Available online 22 May 2024, 104813
Author links open overlay panel, , , AbstractBackgroundThere 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.
ObjectiveWe 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.
DesignDiscrete choice experiment.
Setting(s)Online survey promoted through email and social media to midwives in Germany.
Participants415 midwives participated; we examine the subgroup of 241 midwives who do not offer birth assistance.
MethodsWe 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.
ResultsParticipants 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 %).
ConclusionsThere 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 abstractMidwife-led units help counter shortages: Midwives want to provide birth assistance but reject doing so under physicians' supervision.
Section snippetsBackgroundBeing 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
MethodologyWe 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.
ResultsThe 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
DiscussionOur 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 sourcesNo external funding.
CRediT authorship contribution statementJessica 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 referencesAlbrecht and Loos, 2019
Lancaster, 1966
McFadden, 1973
Conflict of interestNone.
AcknowledgmentsWe 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.
References (50)S. Ahmadi et al.(2022) 'The relationship between burnout and intention to leave work among midwives: the long-lasting impacts of COVID-19′Journal of Healthcare Engineering
(2022)
Albendín-García, L., Suleiman-Martos, N., Cañadas-De la Fuente, Guillermo A., Ramírez-Baena, L., Gómez-Urquiza, J. L....Albrecht, M., Loos, S., an der Heiden, I., Temizdemir, E., Ochsmann, R., Sander, M. and Bock, H. (2019) IGES Report for...AWMFS3-Guideline: Vaginal Birth at Term: S3-Leitline: Vaginale Geburt am Termin [Online](2020)
K. Blum et al.Hospital Barometer: Krankenhaus Barometer [Online]DHV (2016) The Working Situation of Employed Midwives in Clinics: Die Arbeitssituation von angestellten Hebammen in...DHV (2021) Review of Figures on the Situation of Midwives 11/2021: Zahlenspiegel zur Situation der Hebammen 11/2021...J.K. Edmonds et al.Midwife led units: transforming maternity care globallyAnn. Glob. Health
(2020)
O.-Z. Ejebu et al.What might make nurses stay? A protocol for discrete choice experiments to understand NHS nurses' preferences at early-career and late-career stagesBMJ Open
(2024)
V. Hundley et al.Assessing Women's preferences for intrapartum careBirth
(2001)
B. Hunter et al.Midwives in the United Kingdom: levels of burnout, depression, anxiety and stress and associated predictorsMidwifery
(2019)
K. Keller et al.Sample-based longitudinal discrete choice experiments: preferences for electric vehicles over timeJ. Acad. Mark. Sci.
(2021)
K.J. LancasterA new approach to consumer theoryJ. Polit. Econ.
(1966)
P.J. Lenk et al.Hierarchical Bayes conjoint analysis: recovery of Partworth heterogeneity from reduced experimental designsMark. Sci.
(1996)
Y. Li et al.Nurse practitioner job preference: a discrete choice experimentInt. J. Nurs. Stud.
(2023)
View full text© 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
留言 (0)