A survey of burnout and intentions to leave the profession among Western Canadian midwives.

Midwives are at high risk for burnout and occupational stress. This has implications for workforce retention and quality of maternity care. We set out to understand how burnout and occupational stress are experienced by midwives in Western Canada, and whether burnout is linked to intentions to leave the profession and other factors. Midwives were invited to participate in the international WHELM (work, health, and emotional lives of midwives) survey through invitations via their professional organizations. The survey included demographic questions and emotional wellbeing scales such as the Copenhagen Burnout Inventory and the Depression, Anxiety, and Stress Scale. Of 158 midwives who participated, 51 (34.7%) had seriously considered leaving the profession, citing reasons such as the negative impact of an on-call schedule on personal life (n=84, 84.8%), as well as concerns about their mental (n=80, 80.8%) and physical health (n=57, 57.6%). Burnout scores were higher among midwives who planned to leave the profession, midwives with young children, those with higher caseloads and fewer days off. Quality of life was significantly lower among midwives who reported higher burnout scores. Midwives suggested many strategies to reduce stress, such as part-time work options, support for sick days/vacation coverage, more pay per course of care, more off-call career opportunities and initiatives to reduce bullying and interprofessional conflict. The current study identified occupational stressors that are unique to the caseload model. Findings from this study can inform policies and strategies to support the growth and sustainability of caseload midwifery in Canada.

Stoll K ，Gallagher J 《-》

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

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. 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. To assess levels of stress, anxiety, depression, and burnout among midwives in Ontario, Canada and potential factors associated with these conditions. 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. 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. 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.

Cates EC ，Ramlogan-Salanga C ，MacKenzie RK ，Wilson-Mitchell K ，Darling EK ... -  《-》

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 ... -  《-》

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》

Australian midwives' intentions to leave the profession and the reasons why.

There is growing body of evidence that suggests many midwives are unhappy and as a result are making decisions to leave the profession. Determine the incidence of midwives indicating their intention to leave the profession and explore the reasons for this decision including what might cause midwives to be dissatisfied. Data analysed was collected as part of the Australian arm of the Work, Health and Emotional Life of Midwives (WHELM) project. Descriptive statistics and latent content analysis was used to analysis the data set. Almost half (42.8%, n=443/1037) the midwives had considered leaving the profession in the preceding six months. The qualitative and quantitative data aligned with 'dissatisfaction with the organisation of midwifery care' and/or 'dissatisfaction with my role as a midwife' being the two commonest reasons behind the intention to leave. Early career midwives were most likely to consider leaving the profession (p=.05) due to dissatisfaction with their role. Almost half the midwives who had considered leaving the profession were most dissatisfied with managers (p=<.001). Midwives felt their ability to provide quality maternity care was constrained by a fragmented medicalised system that did not work for the women in their care or themselves. The results of this study add to a growing call for policy makers and health care providers to reorientate maternity services to enable women to build positive longitudinal relationships with midwives. Not only will this improve maternal and neonatal outcomes but provide a satisfying and sustainable way for working for midwives.

Harvie K ，Sidebotham M ，Fenwick J 《-》