Depression, anxiety and stress in Swedish midwives: A cross-sectional survey

Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review

AIM

The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors.

DESIGN

Mixed studies systematic review.

DATA SOURCES

PubMed, Scopus and Web of Science were sourced from 2018 and 2023.

REVIEW METHODS

Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years.

EXCLUSION CRITERIA

studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research.

RESULTS

Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors.

CONCLUSION

Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it.

IMPACT

What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem.

REPORTING METHOD

PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA).

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine

BACKGROUND

After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging.

AIM

To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine.

METHODS

Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed.

RESULTS

We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units.

CONCLUSIONS

The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.

Increasing levels of burnout in Swedish midwives - A ten-year comparative study

PROBLEM

Midwives' levels of burnout seem to be increasing worldwide.

BACKGROUND

Previous research show a high prevalence of burnout in midwives.

AIM

To compare levels of burnout in two national Swedish samples of midwives completing a similar survey.

METHODS

A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.

FINDINGS

The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.

DISCUSSION

The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.

CONCLUSION

This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.

How midwives' perceptions of work empowerment have changed over time: A Swedish comparative study

OBJECTIVE

The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012.

DESIGN

A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022.

PARTICIPANTS

475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022.

METHODS

Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years.

FINDINGS

Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment.

CONCLUSIONS

Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.

Emotional wellbeing of student midwives during COVID-19

BACKGROUND

Mental health of students in higher education was affected during the COVID-19 pandemic.

AIM

To examine the emotional wellbeing of midwifery students in the Netherlands and Flanders (Belgium) during COVID-19.

METHODS

A cross-sectional online-based survey with 619 Dutch and Flemish midwifery students. Sociodemographic details were obtained. Anxiety and depression were measured twice (T1, T2) during the COVID-19 pandemic.

FINDINGS

Flemish students had significantly higher mean depression and anxiety scores than Dutch students during the total period of study (p < .001; p < .001). Total group mean depression and anxiety scores were significantly higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, there was a significant increase of depression from T1 to T2 (p < .001). In the Flemish student group, both depression and anxiety scores significantly increased from T1 to T2 (p < .001; p < .001). A history of psychological problems predicted both depression and anxiety, irrespective of COVID-19 period or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) predicted depression, irrespective of period or country. A history of psychological problems predicted depression (p.004; p < .001) and anxiety (p.003; p.001) during the total period of study. Being single also predicted depression during T2 (p.024).

CONCLUSION

These findings inform how emotional wellbeing of midwifery students was affected during the COVID-19 pandemic and identify those students that might need extra attention after the pandemic, during another pandemic or similar situations with social restrictions.

'A perfect fit' - Swedish midwives' interest in continuity models of midwifery care

BACKGROUND

Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated.

OBJECTIVE

to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models.

METHODS

A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis.

RESULTS

A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest.

CONCLUSION

A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.

Self-compassion and professional quality of life among midwives and nurse assistants: A cross-sectional study

INTRODUCTION

Self-compassion and satisfaction derived from helping others is part of healthcare providers’ professional quality of life. The aim of this study was to explore and psychometrically test two instruments measuring self-compassion and professional quality of life among midwives and nurse assistants.

METHODS

This was a cross-sectional study with midwives and nurse assistants working with intrapartum care at five different labor wards in Sweden. The Self-Compassion Scale (SCS) and the modified Professional Quality of Life Measurement (ProQOL) were validated and correlation analyses were calculated between the different subscales. Descriptive statistics, t-test, were calculated to analyze associations between the subscales of the SCS, the ProQOL and the background variables.

RESULTS

Midwives were more self-critical than nurse assistants, and the midwives who were negative towards the new clinical practice scored higher for compassion fatigue. The principal component analysis showed a two-factor solution for both the SCS and the modified ProQOL. The two SCS subscales were named ‘self-criticism’ (α=0.85) and ‘self-kindness’ (α=0.87). The two ProQOL subscales were named ‘compassion satisfaction’ (α=0.83) and ‘compassion fatigue’ (α=0.78). A negative correlation was found between self-kindness and compassion fatigue subscales, between compassion satisfaction and compassion fatigue, and between self-kindness and self-criticism.

CONCLUSIONS

The SCS and modified ProQOL are considered as valid questionnaires for use in a Swedish maternity setting and a correlation between the scales was found. Midwives are more self-critical than nurse assistants. Understanding and identifying compassion fatigue among midwives is important to managers responsible for quality improvement and practice changes.

Burnout among midwives and attitudes toward midwifery: A cross-sectional study from Baden-Württemberg, Germany

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

A fuzzy intelligent system to assess midwives’ burnout conditions

INTRODUCTION

Midwives’ burnout affects their effectiveness and the quality of the services they provide to pregnant women as well as the quality of the collaboration with medical staff. The burnout depends on a number of factors that can exhibit high variability over time. This creates the necessity of introducing intelligent approaches that assess changes in behavior, environmental factors, working conditions, and to make decisions to optimize the physical and mental health of midwives. The aim of this study was to employ fuzzy logic to design a Fuzzy Intelligent or Inference System (FIS) that assesses midwives’ burnout level by emulating the reasoning of human experts.

METHODS

The proposed FIS addresses the assessment of midwives’ burnout comprehensively since it incorporates findings following a thorough analysis of the relevant literature, as well as assimilates experts’ knowledge elicited through semi-structured interviews. Additionally, fuzzy rules are more intuitive and thus easier to understand and modify by human users than dealing and translating numerical results. The FIS performance is compared and evaluated against experienced midwives.

RESULTS

Findings confirm the ability of the proposed FIS to produce judgments that are closer to experts’ consensus, as expressed by their aggregated assessment.

CONCLUSIONS

The proposed FIS is evaluated by comparing its results with judgments made by experts, suggesting that fuzzy logic allows precise and personalized assessment of midwives’ burnout levels. The proposed FIS can be used to evaluate burnout, support organizations to develop burnout policies as well as used as a research instrument to investigate interrelationships of burnout factors.

Psychological Distress and Coping Strategies among Nurses during the COVID-19 Pandemic: A Cross-Sectional Online Survey

Background:

The emergence of COVID-19 has a significant impact on nurse’s overall health. The severity and magnitude of the COVID-19 pandemic means it is extremely likely that health-care professionals will experience psychological distress as a result of their direct contact with patients who have contracted the infection.

Objectives:

This study aimed to evaluate levels of psychological distress among nurses during the COVID-19 pandemic, determine the associated factors, and identify nurses’ coping strategies.

Methods:

This study is a cross-sectional design. Overall, 130 nurses answered online questionnaires. The questionnaires measured sociodemographic characteristics, Fear of COVID-19 Scale, the Depression, Anxiety, and Stress Scale, and the Brief Coping Inventory.

Results:

Nurses have a moderate level of fear (mean score: 24.34 ± 13.43) and depression (43.8% of the sample), and severe anxiety (73.8%) and stress (45.4%). Anxiety and fear were positively correlated (r = .675, p < .001). Independent t-tests revealed that female nurses had higher psychological distress and fear than male nurses (p = 0.015 and p = 0.038, respectively). Nurses who cared for patients who had tested positive for coronavirus disease 2019 and those who had a friend or family member who had tested positive had higher fear and psychological distress than their respective counterparts (p < .001 and p = .010, respectively). Working more hours was moderately correlated with fear and anxiety (p = 0.016). Nurses were found to generally adopt maladaptive coping styles.

Conclusion:

Through careful study of the factors determined through this research to be associated with psychological distress among nurses, the health-care community can better prepare to mitigate nurses’ emotional and psychological toll in future pandemic situations. Working with patients who have tested positive for COVID-2019 causes psychological distress for nurses.

Level of Job Burnout among Midwives Working in Labour Rooms in Barcelona Region: A Cross-Sectional Study

BACKGROUND

Nowadays, burnout syndrome (BS) symptoms appear to have increased in healthcare workers, specifically midwives, but there are no studies on burnout among midwives in Catalonia. The present study aimed to assess and describe the prevalence of BS in midwives working in labour rooms.

METHODS

A cross-sectional descriptive study was conducted on 122 midwives working in 24 maternity hospitals in the Barcelona (region) which were selected using purposive sampling from January to March 2017. Data were collected using two questionnaires (demographic information, job burnout using Spanish Burnout Inventory with 20 items and four subscales). Data analysis was performed using SPSS software version 21 and Chi-Square, U Mann-Whitney, and Kruskall-Wallis. P<0.05 was considered statistically significant.

RESULTS

None of the participants obtained a critical level of BS. 37 (30.33%) participants scored medium burnout and 47 (38.52%) recorded low burnout. Statistically, work stress (P=0.01), marital status (P=0.006), attendance of more than three women per shift (P=0.001), the number of children (P=0.01), parity (P=0.005), health status (P=0.04), and being on sick leave over last year (P=0.04) were significantly correlated with medium-high levels of burnout. Burnout scores were higher in midwives having a life partner and those without children.

CONCLUSION

Following the results, no participant obtained a critical level of BS; about one-third of them scored medium-high burnout. However, specific interventions are suggested to be conducted to maintain the midwives' motivation and prevent burnout development.