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The emotional wellbeing of New Zealand midwives: Comparing responses for midwives in caseloading and shift work settings


ABSTRACT

Background: Ensuring the psychological wellbeing of midwives is becoming increasingly recognised as an important strategy in maintaining a healthy workforce and retaining midwives within the profession. Midwives in New Zealand can choose to be self-employed and work in the community, providing continuity of care to a caseload of women (self-employed caseloading), or can be employed to work within a maternity hospital environment (generally shift work). Some choose to work in both work settings (self-employed and employed by an organisation).

Aim: The overall aim of this study was to explore the emotional wellbeing of midwives in New Zealand. The first objective was to describe and compare the demographic and work-related factors of midwives who were (a) self-employed, (b) employed by an organisation or (c) both self-employed and employed. The second objective was to explore factors associated with burnout within each of the three groups.

Method: Practising New Zealand midwives who were members of the New Zealand College of Midwives were invited to complete an online survey. The study package included demographic questions, the Depression, Anxiety and Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI), Perceptions of Empowerment in Midwifery Scale (PEMS) and the Practice Environment Scale (PES).

Findings: A total of 1073 midwives responded with 44% (n=473) self-employed, 42% (n=452) employed and 14% (n=148) both self-employed and employed. Employed midwives worked fewer hours (median 32hrs) than the other two groups (median 40hrs and 36hrs respectively) but had significantly higher levels of work and personal-related burnout as well as anxiety. Employed midwives also reported lower levels of autonomy, empowerment and professional recognition. Aspects of the work environment found to be associated with burnout (particularly for employed midwives) were inadequacy of resources, lack of management support, and lack of professional recognition and development opportunities.

Conclusion: While levels of stress and depression were high for all midwives, self-employed midwives providing continuity of care to a caseload of women had better emotional health and less burnout than midwives working in an exclusively employed capacity.

Keywords: burnout, anxiety, continuity of care, employment, self-employment, caseload model

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