuity of care provided to women of all risk levels) and to explore aspects of the model that were working well and those that were not working well. the questionnaire 'Attitudes to Professional Role' was used to measure midwives' satisfaction in terms of professional satisfaction, professional support, client interaction, and professional development. Open-ended questions were also included to offer an opportunity for midwives to expand on their experiences of working in the MGP model. The questionnaire was administered at five time points over the 18-month evaluation period. Round 1 was prior to the implementation of MGP, Rounds 2-4 were at three-month intervals, with Round 5 six months later. Analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from -2 (very negative attitudes) to +2 (very positive attitudes), and the open-ended questions were analysed using qualitative content analysis. the Women's and Children's Hospital, Adelaide, South Australia. questionnaires were distributed to all midwives (n=15) working in MGP in Rounds 1, 2 and 3, and to the 12 midwives remaining from the original sample in Rounds 4 and 5. Fourteen questionnaires were returned in Round 1, 12 in Round 2, 10 in Round 3, nine in Round 4, and 10 in Round 5. overall, a positive change in attitudes to professional role was reflected in all sub-scales in the period between start-up and 18 months later; a reduction in scores occurred in Round 3. The mean increases were significant for all sub-scales apart from professional development. Five main themes were identified across the rounds in the content analysis: 'continuity of care', 'working pattern', 'working environment', 'collegiality' and 'issues relating to midwifery practice'. Midwives gained particular satisfaction from providing continuity of care and building relationships with women and their families, and through practising autonomously as a midwife. While there was a struggle to manage the hours worked and being on call, high levels of professional satisfaction were maintained. while there were aspects of MGP that midwives were not satisfied with and wanted to change, overall they were satisfied with the model. there is a need for ongoing evaluation in order to monitor the short- and long-term impact on midwives of working in a caseload model of continuity of midwifery care.

Collins CT ，Fereday J ，Pincombe J ，Oster C ，Turnbull D ... -  《-》