Self-employed continuity of care midwives work more hours but have lower levels of burnout, anxiety, stress and depression than midwives working in New Zealand’s hospitals, new research shows.

A New Zealand College of Midwives’ study of more than 1000 of its members, representing a third of the nation’s midwifery workforce, has found despite being on-call and working longer hours, midwives providing continuity of care in a caseload model have better emotional health than their hospital colleagues.

Employed midwives working in maternity units in hospitals, experiencing rotating shift work, fewer work hours, and staff shortages, have higher levels of burnout and anxiety, the study reveals.

Lead author Dr Lesley Dixon (PhD), a registered midwife and midwifery advisor at the New Zealand College of Midwives, says the research, published in the New Zealand College of Midwives Journal, demonstrates self-employed continuity of care midwifery is a sustainable profession.

“Midwives who work as Lead Maternity Carers are actually on call 24/7 so they work to provide care from early pregnancy, through labour and birth and into the postpartum period,” she says.

“That obviously means they are on call for women who go into labour and get called out at odd times, night times and weekends, so there’s a potential there for long hours and being on-call a lot can be quite problematic.

“We were getting concerns raised about whether this was actually causing problems to the emotional wellbeing of midwives - was this causing problems to their health, was it increasing the levels of burnout for those midwives?”

But Dr Dixon says the research instead shows self-employed midwives experience greater professional autonomy and flexibility, supportive midwifery partners, and feel more empowered - which works to protect their emotional wellbeing.

“Working in continuity of care does not increase burnout or make midwives more vulnerable in their emotional wellbeing, and really what we’re thinking is it’s actually the working with women that supports sustainability, it’s having autonomy over your work hours and your client load, it’s having that control which actually supports the midwives’ emotional wellbeing.

“Self-employed midwives get a lot of satisfaction from working with women through the continuum from early pregnancy through to postnatal, and it seems that being able to do that and working with the women is actually quite protective.

“So despite working the longer hours, the type of work that they’re doing seems to be more protective of their emotional health essentially because they are getting more job satisfaction.”

New Zealand introduced its internationally-renowned autonomous midwife-led model of maternity care in 1990.

Under the system, Lead Maternity Carer (LMC) midwives care for 90 per cent of the country’s pregnant women throughout their pregnancy, labour and postnatal period.

New Zealand women have a choice of where they give birth, and the LMC midwife works with women and provides care in the woman’s choice of birth place.

In 2014, there were 57,242 live births registered in the nation. Statistics from 2012 show 3.1 per cent of women choose to give birth at home and 9.7 per cent give birth in a birthing unit. Meanwhile, 40.9 per cent gave birth in a secondary hospital and 46.3 per cent in a tertiary hospital.

The New Zealand College of Midwives’ study, a project which included researchers from the University of Melbourne, Griffith University, Gold Coast University Hospital and Auckland University of Technology, surveyed members in 2013, with respondents including midwives who worked in hospitals, self-employed caseload midwives, and midwives who worked in both settings.

Dr Dixon says the study found employed midwives are “a lot worse off” - working fewer hours but experiencing more burn-out than self-employed midwives.

“What we’re seeing is that the midwives who are employed have less autonomy over their work hours, over what they’re doing within their work, there’s less resources, and obviously there’s issues around staffing as well. We think that’s actually having quite a strong impact,” she says.

“Levels of autonomy, empowerment and professional recognition, and lack of management support are all having an impact on the employed midwives.

“The work of midwives needs to be valued more within the hospitals, by the hospital managers and the leaders, but also within the Ministry and within the government as well,” Dr Dixon adds.

“It is about gender and gender discrimination in the sense of women are becoming mothers and are not necessarily hugely valued - and women’s work is not always hugely valued either.

“Working with women and midwifery care is what sustains midwives, it’s the environments and the requirements within the institutions that actually cause problems for midwives.”

Dr Dixon says while the research examines the emotional wellbeing of midwives based on their type of work, researchers plan to compare the results with those of midwives in Australia and in Sweden, who have completed the same survey.

Researchers will also review the extensive range of comments provided by New Zealand midwives in response to the survey.

While midwives can use a range of self-report tools, such as the Depression, Anxiety and Stress Scale (DASS-21) and the Copenhagen Burnout Inventory (CBI) questionnaires, to assess their risk of burnout, Dr Dixon says there are some common warning signs.

“When you’re dreading going to work, not enjoying your work any more, becoming worried or anxious when you’re at work for things that would not have caused you anxiety before, those are some of the signs and symptoms,” she says.

“It’s really important to recognise burnout and to start looking at what you can do within your work environment to actually reduce the risk of burnout.

“It’s about recognising it and actually saying - this is an issue, and how do I change my work so that I can actually still continue to enjoy it and looking at what other opportunities are there for midwives?”