Good for midwives too: comparing the emotional wellbeing of midwives providing continuity of midwifery care to those not working in a continuity model

BackgroundDespite compelling evidence that women and babies have better outcomes when provided with continuity of midwifery care compared with other models of care, women still have limited access to this model. Perceptions of... [ view full abstract ]

Background

Despite compelling evidence that women and babies have better outcomes when provided with continuity of midwifery care compared with other models of care, women still have limited access to this model. Perceptions of negative effects of continuity of care on midwives’ wellbeing may be hindering widespread implementation. This paper compares the emotional wellbeing of Australian midwives providing continuity of care with midwives working in other models.

Method

As part of larger cross-cultural study exploring midwives’ emotional wellbeing (WHELM), Australian midwives completed an on-line survey which included demographic questions, the Depression, Anxiety and Stress Scale (DASS 21), the Copenhagen Burnout Inventory (CBI) and Perceptions of Empowerment in Midwifery Scale (PEMS). Data from midwives working in a continuity model were compared with those in non-continuity models using Mann Whitney U tests. An alpha level of p<.01 was used to assess statistical significance. University HREC approval was obtained.

Results

Of the 862 respondents, 214 (24.8%) midwives were providing continuity of care and 648 (75.2%) providing shift-based care. Midwives providing continuity of care had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work p<.001; CBI Client p<.001). Statistically significant differences were also detected for the Anxiety (p=.007) and Depression (p=.004) subscales of the DASS, with the continuity group recording lower median scores. In addition the continuity group recorded significantly higher scores on the Empowerment subscale (p<.001), and the Skills and Resources subscale (p=.002) within the PEMS.  There was no difference between the groups in terms of satisfaction with time off and work-life balance.

Discussion

Australian midwives providing continuity of midwifery care reported lower levels of burnout, depression and anxiety and higher levels of professional identity and autonomy compared to those working in non-continuity models. These results are similar to those obtained in New Zealand where midwives providing continuity also reported significantly lower scores on CBI Personal, CBI Work, and anxiety, and higher scores on the Skills and Resources subscale of the PEMS.

Conclusion

Re-orientating maternity care to align with the evidence around midwifery continuity of care models is likely to improve workforce wellbeing.