Available online 22 May 2024, 104813

Author links open overlay panel, , , AbstractBackground

There is a severe global shortage of midwives, and the situation worsens when qualified professionals leave their jobs because of inadequate working conditions. Hospitals have increasing difficulties in filling vacancies for midwives. In the case of Germany, midwives tend to give up birth assistance after an average of seven years working in delivery rooms, which are usually led by physicians.

Objective

We aim to provide concrete recommendations on encouraging qualified professionals to work in maternity wards by examining the job preferences of midwives who currently do not provide such services. These insights shall help policy makers and hospital managers to fill vacancies more quickly and provide adequate care to more women.

Design

Discrete choice experiment.

Setting(s)

Online survey promoted through email and social media to midwives in Germany.

Participants

415 midwives participated; we examine the subgroup of 241 midwives who do not offer birth assistance.

Methods

We obtain individual parameter estimates through a multinominal logit analysis with hierarchical Bayes estimation techniques, calculate importance weights, and simulate uptake probabilities of different hypothetical job offers that include birth assistance.

Results

Participants want to provide birth assistance but fiercely reject doing so under physicians' supervision. With a 15 % increase in income, however, 16 % would accept this least preferred setting. Forty-four percent, however, would choose to offer birth assistance if they could work in a midwife-led unit. An additional increase in income of 5 % (15 %) could even lead to uptake probabilities of 67 % (77 %).

Conclusions

There is a common understanding that midwife-led care is a safe and effective option for healthy women. Policy makers are advised to further extend their initial support for such units to fill vacancies quicker and enable comprehensive healthcare for more childbearing women.

Tweetable abstract

Midwife-led units help counter shortages: Midwives want to provide birth assistance but reject doing so under physicians' supervision.

Section snippetsBackground

Being a midwife and having to deal with emotions, suffering, and sometimes even death can be challenging and traumatic (Pezaro et al., 2016). This occupational group is at a high risk of burnout, which has been mainly linked to working conditions such as work overload and a lack of professional autonomy and recognition (Albendín-García et al., 2021). It is thus not surprising that there is an exceptionally high level of fluctuation: a severe global shortage of midwives (UNFP, 2021) and hence

Methodology

We use data that we collected via an online survey in early 2021 to evaluate the job preferences of midwives in Germany. To answer our specific research question, we examine the preferences of those respondents who indicated that they do not provide intrapartum care. Furthermore, through counterfactual simulations, we provide actionable starting points for campaigns and tailor-made job offers to help attract midwives for intrapartum care.

Results

The average participating midwife is a 45-year-old female trained at a vocational school who works freelance part-time. Sample characteristics are displayed in Table A1 in the supplementary material. The ß-parameters and importance weights are summarized in Table 2.

While respondents want to provide pre- and postnatal care with an IW of 17 %, the preference for the attribute intrapartum care is much higher, with an IW of 49 %. This indicates that participating midwives want to provide

Discussion

Our counterfactual simulation demonstrates that midwives currently not providing intrapartum care are willing – and would indeed prefer – to work in midwife-led units. We find that their decision to refrain from providing intrapartum services is not based on preferences but on external circumstances that policymakers should address. The most potent levers to win midwives for intrapartum care identified in the experiment are adequate remuneration and a high degree of autonomy in a midwife-led

Funding sources

No external funding.

CRediT authorship contribution statement

Jessica Rheindorf: Writing – original draft, Visualization, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Christian Schlereth: Writing – review & editing, Validation, Supervision, Conceptualization. Hannah Petry: Writing – review & editing, Investigation, Data curation.

Uncited references

Albrecht and Loos, 2019

Lancaster, 1966

McFadden, 1973

Conflict of interest

None.

Acknowledgments

We thank our survey participants for sharing their opinions and preferences with us. We also thank the anonymous reviewers for their valuable comments, and Peter Starling for his linguistic review of the manuscript.

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